Faculty Bibliography
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457
Avastin doesn't blind people, people blind people [Letter]
PMID: 23312446
ISSN: 1879-1891
CID: 1762772
Prospective study of peripheral panretinal photocoagulation of areas of nonperfusion in central retinal vein occlusion
PURPOSE: To investigate the effect that panretinal photocoagulation to peripheral areas of retinal vascular nonperfusion has on the visual acuity and injection frequency of ranibizumab in eyes with previous central retinal vein occlusion. METHODS: Patients enrolled in a prospective study of ranibizumab for central retinal vein occlusion were imaged with wide-field angiography using the Optos P200 system. Laser photocoagulation was carried out and the extent of laser photocoagulation was evaluated with repeat wide-field angiography. Injection of ranibizumab was based on an as needed strategy throughout the study. The injection frequency in the 6 months before laser was compared with a 6-month period starting 2 months after the laser photocoagulation. The visual acuity was measured by Early Treatment Diabetic Retinopathy Study protocol refraction at both the end of the 6-month follow-up period and at the time of laser photocoagulation. RESULTS: There were 10 patients treated in this study with a mean number of 1,757 spots of laser photocoagulation in the peripheral retina. The injection frequency in the 6-month lead-in period was 3.4 and in the 6-month follow-up period was 3.1, a difference that was not significant (P = 0.26). The visual acuity at the time of laser photocoagulation was 54.2 letters (approximate Snellen equivalent of 20/80) and at the end of the observation period was 51.4 letters, a difference that was not significant (P = 0.33). CONCLUSION: In this small study, laser photocoagulation to peripheral areas of nonperfusion as visualized by wide-field angiography did not result in either decreased injection frequency or improved visual acuity in eyes with central retinal vein occlusion treated with ranibizumab.
PMID: 23269405
ISSN: 0275-004x
CID: 811762
The seasick choroid: a finding on enhanced depth imaging spectral-domain optical coherence tomography of choroidal lymphoma
PURPOSE: To describe previously unreported imaging features of choroidal lymphoma using enhanced depth imaging optical coherence tomography (OCT). METHODS: Enhanced depth imaging OCT was performed before and after the therapy. RESULTS: A 32-year-old white man with a 4-month history of blurred vision in the right eye was found to have a macular fold. There was no visible intraocular tumor. There were no signs of anterior segment inflammation, vascular abnormalities, or infiltrative disease. Visual acuity was 20/150 in the right eye and 20/20 in the left eye. Enhanced depth imaging OCT demonstrated a macular retinal fold and marked thickening of the choroid with striking choroidal surface undulation and folds imparting an appearance similar to a "sea storm" (seasick appearance). Deep choroidal structures could not be visualized, and the sclerochoroidal interface could not be identified. Overlying subretinal fluid and intraretinal fluid was noted. Ultrasonography demonstrated diffuse, relatively smooth thickening of the choroid (4.0-mm thickness) with minor extraocular hypoechoic area. Based on these findings, choroidal lymphoid proliferation was suspected, and fine-needle aspiration biopsy confirmed B-cell lymphoma. Results of systemic evaluation were unremarkable. After external beam radiotherapy with dose of 40 Gy, visual acuity returned promptly to 20/40 and the lymphoid infiltration resolved with flattening of the macular fold and resolution of subretinal and intraretinal fluids. The enhanced depth imaging OCT returned to a more normal appearance with the resolution of the retinal fold and reduction of the choroidal mass with retinal pigment epithelial-choroidal surface features to a "calm sea" appearance. CONCLUSION: Enhanced depth imaging OCT is a useful tool for subclinical monitoring of choroidal infiltration from lymphoma before and after therapy.
PMID: 25390513
ISSN: 1937-1578
CID: 1762792
Questioning optical coherence tomography [Editorial]
PMID: 23122463
ISSN: 0161-6420
CID: 811772
"Dissociated optic nerve fiber layer appearance" after internal limiting membrane removal is inner retinal dimpling
PURPOSE: To examine volume-rendered spectral-domain optical coherence tomography images in patients who had undergone vitrectomy, many of whom had internal limiting membrane removal to investigate a condition termed "dissociated optic nerve fiber layer appearance." METHODS: Patients who had undergone vitrectomy for either macular hole or epiretinal membrane were evaluated. Spectral-domain optical coherence tomography B-scan images were acquired with the use of eye tracking at an interval of either 30 mum or 60 mum. These were registered and exported to a volume-rendering program, and the resultant volume-rendered images were evaluated. The images were graded for the presence of inner retinal abnormalities, and correlates were made to corresponding alterations seen in fundus photographs and B-scan spectral-domain optical coherence tomography images. RESULTS: There were 25 eyes of 24 patients with a mean age of 72.4 (+/- 7.3) years, 15 of whom were women. The primary preoperative diagnosis was macular hole in 10 eyes (40%) and epiretinal membrane in 15 eyes (60%). As part of the surgery, 18 eyes (72%) had planned peeling of the internal limiting membrane. Volume rendering showed that 13 eyes had pitting or dimples of the inner retinal surface that seemed to follow the course of the nerve fiber layer in the region of the macula. The inner retinal dimples occurred only in eyes that had internal limiting membrane peeling. Correlation of the volume-rendered images with B-scan spectral-domain optical coherence tomography showed focal areas of thinning of the ganglion cell layer with decreased reflectivity from the nerve fiber layer in the areas of the dimples. CONCLUSION: A high proportion of eyes with internal limiting membrane peeling develop inner retinal dimples that course along the path of the nerve fiber layer. The dimples seem to be the result of an interplay between trauma and healing processes constrained by nerve fiber layer and do not appear to be because of dissociation of optic nerve fibers. The true nature of the abnormalities induced should be investigated to evaluate the long-term risks and benefits of routine internal limiting membrane peeling.
