1
|
Marolo P, Borrelli E, Caselgrandi P, Parisi G, Gelormini F, Ricardi F, Ceroni L, Fallico M, Toro MD, Ventre L, Reibaldi M. Comparison of Functional, Structural, and Microvascular Features in Different Stages of Idiopathic Epiretinal Membrane. J Clin Med 2024; 13:3188. [PMID: 38892898 PMCID: PMC11172683 DOI: 10.3390/jcm13113188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Idiopathic epiretinal membrane (ERM) often leads to visual symptoms such as metamorphopsia and decreased central vision. This study aimed to evaluate functional, structural, and microvascular characteristics in patients with different stages of idiopathic ERM who were candidates for surgery, with a focus on identifying potential indicators for surgical timing. Methods: A retrospective cohort study was conducted on consecutive patients with unilateral idiopathic ERM who were candidates for surgery. Patients underwent comprehensive ophthalmological assessments, including OCT grading, reading performance evaluation, and OCT angiography. Data analysis included comparisons between different ERM stages for functional, structural, and microvascular parameters. Results: A total of 44 eyes were included, classified into four ERM stages according to the Govetto grading system. Functional parameters, including distance and near visual acuity, worsened significantly with higher ERM stages, particularly in the transition from Stage 3 to Stage 4. Structural assessments revealed significant increases in central macular thickness (CMT) from Stage 3 to Stage 4. No significant differences were observed in microvascular features across different ERM stages. Conclusions: This study highlights the significant functional and anatomical impact of OCT staging in idiopathic ERM, particularly during the transition from Stage 3 to Stage 4, characterized by notable reductions in visual acuity and increases in CMT. These findings underscore the importance of considering both functional and structural parameters in surgical decision-making for ERM management. However, further research with larger cohorts is needed to confirm these observations and inform clinical practice.
Collapse
Affiliation(s)
- Paola Marolo
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy; (E.B.); (P.C.); (G.P.); (F.G.); (F.R.); (M.R.)
| | - Enrico Borrelli
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy; (E.B.); (P.C.); (G.P.); (F.G.); (F.R.); (M.R.)
| | - Paolo Caselgrandi
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy; (E.B.); (P.C.); (G.P.); (F.G.); (F.R.); (M.R.)
| | - Guglielmo Parisi
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy; (E.B.); (P.C.); (G.P.); (F.G.); (F.R.); (M.R.)
| | - Francesco Gelormini
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy; (E.B.); (P.C.); (G.P.); (F.G.); (F.R.); (M.R.)
| | - Federico Ricardi
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy; (E.B.); (P.C.); (G.P.); (F.G.); (F.R.); (M.R.)
| | - Luca Ceroni
- Department of Psychology, University of Turin, 10124 Turin, Italy;
| | - Matteo Fallico
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy;
| | - Mario Damiano Toro
- Department of General Ophthalmology, Medical University of Lublin, 20079 Lublin, Poland;
- Eye Clinic, Public Health Department, Federico II University, 80131 Naples, Italy
| | - Luca Ventre
- Department of Ophthalmology, Beauregard Hospital, 11100 Aosta, Italy;
| | - Michele Reibaldi
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy; (E.B.); (P.C.); (G.P.); (F.G.); (F.R.); (M.R.)
| |
Collapse
|
2
|
Kontou EP, Karakosta C, Kounas K, Iatropoulos I, Tsinopoulos I, Kozobolis V, Stavrakas P. Macular Edema Following Silicone Oil Tamponade for Retinal Detachment: A Literature Review. Cureus 2023; 15:e51233. [PMID: 38283484 PMCID: PMC10821764 DOI: 10.7759/cureus.51233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Macular edema (ME) is a major cause of reduced vision following intraocular surgery. Although the pathophysiology of ME is not completely understood, inflammatory mediators play a key role. The incidence of ME following pars plana vitrectomy with silicone oil tamponade varies between 13% and 27%. ME usually resolves spontaneously following silicone oil removal, but treatment may be required for resistant cases. In this review, the mechanisms of ME formation after pars plana vitrectomy, its incidence, and its possible therapeutic approaches are discussed.
Collapse
Affiliation(s)
- Evgenia P Kontou
- Department of Ophthalmology, General Hospital of Athens "Korgialeneio-Benakio" Hellenic Red Cross, Athens, GRC
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, GRC
| | - Christina Karakosta
- Department of Ophthalmology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Konstantinos Kounas
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, GRC
| | - Ioannis Iatropoulos
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, GRC
| | - Ioannis Tsinopoulos
- Second Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Vassilios Kozobolis
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, GRC
| | - Panagiotis Stavrakas
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, GRC
| |
Collapse
|
3
|
Değirmenci MFK, Yalçındağ FN. Are optical coherence tomography and fluorescein angiography comparable for detection of macular edema in Behçet uveitis? Graefes Arch Clin Exp Ophthalmol 2023; 261:3275-3281. [PMID: 37773289 DOI: 10.1007/s00417-023-06249-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023] Open
Abstract
PURPOSE To investigate the role and agreement of spectral domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) for macular edema (ME) diagnosis in Behçet uveitis (BU). METHODS Eyes with ME detected by SD-OCT and/or FA were enrolled. Type of ME by SD-OCT and grade of macular leakage (ML) by FA were investigated. Eyes were divided into three groups according to the agreement of tests. Three groups and factors that could affect the compatibility of tests were statistically analyzed. RESULTS Sixty-one eyes of 61 patients were included. Both imaging methods detected ME in 42.6% of eyes (group 1). In 47.5% of eyes, ME was revealed by OCT (group 2). The remaining 9.8% of the eyes had ME, detected only by FA (group 3). Grade 2 ML by FA was more common in group 1 (p = 0.01). The grade of ML by FA was similar in groups 2 and 3. In group 2, most of the eyes showed diffuse ME by OCT (p < 0.001). Epiretinal membrane was detected more frequently in group 3 (p = 0.005). Duration and activity of uveitis were similar between groups. CONCLUSION SD-OCT was able to detect ME in 90% of the eyes with BU. Duration and activity of uveitis were not related to the compatibility of imaging methods.
Collapse
Affiliation(s)
| | - F Nilüfer Yalçındağ
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
4
|
Boral SK, Agarwal D. Role of Small-Gauge Proportionate Reflux-Assisted Hydrodissection In Elevated Symptomatic Vitreofoveal Traction. Retina 2023; 43:1620-1625. [PMID: 33840788 DOI: 10.1097/iae.0000000000003178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND/PURPOSE To describe a new technique to release the elevated symptomatic vitreofoveal traction. METHODS This was a retrospective, interventional case series where a new technique of hydrodissection by proportionate reflux property of small-gauge vitrectomy cutter was used in cases of elevated symptomatic vitreofoveal traction as evident on optical coherence tomography. After vitrectomy, an opening was made in the taut posterior hyaloid face around the foveal elevation. Then, the cutter tip was insinuated inside the hyaloid opening, and the port opening was directed toward the tip of the fovea at its hyaloid attachment. The proportionate reflux property of the cutter was then used to cause reflux of cassette fluid. The hydrostatic force thus generated separates the vitreofoveal attachment. End point was separation of vitreofoveal traction. RESULTS Seven eyes of seven patients were operated by 27-gauge (n = 3) or 25-gauge (n = 4) vitrectomy system. Mean preoperative and postoperative BCVA were LogMAR 0.44 (20/55) ± 0.14 and LogMAR 0.27 (20/37) ± 0.11, respectively ( P = 0.23). Mean preoperative foveal elevation was 560.86 ± 196.57 μ m, which significantly decreased postoperatively to 251 ± 79.13 μ m ( P < 0.01). VMTs were successfully released in all cases. Mean follow-up was 184.00 ± 80.32 days. CONCLUSION Small-gauge proportionate reflux-assisted hydrodissection is an innovative technique for management of elevated symptomatic cases of vitreofoveal traction.
Collapse
Affiliation(s)
- Subhendu K Boral
- Department of Vitreoretina, Disha Eye Hospitals Pvt Ltd, Barrackpore, Kolkata, West Bengal, India
| | | |
Collapse
|
5
|
Wang X, Yang J, Li Z, Hou Q, Wang C, Li X. Insights into the underlying choroid in different stages of idiopathic epiretinal membranes after Viteromacular surgery. Acta Ophthalmol 2022; 101:403-412. [PMID: 36408816 DOI: 10.1111/aos.15295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/22/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of the study was to longitudinally investigate the correlation between choroidal morphologic and vascular parameters and postoperative visual outcome in different stages of idiopathic epiretinal membranes (iERMs). METHODS A prospective, observational, institutional case series of 102 consecutive patients diagnosed with unilateral iERMs were recruited at Peking University Third Hospital and were followed up for 12 months after surgical treatment with vitrectomy. Participants were classified into four stages according to current staging scheme. All eligible subjects underwent standardized imaging evaluation of choroidal parameters including subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), and choroidal capillary perfusion (CCP) at baseline and each follow-up by enhanced depth optical coherence tomography (EDI-OCT) and OCT angiography (OCTA). Longitudinal follow-up of choroidal parameters over 12 months was analysed, and their correlations with best-corrected visual acuity (BCVA) were also assessed for predictive prognostic value. RESULTS CVI and CCP were significantly correlated with BCVA at each follow-up examination (all p < 0.05). However, SFCT exhibited no variation among different stages of iERMs at baseline (p = 0.981) or during follow-up (p = 0.520). The preoperative CVI correlated with 12-month postoperative BCVA (p < 0.001) and its predictive prognostic effect on BCVA was validated in multiple regression analysis (p = 0.006). CONCLUSION CVI varied among different stages of iERM and was significantly correlated with visual outcomes after the surgery. CVI could serve as a predictive prognostic marker in iERMs, which further indicates the underlying choroid should be taken into consideration in clinical evaluation of iERMs.
