Purpose: To assess the effect of a Capsulorhexis Intensive Training Curriculum (CITC) on the rates of errant, continuous, curvilinear capsulorhexes (CCCs) during cataract surgery among resident surgeons at a teaching hospital.Design: Retrospective educational interventional case series.Participants and Controls: A total of 1037 consecutive cataract surgeries performed at Harbor-UCLA Medical Center during 4 consecutive academic years were considered. The baseline cohort consists of 434 cataract surgeries performed during the 2 academic years before the intervention. The postintervention cohort consists of 603 cataract surgeries performed during the following 2 consecutive academic years.Intervention: The principal intervention was the introduction of the CITC for residents on the Eyesi (VRmagic, Mannheim, Germany) ophthalmic virtual reality surgical simulator.Main Outcome Measures: The main outcome measure was the rate of errant CCCs among the capsulorhexes performed during resident surgical cases. Errant CCCs were defined as attempted CCCs that resulted in the attending physician taking over, radialization of the CCC, conversion to can-opener capsulorhexis, or any combination of the 3 aforementioned conditions. Secondary measures included the use of trypan blue during CCC and correlating errant CCC and surgeons’ level of training (postgraduate year [PGY]).Results: There were 68 errant CCCs (15.7%) in the baseline cohort and 30 errant CCCs (5.0%; P < 0.0001) in the postintervention cohort, a 3.2-fold or 68% reduction. The use of trypan blue increased from 55.3% in the baseline cohort to 76.0% in the postintervention cohort (P < 0.00001), but within each cohort there was no significant difference in the rate of errant CCCs whether trypan blue was used or not. In the baseline cohort, there was a statistical trend toward fewer errant CCCs among PGY 4 (14.6%) compared with PGY 3 (22.8%) surgeons (P = 0.12). The postintervention cohort showed no significant difference in errant CCC rates between PGY 3 (4.4%) and PGY 4 (5.1%) surgeons (P = 1.00).Conclusions: This study strongly suggests that virtual reality surgical simulation training with the CITC on the Eyesi reduces the rate of errant capsulorhexes. The incorporation of a formal program for surgical training via virtual reality simulation should be strongly considered in ophthalmology resident surgical education to reduce the unnecessary risk of complications for live patients.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Category: Peer-reviewed
Ciliary Body Medulloepithelioma: Analysis of 41 Cases – Corrected Proof
Purpose: To describe the clinical features, histopathology, treatment, and outcomes of ciliary body medulloepithelioma.Design: Retrospective study.Participants: Forty-one patients with medulloepithelioma.Intervention: Cryotherapy, plaque radiotherapy, …
The Ahmed Versus Baerveldt Study: Three-Year Treatment Outcomes – Corrected Proof
Objective: To compare 2 commonly used aqueous drainage devices for the treatment of refractory glaucoma.Design: International, multicenter, randomized trial.Participants: Patients aged 18 years or older with uncontrolled or high-risk glaucoma refractory to maximum medical therapy, many of whom had failed trabeculoplasty and trabeculectomy.Methods: Eligible patients were randomized to an Ahmed-FP7 valve implant (New World Medical, Inc., Rancho Cucamonga, CA) or a Baerveldt-350 implant (Abbott Medical Optics, Inc., Santa Ana, CA) using a standardized surgical technique.Main Outcome Measures: The primary outcome was failure, defined as intraocular pressure (IOP) outside of the target range (5–18 mmHg, with ≥20% reduction from baseline) for 2 consecutive visits after 3 months, vision-threatening complications, de novo glaucoma procedures, or loss of light perception. Secondary outcome measures include IOP, medication use, visual acuity, complications, and interventions.Results: A total of 238 patients were enrolled and randomized; 124 received the Ahmed implant and 114 received the Baerveldt implant. Baseline characteristics were similar in both groups. Half the study group had secondary glaucoma, and 37% had previously failed trabeculectomy. The mean preoperative IOP was 31.4±10.8 mmHg on 3.1±1.0 