Optical Coherence Tomography Patterns Research Articles

Correlation between clinical, fluorescein angiography and optical coherence tomography findings in clinically significant macular edema

Background: Macular edema is an important cause of visual morbidity in diabetic retinopathy. It can be assessed by both fluorescein angiography (FA) and optical coherence tomography (OCT). Aims: To study, if any, correlation exists between FA and OCT patterns in Clinically significant macular edema (CSME). Furthermore, to correlate macular thickness as determined by OCT to best-corrected visual acuity (BCVA). Materials and Methods: This was a prospective study which compared patterns in FA and OCT in patients with CSME. All the patients who were diagnosed as CSME underwent a complete ophthalmic examination and were subjected to FA and OCT. Those with a hazy media were excluded from the study. The results were analyzed by Fisher's exact test. Results: A total of 32 eyes were studied. FA revealed that most of the patients had diffuse leak (59%), followed by focal leak (31%) and combined leak (10%). On OCT, isolated sponge-like retinal swelling was seen among 66% eyes, spongy retinal swelling with cystoid macular edema/serous foveal detachment in 28% eyes, and 6% had a combined pattern. There was a statistical correlation between FA and OCT findings in our study (P = 0.038). The mean central foveal thickness in our study was 321.75 ΁ 98.30 μm, and there was a statistically significant correlation between central foveal thickness and BCVA (P = 0.043). Conclusion: There is a significant correlation between OCT and FA findings for CSME. Furthermore, the foveal thickness correlates to BCVA.

Histopathological Differential Diagnosis ofOptical Coherence Tomographic ImageInterpretation After Stenting.

The aim of this study was to identify histological features that correlate with terms commonly used todescribe optical coherence tomographic (OCT) and optical frequency-domain imaging (OFDI) images of stented vessels, by means of a histopathological validation study using stented human coronary arteries. OCT imaging and OFDI are used to evaluate vascular responses to stent implantation. Descriptive termssuch as "peristrut low attenuation" and "heterogeneous" have been used to describe neointimal characteristics that may have clinical relevance. However, only limited histopathological correlations are available. Using the CVPath stent registry, 19 cases were identified in whom implantation duration was >30 days andOCT imaging or OFDI and histological findings were available. Consecutive OCT or OFDI frames (n= 1,063) of stented coronary arteries were categorized according to their predominant imaging features in 1-mm intervals. Coregistration ofOCT or OFDI frames and histopathological cross sections was performed in 111 frames. Seven distinct OCT or OFDI patterns were found: homogenous (45%), layered (15%), high intensity with high attenuation (14%), intraluminal protruding masses (8%), peristrut low attenuation (7%), heterogeneous (2%), and honeycomb (1%). Histopathologically, the homogenous pattern correlated most often with smooth muscle cells within collagenous/proteoglycan matrix and less often with organized thrombus. The layered pattern correlated with healed neointimal rupture or erosion, peristrut neovascularization, or smooth muscle cells within collagen/proteoglycan matrix. High intensity with high attenuation correlated with superficial macrophage accumulation in the majority of cases, but with other histological findings in 30% of cases. The diagnostic accuracy was greater in restenotic lesions. The only OCT or OFDI finding that had a single histological feature was the honeycomb pattern. This study suggests a lack of correlation between OCT image patterns and distinct histological tissuecharacteristics.

Comparison of aqueous concentrations of angiogenic and inflammatory cytokines based on optical coherence tomography patterns of diabetic macular edema

Comparison of aqueous concentrations of angiogenic and inflammatory cytokines based on optical coherence tomography patterns of diabetic macular edema

Morphological and clinical characteristics of myopic posterior staphyloma in Caucasians.