Collapse
Affiliation(s)
- Xinglin Wang
- Department of Ophthalmology Peking University Third Hospital Beijing China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
| | - Jiarui Yang
- Department of Ophthalmology Peking University Third Hospital Beijing China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
| | - Zihan Li
- Department of Ophthalmology Peking University Third Hospital Beijing China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
| | - Qingyi Hou
- Department of Ophthalmology Peking University Third Hospital Beijing China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
| | - Changguan Wang
- Department of Ophthalmology Peking University Third Hospital Beijing China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
| | - Xuemin Li
- Department of Ophthalmology Peking University Third Hospital Beijing China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
| |
Collapse
|
6
|
Abdelmotaal H, Sharaf M, Soliman W, Wasfi E, Kedwany SM. Bridging the resources gap: deep learning for fluorescein angiography and optical coherence tomography macular thickness map image translation. BMC Ophthalmol 2022; 22:355. [PMID: 36050661 PMCID: PMC9434904 DOI: 10.1186/s12886-022-02577-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 08/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background To assess the ability of the pix2pix generative adversarial network (pix2pix GAN) to synthesize clinically useful optical coherence tomography (OCT) color-coded macular thickness maps based on a modest-sized original fluorescein angiography (FA) dataset and the reverse, to be used as a plausible alternative to either imaging technique in patients with diabetic macular edema (DME). Methods Original images of 1,195 eyes of 708 nonconsecutive diabetic patients with or without DME were retrospectively analyzed. OCT macular thickness maps and corresponding FA images were preprocessed for use in training and testing the proposed pix2pix GAN. The best quality synthesized images using the test set were selected based on the Fréchet inception distance score, and their quality was studied subjectively by image readers and objectively by calculating the peak signal-to-noise ratio, structural similarity index, and Hamming distance. We also used original and synthesized images in a trained deep convolutional neural network (DCNN) to plot the difference between synthesized images and their ground-truth analogues and calculate the learned perceptual image patch similarity metric. Results The pix2pix GAN-synthesized images showed plausible subjectively and objectively assessed quality, which can provide a clinically useful alternative to either image modality. Conclusion Using the pix2pix GAN to synthesize mutually dependent OCT color-coded macular thickness maps or FA images can overcome issues related to machine unavailability or clinical situations that preclude the performance of either imaging technique. Trial registration ClinicalTrials.gov Identifier: NCT05105620, November 2021. “Retrospectively registered”.
Collapse
Affiliation(s)
- Hazem Abdelmotaal
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
| | - Mohamed Sharaf
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Wael Soliman
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Ehab Wasfi
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Salma M Kedwany
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| |
Collapse
|
7
|
Non-vasogenic cystoid maculopathies. Prog Retin Eye Res 2022; 91:101092. [PMID: 35927124 DOI: 10.1016/j.preteyeres.2022.101092] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
Besides cystoid macular edema due to a blood-retinal barrier breakdown, another type of macular cystoid spaces referred to as non-vasogenic cystoid maculopathies (NVCM) may be detected on optical coherence tomography but not on fluorescein angiography. Various causes may disrupt retinal cell cohesion or impair retinal pigment epithelium (RPE) and Müller cell functions in the maintenance of retinal dehydration, resulting in cystoid spaces formation. Tractional causes include vitreomacular traction, epiretinal membranes and myopic foveoschisis. Surgical treatment does not always allow cystoid space resorption. In inherited retinal dystrophies, cystoid spaces may be part of the disease as in X-linked retinoschisis or enhanced S-cone syndrome, or occur occasionally as in bestrophinopathies, retinitis pigmentosa and allied diseases, congenital microphthalmia, choroideremia, gyrate atrophy and Bietti crystalline dystrophy. In macular telangiectasia type 2, cystoid spaces and cavitations do not depend on the fluid leakage from telangiectasia. Various causes affecting RPE function may result in NVCM such as chronic central serous chorioretinopathy and paraneoplastic syndromes. Non-exudative age macular degeneration may also be complicated by intraretinal cystoid spaces in the absence of fluorescein leakage. In these diseases, cystoid spaces occur in a context of retinal cell loss. Various causes of optic atrophy, including open-angle glaucoma, result in microcystoid spaces in the inner nuclear layer due to a retrograde transsynaptic degeneration. Lastly, drug toxicity may also induce cystoid maculopathy. Identifying NVCM on multimodal imaging, including fluorescein angiography if needed, allows guiding the diagnosis of the causative disease and choosing adequate treatment when available.
Collapse
|
8
|
Peck T, Salabati M, Mahmoudzadeh R, Soares R, Xu D, Myers JS, Hsu J, Garg SJ, Khan MA. Epiretinal Membrane Surgery in Eyes with Glaucoma: Visual Outcomes and Clinical Significance of Inner Microcystoid Changes. Ophthalmol Retina 2022; 6:693-701. [PMID: 35314387 DOI: 10.1016/j.oret.2022.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/08/2022] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate visual acuity (VA) outcomes and OCT-based biomarkers of vision outcomes in eyes with glaucoma undergoing pars plana vitrectomy (PPV) for idiopathic epiretinal membrane (ERM). DESIGN Retrospective, consecutive case-control series. A previously described ERM grading scale was utilized for OCT analysis. SUBJECTS Eyes with glaucoma undergoing PPV for idiopathic ERM. INTERVENTION PPV with membrane peel (MP) surgery. MAIN OUTCOME MEASURES The primary outcome was VA at postoperative month 6. Outcomes were compared to a contemporary, matched control group of eyes without concurrent glaucoma undergoing PPV for idiopathic ERM. RESULTS A total of 103 eyes from 103 patients with ERM and glaucoma were followed for a mean (± standard deviation) of 656 (± 421) days after PPV with MP surgery. Glaucoma was classified as open angle in 98 (95.1%) eyes and closed angle in 5 (4.9%) eyes. Visual acuity improved from 0.72 ± 0.48 (20/105) to 0.55 ± 0.51 (20/71) at 6 months and to 0.50 ± 0.56 (20/63) at final follow-up (P < 0.001 for both the time points). Eyes with preoperative inner microcystoid changes (n = 59; 57.3%) had significantly worse preoperative VA, postoperative VA at month 6, and final VA compared to eyes without inner microcystoid changes (P = 0.028, 0.004, and 0.007, respectively). Eyes were then compared to a matched control group of 139 eyes without glaucoma. Eyes with ERM and glaucoma had a higher rate of microcystic changes both before surgery (P < 0.001) and at postoperative month 6 (P < 0.001), and had a worse VA at 6 months (P = 0.03) and final follow-up (P = 0.04) compared to control eyes without glaucoma. Advanced disc cupping was the only factor independently correlated with worse 6-month (P = 0.01) and final (P = 0.007) VA in multivariate analysis. CONCLUSIONS Preoperative inner microcystoid changes on OCT were present in over half of eyes with ERM and concurrent glaucoma, and may be a poor prognostic OCT biomarker. Eyes with ERM and concurrent glaucoma experienced worse vision outcomes compared to eyes with ERM alone, particularly those with advanced disc cupping.
Collapse
Affiliation(s)
- Travis Peck
- Wills Eye Hospital, Retina Service, Thomas Jefferson University, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mirataollah Salabati
- Wills Eye Hospital, Retina Service, Thomas Jefferson University, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Raziyeh Mahmoudzadeh
- Wills Eye Hospital, Retina Service, Thomas Jefferson University, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rebecca Soares
- Wills Eye Hospital, Retina Service, Thomas Jefferson University, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - David Xu
- Wills Eye Hospital, Retina Service, Thomas Jefferson University, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jonathan S Myers
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Wills Eye Hospital, Glaucoma Service, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jason Hsu
- Wills Eye Hospital, Retina Service, Thomas Jefferson University, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sunir J Garg
- Wills Eye Hospital, Retina Service, Thomas Jefferson University, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - M Ali Khan
- Wills Eye Hospital, Retina Service, Thomas Jefferson University, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
| |
Collapse
|
9
|
Ito Y, Takatsudo Y, Gehlbach PL, Mori K. Mechanistic Insights into the Pathogenesis of Proliferative and Nonproliferative Vitreomacular Traction. Am J Ophthalmol 2022; 238:1-9. [PMID: 34902326 DOI: 10.1016/j.ajo.2021.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/02/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the vitreoretinal interface in vitreomacular traction (VMT) by using novel optical coherence tomography (OCT) methods; wide-angle montage, and pseudomotion OCT imaging systems. DESIGN Observational case series. METHODS Wide-angle montage OCT images of horizontal and vertical scans through the fovea were acquired in 50 eyes of 46 consecutive patients with VMT. Baseline fundus scans were obtained. These were followed by scans acquired with an eye-tracking system performed immediately after vertical and horizontal eye movements. Three scans were then superimposed to compare changes in the contour and position of the posterior vitreous. RESULTS The subjects were classified as VMT with ("proliferative"; 48.0%) and without ("nonproliferative"; 52.0%) thickened posterior vitreous. Epiretinal membrane was observed in 26.9% of nonproliferative and 95.8% of proliferative VMT eyes (P = 3.6 × 10-7). No eye of proliferative and 57.7% of nonproliferative VMT eyes had wavy contoured posterior vitreous (P = 4.0 × 10-6). None with proliferative VMT, but 91.7% of nonproliferative VMT eyes, showed motion induced changes of posterior vitreous following eye movement (P = 2.0 × 10-8). The posterior vitreous detachment extended beyond the scanned area in 34.6% of nonproliferative and 8.3% of proliferative VMT eyes (P = .040). CONCLUSIONS By dynamically evaluating the vitreoretinal interface of patients with VMT, the static contraction forces of a thickened posterior vitreous at the macula are implicated in proliferative VMT. This contractile force is not strongly implicated in the majority of VMT eyes with nontaut and more mobile vitreous (nonproliferative VMT). VMT and its associated complications are determined by at least 2 different pathophysiological mechanisms.
