DIFFERENCE IN TREATMENT OUTCOMES ACCORDING TO OPTICAL COHERENCE TOMOGRAPHY-BASED STAGES IN TYPE 3 NEOVASCULARIZATION (RETINAL ANGIOMATOUS PROLIFERATION)

Posted Posted in Retina

Optical Coherence Tomography, Neovascularization , Retinal Angiomatous Proliferation

2017 Oct 10. doi: 10.1097/IAE.0000000000001876. [Epub ahead of print]

DIFFERENCE IN TREATMENT OUTCOMES ACCORDING TO OPTICAL COHERENCE TOMOGRAPHY-BASED STAGES IN TYPE 3 NEOVASCULARIZATION (RETINAL ANGIOMATOUS PROLIFERATION).

Abstract

PURPOSE:

To compare 12-month treatment outcomes of Type 3 neovascularization among its different stages as classified using an optical coherence tomography-based method.

METHODS:

This retrospective observational study included 40 patients (40 eyes) who were newly diagnosed with Type 3 neovascularization. The patients were initially administered 3 monthly anti-vascular endothelial growth factor injections. Repeat treatment was performed when recurrence of fluid was noted. Disease staging was classified using the optical coherence tomography-based method. The best-corrected visual acuity at diagnosis and at 12 months and degree of change in best-corrected visual acuity were compared among the different stages of the disease. In addition, incidence of progression in the disease stages was estimated.

RESULTS:

Among the 40 patients, 14 (35.0%) were classified as Stage 2 and 26 (65.0%) were classified as Stage 3. The best-corrected visual acuity values at diagnosis and at 12 months were 0.61 ± 0.31 (20/81 Snellen equivalents) and 0.46 ± 0.30 (20/57) in the Stage 2 group and 0.67 ± 0.42 (20/93) and 0.70 ± 0.49 (20/100) in the Stage 3 group, respectively. There was a significant difference in best-corrected visual acuity change between the two groups (P = 0.036). During the follow-up period, 3 retinal pigment epithelium tears and 2 submacular hemorrhages had developed in the Stage 3 group. Progression of the disease from Stage 2 to Stage 3 was noted in 2 patients (14.3%).

CONCLUSION:

The visual outcome was worse in Stage 3 than in Stage 2, and adverse events that may lead to abrupt visual deterioration developed only in Stage 3. Further studies are needed to reveal whether anti-vascular endothelial growth factor therapy can suppress the progression of the disease stages.

Optical Coherence Tomography, Neovascularization , Retinal Angiomatous Proliferation

PMID:
29019795
DOI:
10.1097/IAE.0000000000001876

Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration

Posted Posted in Retina

Optical Coherence Tomography, Progression, Non-Neovascular, Atrophic, Age-Related Macular Degeneration

2017 Aug 25. pii: S0161-6420(16)32460-5. doi: 10.1016/j.ophtha.2017.06.032. [Epub ahead of print]

Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration.

Abstract

PURPOSE:

Appearance of geographic atrophy (GA) on color photography (CP) is preceded by specific features on spectral-domain optical coherence tomography (SD OCT). We aimed to build SD OCT-based risk assessment models for 5-year new onset of GA and central GA on CP.

DESIGN:

Prospective, longitudinal study.

PARTICIPANTS:

Age-Related Eye Disease Study 2 Ancillary SD OCT study participants with age-related macular degeneration (AMD) with bilateral large drusen or noncentral GA and at least 1 eye without advanced disease (n = 317).

METHODS:

For 1 eye per participant, qualitative and quantitative SD OCT variables were derived from standardized grading and semiautomated segmentation, respectively, at baseline. Up to 7 years later, annual outcomes were extracted and analyzed to fit multivariate logistic regression models and build a risk calculator.

MAIN OUTCOME MEASURES:

New onset of CP-visible GA and central GA.