We aimed to study the morphological characteristics of myopic posterior staphyloma in Caucasians and to evaluate the correlation between posterior staphyloma, myopic macular lesions and visual acuity. Ninety eyes of 67 consecutive patients affected by high myopia associated with posterior staphyloma were recruited between January 2012 and December 2013. Posterior staphyloma was classified according to Curtin's criteria. Every patient underwent fundoscopic examination and best corrected visual acuity measurement (BCVA). A and B-scan ultrasound (US), high-resolution, three-dimensional magnetic resonance image (MRI), optical coherence tomography (OCT), fundus autofluorescence (FAF), red free (RF) and color fundus photography studies were performed. The mean age was 64.4 ± 9.48years (range: 41-82). The mean BCVA was 0.7 ± 0.5 logMAR (range: 0-2). The mean axial length was 29.92 ± 2.39 millimeters (range: 24.25-36.53). The authors found four types of posterior staphyloma according to Curtin's classification: I, II, IV and IX. Significant prevalence of posterior staphyloma in female sex was observed (p = 0.0235). Significant correlation between the depth and the diameters of posterior staphyloma was demonstrated (p < 0.0001). Significant association between posterior staphyloma type and tomographic foveal patterns (p = 0.0230) was highlighted. Posterior staphyloma type I was more frequently associated with peripapillary atrophy and less with macular atrophy compared to type II and IX (p = 0.0169). The prevalence of macular atrophy was more than double in posterior staphyloma type II (33.3%) in comparison to posterior staphyloma type I (12.5%). This study confirms that the type I and II are the most common types of posterior staphyloma, as already highlighted in the literature. A significant association between the type of posterior staphyloma and the MRI ocular shape pattern, the OCT patterns of macular profile and the location of chorioretinal atrophy was highlighted. The correlation between the depth and the width of posterior staphyloma has demonstrated that the deeper the staphyloma, the wider it was. The deepest area of the posterior staphyloma was characterized by a greater thinning of the sclera and by a higher prevalence of chorioretinal atrophy compared to the other parts of the eye. More studies are necessary to support our findings and to add more information on the natural evolution of posterior staphyloma and on its associated complications.

The effectiveness of vitrectomy for diffuse diabetic macular edema may depend on its preoperative optical coherence tomography pattern.

To investigate the effectiveness of vitrectomy for diffuse diabetic macular edema (DDME) and its dependence on optical coherence tomography (OCT) findings. The records of 65 patients and 81 eyes who received vitrectomy for DDME and followed up for at least 6months were retrospectively reviewed. All eyes were classified according to their morphological characteristics on OCT including sponge-like diffuse retinal thickening (SDRT: n = 13), cystoid macular edema (CME: n = 42), serous retinal detachment (SRD: n = 13), and the combination of all morphological characteristics (FULL: n = 13). The best-corrected visual acuity (BCVA) and spectral domain OCT were investigated preoperatively and at 1, 3, and 6months postoperatively. At six months after surgery, BCVA in logMAR units was significantly improved in all groups except the SDRT group. The improvement was -0.04 ± 0.20 in the SDRT group (P = 0.504), -0.16 ± 0.24 in the CME group (P < 0.01), -0.32 ± 0.32 in the SRD group (P < 0.01), and -0.26 ± 0.19 in the FULL group (P < 0.01), and significantly better in eyes with subretinal fluid (SRF; the SRD and FULL groups) than in eyes without SRF (the SDRT and CME groups, P = 0.003). Vitrectomy can be a useful treatment option for DDME, particularly for eyes with SRF.

Correlation between optical coherence tomographic patterns and visual acuity in eyes with diabetic macular edema

Purpose The aim of the present study was to investigate the correlation between different features of optical coherence tomography, macular thickness, and visual acuity (VA) in patients with diabetic macular edema. Patients and methods In total, 168 eyes with clinically significant diabetic macular edema were included in the study. Best-corrected VA was measured and converted to the logarithm of the minimum angle of resolution (logMAR). Optical coherence tomography was carried out and morphology at the presumed fovea was used to classify eyes into four groups: group I, in which the eyes had only noncystoid sponge-like diffuse retinal thickening (DRT); group II, in which the eyes had DRT with cystoid macular edema (CME); group III, in which the eyes had DRT with serous retinal detachment (SRD); and group IV, in which the eyes had DRT with CME and SRD in the same eye. Retinal thickness at the central fovea [center point thickness (CPT)], average macular thickness (AMT), and the height of the cystoid space and the SRD at the fovea were measured. Results DRT was found alone in 65% of the eyes, CME in 16%, SRD in 13%, and CME and SRD in 6%. Mean logMAR was 0.68 with DRT, 1.16 with CME, 0.89 with SRD, and 1.05 with CME and SRD. Mean CPT was 299 μm in DRT, 573 μm in CME, 354 μm in SRD, and 483 μm in CME and SRD, whereas mean AMT was 309 μm with DRT, 374 μm with CME, 344 μm with SRD, and 390 μm with CME and SRD. There was a positive significant correlation between logMAR and CPT in DRT (0.357, P = 0.001), whereas the correlation was less in CME, SRD, and CME and SRD (0.373, P = 0.087; 0.463, P = 0.053; and 0.082, P = 0.847; respectively). The positive correlation between logMAR and AMT was significant in DRT, CME, and SRD but not in CME and SRD (0.314, P = 0.002; 0.605, P = 0.003; 0.646, P = 0.004; and 0.327, P = 0.429, respectively). The height of the SRD was positively correlated with logMAR (0.516, P = 0.028), whereas the correlation between the height of the cystoid space in CME and logMAR was less (0.360, P = 0.099). Conclusion DRT was the most common feature. CME had worst visual outcome and greatest CPT and AMT. In DRT, worse VA correlated more with CPT than with AMT, whereas in CME and SRD, correlation of VA was more with AMT than with CPT. VA correlated with height of lesion in eyes with SRD but not with CME. The height of cystoid space correlated with CPT but not with AMT, whereas the height of SRD correlated with both CPT and AMT.

