Clinical Experience With the First Commercially Available Intraoperative Optical Coherence Tomography System

BACKGROUND AND OBJECTIVE

A retrospective, single-center case-series was initiated to evaluate initial clinical experience with the first commercially available intraoperative optical coherence tomography system (iOCT).

PATIENTS AND METHODS

The Rescan 700 iOCT (Zeiss, Oberkochen, Germany), a spectral-domain OCT system integrated into a surgical microscope, was used in 40 consecutive cases. A standardized review was used to assess whether iOCT imaging resulted in additional information and/or altered decision-making.

RESULTS

The iOCT system was usable in conjunction with common chromovitrectomy dyes and tamponades. The surgeons reported that iOCT imaging provided additional information in 74.1% of the posterior and combined surgical cases, which resulted in altered decision-making in 41.9% of the cases. The iOCT imaging time, on average, amounted to 167 seconds. In anterior procedures, the surgeons reported gaining additional information in 22.2% of all cases, but no cases of altered decision-making were reported. Hereby, the iOCT imaging time amounted to 117 seconds, on average.

CONCLUSION

The demonstrated results suggest iOCT has the potential to improve the quality of posterior and anterior segment surgery.

Intravitreal anti-vascular endothelial growth factor combined with half-fluence photodynamic therapy for choroidal neovascularization in chronic central serous chorioretinopathy

PurposeTo evaluate the results of indocyanine green angiography (ICGA)-guided verteporfin photodynamic therapy (PDT) with half-fluence rate combined with intravitreal application of anti-VEGF in treating choroidal neovascularization (CNV) in chronic central serous chorioretinopathy (CSCR).Patients and methodsIn this retrospective cohort study 17 consecutive patients with secondary CNV due to chronic CSCR had their diagnosis verified with fluorescein angiography (FA) and ICGA at baseline. All eyes received either intravitreal ranibizumab (IVR) or bevacizumab (IVB). On the consecutive day following the initial IVR/IVB treatment, ICGA-guided verteporfin (6 mg/m(2)) PDT with half-fluence rate (25 J/cm(2)) was performed on every patient. IVR or IVB was rescheduled on a pro re nata regimen. Main outcome measures were changes in visual acuity (VA) according to the ETDRS letter score and changes in the central foveal thickness (CFT).ResultsBest-corrected VA at baseline was 65.6 letters (±6.7; n=17) according to the ETDRS letter score. At 12 months, mean ETDRS letter score improved to 71.2 letters (P=0.34). CFT was 309 μm and decreased to 216 μm at month 12 control (P=0.0004). Nine eyes (52.9%) received additional treatment with IVR/IVB due to recurrence of subretinal fluid, with an overall mean number of IVR/IVB treatment of 1.8±3.6 per patient with no systemic side effects during 12 months' follow-up.ConclusionsIVR or IVB combined with ICGA-guided half-fluence PDT with verteporfin is effective in treating CNV in chronic CSCR, with choroidal hyperpermeability in ICGA, resulting in stable vision and significant reduction of CFT.

Needle size in intravitreal injections - pain evaluation of a randomized clinical trial

PURPOSE

To evaluate the influence of the needle size used for intravitreal (IVT) injections on patients' pain experience in a randomized, double-armed, single-blinded, clinical trial.

METHODS

Patients included were randomized to have an IVT injection performed with a 27-gauge needle (group 1) or with a 30-gauge needle (group 2). The topical anaesthesia before the injection was standardized. Immediately after the injection, patients were asked to grade their pain using the visual analogue scale (VAS) and the Wong-Baker FACES scale. The main outcome measure was the pain score assessment. Cofactors analysed were patients' demographics (age and gender) and clinical characteristics (such as the number of previous IVT injections). In addition, scaled surgeon's questionnaires to assess the IVT injection procedure were evaluated. For statistical analysis, a regression model was used.

RESULTS

The data of 208 patients (group 1: 104 patients; group 2: 104 patients) were analysed. There was no significant difference in the VAS pain scores (p > 0.18) and in the Wong-Baker pain scores (p > 0.59) between both treatment groups. Gender (p = 0.0288) and the number of previous IVT injections (p = 0.0028) significantly influenced the VAS pain scores (p < 0.05). Female patients and patients with a history of previous IVT injections had higher pain scores. The surgeon's questionnaire showed an overall preference towards the use of a 30-gauge needle for IVT injections.