glaucoma medications. Median baseline Snellen visual acuity was 20/100. At 3 years, the cumulative probability of failure was 51% in the Ahmed group and 34% in the Baerveldt group (P = 0.03). Mean IOP was 15.7±4.8 mmHg in the Ahmed group (49% reduction) and 14.4±5.1 mmHg in the Baerveldt group (55% reduction; P = 0.09). Mean number of glaucoma medications was 1.8±1.4 in the Ahmed group (42% reduction) and 1.1±1.3 in the Baerveldt group (65% reduction; P = 0.002). There was a moderate but similar decrease in visual acuity in both groups (P < 0.001). The 2 groups had similar complication rates (52% Ahmed, 62% Baerveldt; P = 0.12); however, the Baerveldt group had a higher rate of hypotony-related vision-threatening complications (0% Ahmed, 6% Baerveldt; P = 0.005). More interventions were required in the Baerveldt group, although the difference did not reach statistical significance (38% Ahmed, 50% Baerveldt; P = 0.07). Most complications were transient, and most interventions were slit-lamp procedures.Conclusions: Both devices were effective in reducing IOP and glaucoma medications. The Baerveldt group had a lower failure rate and required fewer medications than the Ahmed group after 3 years, but it experienced more hypotony-related vision-threatening complications.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
A Prospective Randomized Trial of Intravitreal Bevacizumab Versus Ranibizumab for the Management of Diabetic Macular Edema – Corrected Proof
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.
Interferon versus Methotrexate in Intermediate Uveitis With Macular Edema: Results of a Randomized Controlled Clinical Trial – Corrected Proof
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
Clinicopathologic and Immunohistochemical Studies of Conjunctival Large Cell Acanthoma, Epidermoid Dysplasia, and Squamous Papilloma – Corrected Proof
Purpose: To evaluate clinicopathologically and immunohistochemically a spectrum of conjunctival squamous proliferations.Design: Retrospective clinicopathologic study.Methods: One large cell acanthoma, 7 epidermoid dysplasias, and 4 squamous papillomas …
Evolution of Phototransduction, Vertebrate Photoreceptors and Retina
Publication date: Available online 18 June 2013
Source:Progress in Retinal and Eye Research
Author(s): Trevor D. Lamb
Evidence is reviewed from a wide range of studies relevant to the evolution of vertebrate photoreceptors and phototransduction, in order to permit the synthesis of a scenario for the major steps that occurred during the evolution of cones, rods and the vertebrate retina. The ancestral opsin originated more than 700 Mya (million years ago) and duplicated to form three branches before cnidarians diverged from our own lineage. During chordate evolution, ciliary opsins (C-opsins) underwent multiple stages of improvement, giving rise to the ‘bleaching’ opsins that characterise cones and rods. Prior to the ‘2R’ rounds of whole genome duplication near the base of the vertebrate lineage, ‘cone’ photoreceptors already existed; they possessed a transduction cascade essentially the same as in modern cones, along with two classes of opsin: SWS and LWS (short- and long-wave-sensitive). These cones appear to have made synaptic contact directly onto ganglion cells, in a two-layered retina that resembled the pineal organ of extant non-mammalian vertebrates. Interestingly, those ganglion cells appear to be descendants of microvillar photoreceptor cells. No lens was associated with this two-layered retina, and it is likely to have mediated circadian timing rather than spatial vision. Subsequently, retinal bipolar cells evolved, as variants of ciliary photoreceptors, and greatly increased the computational power of the retina. With the advent of a lens and extraocular muscles, spatial imaging information became available for central processing, and gave rise to vision in vertebrates more than 500 Mya. The ‘2R’ genome duplications permitted the refinement of cascade components suitable for both rods and cones, and also led to the emergence of five visual opsins. The exact timing of the emergence of ‘true rods’ is not yet clear, but it may not have occurred until after the divergence of jawed and jawless vertebrates. [292 words]