Assessment of diabetic macular edema by fundus autofluorescence and optical coherence tomography

Objectives The objective of this study was to evaluate the role of fundus autofluorescence (FAF) in the diagnosis of diabetic macular edema (DME) and to compare it with optical coherence tomography findings. Background FAF imaging is a new technology that can be used to characterize eyes with macular disease. Specific FAF patterns observed in patients with DME seem to correlate with various optical coherence tomography patterns rather than with visual acuity. Patients and methods This study included a total of 51 eyes (26 right and 25 left eyes) of 27 patients (12 male and 15 female) with a mean age of 56.5 years. Main outcome measurements included best corrected visual acuity (BCVA), central macular thickness (CMT), the integrity of photoreceptors inner/outer segment junction (IS/OS), and the presence or absence of increased FAF (iFAF) at the foveola. Results Among the 51 eyes, 37 (72.5%) eyes had no FAF, eight (15.7%) eyes had single-spot iFAF, and six (11.8%) eyes had multispot iFAF; only three (5.8%) eyes of 51 eyes showed the presence of iFAF at the foveola. There was a significant association between grades of FAF regarding intact IS/OS layer (P = 0.003) and significant association between grades of FAF regarding partly interrupted IS/OS layer (P = 0.04). There was a significant association between grades of FAF and the mean CMT (P = 0.002). There was a nonsignificant association between grades of FAF and the mean values of BCVA (P = 0.27), and there was a highly significant positive correlation between BCVA and CMT (P Conclusion FAF might reflect the damage of the retina and had a relationship with the integrity of photoreceptors, as well as CMT, which gives new insight into the evaluation of DME, but it cannot reflect the severity of DME and cannot help us to evaluate the visual function of the patients.

Macular drusen variability: multimodal imaging potential

The purpose of the study – to assess clinical feature of MD using modern digital imaging technologies. Patients with both hard and soft drusen were studied using fluorescein angiography, swept-source optical coherence tomography (OCT), OCT-angiography, autofluorescence (both short-wavelength and near infra-red), scanning laser ophthalmoscopy in Multicolor mode. The retina, choroid and vitreoretinal interface were assessed on 50 patients with AMD and drusen using different imaging modalities. An additional group of the study was presented by 5 patients with geographic atrophy (GA) formed as a result of soft drusen fading, where retrospective assessment of the OCT scans was performed with special attention to the signs of soft drusen regression associated with atrophy of the overlying RPE. Two types of hard drusen were defined as the reticular pseudodrusen and the cuticular drusen. The qualitative and comparative analysis of data for each type of MD was performed. Vitreoretinal interface evaluation demonstrated the correlation between vitreomacular adhesion and mixed reticular and cuticular drusen. The choroidal thickness assessment in 9 different macular sectors in drusenoid eyes does not reveal a significant difference with control group. All of the analysed drusen-faded-eyes initially had been presented with OCT patterns of “nascent” GA. The modern retinal imaging techniques enable new approach to the diagnostic differentiation and description of various macular drusen types. The value of these methods for AMD prognosis is yet to be further investigated.

What biomarkers explain about pterygium OCT pattern.