RESULTS:

Over a follow-up median of 4.0 years and among 292 AMD eyes (without advanced disease at baseline) with complete outcome data, 46 (15.8%) developed central GA. Among 265 eyes without any GA on baseline CP, 70 (26.4%) developed CP-visible GA. Final multivariate models were adjusted for age. In the model for GA, the independent predicting SD OCT factors (P < 0.001-0.03) were: hyperreflective foci and retinal pigment epithelium (RPE) layer atrophy or absence, followed by choroid thickness in absence of subretinal drusenoid deposits, photoreceptor outer segment loss, RPE drusen complex volume, and RPE drusen complex abnormal thinning volume. For central GA, the factors (P < 0.001) were RPE drusen complex abnormal thinning volume, intraretinal fluid or cystoid spaces, hyperreflective foci, and RPE layer atrophy or absence. The models yielded a calculator that computes the probabilities of CP-visible, new-onset GA and central GA after 1 to 5 years.

CONCLUSIONS:

For AMD eyes with large drusen and no advanced disease, we built a novel risk assessment model-based on age and SD OCT segmentation, drusen characteristics, and retinal pathology-for progression to CP-visible GA over up to 5 years. This calculator may simplify SD OCT grading and with future validation has a promising role as a clinical prognostic tool.

PMID:
28847641
DOI:
10.1016/j.ophtha.2017.06.032

Evaluating structural progression of retinitis pigmentosa after cataract surgery

Posted Posted in Cataracts and Cataract Surgery, Retina

cataract surgery, ellipsoid zone, optical coherence tomography, phacoemulsification, posterior subcapsular cataract, retinitis pigmentosa, visual acuity

2017 Jun 7. pii: S0002-9394(17)30238-6. doi: 10.1016/j.ajo.2017.05.026. [Epub ahead of print]

Evaluating structural progression of retinitis pigmentosa after cataract surgery.

Abstract

PURPOSE:

To determine whether cataract surgery accelerates disease progression in retinitis pigmentosa (RP).

DESIGN:

Retrospective cohort study.

METHODS:

Seventy eyes of 40 patients with RP were categorized as having had phacoemulsification with intraocular lens implantation versus no cataract surgery at a single tertiary-level institution. Spectral domain optical coherence tomography (SD-OCT) was used to measure the ellipsoid zone (EZ) width, which has been demonstrated to be a reliable marker of RP severity, at baseline and throughout follow-up (median 768 days). RP progression was calculated as the loss of EZ width over time for all patients. Additional post-operative data was collected for the cataract surgery group, including pre- and post-operative best-corrected visual acuity, incidence of macular edema, posterior capsular opacification, epiretinal membrane, and intraocular lens subluxation.

RESULTS:

Multivariable analysis including age, baseline EZ width, mode of inheritance, and cataract surgery status showed that there was no significant difference in RP progression between the cataract surgery and control groups (P=0.23). Mode of inheritance was associated with RP progression, with autosomal recessive RP progressing at 148 microns/year and autosomal dominant RP progressing at 91 microns/year (P=0.003). Visual acuity improved in almost all eyes that underwent surgery (17/19, 89%), and remained stable in remaining eyes (2/19, 11%). There was a high incidence of post-surgical posterior capsular opacification (18/19, 95%). There were no serious complications such as lens subluxation or endophthalmitis.

CONCLUSIONS:

Our findings suggest that cataract surgery is a safe and effective means of improving visual acuity in RP patients and that it does not seem to be associated with faster disease progression as measured using SD-OCT.

KEYWORDS:

IS/OS; cataract surgery; ellipsoid zone; optical coherence tomography; phacoemulsification; posterior subcapsular cataract; retinitis pigmentosa; visual acuity

PMID:
28601586
DOI:
10.1016/j.ajo.2017.05.026
cataract surgery, ellipsoid zone, optical coherence tomography, phacoemulsification, posterior subcapsular cataract, retinitis pigmentosa, visual acuity
Retinitis pigmentosa example not from article

Guiding flying-spot laser transepithelial phototherapeutic keratectomy with optical coherence tomography

Posted Posted in cornea, lasik

 flying spot, laser, transepithelial, phototherapeutic keratectomy, optical coherence tomography

J Cataract Refract Surg. 2017 Apr;43(4):525-536. doi: 10.1016/j.jcrs.2017.03.004.

Guiding flying-spot laser transepithelial phototherapeutic keratectomy with optical coherence tomography.