One-Year Outcomes from a Prospective, Randomized, Eye-to-Eye Comparison of Wavefront-Guided and Wavefront-Optimized LASIK in Myopes – Corrected Proof
Objective: To compare wavefront (WF)-guided and WF-optimized LASIK in myopes.Design: Prospective, randomized, eye-to-eye study.Participants: A total of 72 eyes of 36 participants with myopia with or without astigmatism.Methods: Participants were randomized to receive WF-guided or WF-optimized LASIK with the WaveLight Allegretto Eye-Q 400-Hz excimer laser platform (Alcon, Inc., Hüenberg, Switzerland). LASIK flaps were created using the 150-kHz IntraLase iFS (Abbott Medical Optics, Santa Ana, CA). Evaluations included measurement of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), <5% and <25% contrast sensitivity, and WF aberrometry. Patients also completed a validated questionnaire detailing symptoms on a quantitative scale.Main Outcome Measures: Safety, efficacy, predictability, refractive error, UDVA, CDVA, contrast sensitivity, and higher-order aberrations (HOAs).Results: The frequency with which the WF-guided and WF-optimized groups achieved postoperative UDVA of ≥20/16 or ≥20/20 and the frequency with which the groups lost 1 or 2 or more lines or maintained their preoperative CDVA were not statistically different from each other (all P > 0.05). The frequency with which the WF-guided group attained a refractive error within ±0.25 diopters of emmetropia was higher than in the WF-optimized group (67.6%, 95% confidence interval [CI], 50.4–84.8 vs. 41.2%, 95% CI, 23.2–59.2; P = 0.03). The WF-guided group’s mean UDVA was better than the WF-optimized group’s UDVA by approximately 1 Early Treatment Diabetic Retinopathy Study line (−0.17±0.11 logarithm of the minimum angle of resolution [logMAR], slightly <20/12 Snellen vs. −0.13±0.12, slightly >20/16; P = 0.05). There were no statistically significant differences in contrast sensitivity, astigmatism, coma, or higher-order root mean square error between the groups (all P > 0.05), but the WF-guided group had less trefoil compared with the WF-optimized group (0.14±0.07 vs. 0.20±0.09; P 0.05).Conclusions: Wavefront-guided and WF-optimized LASIK using the Alcon WaveLight Allegretto Eye-Q 400-Hz excimer laser platform provide similar results in myopic patients; however, the WF-guided approach may yield small gains in visual acuity, predictability, and HOAs.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
One-Year Outcomes from a Prospective, Randomized, Eye-to-Eye Comparison of Wavefront-Guided and Wavefront-Optimized LASIK in Myopes – Corrected Proof
Objective: To compare wavefront (WF)-guided and WF-optimized LASIK in myopes.Design: Prospective, randomized, eye-to-eye study.Participants: A total of 72 eyes of 36 participants with myopia with or without astigmatism.Methods: Participants were randomized to receive WF-guided or WF-optimized LASIK with the WaveLight Allegretto Eye-Q 400-Hz excimer laser platform (Alcon, Inc., Hüenberg, Switzerland). LASIK flaps were created using the 150-kHz IntraLase iFS (Abbott Medical Optics, Santa Ana, CA). Evaluations included measurement of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), <5% and <25% contrast sensitivity, and WF aberrometry. Patients also completed a validated questionnaire detailing symptoms on a quantitative scale.Main Outcome Measures: Safety, efficacy, predictability, refractive error, UDVA, CDVA, contrast sensitivity, and higher-order aberrations (HOAs).Results: The frequency with which the WF-guided and WF-optimized groups achieved postoperative UDVA of ≥20/16 or ≥20/20 and the frequency with which the groups lost 1 or 2 or more lines or maintained their preoperative CDVA were not statistically different from each other (all P > 0.05). The frequency with which the WF-guided group attained a refractive error within ±0.25 diopters of emmetropia was higher than in the WF-optimized group (67.6%, 95% confidence interval [CI], 50.4–84.8 vs. 41.2%, 95% CI, 23.2–59.2; P = 0.03). The WF-guided group’s mean UDVA was better than the WF-optimized group’s UDVA by approximately 1 Early Treatment Diabetic Retinopathy Study line (−0.17±0.11 logarithm of the minimum angle of resolution [logMAR], slightly <20/12 Snellen vs. −0.13±0.12, slightly >20/16; P = 0.05). There were no statistically significant differences in contrast sensitivity, astigmatism, coma, or higher-order root mean square error between the groups (all P > 0.05), but the WF-guided group had less trefoil compared with the WF-optimized group (0.14±0.07 vs. 0.20±0.09; P 0.05).Conclusions: Wavefront-guided and WF-optimized LASIK using the Alcon WaveLight Allegretto Eye-Q 400-Hz excimer laser platform provide similar results in myopic patients; however, the WF-guided approach may yield small gains in visual acuity, predictability, and HOAs.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