Collapse
Affiliation(s)
- Yoko Ito
- From the Department of Ophthalmology, International University of Health and Welfare, Nasu-shiobara, Tochigi, Japan (Y.I., Y.K., K.M.)
| | - Yuki Takatsudo
- From the Department of Ophthalmology, International University of Health and Welfare, Nasu-shiobara, Tochigi, Japan (Y.I., Y.K., K.M.)
| | - Peter L Gehlbach
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA (P.L.G.)
| | - Keisuke Mori
- From the Department of Ophthalmology, International University of Health and Welfare, Nasu-shiobara, Tochigi, Japan (Y.I., Y.K., K.M.); Department of Ophthalmology, Saitama Medical University, Iruma, Saitama, Japan (K.M.).
| |
Collapse
|
10
|
Bloch E, Flores-Sánchez B, Georgiadis O, Sundaram V, Saihan Z, Mahroo OA, Webster AR, da Cruz L. AN ASSOCIATION BETWEEN STELLATE NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS, PERIPHERAL RETINOSCHISIS, AND POSTERIOR HYALOID ATTACHMENT. Retina 2021; 41:2361-2369. [PMID: 33840784 PMCID: PMC7611880 DOI: 10.1097/iae.0000000000003191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Stellate nonhereditary idiopathic foveomacular retinoschisis is a disorder characterized by splitting of the retina at the macula, without a known underlying mechanical or inherited cause. This study investigates demographic, anatomical, and functional characteristics of subjects with stellate nonhereditary idiopathic foveomacular retinoschisis, to explore potential underlying mechanisms. METHODS In this single-site, retrospective, and cross-sectional, observational study, data were collected from 28 eyes from 24 subjects with stellate nonhereditary idiopathic foveomacular retinoschisis. Descriptive statistics were reported, based on the observed anatomico-functional features. RESULTS The visual acuity remained stable (median 20/20) in all subjects over a median follow-up of 17 months. All cases demonstrated foveomacular retinoschisis within Henle's fiber layer, at the junction of the outer plexiform and outer nuclear layers. This schisis cavity extended beyond the limits of the macular OCT temporally in all eyes. In most affected eyes, there were documented features of peripheral retinoschisis and broad attachment of the posterior hyaloid at the macula. Functional testing in a cross-sectional subset demonstrated normal retinal sensitivity centrally but an absolute scotoma peripherally. CONCLUSION Stellate nonhereditary idiopathic foveomacular retinoschisis seems to be associated with peripheral retinoschisis and anomalous or incomplete posterior hyaloid detachment. Despite chronic manifestation, this does not significantly affect central visual function but can manifest with profound loss of peripheral visual function.
Collapse
Affiliation(s)
- Edward Bloch
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
- Wellcome EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
| | - Blanca Flores-Sánchez
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
| | - Odysseas Georgiadis
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
| | - Venki Sundaram
- Department of Ophthalmology, Luton and Dunstable University Hospital, United Kingdom
| | - Zubin Saihan
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Omar A. Mahroo
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
| | - Andrew R. Webster
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
| | - Lyndon da Cruz
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
- Wellcome EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
| |
Collapse
|
11
|
Morescalchi F, Russo A, Semeraro F. SURGICAL OUTCOMES OF VITREOMACULAR TRACTION TREATED WITH FOVEAL-SPARING PEELING OF THE INTERNAL LIMITING MEMBRANE. Retina 2021; 41:2026-2034. [PMID: 33595256 PMCID: PMC10013165 DOI: 10.1097/iae.0000000000003139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare sensitivity of the retina after complete internal limiting membrane (ILM) peeling versus foveal-sparing ILM peeling in vitrectomy for vitreomacular traction syndrome. METHODS This was a randomized, prospective, comparative study. Thirty-four eyes were randomized to undergo peeling with foveal sparing of the ILM (FS group) or complete peeling group. Foveal and perifoveal retinal sensitivity, visual acuity, and central macular thickness were the main outcome measures. RESULTS Parafoveal retinal sensitivity exhibited a significant improvement in both the FS and complete peeling groups (+2.43 ± 0.82 dB and +1.79 ± 0.86 dB, respectively; P = 0.037). Significant improvements were observed in both visual acuity and central macular thickness in both groups. No cases of epiretinal membrane recurrence were observed in the FS group. CONCLUSION Both the FS and complete peeling surgical techniques are safe and yielded good anatomical and functional results; however, a significant difference in favor of FS was found in relation to the best-corrected visual acuity and perifoveal retinal sensitivity. Preservation of the foveal ILM disc allowed the anatomical restoration of the foveal architecture in most vitreomacular traction syndrome cases without signs of stiffening or ILM fibrosis over a follow-up period of 1 year.
Collapse
Affiliation(s)
- Francesco Morescalchi
- Department of Neurological and Vision Sciences, Eye Clinic, University of Brescia, Italy.
| | - Andrea Russo
- Department of Neurological and Vision Sciences, Eye Clinic, University of Brescia, Italy.
| | - Francesco Semeraro
- Department of Neurological and Vision Sciences, Eye Clinic, University of Brescia, Italy.
| |
Collapse
|
12
|
dell'Omo R, Filippelli M, De Turris S, Cimino L, Steel DH, Pavesio CE, Govetto A, Chehaibou I, Parmeggiani F, Romano MR, Ziccardi L, Pirozzi E, Costagliola C. Fluorescein Angiography Findings in Eyes With Lamellar Macular Hole and Epiretinal Membrane Foveoschisis. Invest Ophthalmol Vis Sci 2021; 62:34. [PMID: 33512403 PMCID: PMC7846948 DOI: 10.1167/iovs.62.1.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose The purpose of this paper was to study fluorescein angiography (FA) findings in eyes with lamellar macular hole (LMH), and epiretinal membrane (ERM) foveoschisis. Methods In this prospective, observational case series, 46 eyes of patients affected by either LMH or ERM foveoschisis were examined using optical coherence tomography (OCT) and FA. All patients underwent a comprehensive ophthalmological examination and a general workup to exclude uveitis. Main outcome measures were: presence of FA abnormalities, measurements of the areas of vascular leakage, and intensity of pixels in the vitreous. Results Twenty-four (52.2%) eyes with LMH and 22 (47.8%) with ERM foveoschisis were studied. Overall, FA abnormalities were found in 20 (83.3%) eyes with LMH and 18 (81.8%) with ERM foveoschisis. The median areas of posterior pole and peripheral leakage were 7.52 vs. 1.07 mm2 (P = 0.03) and 21.8 vs. 3.74 mm2 (P = 0.02) in the LMH and ERM foveoschisis group, respectively. Disk hyperfluorescence was found in 8 and 4 eyes and perivascular leak in 10 and 4 eyes with LMH and ERM foveoschisis, respectively. OCT-derived measurements of vitreous intensity did not differ between the two groups, and the investigational workup for uveitis was negative in all patients. Conclusions Discrete areas of central and peripheral leakage are commonly found in eyes with LMH and ERM foveoschisis, whereas perivascular leak and hyperfluorescence of the disc are less frequently observed. These findings suggest that breakdown of the retinal blood barrier, involving the posterior pole and the periphery, is frequently associated with these two vitreoretinal disorders.
Collapse
Affiliation(s)
- Roberto dell'Omo
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | - Mariaelena Filippelli
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | | | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - David H Steel
- Department of Ophthalmology, Sunderland Eye Infirmary, Sunderland, United Kingdom and Newcastle University, Sunderland, Newcastle, United Kingdom
| | | | - Andrea Govetto
- Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Ismael Chehaibou
- Université de Paris, Ophthalmology Department, AP-HP, Hôpital Lariboisière, Paris, France
| | - Francesco Parmeggiani
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Mario R Romano
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Lucia Ziccardi
- Neurophysiology and Neurophthalmology Unit, IRCCS- Fondazione Bietti, Rome, Italy
| | - Enza Pirozzi
- Institute of Ophthalmology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Ciro Costagliola
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| |
Collapse
|
13
|
Govetto A, Sarraf D, Hubschman JP, Tadayoni R, Couturier A, Chehaibou I, Au A, Grondin C, Virgili G, Romano MR. Distinctive Mechanisms and Patterns of Exudative Versus Tractional Intraretinal Cystoid Spaces as Seen With Multimodal Imaging. Am J Ophthalmol 2020; 212:43-56. [PMID: 31862446 DOI: 10.1016/j.ajo.2019.12.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/07/2019] [Accepted: 12/10/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine clear-cut distinctions between tractional and exudative intraretinal cystoid spaces subtypes. DESIGN Retrospective, multicenter, observational case series. METHODS A cohort of patients diagnosed with intraretinal cystoid spaces and imaged with optical coherence tomography (OCT), fluorescein angiography (FA), blue fundus autofluorescence (BFAF), en face OCT, and OCT angiography (OCT-A) was included in the study. All images were qualitatively and quantitatively evaluated. RESULTS In this study were included 72 eyes of 69 patients. Exudative intraretinal cystoid spaces (36/72 eyes, 50%) displayed a "petaloid" morphology as seen with en face OCT, FA, and BFAF. Tractional intraretinal cystoid spaces (24/72 eyes, 33.3%), displayed a radial "spoke-wheel" en face OCT pattern. There was no leakage with FA and BFAF did not reveal specific patterns. Eyes with full-thickness macular hole (FTMH, 12/72 eyes, 16.7%) displayed a "sunflower" en face OCT appearance. FTMH showed OCT, OCT-A, and BFAF features of both exudative and tractional cystoid spaces, but without any FA leakage. Inner nuclear layer (INL) thickness was significantly lower in tractional cystoid spaces (P < .001). There were a greater number of INL cystoid spaces in both the exudative and FTMH subgroups (P = .001). The surface area of INL cystoid spaces was significantly lower in the tractional subgroup (P < .001). There was a significant reduction of the microvascular density in eyes with exudative vs tractional (P = .002) and FTMH (P < .001) subgroups. CONCLUSIONS Exudative and tractional intraretinal cystoid spaces displayed characteristic multimodal imaging features and they may represent 2 different pathologic conditions with equally different clinical implications.
