Author: Am J Ophthalmol

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We thank Dr Kocatürk and associates for their thoughtful correspondence regarding our manuscript. First, inflammation plays a critical role in the development of corneal neovascularization; therefore, inflammation received careful consideration in t…

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The term retinal vasoproliferative tumor (VPT, or what we call reactive retinal astrocytic tumor) was initially applied to the entity under discussion by J. Shields, and we can appreciate the Shieldses’ ongoing attachment to it. We do not wish, however…

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Scheimpflug Corneal Power Measurements for Intraocular Lens Power Calculation in Cataract Surgery – Corrected Proof

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Purpose: To compare the keratometric (K) readings from the Pentacam-HR (High Resolution) unit with the automated K values from the IOLMaster keratometer (KIOLM), and to evaluate them in the commonly used intraocular lens (IOL) power calculation formulas for routine cataract surgery.Design: Prospective, comparative observational study.Methods: setting: Private practice, Lynwood, California. study population: Fifty cataractous eyes scheduled for surgery between July and August 2012. observation procedure: The K readings from the Pentacam-HR unit taken at the 2-, 3-, 4-, and 5-mm zones and the 2-, 3-, 4-, and 5-mm rings, respectively, from 3 different maps: sagittal corneal front (KF), true net power (KTNP), and total refractive power (KRP) are compared with KIOLM. IOL power calculations were performed with each of the 25 sets of K readings. main outcome measures: The IOL prediction median absolute error (MedAE) obtained with each measurement.Results: KF averaged 0.03-0.13 diopter (D) higher than KIOLM (P > .05), KTNP averaged 1.16-1.21 D lower than KIOLM (P > .001), and KRP averaged 0.23-0.72 D lower than KIOLM (P > .001), with large variations in the measurements. The MedAE obtained with the different Pentacam K readings ranged from 0.44-0.64 D vs 0.52 D obtained with KIOLM (P > .05). MedAE was lower in all categories when the pupil was 3 mm or smaller.Conclusion: The Pentacam KF values were the closest to KIOLM and the KF readings from the 2-mm ring yielded the best results for IOL power calculation.

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Choroidal Thickness Changes After Intravitreal Ranibizumab and Photodynamic Therapy in Recurrent Polypoidal Choroidal Vasculopathy – Corrected Proof

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Purpose: To evaluate subfoveal choroidal thickness changes in cases with recurrent polypoidal choroidal vasculopathy (PCV) after combination therapy with intravitreal ranibizumab and photodynamic therapy (PDT).Design: Retrospective observational case series study.Methods: We measured subfoveal choroidal thickness in PCV using optical coherence tomography (OCT) before and after PDT. In recurrent cases, the choroidal thickness was measured at the time of the recurrence. In nonrecurrent cases, choroidal thickness was measured 1 year after PDT.Results: Combination therapy was performed in 27 eyes (27 patients). Polypoidal lesions regressed within 3 months after initial treatment in all eyes. Retreatment was needed in 10 of 27 eyes (37.0%) after more than 3 months of follow-up. In recurrent cases, subfoveal choroid decreased from 188 μm at baseline to 157 μm 3 months after PDT (P < .01); however, choroidal thickness increased to 179 μm with recurrence (P = .54 compared to baseline; average, 8.0 months). In nonrecurrent cases, subfoveal choroid decreased from 257 μm at baseline to 210 μm 3 months after PDT and 212 μm 1 year after PDT (P < .01, respectively).Conclusion: Subfoveal choroidal thickness in PCV at the time of recurrence returned to the baseline level after choroidal thinning as a result of PDT treatment. Choroidal thickness changes after PDT examined using OCT may reflect disease activity in PCV.

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A Prospective Randomized Trial of Intravitreal Bevacizumab Versus Ranibizumab for the Management of Diabetic Macular Edema – Corrected Proof