Peripheral Lesions Identified by Mydriatic Ultrawide Field Imaging: Distribution and Potential Impact on Diabetic Retinopathy Severity – Corrected Proof
Objective: To assess diabetic retinopathy (DR) as determined by lesions identified using mydriatic ultrawide field imaging (DiSLO200; Optos plc, Scotland, UK) compared with Early Treatment Diabetic Retinopathy Study (ETDRS) 7-standard field film photography.Design: Prospective comparative study of DiSLO200, ETDRS 7-standard field film photographs, and dilated fundus examination (DFE).Participants: A total of 206 eyes of 103 diabetic patients selected to represent all levels of DR.Methods: Subjects had DiSLO200, ETDRS 7-standard field film photographs, and DFE. Images were graded for severity and distribution of DR lesions. Discrepancies were adjudicated, and images were compared side by side.Main Outcome Measures: Distribution of hemorrhage and/or microaneurysm (H/Ma), venous beading (VB), intraretinal microvascular abnormality (IRMA), and new vessels elsewhere (NVE). Kappa (κ) and weighted κ statistics for agreement.Results: The distribution of DR severity by ETDRS 7-standard field film photographs was no DR 12.5%; nonproliferative DR mild 22.5%, moderate 30%, and severe/very severe 8%; and proliferative DR 27%. Diabetic retinopathy severity between DiSLO200 and ETDRS film photographs matched in 80% of eyes (weighted κ = 0.74,κ = 0.84) and was within 1 level in 94.5% of eyes. DiSLO200 and DFE matched in 58.8% of eyes (weighted κ = 0.69,κ = 0.47) and were within 1 level in 91.2% of eyes. Forty eyes (20%) had DR severity discrepancies between DiSLO200 and ETDRS film photographs. The retinal lesions causing discrepancies were H/Ma 52%, IRMA 26%, NVE 17%, and VB 4%. Approximately one-third of H/Ma, IRMA, and NVE were predominantly outside ETDRS fields. Lesions identified on DiSLO200 but not ETDRS film photographs suggested a more severe DR level in 10% of eyes. Distribution in the temporal, superotemporal, inferotemporal, superonasal, and inferonasal fields was 77%, 72%, 61%, 65%, and 59% for H/Ma, respectively (P < 0.0001); 22%, 24%, 21%, 28%, and 22% for VB, respectively (P = 0.009); 52%, 40%, 29%, 47%, and 36% for IRMA, respectively (P < 0.0001), and 8%, 4%, 4%, 8%, and 5% for NVE, respectively (P = 0.03). All lesions were more frequent in the temporal fields compared with the nasal fields (P < 0.0001).Conclusions: DiSLO200 images had substantial agreement with ETDRS film photographs and DFE in determining DR severity. On the basis of DiSLO200 images, significant nonuniform distribution of DR lesions was evident across the retina. The additional peripheral lesions identified by DiSLO200 in this cohort suggested a more severe assessment of DR in 10% of eyes than was suggested by the lesions within the ETDRS fields. However, the implications of peripheral lesions on DR progression within a specific ETDRS severity level over time are unknown and need to be evaluated prospectively.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
Palladium-103 Radiation Therapy for Small Choroidal Melanoma – Corrected Proof
Purpose: To evaluate outcomes after ophthalmic plaque radiation therapy for small choroidal melanomas.Design: Retrospective study, case series.Participants: Seventy-two patients with choroidal melanomas ≥1.5 and ≤2.4 mm apical height and ≤10 mm w…
Assessment of Circumferential Angle-Closure by the Iris–Trabecular Contact Index with Swept-Source Optical Coherence Tomography – Corrected Proof