Collapse
|
14
|
Kim C, Sun HJ, Lee SJ, Choi KS. Comparison of Visual Acuity and Retinal Thickness According to Membranectomy in Idiopathic Epiretinal Membrane. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.1.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Charm Kim
- Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Korea
| | - Hae Jung Sun
- Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Korea
| | - Sung Jin Lee
- Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Korea
| | - Kyung Seek Choi
- Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Korea
| |
Collapse
|
15
|
Dysli M, Rückert R, Munk MR. Differentiation of Underlying Pathologies of Macular Edema Using Spectral Domain Optical Coherence Tomography (SD-OCT). Ocul Immunol Inflamm 2019; 27:474-483. [PMID: 31184556 DOI: 10.1080/09273948.2019.1603313] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose: To describe the morphological characteristics of macular edema (ME) of different origins using spectral domain optical coherence tomography (SD-OCT). Methods: This article summarizes and highlights key morphologic findings, based on published articles, describing the characteristic presentations of ME of different origins using SD-OCT. The following pathologies were included: uveitic macular edema, pseudophakic cystoid macular edema (PCME), diabetic macular edema (DME), macular edema secondary to central or branch retinal vein occlusion (CRVO/BRVO), microcystic macular edema (MME), ME associated with epiretinal membrane (ERM), and retinitis pigmentosa (RP). Conclusions: Macular edema of different origins show characteristic patterns that are often indicative of the underlying cause and pathology. Thus, trained algorithms may in the future be able to automatically differentiate underlying causes and support clinical diagnosis. Knowledge of different appearances support the clinical diagnosis and can lead to improved and more targeted treatment of ME.
Collapse
Affiliation(s)
- Muriel Dysli
- a Department of Ophthalmology, Inselspital , Bern University Hospital and University of Bern , Bern , Switzerland.,b BPRC, Bern Photographic Reading Center , University of Bern , Bern , Switzerland
| | - René Rückert
- c Department of Ophthalmology , eye.gnos consulting , Bern , Switzerland
| | - Marion R Munk
- a Department of Ophthalmology, Inselspital , Bern University Hospital and University of Bern , Bern , Switzerland.,b BPRC, Bern Photographic Reading Center , University of Bern , Bern , Switzerland.,d Feinberg School of Medicine , Northwestern University Chicago , Chicago , IL , USA
| |
Collapse
|
16
|
Abstract
PURPOSE To compare the effect of intravitreal injections of air with gas on vitreomacular traction (VMT) release and attempt to analyze predictive factors for success. METHODS The medical records of patients with symptomatic VMT undergoing intravitreal injections (0.3 mL) of either octafluoropropane (C3F8) or air were retrospectively reviewed. The VMT release (primary end point) and the best-corrected visual acuity (secondary end point) were noted 1 month after injection. At baseline and 1 month after the injection, a macular optical coherence tomography was performed. RESULTS Twenty-four eyes of 22 patients were included. Vitreomacular traction was released in 10 cases, 7 among 11 C3F8-injected eyes (63%) and 3 among 13 air-injected eyes (23%) (P = 0.045). In eyes with released VMT, ETDRS improved from 61 ± 35 (0-100) to 65 ± 37 (0-100) 1 month after the injection (P = 0.03). All patients with VMT release had a horizontal vitreomacular adhesion of less than 600 µm. Five eyes (23%) underwent vitrectomy after the injection of gas or air. CONCLUSION Posterior vitreous detachment in VMT can be observed with both air and gas injection with a low complication rate. The occurrence of VMT release observed with air seemed to be less frequent than that observed with gas.
Collapse
|
17
|
Minami S, Shinoda H, Shigeno Y, Nagai N, Kurihara T, Watanabe K, Sonobe H, Takagi H, Tsubota K, Ozawa Y. Effect of axial length and age on the visual outcome of patients with idiopathic epiretinal membrane after pars plana vitrectomy. Sci Rep 2019; 9:19056. [PMID: 31836768 PMCID: PMC6911110 DOI: 10.1038/s41598-019-55544-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/30/2019] [Indexed: 11/12/2022] Open
Abstract
We evaluated predictive factors for visual outcomes in patients with idiopathic epiretinal membrane (iERM) after pars plana vitrectomy (PPV). Clinical records for 114 eyes (114 patients, mean age: 70.6 years) with iERM treated by PPV between March 2012 and March 2018 were retrospectively reviewed. Overall, the mean postoperative best-corrected visual acuity (BCVA) and central retinal thickness measured by optical coherence tomography improved as early as 1 month after surgery, and further improved until 3 months (P < 0.01). Multiple linear regression analyses adjusted for the preoperative BCVA showed that older age (B, 0.010; 95% confidence interval, 0.003 to 0.016; P = 0.003) and a shorter axial length (AL; B, −0.059; 95% confidence interval, −0.099 to −0.019; P = 0.005) predicted worse postoperative BCVA. The Mann-Whitney U test showed that the postoperative BCVA was worse in eyes with AL < 23.6 mm than in eyes with AL ≥ 23.6 mm (P = 0.037), and in patients aged ≥69 years than in patients aged <69 years (P = 0.024). The findings may help in evaluating surgical indications for each patient to obtain satisfactory outcomes, irrespective of the preoperative BCVA.
Collapse
Affiliation(s)
- Sakiko Minami
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Inagi Municipal Hospital, Tokyo, Japan.,Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hajime Shinoda
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yuta Shigeno
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Norihiro Nagai
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.,Laboratory of Retinal Cell Biology, Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Toshihide Kurihara
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuhiro Watanabe
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Sonobe
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Hitoshi Takagi
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yoko Ozawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. .,Laboratory of Retinal Cell Biology, Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
| |
Collapse
|
18
|
Özdemir HB, Özdek Ş, Hasanreisoğlu M. Pneumatic Vitreolysis for the Treatment of Vitreomacular Traction Syndrome. Turk J Ophthalmol 2019; 49:201-208. [PMID: 31486607 PMCID: PMC6761384 DOI: 10.4274/tjo.galenos.2019.00400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: To evaluate the posterior vitreous release rates after a single injection of expansile gas in patients with vitreomacular traction (VMT) syndrome with or without associated full-thickness macular hole (FTMH). Materials and Methods: Thirteen eyes of 12 consecutive patients with VMT (11 eyes) or VMT+FTMH (2 eyes) were reviewed retrospectively. Intravitreal injection of 0.3 mL of pure sulfur hexafluoride (SF6) (9 eyes) or perfluoropropane (C3F8) (4 eyes) was performed. Bobbing the head forward and backward similar to ‘drinking bird’ head movements was instructed until VMT release. Full ophthalmic examination and optical coherence tomography was performed at each visit. Results: VMT was released in all patients (100%) and mean release time was 5.2 days (1-19 days). Macular hole closure was not achieved in either of the two eyes with FTMH. Mean central subfield thickness decreased significantly from 361 μm to 263 μm (p=0.007). The mean pretreatment visual acuity was 0.44 LogMAR, which significantly improved to 0.25 LogMAR at the last visit (p=0.003). One of 13 eyes had retinal tear after the procedure which was successfully treated with laser retinopexy. Gas migration to the anterior chamber occurred in one patient. No other complications were observed. Conclusion: Pneumatic vitreolysis with C3F8 and SF6 gases is a relatively safe, low-cost, and minimally invasive treatment modality for VMT. However, FTMH closure could not be achieved with pneumatic vitreolysis.
Collapse
Affiliation(s)
- Hüseyin Baran Özdemir
- University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
| | - Şengül Özdek
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Murat Hasanreisoğlu
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| |
Collapse
|
19
|
Klaas JE, Burzer S, Abraham S, Feucht N, Lohmann CP, Maier M. [Morphology of the vitreoretinal interface in fellow eyes of patients with full thickness macular holes]. Ophthalmologe 2019; 115:1050-1055. [PMID: 29138978 DOI: 10.1007/s00347-017-0614-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We performed a retrospective, observational clinical study to evaluate the vitreoretinal interface (VRI) in fellow eyes of patients with full thickness macular holes (FTMH) based on spectral domain optical coherence tomography (SD-OCT) examinations. METHODS The VRI in fellow eyes of 38 patients with idiopathic FTMH, 6 of which had concomitant vitreomacular traction (VMT) and the VRI of 32 patients with FTMH with complete resolution of VMT were examined by SD-OCT for the presence of vitreomacular adhesion (VMA), VMT and the formation of FTMH, lamellar macular holes (LMH), macular pseudoholes (MPH) or epiretinal membranes (ERM). Patients underwent complete ophthalmic evaluation, including SD-OCT at baseline and follow-up visits. To classify the morphology of the VRI, we used the international vitreomacular traction study classification system by Duker et al. (Ophthalmology 2013), evaluating the baseline SD-OCT data for significant classification parameters, including size of VMA, macular thickness and volume and structural changes of retinal layers. RESULTS Of the 38 eyes with FTMH, 2 (5.3%) fellow eyes also showed evidence of FTMH, 5 (13.2%) had isolated VMT while 5 (13.2%) showed formation of ERM, of which 2 demonstrated MPH. In 5 patients (13.2%) showing evidence of VMA and 17 patients (44.7%) with an unremarkable VRI, 22 fellow eyes (57.9%) showed no pathological morphology. Altogether, 16 fellow eyes (42.1%) of patients with FTMH showed pathological changes of the vitreoretinal interface. CONCLUSION This high-resolution SD-OCT-based retrospective study showed that fellow eyes of patients with VMT or FTMH were at increased risk of demonstrating pathological changes in the morphology of the VRI.