Optical coherence tomography (OCT) has become a very useful tool to study in vivo different ocular structures and to improve differential diagnosis and management of many ocular pathologies. This study aims to identify pterygium alterations that trigger characteristic OCT images, and analyze if this pattern correctly demarcates lesion boundary. Thirty-two patients, 22 men, and ten women, aged between 26 and 56 (mean age 40.5 ± 6.9) with symptomatic primary pterygium were recruited. After excision, lesion images were obtained by high-definition OCT. Specimens were stained with hematoxylin–eosin (H&E), antivimentin for all mesenchymal origin cells and altered limbal basal cells, CD45 for lymphocyte and macrophage cells, CD1a for Langerhans cells, and S100 for melanocyte and Langerhans cells. The typical OCT wedge-shape hyperreflective mass was evident only by vimentin antibody and included, mainly, fibroblasts but also immune cells (verified by CD45) in a rich network of collagen fibers. The mass apex, often extended centripetally as a thin subepithelial line, hyperreflective by OCT, was formed by a row of fibroblasts under an apparently intact Bowman’s layer, as vimentin samples revealed. Hyperreflective epithelium overlying the mass showed a great number of vimentin-positive infiltrated cells such as melanocytes, Langerhans cells, and lymphocytes (identified by the other biomarkers). H&E staining revealed the presence of goblet cells. Nevertheless, only vimentin staining revealed the presence of altered basal cells above partially dissolved or apparently intact Bowman’s layer, coinciding in this last case with the fibroblast subepithelial line. In most of the cases (72 %), the altered cells occupied a basal segment shorter than the fibroblast subepithelial line but in some specimens, these cells exceeded the fibroblast line length. This study demonstrated the great visual accordance between pterygium OCT images and vimentin staining. Alteration in collagen arrangement, infiltration of inflammatory cells, and fibroblast subepithelial line in the lesion apex were the main histological changes responsible for the anomalous hyperreflectivity of the OCT pattern. By contrast, altered basal cells located in the basal epithelial layer of the pterygium head could not be detected by OCT, which might generate lesion size underestimation.

Optical Coherence Tomography Angiography and En Face Optical Coherence Tomography Features of Paracentral Acute Middle Maculopathy

To characterize the optical coherence tomography (OCT) angiography, en face OCT, and microperimetry features of paracentral acute middle maculopathy in both the acute phase and after resolution, and to propose a classification of distinct subtypes of this entity. Retrospective observational case series. Clinical histories, high-resolution digital color imaging, spectral-domain OCT images, fluorescein angiography, OCT angiography images, and en face OCT images of 16 patients with paracentral acute middle maculopathy were evaluated. Microperimetry was available in 6 patients. The most common referring diagnoses were isolated branch retinal arterial occlusion (5/16), combined central retinal vein and cilioretinal artery occlusion (4/16), and isolated central retinal vein occlusion (4/16). All patients demonstrated hyperreflective plaque-like lesions at the level of the inner nuclear layer on spectral-domain OCT, with no fluorescein angiographic correlate. OCT angiography demonstrated variable areas of capillary dropout within the superficial and deep retinal capillary plexi in these areas. En face OCT highlighted confluent areas of middle retina hyperreflectivity corresponding to these lesions. Three distinct en face OCT patterns were observed: arteriolar, fern-like, and globular. Microperimetry demonstrated relative scotomas mapping to the area of middle retinal hyperreflectivity seen on en face OCT. Paracentral acute middle maculopathy may be best evaluated with the use of en face OCT imaging, which corresponds to subjective and objective visual field defects. En face OCT appearance may be used to classify paracentral acute maculopathy into distinct subtypes.

Retinal pathology in Susac syndrome detected by spectral-domain optical coherence tomography.