Abstract

PURPOSE:

To analyze transepithelial phototherapeutic keratectomy (PTK) results using optical coherence tomography (OCT) and develop a model to guide the laser dioptric and depth settings.

SETTING:

Casey Eye Institute, Portland, Oregon, USA.

DESIGN:

Prospective nonrandomized case series.

METHODS:

Patients with superficial corneal opacities and irregularities had transepithelial PTK with a flying-spot excimer laser by combining wide-zone myopic and hyperopic astigmatic ablations. Optical coherence tomography was used to calculate corneal epithelial lenticular masking effects, guide refractive laser settings, and measure opacity removal. The laser ablation efficiency and the refractive outcome were investigated using multivariate linear regression models.

RESULTS:

Twenty-six eyes of 20 patients received PTK to remove opacities and irregular astigmatism due to scar, dystrophy, radial keratotomy, or previous corneal surgeries. The uncorrected distance visual acuity and corrected distance visual acuity were significantly improved (P < .01) by 3.7 Snellen lines and 2.0 Snellen lines, respectively, to a mean of 20/41.2 and 20/22.0, respectively. Achieved laser ablation depths were 31.3% (myopic ablation) and 63.0% (hyperopic ablation) deeper than the manufacturer’s nomogram. The spherical equivalent of the corneal epithelial lenticular masking effect was 0.73 diopter ± 0.61 (SD). The refractive outcome highly correlated to the laser settings and epithelial lenticular masking effect (Pearson R = 0.96, P < .01). The ablation rate of granular dystrophy opacities appeared to be slower. Smoothing ablation under masking fluid was needed to prevent focal steep islands in these cases.

CONCLUSIONS:

The OCT-measured ablation depth efficiency could guide opacity removal. The corneal epithelial lenticular masking effect could refine the spherical refractive nomogram to achieve a better refractive outcome after transepithelial ablation.

Automated Staging of Age-Related Macular Degeneration Using Optical Coherence Tomography

Posted Posted in Retina
Invest Ophthalmol Vis Sci. 2017 Apr 1;58(4):2318-2328. doi: 10.1167/iovs.16-20541.

Automated Staging of Age-Related Macular Degeneration Using Optical Coherence Tomography.

Abstract

PURPOSE:

To evaluate a machine learning algorithm that automatically grades age-related macular degeneration (AMD) severity stages from optical coherence tomography (OCT) scans.

METHODS:

A total of 3265 OCT scans from 1016 patients with either no signs of AMD or with signs of early, intermediate, or advanced AMD were randomly selected from a large European multicenter database. A machine learning system was developed to automatically grade unseen OCT scans into different AMD severity stages without requiring retinal layer segmentation. The ability of the system to identify high-risk AMD stages and to assign the correct severity stage was determined by using receiver operator characteristic (ROC) analysis and Cohen’s κ statistics (κ), respectively. The results were compared to those of two human observers. Reproducibility was assessed in an independent, publicly available data set of 384 OCT scans.

RESULTS:

The system achieved an area under the ROC curve of 0.980 with a sensitivity of 98.2% at a specificity of 91.2%. This compares favorably with the performance of human observers who achieved sensitivities of 97.0% and 99.4% at specificities of 89.7% and 87.2%, respectively. A good level of agreement with the reference was obtained (κ = 0.713) and was in concordance with the human observers (κ = 0.775 and κ = 0.755, respectively).

CONCLUSIONS:

A machine learning system capable of automatically grading OCT scans into AMD severity stages was developed and showed similar performance as human observers. The proposed automatic system allows for a quick and reliable grading of large quantities of OCT scans, which could increase the efficiency of large-scale AMD studies and pave the way for AMD screening using OCT.

CONCLUSIONS:

A machine learning system capable of automatically grading OCT scans into AMD severity stages was developed and showed similar performance as human observers. The proposed automatic system allows for a quick and reliable grading of large quantities of OCT scans, which could increase the efficiency of large-scale AMD studies and pave the way for AMD screening using OCT.

Comparison of corneal flaps created by Wavelight FS200 and Intralase FS60 femtosecond lasers.