Collapse
Affiliation(s)
- J E Klaas
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - S Burzer
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - S Abraham
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - N Feucht
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - C P Lohmann
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - M Maier
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| |
Collapse
|
20
|
Chung YR, Kim YH, Lee SY, Byeon HE, Lee K. Insights into the pathogenesis of cystoid macular edema: leukostasis and related cytokines. Int J Ophthalmol 2019; 12:1202-1208. [PMID: 31341814 DOI: 10.18240/ijo.2019.07.23] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/02/2019] [Indexed: 12/29/2022] Open
Abstract
Cystoid macular edema (CME) is the abnormal collection of intraretinal fluid in the macular region, especially in the inner nuclear and outer plexiform layers. CME leads to severe visual impairment in patients with various retinal diseases, such as diabetic retinopathy, retinal vascular occlusion, choroidal neovascularization, and uveitis. Although various retinal conditions lead to CME, a shared pathogenesis of CME is involved in these diseases. Accordingly, the pathogenesis of CME based on vasogenic mechanisms is first discussed in this review, including vascular hyperpermeability, leukostasis, and inflammation. We then describe cytotoxic mechanisms based on retinal Müller cell dysfunction. This comprehensive review will provide an understanding of the pathogenesis of CME for potential therapeutic strategies.
Collapse
Affiliation(s)
- Yoo-Ri Chung
- Department of Ophthalmology, Ajou University School of Medicine, Suwon 16499, Korea
| | - Young Ho Kim
- Department of Ophthalmology, Ajou University School of Medicine, Suwon 16499, Korea
| | - Seung Yeop Lee
- Department of Ophthalmology, Ajou University School of Medicine, Suwon 16499, Korea
| | - Hye-Eun Byeon
- Institute of Medical Science, Ajou University School of Medicine, Suwon 16499, Korea
| | - Kihwang Lee
- Department of Ophthalmology, Ajou University School of Medicine, Suwon 16499, Korea
| |
Collapse
|
21
|
|
22
|
|
23
|
Photoreceptor Layer Changes Overlying Drusen in Eyes with Age-Related Macular Degeneration Associated with Vitreomacular Traction. Eur J Ophthalmol 2018; 24:582-92. [DOI: 10.5301/ejo.5000412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2013] [Indexed: 11/20/2022]
|
24
|
Govetto A, Su D, Farajzadeh M, Megerdichian A, Platner E, Ducournau Y, Virgili G, Hubschman JP. Microcystoid Macular Changes in Association With Idiopathic Epiretinal Membranes in Eyes With and Without Glaucoma: Clinical Insights. Am J Ophthalmol 2017; 181:156-165. [PMID: 28673749 DOI: 10.1016/j.ajo.2017.06.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE To describe the clinical and surgical significance of microcystoid macular changes in the inner nuclear layer in patients with idiopathic epiretinal membranes, with and without glaucomatous optic neuropathy. DESIGN Retrospective case series. METHODS Clinical charts and spectral-domain optical coherence tomography images of 264 eyes of 234 consecutive patients diagnosed with idiopathic epiretinal membranes were reviewed and analyzed. Surgical data were analyzed in a subgroup of eyes with microcystoid macular changes treated with pars plana vitrectomy and epiretinal and internal limiting membrane peel. In surgical cases, postoperative functional and anatomic results at 1 and 6 months were compared between glaucomatous and nonglaucomatous eyes. Associations of microcystoid macular changes with visual acuity and other morphometric parameters were assessed by means of linear or multiple logistic regressions. RESULTS Microcystoid macular changes in the inner nuclear layer were diagnosed in 52 out of 264 eyes with epiretinal membranes (19.7%), of which 28 (55.0%) had concomitant glaucoma. The likelihood to develop microcystoid macular changes increased at advanced glaucoma and epiretinal membrane stages. The morphology of microcystoid macular changes was similar between glaucomatous and nonglaucomatous eyes. Forty-four out of 52 eyes (84.6%) with microcystoid macular changes, of which 20 were with glaucoma and 24 without glaucoma, underwent surgery with pars plana vitrectomy and epiretinal and internal limiting membrane peel. At 1 and 6 months after surgery the mean number of microcysts decreased significantly from baseline in nonglaucomatous eyes (P = .003 and P = .002, respectively) and remained unchanged in glaucomatous eyes (P = .400 and P = .700, respectively). CONCLUSIONS This study reports a high frequency of microcystoid macular changes in the inner nuclear layer in eyes with concomitant epiretinal membrane and glaucomatous optic neuropathy. In glaucomatous eyes, pars plana vitrectomy with epiretinal and internal limiting membrane peel was ineffective in the treatment of microcystoid macular changes.
Collapse
Affiliation(s)
- Andrea Govetto
- Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Daniel Su
- Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Matthew Farajzadeh
- Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Alin Megerdichian
- Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Eva Platner
- Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Yvette Ducournau
- Pathological Anatomy and Cytology Department, Nantes University Hospital, Nantes, France
| | - Gianni Virgili
- Department of Opthalmology, Careggi University Hospital, Florence, Italy
| | - Jean Pierre Hubschman
- Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California.
| |
Collapse
|
25
|
Uzel MM, Citirik M, Ilhan C, Tekin K. CORRELATION BETWEEN CENTRAL FOVEAL THICKNESS AND VISUAL ACUITY IN PATIENTS WITH IDIOPATHIC VITREOMACULAR TRACTION. Retina 2017; 38:907-912. [PMID: 28338558 DOI: 10.1097/iae.0000000000001635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the impact of preoperative central foveal thickness (CFT) on visual acuity after surgery in patients with idiopathic vitreomacular traction and to calculate a cut-off value in preoperative CFT. METHODS Thirty-five patients with idiopathic vitreomacular traction were evaluated retrospectively. A complete ophthalmological examination including spectral domain optical coherence tomography was performed preoperatively and at 12 months after the surgery. Receiver operating characteristic analysis was used to determine the critical point for the CFT associated with improvement of 10 or more letters in visual acuity on the Early Treatment Diabetic Retinopathy Study. RESULTS Among 35 patients, the mean CFT at postoperative 12 months was significantly decreased from baseline (P = 0.001). Preoperative CFT and visual improvement were not significantly correlated (r = -0.090, P = 0.605), whereas preoperative CFT and preoperative visual acuity were significantly correlated (r = 0.757, P < 0.001). Improvement in CFT and visual improvement were also correlated significantly (r = 0.449, P = 0.007). According to the receiver operating characteristic analysis, the threshold CFT was 471 μm. When 15 patients with CFT thickness under 471 μm were evaluated, preoperative CFT was significantly correlated with improvement in visual acuity after the surgery (r = 0.561, P = 0.030). CONCLUSION Preoperative CFT is important for the visual prognosis of patients with vitreomacular traction. Preoperative CFT of these patients should be considered in surgical decisions.
Collapse
Affiliation(s)
- Mehmet M Uzel
- Ophthalmology Department, SB Ankara Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | | | | | | |
Collapse
|
26
|
Govetto A, Lalane RA, Sarraf D, Figueroa MS, Hubschman JP. Insights Into Epiretinal Membranes: Presence of Ectopic Inner Foveal Layers and a New Optical Coherence Tomography Staging Scheme. Am J Ophthalmol 2017; 175:99-113. [PMID: 27993592 DOI: 10.1016/j.ajo.2016.12.006] [Citation(s) in RCA: 269] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe the presence of continuous ectopic inner foveal layers associated with epiretinal membranes (ERMs) and to present a new optical coherence tomography (OCT) staging system of ERMs. DESIGN Retrospective multicenter observational case series. METHODS Clinical charts and spectral-domain OCT images of 194 eyes of 172 consecutive patients diagnosed with ERMs were reviewed and analyzed. RESULTS The presence of continuous ectopic inner foveal layers was identified in 63 out of 194 eyes (32.5%) and this morphology was significantly associated with lower visual acuity. ERMs were divided into 4 stages. Stage 1 (43 out of 194 eyes, 22.1%) ERMs were mild and thin and a foveal depression was present. Stage 2 (88 out of 194 eyes, 45.4%) ERMs were associated with widening of the outer nuclear layer and loss of the foveal depression. Stage 3 (51 out of 194 eyes, 26.3%) ERMs were associated with continuous ectopic inner foveal layers crossing the entire foveal area. In stages 1, 2, and 3 all retinal layers were clearly defined on OCT. Stage 4 ERMs (12 out of 194 eyes, 6.2%) were thick and associated with continuous ectopic inner foveal layers. In addition, retinal layers were disrupted. Visual acuity progressively declined from stage 1 through stage 4 (P < .001). CONCLUSIONS The presence of continuous ectopic inner foveal layers in ERMs is a newly described OCT finding associated with significant vision loss and is an essential element of a novel OCT-based grading scheme of ERMs that may influence visual prognosis.
Collapse
|
27
|
Petrou P, Kontos A, Errera MH, Banerjee PJ, Liyanage SE, Wickham L, Patel K, Georgalas I, Gotzaridis E, Papaconstantinou D, Charteris DG. Pars Plana Vitrectomy for Vitreomacular Traction Syndrome: Analysing the Preoperative Prognostic Factors. Semin Ophthalmol 2016; 33:313-317. [PMID: 27935338 DOI: 10.1080/08820538.2016.1229342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To identify the prognostic factors affecting the surgical outcomes in patients with vitreomacular traction syndrome undergoing pars plana vitrectomy. METHODS This was a retrospective clinical study of 67 eyes of 67 patients with vitreomacular traction syndrome who underwent pars plana vitrectomy. Demographic, clinical, and optical coherence tomography (OCT) characteristics were collected and analyzed. Univariate and multivariate linear regression analysis were used to examine the effect of parameters on change in best-corrected visual acuity (BCVA). RESULTS At a mean follow-up period of 15.9±12 months (mean±SD), the BCVA improved from 0.7±0.3 LogMAR (mean±SD) to 0.5±0.3. Seven patients developed full-thickness macular hole intraoperatively and tamponade (air, 20% SF6 or 12% C3F8) was used in 41 patients. Retinal breaks were identified intraoperatively in four patients. Regression analysis demonstrated that the preoperative BCVA was the only parameter affecting the postoperative visual outcome. CONCLUSION In the present study, the preoperative BCVA plays a predictive role in the surgical outcome of patients with VMT undergoing pars plana vitrectomy. No other preoperative OCT characteristics demonstrated prognostic potential. Further prospective studies are needed in order to examine the role of several factors that could potentially facilitate preoperative patient counselling.