The aim of this non-interventional study was to characterize retinal layer pathology in Susac syndrome (SuS), a disease with presumably autoimmune-mediated microvessel occlusions in the retina, brain, and inner ear, in comparison to the most important differential diagnosis multiple sclerosis (MS). Seventeen patients with SuS and 17 age- and sex-matched patients with relapsing-remitting MS (RRMS) and healthy controls (HC) were prospectively investigated by spectral-domain optical coherence tomography (OCT) including intraretinal layer segmentation in a multicenter study. Patients with SuS additionally received retinal fluorescein angiography (FA) and automated perimetry. Patchy thinning of the retinal nerve fiber layer, ganglion cell layer, inner plexiform layer, inner nuclear layer, and outer plexiform layer compared to corresponding sectors in RRMS and HC eyes (p < 0.003 for SuS vs RRMS and HC) was observed in 23/34 (68%) SuS eyes, particularly in temporal quadrants. The outer nuclear layer (ONL) and photoreceptor layers (PRL) were not affected. FA performed in 15/17 patients with SuS was negative for disease-specific branch retinal artery occlusions in all but 1 eye at the time of OCT examination and revealed no additional vascular abnormalities, even in severely damaged OCT areas. In a subset of patients with SuS, associations of visual field data with distinct retinal layers were observed. Distinct OCT patterns of scattered, scar-like intraretinal pathology in SuS eyes, sparing the ONL and PRL, suggest a retinal, but not choroidal, vascular pathomechanism and clearly differentiate SuS from RRMS. Depending on the disease stage, OCT and FA provide specific complementary diagnostic information in SuS.

CLASSIFICATION OF SCLEROCHOROIDAL CALCIFICATION BASED ON ENHANCED DEPTH IMAGING OPTICAL COHERENCE TOMOGRAPHY "MOUNTAIN-LIKE" FEATURES.

To describe distinct enhanced depth optical coherence tomography patterns of sclerochoroidal calcification and their correlation to clinical features. Retrospective chart review of 67 eyes of 46 patients with spectral domain optical coherence tomography imaging. The mean patient age at diagnosis was 68 years. There were 20 (43%) men and 26 (57%) women of white (n = 45, 98%) or Hispanic (n = 1, 2%) heritage. The most prominent sclerochoroidal calcification lesions were located in the superotemporal quadrant (n = 57, 85%) between the temporal arcades and the equator (n = 58, 87%). On enhanced depth optical coherence tomography, the sclerochoroidal calcification was located within the sclera in all cases and the inner surface topography assumed specific "mountain-like" patterns, including flat (Type 1) (n = 9) at median thickness of 1.2 mm, rolling (Type 2) (n = 28) at 1.4 mm thickness, rocky-rolling (Type 3) (n = 21) at 2.1 mm thickness, and table mountain (Type 4) (n = 9) at a thickness of 1.9 mm. The retinal layers were undisturbed in flat lesions, and outer retinal abnormalities were found in all other types. A comparison of the 4 types revealed that Type 3 lesions were thickest (P < 0.001), showing abnormalities in the retinal pigment epithelium, ellipsoid region, and external limiting membrane most commonly (P < 0.05) and demonstrating the most dramatic thinning of the overlying choroid (P < 0.01) and retina (P < 0.05). Type 4 lesions showed greatest basal diameter (P < 0.01) and least outer retinal abnormalities (P < 0.05) or choroid thinning (P < 0.05). In this report, enhanced depth optical coherence tomography has demonstrated that sclerochoroidal calcification is a scleral-based disease and can be classified based on four "mountain-like" topographic patterns, associated with variable effects on the choroid and retina.

Spectral-domain Optical Coherence Tomography Patterns in Intraocular Lymphoma

Purpose: To examine spectral-domain optical coherence tomography (SD-OCT) patterns in intraocular lymphoma (IOL).Methods: Records of 13 patients (21 eyes) with IOL were retrospectively reviewed. SD-OCT was evaluated at initial visit and during follow-up.Results: SD-OCT images at initial visit demonstrated disruption of the ellipsoid zone (8 eyes, 38.1%) and hyperreflective nodules at the retinal pigment epithelium (RPE) level (5 eyes, 23.8%). During follow-up, disruption of the ellipsoid zone (10 eyes, 47.6%) and hyperreflective nodules at the RPE level (7 eyes, 33.3%) were noted. In 5 eyes showing hyperreflective nodules at the RPE level, the hyperreflective nodules were reduced after treatment with intravitreal methotrexate.Conclusions: Hyperreflective nodules in the outer retina and disruption of the ellipsoid zone were observed in nearly one-half of patients with IOL over time. SD-OCT may allow for early detection of small macular abnormalities and aid in monitoring of treatment efficacy in this disease.