CONCLUSION

The use of a 30-gauge needle for IVT injections showed no significant effect in pain relief compared to the use of a 27-gauge needle. However, a 30-gauge needle was preferred by all surgeons.

Impact of visceral fat and pro-inflammatory factors on the pathogenesis of age-related macular degeneration

PURPOSE

Previous studies have indicated that the immune system is involved in the pathogenesis of the AMD. Increased visceral fat, in addition, has a pro-inflammatory effect on the organism by producing or influencing different kinds of inflammatory factors. The aim of this study is to determine the relationship of body fat distribution in patients with age-related macula degeneration in comparison to a control group in the Austrian population.

METHODS

In this case-control study, body weight and height, and body mass index (BMI) were measured for each subject in 54 patients with exudative AMD and compared to 46 gender- and age-matched healthy control subjects. Body composition and abdominal fat areas were measured using dual-energy X-ray absorptiometry (DEXA). Data on age, gender distribution, smoking history and systemic diseases, respectively, were compared. The inflammatory markers CRP, tumour necrosis factor-alpha (TNF-alpha), leptin, amyloid A, amyloid beta and interleukin-6 (IL-6) were assayed by ELISA (R&D).

RESULTS

DEXA revealed central-abdominal-to-total body fat ratio of 0.073 +/- 0.011 in AMD patients compared to 0.061 +/- 0.013 in the controls (p <0.001; d = 0.98). The calculation of BMI has provided a significant result (p =0.045). U-test results for Aß1-42, IL-6, SAA and CRP each were significant (p < 0.05), with higher values in AMD patients. Leptin, TNF-alpha and Aß1-40 showed no significant differences between the groups.

CONCLUSION

Our results suggest that abdominal fat distribution is significantly associated with age-related macular degeneration. Analysis of patients with exudative AMD revealed higher levels of CRP, amyloid ß1-42, IL-6 and amyloid alpha.

Vitrectomy combined with endolaser or an encircling scleral buckle in primary retinal detachment surgery: a pilot study

PURPOSE

To compare pars plana vitrectomy and 360° endolaser therapy with pars plana vitrectomy and an encircling scleral buckle for the treatment of primary rhegmatogenous retinal detachments in a randomized pilot study including 60 patients.

METHODS

Main outcome measures were single-surgery anatomic success rate and final best-corrected visual acuity at 6 months follow-up. Cofactors analysed were complication rates, patients' comfort, refractive outcome and macula status assessed using a spectral-domain optical coherence tomography.

RESULTS

With differences between both treatment groups regarding type of the retinal detachment, localization of retinal tears (p = 0.0085) and the choice of the intraocular tamponade (p < 0.0202), there were no significant differences between the single-surgery anatomic success rate (93.33% both groups, p = 1.0) and the visual acuity at final follow-up (≤0.3 logMAR [logarithm of minimum angle of resolution] in 66.67% in the endolaser group versus 40.0% in the scleral buckle group, p = 0.0514). Questionnaire responses showed lower levels of patients' discomfort in the endolaser group. A significant difference between both groups was found in the refractive error change after surgery (-0.20 ± 0.51 dioptres in the endolaser group versus -0.88 ± 0.88 dioptres in the scleral buckle group, p = 0.0003).

CONCLUSION

Primary vitrectomy combined with 360° endolaser therapy seems to be as effective as vitrectomy combined with an encircling scleral buckle in patients with rhegmatogenous retinal detachment, with possible benefits of an improved patients' comfort and a more stable refractive status after surgery.

Nonperturbative shell-model interactions from the in-medium similarity renormalization group

We present the first ab initio construction of valence-space Hamiltonians for medium-mass nuclei based on chiral two- and three-nucleon interactions using the in-medium similarity renormalization group. When applied to the oxygen isotopes, we find experimental ground-state energies are well reproduced, including the flat trend beyond the drip line at (24)O. Similarly, natural-parity spectra in (21,22,23,24)O are in agreement with experiment, and we present predictions for excited states in (25,26)O. The results exhibit a weak dependence on the harmonic-oscillator basis parameter and reproduce spectroscopy within the standard sd valence space.