Collapse
Affiliation(s)
- Petros Petrou
- a Moorfields Eye Hospital , London , UK.,b First Department of Ophthalmology , "Gennimatas Hospital," National and Kapodistrian University of Athens , Athens , Greece
| | | | | | | | | | | | | | - Ilias Georgalas
- b First Department of Ophthalmology , "Gennimatas Hospital," National and Kapodistrian University of Athens , Athens , Greece
| | - Efstratios Gotzaridis
- b First Department of Ophthalmology , "Gennimatas Hospital," National and Kapodistrian University of Athens , Athens , Greece
| | - Dimitris Papaconstantinou
- b First Department of Ophthalmology , "Gennimatas Hospital," National and Kapodistrian University of Athens , Athens , Greece
| | | |
Collapse
|
28
|
Morescalchi F, Gambicorti E, Duse S, Costagliola C, Semeraro F. From the analysis of pharmacologic vitreolysis to the comprehension of ocriplasmin safety. Expert Opin Drug Saf 2016; 15:1267-78. [PMID: 27388220 DOI: 10.1080/14740338.2016.1208169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Pharmacologic vitreolysis is a strategy used to treat anomalous posterior vitreous detachment, by weakening vitreoretinal adhesion with an intravitreal drug. Pharmacologic vitreolysis facilitates surgery, and abnormalities of the vitreoretinal interface including vitreomacular traction (VMT) and early stage macular hole (MH) could be resolved. Ocriplasmin is a recombinant protease, active against fibronectin and laminin, which are important components of the vitreoretinal interface. Ocriplasmin has been approved for symptomatic treatment of VMT and MH with visible traction, and it functions by dissolving the proteins that link the vitreous to the macula, thereby creating a complete posterior vitreous detachment (PVD). AREAS COVERED This paper reviews the current knowledge and status of investigations regarding the use of ocriplasmin for pharmacologic vitreolysis and its safety. EXPERT OPINION Ocriplasmin is a non-specific enzyme; therefore, it dissolves vitreal proteins as well as possibly proteins associated with visual function in the retina, choroid, and lens. Ocular adverse events (OAEs) of ocriplasmin include transient visual loss, intraocular inflammation, vitreous floaters, lens opacification, zonular instability of the lens, and intraocular hemorrhage. The prevalence of the OAEs is very low; however, on rare occasions, they can result in widespread retinal dysfunction. Research into the acute and long-term safety of ocriplasmin is required.
Collapse
Affiliation(s)
- Francesco Morescalchi
- a Ophthalmology Clinic, Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Specialties and Public Health , University of Brescia , Brescia , Italy
| | - Elena Gambicorti
- a Ophthalmology Clinic, Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Specialties and Public Health , University of Brescia , Brescia , Italy
| | - Sarah Duse
- a Ophthalmology Clinic, Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Specialties and Public Health , University of Brescia , Brescia , Italy
| | - Ciro Costagliola
- b Ophthalmology Clinic, Department of Health Science , University of Molise , Campobasso , Italy.,c Istituto Neurologico Mediterraneo, I.R.C.C.S Neuromed , Pozzilli ( Isernia ), Italy
| | - Francesco Semeraro
- a Ophthalmology Clinic, Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Specialties and Public Health , University of Brescia , Brescia , Italy
| |
Collapse
|
29
|
Prospero Ponce CM, Stevenson W, Gelman R, Agarwal DR, Christoforidis JB. Ocriplasmin: who is the best candidate? Clin Ophthalmol 2016; 10:485-95. [PMID: 27051270 PMCID: PMC4803238 DOI: 10.2147/opth.s97947] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Enzymatic vitreolysis is currently the focus of attention around the world for treating vitreomacular traction and full-thickness macular hole. Induction of posterior vitreous detachment is an active area of developmental clinical and basic research. Despite exerting an incompletely elucidated physiological effect, ocriplasmin (also known as microplasmin) has been recognized to serve as a well-tolerated intravitreal injection for the treatment of vitreomacular traction and full-thickness macular hole. There are several unexplored areas of intervention where enzymatic vitreolysis could potentially be used (ie, diabetic macular edema). Recent promising studies have included combinations of enzymatic approaches and new synthetic molecules that induce complete posterior vitreous detachment as well as antiangiogenesis. Although no guidelines have been proposed for the use of ocriplasmin, this review attempts to aid physicians in answering the most important question, "Who is the best candidate?"
Collapse
Affiliation(s)
- Claudia M Prospero Ponce
- Retina Division, Department of Ophthalmology, University of Arizona Medical Center, Tucson, AZ, USA
| | - William Stevenson
- Retina Division, Department of Ophthalmology, University of Arizona Medical Center, Tucson, AZ, USA
| | - Rachel Gelman
- Retina Division, Department of Ophthalmology, University of Arizona Medical Center, Tucson, AZ, USA
| | - Daniel R Agarwal
- Retina Division, Department of Ophthalmology, University of Arizona Medical Center, Tucson, AZ, USA
| | - John B Christoforidis
- Retina Division, Department of Ophthalmology, University of Arizona Medical Center, Tucson, AZ, USA
| |
Collapse
|
30
|
PHOTORECEPTOR OUTER SEGMENT LENGTH AND OUTER FOVEAL THICKNESS AS FACTORS ASSOCIATED WITH VISUAL OUTCOME AFTER VITRECTOMY FOR VITREOMACULAR TRACTION SYNDROME. Retina 2016; 36:1707-12. [PMID: 26866525 DOI: 10.1097/iae.0000000000000985] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the predictive factors for postoperative best-corrected visual acuity (BCVA) in patients with vitreomacular traction syndrome treated with vitrectomy. METHODS The records of 21 patients with 21 eyes that underwent vitrectomy for vitreomacular traction syndrome and followed for at least 12 months were retrospectively reviewed. The BCVA and spectral domain optical coherence tomography findings were investigated preoperatively and at 1, 3, 6, and 12 months postoperatively. Axial length was measured preoperatively. The correlations between 12-month postoperative BCVA and preoperative parameters, including BCVA, age, axial length, central foveal thickness, outer foveal thickness, and photoreceptor outer segment length, were evaluated. RESULTS Twelve-month postoperative BCVA was significantly negatively correlated with preoperative outer foveal thickness and photoreceptor outer segment length (outer foveal thickness: P = 0.029, r = -0.501; photoreceptor outer segment length: P = 0.022, r = -0.523, respectively) but not correlated with age, axial length, preoperative BCVA, and preoperative central foveal thickness (age: P = 0.346, r = 0.216; axial length: P = 0.333, r = 0.242; BCVA: P = 0.202, r = 0.290; central foveal thickness: P = 0.065, r = -0.410, respectively). CONCLUSION Preoperative outer foveal thickness and photoreceptor outer segment length could be good predictive factors of postoperative BCVA in patients with vitreomacular traction syndrome.
Collapse
|
31
|
Familial Exudative Vitreoretinopathy. Ophthalmology 2015; 122:2270-7. [DOI: 10.1016/j.ophtha.2015.07.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/09/2015] [Accepted: 07/22/2015] [Indexed: 11/18/2022] Open
|
32
|
Parsa CF, Hoyt WF. Nonarteritic anterior ischemic optic neuropathy (NAION): a misnomer. Rearranging pieces of a puzzle to reveal a nonischemic papillopathy caused by vitreous separation. Ophthalmology 2015; 122:439-42. [PMID: 25703466 DOI: 10.1016/j.ophtha.2014.11.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/12/2014] [Accepted: 11/12/2014] [Indexed: 11/24/2022] Open
|
33
|
Intravitreal autologous plasmin prepared by urokinase for vitreolysis: a pilot study. Eur J Ophthalmol 2015; 26:67-70. [PMID: 26044374 DOI: 10.5301/ejo.5000628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the effects of intravitreal autologous plasmin injection (IVAP) on vitreoretinal diseases and vitreolysis. METHODS In this interventional, prospective, case series pilot study, 8 eyes were assigned to IVAP. Plasminogen as centrifuged from the patients' plasma was converted to plasmin by adding urokinase. A total of 0.2 mL extracted plasmin was injected intravitreally. Posterior vitreous detachment (PVD) and potential injection-related complications at week 4 were the primary outcome measures. Secondary outcomes included changes in best-corrected visual acuity (VA) (logMAR) and central macular thickness (CMT). RESULTS Mean age of the patients was 54.35 years. Two patients had complete PVD and 3 patients had partial PVD. Four patients had decrease in CMT. The VA was not changed in 6 patients, improved in 1 patient, and decreased in 1 patient. No uveitis, endophthalmitis, or postinjection vitreous hemorrhage was observed. CONCLUSIONS This pilot study demonstrated the efficacy of urokinase-prepared IVAP injection on releasing vitreomacular traction and inducing vitreolysis.