Patterns of fundus autofluorescence and optical coherence tomography in diabetic macular edema and functional correlations

Objective To assess and classify the features of fundus autofluorescence (FAF) with optical coherence tomography (OCT) in clinically significant diabetic macular edema according to the criteria reported by ETDRS.Methods Eighty-four eyes of 47 diabetic patients with untreated clinically significant macular edema (CSME) diagnosed by OCT/FAF examination were enrolled in this study.The mean BCVA was 0.38±0.26,CRT was (360.23±139.40) μm and volume was (9.59±1.97) mm3.According to the FAF patterns,the CSME patients were divided into normal group (30 eyes),single-spot group (20 eyes),and multiple-spot group (22 eyes).There were 44,18 and 22 eyes with diffuse edema,cystoid edema and serous retinal detachment,respectively.The correlation of visual acuity with central retinal thickness and total volume of macular was analyzed between different groups.Results In the normal group and the singlespot group,the prevalence of the diffuse type was highest in the OCT (83.3％,60.0％).In the multiplespot group,the prevalence of the SRD type was highest in the OCT (50.0％).In the three FAF pattern groups,the BCVA were 0.47±0.26,0.43±0.30,0.28±0.19; the CRT were (272.41±48.62),(402.84±134.89),(505.67±135.20) μm ; the total volume was (8.67± 1.03),(8.94± 1.63),(10.79±2.20) mm3.The BCVA were 0.43±0.25,0.45±0.30,0.22±0.14; the CRT were (272.41± 48.62),(402.84±134.89),(505.67± 135.20) μm ; the total volume was (8.58±0.95)、(9.22± 1.33)、(12.03±2.01) mm3 in eyes with diffuse edema,cystoid edema and serous retinal detachment,respectively (r=-0.31,-0.34; P＞ 0.05).Correlation analysis showed CRT positively correlated to volume (r=0.85,P＜ 0.05),BCVA negatively correlated to CRT and volume (r=-0.31,-0.34; P＞ 0.05).Conclusion There are more diffuse edema eyes in normal group and single-spot group,while serous retinal detachmen in multiple-spot group.FAF correlates better with visual acuity than OCT patterns. Key words: Diabetic retinopathy/complications; Macular edema; Vision disorders/ physiopathology; Tomography, optical coherence

Improvement of visual acuity based on optical coherence tomography patterns following intravitreal bevacizumab treatment in patients with diabetic macular edema.

To report the visual outcome based on various patterns of optical coherence tomography (OCT) morphology in diabetic macular edema (DME), following treatment with anti-VEGF intravitreal bevacizumab (IVB) injection. Sixty-seven consecutive subjects with centre involving DME underwent intravitreal injection of Bevacizumab (1.25 mg/0.05 mL) in this retrospective, comparative, non randomized study. The DME was classified into one of four categories: focal, diffuse, focal cystoid and neurosensory detachment based on OCT. Best corrected visual acuity (BCVA), macular appearance, and OCT findings were used to decide whether the subject should have a repeat injection of intravitreal bevacizumab. Outcome measures were a change in mean BCVA (Snellen converted to logMAR) and central macular thickness (CMT) in each group during the six month follow-up period. The mean BCVA improved to logMAR 0.23 at final follow-up from a baseline of 0.32 logMAR (P=0.040) in the focal group, logMAR 0.80 at final follow-up from a baseline of 0.82 logMAR (P=0.838) in the diffuse group, worsened to logMAR 0.53 at final follow-up from a baseline of 0.43 logMAR (P=0.276) in the focal cystoid group, and improved to logMAR 0.79 at final follow-up from a baseline of 0.93 logMAR (P=0.490) in the neurosensory detachment group. The mean CMT before treatment were 298.8±25.03 µm in the focal group, 310.8±40.6 µm in the diffuse group, 397.15±31.05 µm in the focal cystoid group and 401.03±75.1 µm in the neurosensory detachment group. A mean of 2.05 (range: 1-5) injections in the focal group, 1.32 (range: 1-2) in the diffuse group, 2.6 (range: 1-6) in the focal cystoid group and 2.6 (range: 1-6) in the neurosensory detachment group were performed during the six month follow-up period. Following intravitreal bevacizumab treatment, vision improved, remained unchanged or worsened in 11, 7 and 2 subjects in focal group; 11, 9 and 8 in diffuse group; 0, 2 and 4 in focal cystoid group and 5, 5 and 3 subjects respectively in neurosensory detachment group. OCT morpholgy patterns in DME may predict the effects of intravitreal bevacizumab treatment, and patients with focal DME are most likely to benefit from the improvent of visual acuity from this treatment.