Posted Posted in lasik
Fourier,optical coherence tomography,Intralase FS60, Wavelight FS200, femtosecond laser,flap, Lasik
Int J Ophthalmol. 2016 Jul 18;9(7):1006-10. doi: 10.18240/ijo.2016.07.12. eCollection 2016.

Comparison of corneal flaps created by Wavelight FS200 and Intralase FS60 femtosecond lasers.

Abstract

AIM:

To assess and compare the morphology of corneal flaps created by the Wavelight FS200 and Intralase FS60 femtosecond lasers in laser in situ keratomileusis (LASIK).

METHODS:

Four hundred eyes of 200 patients were enrolled in this study and divided into Wavelight FS200 groups (200 eyes) and Intralase FS60 groups (200 eyes). Fourier-domain optical coherence tomography (RTVue OCT) was used to measure the corneal flap thickness of 36 specified measurements on each flap one week after surgery. Results were used to analyze the regularity, uniformity and accuracy of the two types ofLASIK flaps.

RESULTS:

The mean thickness of corneal flap and central flap was 105.71±4.72 µm and 105.39±4.50 µm in Wavelight FS200 group and 109.78±11.42 µm and 109.15 ±11.59 µm in Intralase FS60 group, respectively. The flaps made with the Wavelight FS200 femtosecond laser were thinner than those created by the Intralase FS60 femtosecond laser (P=0.000). Corneal flaps in the 2 groups were uniform and regular, showing an almost planar configuration. But the Wavelight FS200 group has more predictability and uniformity of flap creation. The mean deviation between achieved and attempted flap thickness was smaller in the Wavelight FS200 group than that in the Intralase FS60 group, which were 5.18±3.71 µm and 8.68±7.42 µm respectively. The deviation of more than 20 µm was 0.2% measurements in Wavelight FS200 group and 8.29% measurements in Intralase FS60 group.

CONCLUSION:

The morphologies of flaps created by Wavelight FS200 are more uniform and thinner than those created by Intralase FS60.

KEYWORDS:

Fourier-domain optical coherence tomography; Intralase FS60; Wavelight FS200; femtosecond laser; flap; laser in situ keratomileusis

Surgical Treatment of Subretinal Fibrosis Caused Macular Detachment in Vogt-Koyanagi-Harada Disease: A Pioneer Study

Posted Posted in Retina
Macular detachment, Vogt Koyanagi Harada disease,spectral domain, optical coherence tomography, subretinal fibrosis,surgery
Ocul Immunol Inflamm. 2016 Aug 5:1-6. [Epub ahead of print]

Surgical Treatment of Subretinal Fibrosis Caused Macular Detachment in Vogt-Koyanagi-Harada Disease: A Pioneer Study.

Abstract

PURPOSE:

To describe surgical outcomes of macular detachment caused by subretinal fibrosis (SRF) in Vogt-Koyanagi-Harada disease (VKH).

METHODS:

Retrospective review of VKH patients who underwent SRF removal surgery.

RESULTS:

Seven eyes of six VKH patients with preoperative BCVA ranging from light perception to 20/250 were included. Six eyes underwent uncomplicated SRF removal with C3F8 or silicone oil (SO) tamponade and the following optional primary or subsequent procedures: intravitreal injection of triamcinolone acetonide, SO removal, lensectomy, or phacoemulsification with intraocular lens (IOL) implantation. All six eyes had attached macula and improved BCVA at the last visit (ranging from 20/2000 to 20/67) compared to baseline; the other eye, however, showed no light perception after surgery due to optic nerve injury.

CONCLUSIONS:

In VKH patients, macular detachment caused by SRF can be treated with surgery with generally favorable outcomes. Extreme caution should be taken to avoid optic nerve injury.

KEYWORDS:

Macular detachment; Vogt-Koyanagi-Harada disease; spectral domain optical coherence tomography; subretinal fibrosis; surgery

Abstract

PURPOSE:

To describe surgical outcomes of macular detachment caused by subretinal fibrosis (SRF) in Vogt-Koyanagi-Harada disease (VKH).

METHODS:

Retrospective review of VKH patients who underwent SRF removal surgery.