Collapse
|
34
|
Bottos J, Elizalde J, Rodrigues EB, Farah M, Maia M. Vitreomacular traction syndrome: postoperative functional and anatomic outcomes. Ophthalmic Surg Lasers Imaging Retina 2015; 46:235-42. [PMID: 25707050 DOI: 10.3928/23258160-20150213-14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 04/17/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To analyze a variety of vitreomacular traction (VMT) morphologies to establish a major classification that better reflects the preoperative predictive factors of postoperative visual and anatomic outcomes. PATIENTS AND METHODS Thirty-six eyes submitted to vitrectomy surgery were categorized with a VMT pattern (V- or J-shaped) and diameter (focal < 1,500 µm or broad > 1,500 µm) based on optical coherence tomography. RESULTS The researchers compared different classifications of VMT. Despite similar postoperative best corrected visual acuity (BCVA) values (P = .393), cases with focal VMT had greater visual improvement (P = .027) because the preoperative BCVA was significantly lower in the focal group (P = .007). However, the BCVA improvements did not differ between the groups regarding the classic VMT morphologic patterns (P = .235). CONCLUSION Postoperative outcomes and macular disorders are closely related to VMT size. The adhesion diameter (focal or broad VMT) and not the classic VMT morphologic pattern (V- or J-shaped) may better predict the postoperative anatomic and functional outcomes.
Collapse
|
35
|
Abstract
PURPOSE The purpose of the study was to investigate the clinical course of patients with idiopathic vitreomacular adhesion (VMA). METHODS A noncomparative case series of patients who had clinical symptoms and spectral-domain optical coherence tomography findings consistent with VMA. The VMA was graded based on the optical coherence tomography findings at initial and follow-up examinations. Grade 1 was incomplete cortical vitreous separation with attachment at the fovea, Grade 2 was the Grade 1 findings and any intraretinal cysts or clefts, and Grade 3 was the Grade 2 findings and the presence of subretinal fluid. RESULTS One hundred and six eyes of 81 patients were identified as having VMA by spectral-domain optical coherence tomography at 3 retina clinics. The mean age was 73 years and the mean time of follow-up was 23 months. Forty-three eyes (41%) had Grade 1 VMA, 56 eyes (52%) had Grade 2 VMA, and 7 eyes (7%) had Grade 3 VMA. By the last follow-up, spontaneous release of VMA occurred in 34 eyes (32%), and pars plana vitrectomy was performed in 5 eyes (4.7%). Mean best-corrected visual acuity was 0.269 logarithm of the minimum angle of resolution or 20/37 at baseline (range, 20/20-20/200) and logarithm of the minimum angle of resolution 0.251 or 20/35 at the last examination (range, 20/20-20/400). CONCLUSION In this selected patient cohort with mild symptoms, the clinical course of patients with VMA managed by initial observation was generally favorable.
Collapse
|
36
|
Classifications of vitreomacular traction syndrome: diameter vs morphology. Eye (Lond) 2014; 28:1107-12. [PMID: 24993318 DOI: 10.1038/eye.2014.128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 04/28/2014] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The aim of this study is to analyze the agreement between the classifications based on morphology and diameter of vitreomacular traction (VMT) syndrome, as well as to correlate the morphological findings of VMT with specific maculopathies. METHODS Fifty-three eyes with VMT syndrome were categorized into two classifications based on optical coherence tomography images: the VMT morphology (V- or J-shaped) and the diameter of adhesion (focal ≤ 1500 μm or broad>1500 μm). RESULTS High correlation was seen between V-shaped and focal-VMT and between J-shaped and broad-VMT (kappa=0.850; P<0.001), except in four cases with broad adhesion despite the presence of a V-shaped pattern. These four cases had common characteristics to those with broad vitreal attachment regarding associated maculopathies and visual function. V-shaped VMT (n=29) and focal-VMT (n=25) led to tractional cystoid macular edema (CME; 79.31% and 84%, respectively) and macular hole (MH; 37.93% and 44%); J-shaped VMT (n=24) and broad-VMT (n=28) were associated with epiretinal membranes (ERMs; 91.66% and 92.85%, respectively) and diffuse retinal thickening (62.50% and 64.28%). The best-corrected visual acuity (BCVA) was not significantly different between the groups (BCVA logarithm of the minimum angle of resolution: V-shaped, 0.45; J-shaped, 0.46; P=0.816; and focal, 0.50; broad, 0.42; P=0.198). CONCLUSIONS Although highly concordant, the classification based on the diameter of the adhesion and not on the classical adhesion morphology seemed to better reflect the specific macular changes. V-shaped and focal VMT led to tractional CME and MH, while J-shaped and broad VMT were associated with ERM and diffuse retinal thickening.
Collapse
|
37
|
A novel spectral-domain optical coherence tomography model to estimate changes in vitreomacular traction syndrome. Graefes Arch Clin Exp Ophthalmol 2014; 252:1729-35. [DOI: 10.1007/s00417-014-2645-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/04/2014] [Accepted: 04/09/2014] [Indexed: 02/05/2023] Open
|
38
|
Theodossiadis GP, Grigoropoulos VG, Theodoropoulou S, Datseris I, Theodossiadis PG. Spontaneous resolution of vitreomacular traction demonstrated by spectral-domain optical coherence tomography. Am J Ophthalmol 2014; 157:842-851.e1. [PMID: 24445034 DOI: 10.1016/j.ajo.2014.01.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 01/14/2014] [Accepted: 01/15/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the natural course of idiopathic vitreomacular traction (VMT) with spectral-domain optical coherence tomography (SDOCT) from the vitreomacular adhesion (VMA) stage to the spontaneous resolution of VMT. DESIGN Prospective observational case series. METHODS We studied the natural course of idiopathic VMT in 46 eyes (46 patients), divided into those that proceeded to spontaneous VMT resolution (12 cases) and those that remained at the VMT stage (34 cases). All patients were examined with SDOCT at regular 3-month intervals. We recorded the vitreomacular angle of VMA nasally and temporally, the horizontal diameter of VMA, macular thickness, visual acuity, photoreceptor layer, and external limiting membrane. RESULTS In the 12 eyes that proceeded to spontaneous resolution, the vitreous adhesion angle had a mean increase of 38 degrees at VMT, compared to the angle at the VMA stage. In the 34 eyes that remained at the VMT stage, the mean angle of traction increased by only 1 degree throughout follow-up. In all 46 patients, the angle at the VMT stage was significantly associated with traction resolution (nasally P = .001, temporally P < .001). The likelihood of resolution was more than 99% lower for patients with a VMT diameter >400 μm compared with that of eyes with a VMT diameter <400 μm. Patients with broad-type VMT remained at the same stage, whereas patients with V-type VMT had 80% probability of resolution. CONCLUSIONS Spontaneous VMT resolution is negatively associated with the horizontal adhesion diameter. The strength of the traction exerted by the vitreous on the fovea seems to be positively related to the size of the vitreomacular angle.
Collapse
|
39
|
Safety and efficacy of oral fluorescein angiography in detecting macular edema in comparison with spectral-domain optical coherence tomography. Retina 2014; 33:1574-83. [PMID: 23584697 DOI: 10.1097/iae.0b013e318285cd84] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the safety of oral fluorescein angiography (FA) and to compare its efficacy in detection of macular edema (ME) with spectral-domain optical coherence tomography (SD-OCT). METHODS Results of imaging studies for 1,928 eyes of 1,019 patients who had simultaneously undergone both oral FA and SD-OCT by a confocal laser ophthalmoscope were reviewed. Sensitivity in detecting ME, discrepancy rate, and "kappa" agreement were determined for both the techniques and with eyes stratified by disease diagnosis. RESULTS No allergic reactions occurred after oral FA. Mild gastric discomfort was noted in <1% of the patients; 1,840 eyes (95.4%) showed concordance between the two techniques, and kappa agreement was 90.3%. For ME, oral FA showed an overall sensitivity of 0.97 and SD-OCT of 0.91. Equivalent sensitivity was found in cases of wet age-related macular degeneration (0.99). Oral FA was more sensitive than SD-OCT in cases of retinovascular diseases. The SD-OCT showed higher sensitivity in cases of macular holes. Detection of ME by SD-OCT was significantly higher in cases of intense leakage on oral FA (P < 0.001). CONCLUSION Oral FA proved to be a safe and an adequate technique to evaluate ME. It is more sensitive than SD-OCT in detection of ME in cases of retinovascular diseases but can fail to detect ME in cases of macular holes. A noninvasive examination with simultaneous oral FA and SD-OCT may be considered to obtain a comprehensive evaluation of the presence of ME from different pathologies.
Collapse
|
40
|
Schumann RG, Gandorfer A. Pathophysiology of Vitreo-Macular Interface. DISEASES OF THE VITREO-MACULAR INTERFACE 2014. [DOI: 10.1007/978-3-642-40034-6_5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
41
|
Inflammation and macular oedema after pars plana vitrectomy. Mediators Inflamm 2013; 2013:971758. [PMID: 24288446 PMCID: PMC3833009 DOI: 10.1155/2013/971758] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/23/2013] [Indexed: 11/29/2022] Open
Abstract
Cystoid macular oedema (CMO) is a major cause of reduced vision following intraocular surgery. Although the aetiology of CMO is not completely clarified, intraocular inflammation is known to play a major role in its development. The macula may develop cytotoxic oedema when the primary lesion and fluid accumulation occur in the parenchymatous cells (intracellular oedema) or vasogenic oedema when the primary defect occurs in the blood-retinal barrier and leads to extracellular fluid accumulation (extracellular oedema). We report on the mechanisms of CMO formation after pars plana vitrectomy and associated surgical procedures and discuss possible therapeutic approaches.