EFFECT OF 360° EPISCLERAL BAND AS ADJUNCTIVE TO PARS PLANA VITRECTOMY AND SILICONE OIL TAMPONADE IN THE MANAGEMENT OF MYOPIC MACULAR HOLE RETINAL DETACHMENT

To report the effect of 360° scleral band in combination with pars plana vitrectomy (PPV) and silicone oil tamponade on the anatomical success and on the closure of macular hole (MH) in cases of myopic macular hole retinal detachment. A retrospective consecutive interventional study from medical records on patients who had pars plana vitrectomy and silicone oil. with or without 360° scleral band for the treatment of retinal detachment associated with MH. The cases were operated in the period from February 2006 to May 2012. The included cases were classified into two groups: the first group with scleral band and the second group without scleral band. The primary anatomical success and optical coherence tomography patterns of MH closure were the main outcomes. After the first procedure, the overall success rate was 90.6% (in both groups). In 9.4%, there was recurrent retinal detachment. In the first group the success rate was 89.5%, and in 10.5% there was recurrent retinal detachment. In the second group 92.5% was success and 7.5% was recurrent retinal detachment. After the second interference, the success rate was 98.4% in both groups. Closure of MH was achieved in 45.2% in both groups. In the first group, there was closure of MH in 43.5%, while in 47.8% the hole remained open flat, in 4.3% the hole closed partially and in 4.3% there was macular scar. In the second group, MH closure was achieved in 47.4%, whereas in 52.6% the hole was open flat. The use of 360° band in combination with pars plana vitrectomy and silicone oil offered no additional effect on either the anatomical success or the rate of MH closure in the management of myopic macular hole retinal detachment. Four patterns of MH were reported closed MH, partial thickness MH, open flat MH, and macular scar.

Correlation of morphological pattern of optical coherence tomography in diabetic macular edema with systemic risk factors in middle aged males

To study correlation of different optical coherence tomography (OCT) patterns of diabetic macular edema (DME) with systemic risk factors. Institutional cross-sectional double-masked non-interventional study with 330 eyes of middle-aged male type 2 diabetes patients with DME. Various systemic parameters were measured. Diffuse retinal thickening (DRT), cystoid and serous patterns of DME were identified on OCT. Comparison between DRT versus non-DRT and serous versus non-serous eyes was done in respect to systemic parameters. Correlation of serous and DRT pattern was tested with systemic parameters above and below specified values. Mean age was 54.4 ± 7.1 years. Mean duration of diabetes was 8.7 ± 4.2 years. Mean serum globulin level was significantly higher (p = 0.018) in serous compared to non-serous group. Prevalence of serous DME was significantly high in those with serum globulin level >3.5 gm/dl (prevalence ratio = 3.01, p = 0.040). Significant correlation of central macular thickness was observed with duration of diabetes (p = 0.002, r = 0.440).Visual acuity (logMAR) was correlated significantly with HbA1C (p = 0.031, r = 0.305). Increased serum globulin, a positive phase reactant of inflammation, was found significant independent risk factor for development of serous DME. This study did not identify any modifiable systemic factor for any of the OCT patterns in DME.

Optical Coherence Tomography Patterns in Diabetic Macular Edema can Predict the Effectiveness of Intravitreal Bevacizumab Combined with Macular Photocoagulation

Purpose: To compare the effectiveness of intravitreal bevacizumab (IVB) combined with macular photocoagulation (MPC) for the treatment of patients with different optical coherence tomography (OCT) patterns of diabetic macular edema. Methods: In this prospective study were included 72 eyes of 58 patients with nonproliferative diabetic retinopathy (NPDR) and nontractional DME with central macular thickness (CMT) over 300 μm. The eyes were categorized into three groups according to OCT features: 22 eyes with diffuse retinal thickening (DRT), 30 eyes with cystoid macular edema (CME), 20 eyes with serous retinal detachment (SRD). All patients received a single dose (1.25mg/0.05ml) of IVB. MPC was applied one month later (25-30 days). Early Treatment Diabetic Retinopahty Study ( ETDRS) best corrected visual acuity (BCVA) and СМТ were assessed before and after the treatment (in the 1st, 3rd and 6th month). Results: At month 6, mean BCVA changed with +8.27 ± 10.7 ETDRS letters (P=0.074), -0.97 ± 8.2 ETDRS letters (P=0.351) and +1.8 ± 10.1 ETDRS letters (P=0.925), respectively, for DRT, CME and SRD groups. Mean CMT decreased by 80.7 ± 65.7 μm (P=0.003) in DRT group, by 24.5 ± 104.6 μm (P=0.909) in CME group and by 51.7 ± 124.3 μm (P=0.580) in SRD group. The DRT group was associated with superior BCVA improvement and greater reduction in CMT as compared with the CME and SRD groups. Conclusions: Intravitreal injection of bevacizumab combined with MPC is more effective in the DRT pattern than in the CME or SRD patterns of DME. The pattern of DME shown by OCT may predict the effectiveness of combination treatment.