RESULTS:

Seven eyes of six VKH patients with preoperative BCVA ranging from light perception to 20/250 were included. Six eyes underwent uncomplicated SRF removal with C3F8 or silicone oil (SO) tamponade and the following optional primary or subsequent procedures: intravitreal injection of triamcinolone acetonide, SO removal, lensectomy, or phacoemulsification with intraocular lens (IOL) implantation. All six eyes had attached macula and improved BCVA at the last visit (ranging from 20/2000 to 20/67) compared to baseline; the other eye, however, showed no light perception after surgery due to optic nerve injury.

CONCLUSIONS:

In VKH patients, macular detachment caused by SRF can be treated with surgery with generally favorable outcomes. Extreme caution should be taken to avoid optic nerve injury.

KEYWORDS:

Macular detachment; Vogt-Koyanagi-Harada disease; spectral domain optical coherence tomography; subretinal fibrosis; surgery

Optical coherence tomography angiography: a useful tool for diagnosis of treatment-naïve quiescent choroidal neovascularization

Posted Posted in Retina
choroidal neovascularization, indocyanine green angiography, optical coherence tomography,angiography, retinal imaging
Am J Ophthalmol. 2016 Jul 6. pii: S0002-9394(16)30316-6. doi: 10.1016/j.ajo.2016.06.042. [Epub ahead of print]

Optical coherence tomography angiography: a useful tool for diagnosis of treatment-naïve quiescent choroidal neovascularization.

Abstract

PURPOSE:

To describe the optical coherence tomography angiography (OCT-A) features of treatment-naïve quiescent choroidal neovascularization (CNV) secondary to age-related macular degeneration, and to estimate the detection rate for neovascularization by means of OCT-A.

DESIGN:

Diagnostic tool validity assessment.

METHODS:

Treatment-naïve quiescent CNV were identified from a pool of patients at 2 retina referral centers. Patients underwent a complete ophthalmologic examination including fluorescein angiography, indocyanine green angiography, spectral-domain OCT and OCT-A. Detection rates of CNV by means of OCT-A were estimated with a second cohort of patients without CNV (negative controls) RESULTS: Twenty-two eyes of 20 consecutive patients with quiescent CNV were included. In 4 out of 22 eyes it was not possible to classify the CNV “shape”, “core”, “margin”, and “location” ether because the vascular network was not clearly shown (3 cases) or because it was not visible at all (1 case). CNV shape on OCT-A was rated as circular in 8 eyes and irregular in 10 eyes. CNV core was visible in 2 eyes. CNV margin was considered as well-defined in 15 eyes, and poorly-defined in 3 eyes. CNV margin showed small loops in 9 eyes and large loops in the other 6 eyes. CNV location was foveal-sparing in 12 eyes. Sensitivity and specificity of quiescent CNV detection by OCT-A turned out to be 81.8% and 100%, respectively.

CONCLUSIONS:

OCT-A allows the clinician to identify noninvasively treatment-naive quiescent CNV and may possibly be considered as a useful tool to guide the frequency of return visits and possibly make treatment decisions.

Copyright © 2016. Published by Elsevier Inc.

KEYWORDS:

choroidal neovascularization; indocyanine green angiography; optical coherence tomography aniography; retinal imaging

Increased Choroidal Vascularity in Central Serous Chorioretinopathy Quantified Using Swept-Source Optical Coherence Tomography

Posted Posted in Retina
Choroid, Vascularity,Central Serous Chorioretinopathy,Optical Coherence Tomography,OCT
Am J Ophthalmol. 2016 Jul 6. pii: S0002-9394(16)30317-8. doi: 10.1016/j.ajo.2016.06.043. [Epub ahead of print]

Increased Choroidal Vascularity in Central Serous Chorioretinopathy Quantified Using Swept-Source Optical Coherence Tomography.

Abstract

PURPOSE:

To investigate the choroidal vascular structural changes in eyes with central serous chorioretinopathy (CSC) by using swept-source optical coherence tomography (SS-OCT).

DESIGN:

Prospective cross-sectional study.

METHODS:

We prospectively examined 40 eyes of 34 consecutive patients with CSC. Three-dimensional choroidal images of the macular area, covering 3 × 3 mm and 6 × 6 mm, were obtained with SS-OCT. En face images of the microvasculature of the inner choroid and large choroidal vessel layers were converted to binary images. Choroidal vascular areas were analyzed quantitatively using the binary images.