Collapse
|
42
|
Kashani AH, Aaberg TM, Capone A. Vitreomacular traction as a consequence of posterior hyaloidal contraction after transpupillary thermotherapy. Am J Ophthalmol 2013; 155:937-45. [PMID: 23352339 DOI: 10.1016/j.ajo.2012.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 11/11/2012] [Accepted: 11/15/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To describe the pathogenesis, clinical characteristics, management, and outcomes of patients in whom vitreomacular traction evolved pursuant to treatment of choroidal melanoma with transpupillary thermotherapy. DESIGN Retrospective, uncontrolled, observational, interventional case series. METHODS Vitreomacular traction with macular distortion, macular edema, and vision loss developed in 6 eyes of 6 patients after successful transpupillary thermotherapy for choroidal melanoma. Clinical examination, fluorescein angiography, fundus photography, and spectral-domain optical coherence tomography were performed. Symptomatic patients underwent pars plana vitrectomy (PPV). Primary outcome measures include visual acuity and resolution of macular distortion by clinical examination, spectral-domain optical coherence tomography, or both. RESULTS In all 6 patients, the malignant lesions were treated successfully. The posterior hyaloid was attached in all eyes before transpupillary thermotherapy. All eyes demonstrated focal hyaloidal contraction and vitreomacular traction between the transpupillary thermotherapy scar and the macula. Mean time from transpupillary thermotherapy to PPV for treatment of vitreomacular traction was 23 ± 18 months. Mean length of follow-up was 11 months. Mean logarithm of the minimal angle of resolution visual acuity before transpupillary thermotherapy was 0.23 ± 0.38. Mean visual acuity after transpupillary thermotherapy was 0.53 ± 0.42. Mean visual acuity before membrane peel was 0.65 ± 0.34. Mean visual acuity after membrane peel was 0.44 ± 0.21. All patients undergoing PPV showed visual improvement. CONCLUSIONS Hyaloidal contraction can occur after transpupillary thermotherapy and is a reversible cause of vision loss. The mechanism of vision loss resulting from hyaloidal contraction is flat vitreomacular traction. PPV and membrane peeling are effective in improving macular anatomic features and visual function.
Collapse
|
43
|
Shao L, Xu L, You QS, Wang YX, Chen CX, Yang H, Zhou JQ, Jonas JB, Wei WB. Prevalence and associations of incomplete posterior vitreous detachment in adult Chinese: the Beijing Eye Study. PLoS One 2013; 8:e58498. [PMID: 23544043 PMCID: PMC3609755 DOI: 10.1371/journal.pone.0058498] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 02/05/2013] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To determine prevalence and associations of incomplete posterior vitreous detachment (PVD). METHODS The population-based cross-sectional Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years (range: 50-93 years). A detailed ophthalmic examination was performed including spectral-domain optical coherence tomography (SD-OCT). Incomplete PVD was differentiated into type 1 (shallow PVD with circular perifoveal vitreous attachment), type 2 (PVD reaching fovea but not foveola), type 3 (shallow PVD with pinpoint vitreous attachment at the foveola), and type 4 (PVD completely detached from the macula, attached to the optic disc). RESULTS An incomplete PVD was detected in 3948 eyes (prevalence: 60.5±0.6%; 95% Confidence Interval (CI): 59.3%,61.7%) of 2198 subjects (67.1±0.8%;95%CI: 65.6%,68.7%). Type 1 PVD was seen in 3090 (78.3%) eyes, type 2 PVD in 504 (12.8%) eyes, type 3 PVD in 70 (1.8%) eyes, and type 4 PVD in 284 (7.2%) eyes. Prevalence of incomplete PVD was associated with younger age (P<0.001;OR:0.91), male gender (P<0.001;OR:0.64), rural region of habitation (P<0.001;OR:0.49), larger corneal diameter (P = 0.04;OR:0.91), better best corrected visual acuity (P = 0.02;OR:0.41), and hyperopic refractive error (P<0.001;OR:1.15). The type of incomplete PVD was associated with higher age (P<0.001), urban region of habitation (P<0.001), myopic refractive error (P = 0.001), thinner cornea (P = 0.005), and better best corrected visual acuity (P = 0.056). CONCLUSIONS In adult Chinese in Greater Beijing, prevalence of an incomplete PVD (detected in 67.1% subjects) was associated with younger age, male gender, rural region of habitation, larger corneal diameter, better best corrected visual acuity and hyperopic refractive error.
Collapse
Affiliation(s)
- Lei Shao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qi Sheng You
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chang Xi Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hua Yang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jin Qiong Zhou
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jost B. Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Heidelberg, Germany
| | - Wen Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
44
|
Simpson ARH, Petrarca R, Jackson TL. Vitreomacular adhesion and neovascular age-related macular degeneration. Surv Ophthalmol 2013; 57:498-509. [PMID: 23068973 DOI: 10.1016/j.survophthal.2012.01.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 01/30/2012] [Accepted: 01/31/2012] [Indexed: 02/05/2023]
Abstract
We explore the hypothesis that vitreomacular adhesion (VMA) and vitreomacular traction (VMT) play a role in the pathogenesis and clinical course of neovascular ("wet") age-related macular degeneration (AMD). Several biological theories are offered to explain this possible association, including direct tractional force, altered vitreous oxygenation, altered diffusion coefficients of intravitreal molecules, and alterations in the pharmacokinetics of intravitreal drugs. Release of VMT may improve the clinical course of neovascular AMD, and a few case series suggest that vitrectomy can lead to both a functional and anatomic improvement. A large, randomized, controlled clinical trial is underway, investigating pharmacologic release of VMA in eyes with neovascular AMD.
Collapse
Affiliation(s)
- Andrew R H Simpson
- King's College London and King's College Hospital, London, United Kingdom
| | | | | |
Collapse
|
45
|
Intravitreal injection of expansile perfluoropropane (c(3)f(8)) for the treatment of vitreomacular traction. Am J Ophthalmol 2013; 155:270-276.e2. [PMID: 23164159 DOI: 10.1016/j.ajo.2012.08.018] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/24/2012] [Accepted: 08/28/2012] [Indexed: 02/01/2023]
Abstract
PURPOSE To study the efficacy of a single intravitreal injection of expansile gas in releasing vitreomacular traction. DESIGN Retrospective, interventional case series. METHODS Fifteen eyes of 14 consecutive patients with symptomatic and persistent vitreomacular traction (>3 months' duration) on spectral-domain optical coherence tomography (SD OCT) received a single intravitreal injection of 0.3 mL 100% perfluoropropane (C(3)F(8)) as an alternative to pars plana vitrectomy (PPV). Primary outcome was the number of eyes with complete vitreomacular traction release on OCT 1 month following treatment. Secondary outcomes included changes in visual acuity (VA), foveal contour, central foveal thickness, and maximal foveal thickness 1 month following treatment, and final VA. RESULTS Mean age (± SD) was 72.1 ± 12.6 years. Mean follow-up was 398.7 ± 174.4 days. Vitreomacular traction was idiopathic in 7 eyes and associated with diabetes in 6. One month following treatment, vitreomacular traction was released in 6 eyes (40%). Three further eyes (20%) had resolution of vitreomacular traction within 6 months, 4 (27%) underwent PPV, and 2 (13%) subsequently declined surgery. Foveal contour was restored in 7 eyes (47%). VA and central foveal thickness were similar 1 month following treatment, but maximal foveal thickness decreased by 65.8 μm (P = .041). Mean final VA decreased 0.03 logMAR units from baseline (P = .536). Eyes with vitreomacular traction release within 1 month had less extensive vitreomacular traction (P = .037), low vitreous face reflectivity, and maximal foveal thickness <500 μm (P = .004) pretreatment. There were no associated adverse events. CONCLUSIONS Intravitreal C(3)F(8) injection could offer a minimally invasive alternative to PPV in patients with symptomatic and persistent vitreomacular traction. It appears particularly effective in eyes with less extensive vitreomacular traction and low vitreous face reflectivity on SD OCT. Further studies are warranted.
Collapse
|
46
|
Johnson MW. How should we release vitreomacular traction: surgically, pharmacologically, or pneumatically? Am J Ophthalmol 2013; 155:203-205.e1. [PMID: 23312439 DOI: 10.1016/j.ajo.2012.10.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 10/17/2012] [Accepted: 10/17/2012] [Indexed: 02/03/2023]
|
47
|
de Amorim Garcia Filho CA, Yehoshua Z, Gregori G, Puliafito CA, Rosenfeld PJ. Optical Coherence Tomography. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00003-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
48
|
|
49
|
Discrepancies between fluorescein angiography and optical coherence tomography in macular edema in uveitis. Am J Ophthalmol 2012; 154:233-9. [PMID: 22541651 DOI: 10.1016/j.ajo.2012.02.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 02/02/2012] [Accepted: 02/03/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the frequency and characteristics of discrepant findings between fluorescein angiography (FA) and optical coherence tomography (OCT) in uveitic macular edema (ME). DESIGN Retrospective cross-sectional study of 112 eyes of 78 patients with uveitic ME on FA, OCT, or both. METHODS ME was graded on OCT and FA of uveitis patients attending the University Medical Center Utrecht. The frequency and severity of discrepant findings were analyzed, and the clinical findings at the time of imaging were assessed. The imaging studies were compared with the clinical characteristics. RESULTS Positive results of both imaging methods (FA+/OCT+) were observed in 61 (54%) of 112 eyes, whereas discrepant results occurred in 51 (46%) of 112 eyes. The FA+/OCT- discrepancy occurred in 34 (30%) of 112 eyes, and the FA-/OCT+ discrepancy occurred in 17 (15%) of 112 eyes. No correlations between the discrepant imaging results and age, gender, duration of uveitis or ME, visual acuity, or cause of uveitis were identified. FA+/OCT- and FA-/OCT+ discrepancies comprised typically mild degrees of ME. The FA+/OCT- discrepancy occurred in 50% of eyes with birdshot chorioretinopathy (7/14), and the FA-/OCT+ discrepancy occurred more often in intermediate uveitis than in other anatomic locations. Although the FA+/OCT+ consistency was noted frequently in active uveitis, the FA-/OCT+ discrepancy was common in eyes with inactive uveitis (8/18; 44% of inactive eyes). CONCLUSIONS Our results emphasize that FA and OCT are complementary investigations, each revealing different aspects of the pathophysiology of uveitic ME.
Collapse
|
50
|
|