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Purpose: To compare visual acuity and spectral-domain optical coherence tomography (SDOCT) outcomes associated with intravitreal (IV) bevacizumab vs IV ranibizumab for the management of diabetic macular edema (DME).Design: Prospective randomized trial.Methods: Forty-eight patients (63 eyes) with center-involved DME were randomly assigned to receive 1.5 mg (0.06 cc) IV bevacizumab or 0.5 mg (0.05 cc) IV ranibizumab at baseline and monthly if central subfield thickness was greater than 275 μm.Results: Forty-five patients (60 eyes) completed 48 weeks of follow-up. At baseline, mean ± standard error best-corrected visual acuity (BCVA) (logMAR) was 0.60 (20/80) ± 0.05 in the IV bevacizumab group and 0.63 (20/85) ± 0.05 in the IV ranibizumab group. A significant improvement in mean BCVA was observed in both groups at all study visits (P < .05); this improvement was significantly greater in the IV ranibizumab group compared with the IV bevacizumab group at weeks 8 (P = .032) and 32 (P = .042). A significant reduction in mean central subfield thickness was observed in both groups at all study visits compared with baseline (P < .05), with no significant difference in the magnitude of macular thickness reduction between groups. The mean number of injections was significantly higher (P = .005) in the IV bevacizumab group (9.84) than in the IV ranibizumab group (7.67).Conclusions: IV bevacizumab and IV ranibizumab are associated with similar effects on central subfield thickness in patients with DME through 1 year of follow-up. IV ranibizumab is associated with greater improvement in BCVA at some study visits, and the mean number of injections is higher in the IV bevacizumab group.

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Interferon versus Methotrexate in Intermediate Uveitis With Macular Edema: Results of a Randomized Controlled Clinical Trial – Corrected Proof

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Purpose: To compare interferon (IFN) beta with methotrexate (MTX) in the treatment of intermediate uveitis with macular edema.Design: Monocentric, prospective, randomized, controlled clinical trial.Methods: setting: Specialized uveitis center at the University of Heidelberg. patient or study population: Patients with either primary intermediate uveitis or uveitis associated with multiple sclerosis. main inclusion criteria: Visual acuity of 20/30 or worse (0.2 logarithm of the minimal angle of resolution) and macular edema of more than 250 μm (central 1-mm in optical coherence tomography; Stratus). Randomization into either IFN beta 44 μg subcutaneously 3 times weekly or 20 mg MTX subcutaneously once weekly. main outcome measures: At 3 months, the primary outcome parameter of mean change in visual acuity was evaluated and efficacy was determined. Secondary parameters were macular edema by optical coherence tomography, inflammatory activity, and retinal sensitivity by microperimetry (MP-1; Nidek). In case of treatment failure, switching to the other treatment arm was possible.Results: Nineteen patients were included. Ten were randomized to MTX, and 9 were randomized to IFN beta. At 3 months, visual acuity improved a mean 0.31 logarithm of the minimal angle of resolution (range, −0.02 to −0.96, 15.6 letters on the Early Treatment Diabetic Retinopathy Study chart) in the IFN beta group versus a mean 0.09 logarithm of the minimal angle of resolution (range, 0.12 to −0.38, 4.7 letters) in the MTX arm (P = .0435, Mann–Whitney U test). Macular thickness decreased by a mean of 206 μm (range, −41 to −416 μm) in the IFN arm, but increased by 47 μm (range, 108 to −28 μm) in the MTX group (P < .0001).Conclusions: Although the sample size is small, results of the trial support superiority of IFN beta over MTX in the treatment of macular edema in the setting of intermediate uveitis

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Macular Imaging in Highly Myopic Eyes With and Without Glaucoma – Corrected Proof

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Purpose: To determine how evaluations of macular structures on spectral-domain optical coherence tomography compare with those of the optic disc and circumpapillary retinal nerve fiber layer (RNFL) in discriminating between highly myopic eyes with and without glaucoma.Design: Retrospective, comparative study.Methods: The appearances of ganglion cell layer and RNFL on Spectralis macular scans (Heidelberg Engineering) and optic disc on photographs were evaluated by 2 observers. The receiver operating characteristic regression was conducted for macular ganglion cell complex and circumpapillary RNFL measurements on RTVue-100 (Optovue).Results: Ninety highly myopic eyes (−6.0 to −15.0 diopters; mean deviation [MD], −5.6 ± 5.1 dB) and 91 non–highly myopic eyes (1.0 to −5.5 diopters; MD, −4.9 ± 5.7 dB) were enrolled. In highly myopic eyes (<−6 diopters), the Cohen κ for qualitative decisions by observers was 0.363 for photographs and 0.946 for Spectralis macular scans, and observers’ evaluations of Spectralis macular scans were more accurate (94.5% and 94.5%, respectively; P < .0001) than their evaluations of photographs (71.4% and 80.2%, respectively). In the receiver operating characteristic regression analyses assessing the influences of age, sex, MD, and axial length, the better MD (P = .002 to .016) and longer axial length (P = .031 to .041) were associated significantly with diagnostic performances for all or some spectral-domain optical coherence tomography parameters. The receiver operating characteristic curves of average macular ganglion cell complex and circumpapillary RNFL thicknesses were comparable at low MD.Conclusions: In high myopes, observers’ assessments of the spectral-domain optical coherence tomography macular scans may agree better and be more accurate than observers’ optic disc assessments. Glaucoma diagnostic performance of the macular ganglion cell complex may be less affected by axial length compared with that of circumpapillary RNFL.