RESULTS:

The choroidal vascular area was larger in eyes with CSC (the microvasculature of the inner choroid: 53.4 ± 2.4%, P = .028; 3 × 3 mm large choroidal vessels: 66.9 ± 7.1%, P < .001; and 6 × 6 mm large choroidal vessels: 64.8 ± 7.3%, P < .001) than in age-matched normal eyes (52.2 ± 1.8%, 54.9 ± 4.4%, and 53.8 ± 4.3%, respectively). The choroidal vascular area at the microvasculature of the inner choroid level was larger in multifocal posterior pigment epitheliopathy (55.8 ± 2.2%) than in classic CSC (53.1 ± 2.1%, P = .038) and in diffuse retinal pigment epitheliopathy (52.9 ± 2.6%, P = .042). The subfoveal choroidal thickness was significantly associated with the choroidal vascular area at the level of large choroidal vessels (P < .001).  The choroidal vascular area at the microvasculature of the inner choroid level was larger in multifocal posterior pigment epitheliopathy (55.8 ± 2.2%) than in classic CSC (53.1 ± 2.1%, P = .038) and in diffuse retinal pigment epitheliopathy (52.9 ± 2.6%, P = .042). The subfoveal choroidal thickness was significantly associated with the choroidal vascular area at the level of large choroidal vessels (P < .001).

CONCLUSIONS:

Increased choroidal vascular area was observed in the whole macula area in eyes with CSC. This finding suggests that CSC may originate from a choroidal circulatory disturbance.  Increased choroidal vascular area was observed in the whole macula area in eyes with CSC. This finding suggests that CSC may originate from a choroidal circulatory disturbance

Retinal nerve fibre layer thickness changes in Alzheimer’s disease: Results from a 12-month prospective case series

Posted Posted in Retina
Alzheimer, biomarker, optical coherence tomography, retinal nerve fibre layer thickness
Neurosci Lett. 2016 Jul 6. pii: S0304-3940(16)30492-X. doi: 10.1016/j.neulet.2016.07.006. [Epub ahead of print]

Retinal nerve fibre layer thickness changes in Alzheimer’s disease: Results from a 12-month prospective case series.

Abstract

PURPOSE:

To compare the 12-month peripapillary retinal nerve fibre layer (pRNFL) thickness change between AD patients and normal subjects.

METHODS:

In this prospective case series, thirty-six patients with a diagnosis of mild to moderate AD and 36 age-matched control subjects were included. All the subjects underwent neuropsychological (MMSE, ADAS-Cog and CDR) and ophthalmological evaluation, including spectral domain optical coherence tomography (SD-OCT), at baseline and after 12 months.

RESULTS:

Compared with controls, AD patients had a significant reduction of the total pRNFL thickness, as well as the pRNFL thickness of the inferior and superior quadrants (p=0.04, p=0.001, and p=0.01, respectively, adjusted for baseline pRNFL measurement, age, gender, and axial length). Correlation analysis showed a significant relationship between inferior pRNFL thickness change and ADAS-Cog scores change (r=-0.35, p=0.02) as well as CDR scores at 12 months (r=-0.39, p=0.008).

CONCLUSIONS:

Compared with controls, AD patients had a significant reduction in pRNFL thickness over a period of 12 months. The pRNFL reduction was more prominent in the inferior quadrant and paralleled patient’s cognitive decline.

RESULTS:

Compared with controls, AD patients had a significant reduction of the total pRNFL thickness, as well as the pRNFL thickness of the inferior and superior quadrants (p=0.04, p=0.001, and p=0.01, respectively, adjusted for baseline pRNFL measurement, age, gender, and axial length). Correlation analysis showed a significant relationship between inferior pRNFL thickness change and ADAS-Cog scores change (r=-0.35, p=0.02) as well as CDR scores at 12 months (r=-0.39, p=0.008).

CONCLUSIONS:

Compared with controls, AD patients had a significant reduction in pRNFL thickness over a period of 12 months. The pRNFL reduction was more prominent in the inferior quadrant and paralleled patient’s cognitive decline.