PMID: 23007669
ISSN: 0275-004x
CID: 811792
Vitreomacular disorders: pathogenesis and treatment
PMID: 22929315
ISSN: 0275-004x
CID: 811812
Vitreomacular traction syndrome
PMID: 22929319
ISSN: 0275-004x
CID: 811802
Acquired optic nerve and peripapillary pits in pathologic myopia
PURPOSE: To examine the incidence and characteristics of pit-like structures around the optic disc and myopic conus in eyes with high myopia. DESIGN: Prospective, observational case series. PARTICIPANTS: We evaluated 198 eyes of 119 patients with pathologic myopia (spherical equivalent >-8 diopters [D]). We also evaluated 32 eyes of 32 subjects with emmetropia (refractive error
PMID: 22494632
ISSN: 0161-6420
CID: 811822
Choroidal thickness and visual acuity in highly myopic eyes
PURPOSE: To examine predictive factors for visual acuity in highly myopic eyes. METHODS: Consecutive patients with high myopia (>/=6 diopters [D]) with no other pathology such as lacquer cracks in the fovea, choroidal neovascularization, or myopic macular schisis, were evaluated. The study was performed in 2 retina centers, one in the United States and the other in Japan. Enhanced depth imaging optical coherence tomography was obtained, and the central foveal, outer retinal hyporeflective layer and inner segment to retinal pigment epithelium aggregate, and the subfoveal choroidal thicknesses were measured. Correlations were calculated among the measured variables and visual acuity. Generalized estimating equation models were used to identify predictors of visual acuity. RESULTS: The New York cohort was composed of 35 eyes of 25 patients who had a mean age of 57 years (standard deviation, +/-18.1 years) and a mean refractive error of -10.9 D (+/-3.6 D). The Japanese cohort was composed of 110 eyes of 61 patients who had a mean age of 46.8 years (+/-14.7 years) and a mean refractive error of -9.2 D (+/-3.1 D) and a mean axial length of 27 mm (+/-1.4 mm). The mean subfoveal choroidal thickness was 113.3 mum (+/-53.9 mum) in the New York group and 172.9 mum (+/-72.8 mum) in the Japanese group. In each group, the subfoveal choroidal thickness showed a significant inverse correlation with age and myopic refractive spherical equivalent. The subfoveal choroidal thickness was inversely correlated with logarithm of the minimum angle of resolution visual acuity (P = 0.041, New York group; P = 0.001, Japan group). The only significant predictor in the pooled data for logarithm of the minimum angle of resolution visual acuity was subfoveal choroidal thickness (P
PMID: 22466466
ISSN: 0275-004x
CID: 811832
Segregation of ophthalmoscopic characteristics according to choroidal thickness in patients with early age-related macular degeneration
PURPOSE: To investigate the association of fundus features with choroidal thickness in eyes with early age-related macular degeneration. METHODS: Consecutive patients with age-related macular degeneration were evaluated. Major exclusionary criteria included late age-related macular degeneration (central geographic atrophy or choroidal neovascularization), macular laser therapy, myopia greater than -6 diopters, past vitreoretinal surgery, or central serous chorioretinopathy. Charts and multimodal imaging were reviewed for refraction, cataract, hypertension, diabetes, open-angle glaucoma, beta-zone peripapillary atrophy, fundus tessellation, pigmentary changes, drusen, subretinal drusenoid deposits (also known as reticular pseudodrusen). Data measured from enhanced-depth imaging spectral-domain optical coherence tomography included subfoveal choroidal thickness, central foveal thickness, outer nuclear layer thickness, inner segment to retinal pigment epithelium aggregate thickness, presence of subretinal drusenoid deposit, and outer retinal hyperreflective layers (including the band corresponding to overlap between retinal pigment epithelium apical processes and outer segments). Correlations were calculated among the measured variables, fundus features, open-angle glaucoma, and visual acuity. RESULTS: In 90 eyes of 70 early age-related macular degeneration patients with mean visual acuity 20/31 (logarithm of the minimum angle of resolution 0.193), subfoveal choroidal thickness showed a significant inverse correlation with age (P = 0.004) and increasing myopic spherical equivalent refractive error (P = 0.023). Subfoveal choroidal thickness was thinner in eyes with fundus tessellation (P < 0.001), subretinal drusenoid deposit (P = 0.023), an absence of conventional drusen (P < 0.001), the presence of beta-zone peripapillary atrophy (P < 0.001), and in eyes with a diagnosis of open-angle glaucoma (P = 0.003) or an absent band on optical coherence tomography corresponding to overlap between outer segment and retinal pigment epithelium apical processes (P = 0.022). CONCLUSION: Major ocular manifestations in early age-related macular degeneration and open-angle glaucoma are associated with the choroid-the main blood supply in the eye. Theories concerning the pathogenesis of these two diseases should incorporate interactions involving the choroid.
PMID: 22222760
ISSN: 0275-004x
CID: 811842