Electronic screening-enhanced hole pairing in two-leg spin ladders studied by high-resolution resonant inelastic x-ray scattering at Cu M edges

We study the electronic screening mechanisms of the effective Coulomb on-site repulsion in hole-doped Sr(14)Cu(24)O(41) compared to undoped La(6)Ca(8)Cu(24)O(41) using polarization dependent high-resolution resonant inelastic x-ray scattering at Cu M edges. By measuring the energy of the effective Coulomb on-site repulsion and the spin excitations, we estimate superexchange and hopping matrix element energies along rungs and legs, respectively. Interestingly, hole doping locally screens the Coulomb on-site repulsion reducing it by as much as 25%. We suggest that the increased ratio of the electronic kinetic to the electronic correlation energy contributes to the local superexchange mediated pairing between holes.

Choroid, Haller's, and Sattler's layer thickness in intermediate age-related macular degeneration with and without fellow neovascular eyes

PURPOSE

To analyze choroidal, Sattler's, and Haller's layer thickness maps in age-related macular degeneration (AMD) patients having eyes with bilateral large drusen and pigment changes (intermediate AMD), in patients having intermediate AMD eyes with neovascular fellow eyes (nAMD), and in healthy subjects using three-dimensional (3D) 1060-nm optical coherence tomography (OCT).

METHODS

Automatically generated choroidal thickness (ChT), retinal thickness, and Sattler's and Haller's layer thickness maps were statistically analyzed in 67 subjects consisting of intermediate AMD (n = 21), intermediate AMD (n = 22) with fellow nAMD eyes (n = 22), and healthy eyes (n = 24) with no age and axial eye length difference between groups of eyes (P > 0.05, ANOVA). Eyes were imaged by a prototype high-speed (60,000 A-scans/s) spectral-domain 3D 1060-nm OCT over a 36° × 36° field of view.

RESULTS

The mean ± SD (μm) subfoveal ChT for healthy subjects and for bilateral intermediate AMD, unilateral intermediate AMD, and their nAMD fellow eyes was 259 ± 95 and 222 ± 98, 149 ± 60, and 171 ± 78, respectively. Choroidal thickness maps demonstrated significant submacular thinning in unilateral intermediate AMD in comparison to healthy and bilateral intermediate AMD eyes (P < 0.001, ANOVA, post hoc P < 0.001 and P < 0.05, respectively). Sattler's and Haller's layers were thinnest in intermediate AMDs that presented with nAMD fellow eyes (Kruskal-Wallis test P < 0.01). For the choroid and its sublayers, there was no difference between the intermediate AMD eyes and their fellow nAMD eyes (paired testing, P < 0.05).

CONCLUSIONS

The 3D 1060-nm OCT choroidal imaging visualized significant changes in choroidal, Sattler's, and Haller's layer thickness in relation to the progression of AMD. This may be important for understanding the choroidopathy in the pathophysiology of AMD.

Choroidal Haller's and Sattler's layer thickness measurement using 3-dimensional 1060-nm optical coherence tomography

Objectives

To examine the feasibility of automatically segmented choroidal vessels in three-dimensional (3D) 1060-nmOCT by testing repeatability in healthy and AMD eyes and by mapping Haller's and Sattler's layer thickness in healthy eyes

Methods

Fifty-five eyes (from 45 healthy subjects and 10 with non-neovascular age-related macular degeneration (AMD) subjects) were imaged by 3D-1060-nmOCT over a 36°x36° field of view. Haller's and Sattler's layer were automatically segmented, mapped and averaged across the Early Treatment Diabetic Retinopathy Study grid. For ten AMD eyes and ten healthy eyes, imaging was repeated within the same session and on another day. Outcomes were the repeatability agreement of Haller's and Sattler's layer thicknesses in healthy and AMD eyes, the validation with ICGA and the statistical analysis of the effect of age and axial eye length (AL) on both healthy choroidalsublayers.

Results

The coefficients of repeatability for Sattler's and Haller's layers were 35% and 21% in healthy eyes and 44% and 31% in AMD eyes, respectively. The mean±SD healthy central submacular field thickness for Sattler's and Haller's was 87±56 µm and 141±50 µm, respectively, with a significant relationship for AL (P<.001).

Conclusions

Automated Sattler's and Haller's thickness segmentation generates rapid 3D measurements with a repeatability correspondingto reported manual segmentation. Sublayers in healthy eyes thinnedsignificantly with increasing AL. In the presence of the thinned Sattler's layer in AMD, careful measurement interpretation is needed. Automatic choroidal vascular layer mapping may help to explain if pathological choroidal thinning affects medium and large choroidal vasculature in addition to choriocapillaris loss.