Purpose: To evaluate the diagnostic performance of the iris–trabecular contact (ITC) index, a measure of the degree of angle-closure, using swept-source optical coherence tomography (SSOCT, CASIA SS-1000, Tomey Corporation, Nagoya, Japan) in comparison with gonioscopy.Design: Prospective observational study.Participants: A total of 108 normal subjects and 32 subjects with angle-closure.Methods: The SSOCT 3-dimensional angle scans, which obtain radial scans for the entire circumference of the angle, were performed under dark conditions and analyzed using customized software by a single examiner masked to the subjects’ clinical details. The ITC index was calculated as a percentage of the angle that was closed on SSOCT images. First-order agreement coefficient (AC1) statistics and area under the receiver operating characteristic curve (AUC) analyses were performed for angle-closure on the basis of the ITC index in comparison with gonioscopy.Main Outcome Measures: Angle-closure on gonioscopy was defined as nonvisibility of posterior trabecular meshwork for at least 2 quadrants. Agreement of the ITC index with gonioscopically defined angle-closure was assessed using the AC1 statistic.Results: Study subjects were predominantly Chinese (95.7%) and female (70.7%), with a mean age of 59.2 (standard deviation, 8.9) years. The median ITC index was 15.24% for gonioscopically open-angle eyes (n = 108) and 48.5% for closed-angle eyes (n = 32) (P = 0.0001). The agreement for angle-closure based on ITC index cutoffs (>35% and ≥50%) and gonioscopic angle-closure was 0.699 and 0.718, respectively. The AUC for angle-closure detection using the ITC index was 0.83 (95% confidence interval, 0.76–0.89), with an ITC index >35% having a sensitivity of 71.9% and specificity of 84.3%.Conclusions: The ITC index is a summary measure of the circumferential extent of angle-closure as imaged with SSOCT. The index had moderate agreement and good diagnostic performance for angle-closure with gonioscopy as the reference standard.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Macular Imaging in Highly Myopic Eyes With and Without Glaucoma – Corrected Proof
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.
The Relationship between Anisometropia and Amblyopia
Publication date: Available online 15 June 2013 Source:Progress in Retinal and Eye Research Author(s): Brendan T. Barrett , Arthur Bradley , T. Rowan Candy This review aims to disentangle cause and effect in the relationship between…
Retinal Thickness and Volume Measured With Enhanced Depth Imaging Optical Coherence Tomography – Corrected Proof
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.
Indications and Outcomes of Corneal Transplantation in Geriatric Patients – Corrected Proof
Purpose: To identify the most common corneal transplant procedures, indications, coexisting ocular diseases, and outcomes in elderly patients, and to compare younger geriatric patients with super-geriatric patients.Design: Retrospective case series.Met…
Anti–Vascular Endothelial Growth Factor Monotherapy in the Treatment of Submacular Hemorrhage Secondary to Polypoidal Choroidal Vasculopathy – Corrected Proof
Purpose: To evaluate the effect of intravitreal anti–vascular endothelial growth factor (VEGF) injections on submacular hemorrhage secondary to polypoidal choroidal vasculopathy.Design: Retrospective, interventional case series.Methods: Twenty-seven …
The Continued Movement for Open Access to Peer-Reviewed Literature – Corrected Proof
Purpose: To provide a current overview of the movement for open access to the peer review literature.Design: Perspective.Methods: Literature review of recent advances in the open access movement with a personal viewpoint of the nuances of the movement….
Accuracy of the Heidelberg Spectralis in the Alignment Between Near-Infrared Image and Tomographic Scan in a Model Eye: A Multicenter Study – Corrected Proof
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.
Differential Sensitivity of Choroidal Endothelial, Retinal Ganglion, and Retinal Pigment Epithelial Cells In Vitro to Proton Radiation – Corrected Proof
Purpose: To evaluate the differential sensitivity of choroidal endothelial, retinal pigment epithelial, and retinal ganglion cells to escalating doses of proton beam radiation and to establish a safe dose range for the management of choroidal neovascul…