Different Concentrations of Aqueous Cytokines According to Diabetic Macular Edema Patterns as Determined Optical Coherence Tomography

Objective: To evaluate the relationship between various cytokine levels in aqueous humor and diabetic macular edema (DME) types as determined by optical coherence tomographic (OCT) patterns. Methods: The study examined 76 patients with DME at early phase. Ten patients who underwent cataract surgery served as controls. Eyes with DME were divided into four groups, based on OCT patterns of DME, prior to intravitreal bevacizumab injection (IVB). Patterns included sponge-like diffuse retinal thickening (SDRT) (n=27), cystoid macular edema (CME) (n=18), serous retinal detachment (SRD) (n=15), and combined CME and SRD (n=16). Visual acuity, central macular thickness (CMT) through OCT, and aqueous cytokine concentrations of interleukin (IL)-6, IL-8, IL-10, IL-13, monocyte chemo attractant protein-1 (MCP-1), vascular endothelial growth factor (VEGF) were measured in all subjects. The odds ratio (OR) between aqueous cytokines and each DME pattern were calculated using multivariate regression analysis. Results: After IVB, CMT was reduced in all groups, but the highest reduction ratio occurred in eyes with SDRT and CME. Aqueous analyses showed that VEGF was associated with development of SDRT (P=0.003, OR=1.043, 95% CI=1.015-1.072). IL-6, MCP-1 were related with CME (P<0.001, OR=1.025, 95% CI=1.011-1.039; P<0.001, OR=1.003, 95% CI=1.001-1.004, respectively). IL-6 was also associated with SRD (P=0.045, OR=1.018, 95% CI=1.006-1.030). Furthermore, IL-6, VEGF were related with Combined pattern (P=0.031, OR=1.013, 95% CI=1.002-1.024; P=0.038, OR=1.014, 95% CI=1.014-1.043, respectively). Conclusion: Specific aqueous cytokines may play an important role in developing each DME pattern based on OCT.

OCT determined macular thickness in diabetic retinopathy and relation to colour vision deficiency patterns

Background: Diabetic retinopathy is the most common cause of blindness in industrialised nations and the incidence of diabetes is expected to rise over the next 10 years. Early treatment of proliferative diabetic retinopathy and diabetic maculopathy improves visual outcome and with effective screening, blindness could be reduced. Patients suffering from diabetes mellitus show alterations in their colour perception. Colour vision testing provides a sensitive, non-invasive method to assess macular damage in diabetic retinopathy and any deterioration in colour vision often precedes changes in other clinical measures such as visual acuity and morphological changes. Optical coherence tomography (OCT) provides cross-sectional images of the retina, information concerning internal retinal structure as well as reproducible measurements of retinal thickness. Aims & Objective: This study was intended to examine the relationship between macular thickness on OCT (Optical coherence tomography) and colour vision deficiency patterns in diabetics. Material and Methods: A total of 100 patients with established diabetic retinopathy visiting hospital were examined and a detailed history of diabetes, duration and inability to differentiate colours was taken. Retinal examination for evidence of diabetic retinopathy and colour vision patterns on Ishihara colour vision chart were noted. OCT was performed on these patients. Results: 21% (21 out of 100) of patients under study showed a gross deficiency of red green pattern of colour blindness. The colour vision deficiency increased with increasing macular thickness. Macula thickness on OCT in subjects varied from 188 to 462 microns. The average macular thickness of patients with total colour vision deficiency was 290 microns that with red green was 274 micron and those without any colour vision deficiency was 228. Prevalence of colour vision deficiency increased with duration of diabetes and severity of retinopathy. Conclusion: Higher prevalence of red green colour blindness was observed in patients of diabetes with macular oedema. Impaired colour vision was more in patients with macular thickness above 228 micron.