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Retinal Thickness and Volume Measured With Enhanced Depth Imaging Optical Coherence Tomography – Corrected Proof

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Purpose: To evaluate the retinal thickness and volume measured with the enhanced depth imaging (EDI) method compared with those measured with the conventional method using spectral-domain optical coherence tomography (OCT).Design: Retrospective, observational, case-control study.Methods: Clinical records of 20 healthy subjects and those of 35 patients with chorioretinopathy (central serous chorioretinopathy, polypoidal choroidal vasculopathy, Vogt-Koyanagi-Harada disease, and reticular pseudodrusen) were analyzed retrospectively. All subjects underwent spectral-domain OCT using both the conventional and the EDI OCT raster scan protocols. The raster scan was composed of 31 B-scans that were 9.0 mm in length and 240 μm apart. Retinal thickness and volume of 9 Early Treatment Diabetic Retinopathy Study subfields were investigated. Intraclass correlation coefficients, Bland-Altman plots, and Wilcoxon signed-rank test results were used for the analysis.Results: Sixty-five eyes of 35 patients with chorioretinal diseases and 40 eyes of 20 normal healthy subjects were evaluated. The automatically measured retinal thickness and volume of 9 Early Treatment Diabetic Retinopathy Study subfields with conventional and EDI raster scan showed an intraclass correlation coefficient of 0.861 to 0.995 and 0.873 to 0.995, respectively. The 95% limits of agreement between the 2 protocols in the measurement of central subfield were −14.52 to 12.88 μm in retinal thickness and −0.014 to 0.013 mm3 in retinal volume. The differences of segmentation error rate between the 2 protocols were statistically insignificant (P > .05), except in eyes with reticular pseudodrusen in the subgroup analysis (P = .006). No significant differences were observed in measured values between healthy eyes and unaffected fellow eyes.Conclusions: The EDI OCT raster scan showed high agreement with conventional OCT in the measurement of retinal thickness and volume and could be used to evaluate both the retina and choroid in normal eyes and in eyes with some forms of chorioretinal disorder.

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Accuracy of the Heidelberg Spectralis in the Alignment Between Near-Infrared Image and Tomographic Scan in a Model Eye: A Multicenter Study – Corrected Proof

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Purpose: To evaluate temporal changes and predictors of accuracy in the alignment between simultaneous near-infrared image and optical coherence tomography (OCT) scan on the Heidelberg Spectralis using a model eye.Design: Laboratory investigation.Methods: After calibrating the device, 6 sites performed weekly testing of the alignment for 12 weeks using a model eye. The maximum error was compared with multiple variables to evaluate predictors of inaccurate alignment. Variables included the number of weekly scanned patients, total number of OCT scans and B-scans performed, room temperature and its variation, and working time of the scanning laser. A 4-week extension study was subsequently performed to analyze short-term changes in the alignment.Results: The average maximum error in the alignment was 15 ± 6 μm; the greatest error was 35 μm. The error increased significantly at week 1 (P = .01), specifically after the second imaging study (P < .05); reached a maximum after the eighth patient (P < .001); and then varied randomly over time. Predictors for inaccurate alignment were temperature variation and scans per patient (P < .001). For each 1 unit of increase in temperature variation, the estimated increase in maximum error was 1.26 μm. For the average number of scans per patient, each increase of 1 unit increased the error by 0.34 μm.Conclusion: Overall, the accuracy of the Heidelberg Spectralis was excellent. The greatest error happened in the first week after calibration, and specifically after the second imaging study. To improve the accuracy, room temperature should be kept stable and unnecessary scans should be avoided. The alignment of the device does not need to be checked on a regular basis in the clinical setting, but it should be checked after every other patient for more precise research purposes.

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