C. Simader

Long-term results of implantation of phakic posterior chamber intraocular lenses

Purpose: To study the incidence and progression of lens opacification after implantation of phakic posterior chamber intraocular lenses for myopia and its correlation with vaulting and endothelial cell density (ECD). Setting: Department of Ophthalmology, University of Vienna Medical School, Vienna, Austria. Methods: An implantable contact lens (ICL V4, Staar Surgical Inc.) was inserted in 76 myopic eyes. Patients were prospectively followed preoperatively and at 1, 3, 6, 12, 24, and 36 months. The uncorrected visual acuity and best corrected visual acuity (BCVA) were determined. Vaulting was measured optically with a Jaeger II pachymeter, and the crystalline lens was examined at the slitlamp for the presence and characteristics of opacification. Endothelial cell morphometry was performed by specular microscopy, and the ECD was calculated. Eyes in which lens opacification developed were followed for at least 12 months to determine the degree and course of visual impairment. Results: Lens opacification occurred in 11 eyes (14.5%). Opacification was correlated with intraoperative trauma to the crystalline lens, age older than 50 years, and decreased ECD values throughout the observation period. Vaulting of the ICL did not correlate with the risk for lens opacification. After onset of lens opacification, 6 eyes (55%) had a stable BCVA within ±0.5 lines and 5 eyes had progressive opacification, losing between 3.5 lines and 0.5 lines (mean 1.8 lines ± 1.1 [SD]). Three eyes (3.9%) in the progressive group had a 1‐ to 2‐line loss of BCVA over preoperative values and subsequently had cataract surgery. Conclusions: Risk factors for lens opacification after implantation of the model V4 ICL included intraoperative trauma to the crystalline lens and older age. Decreased ECD in eyes with opacification suggests ongoing inflammation as a cause. Patients younger than 45 years may have a significantly lower incidence of opacification.

Two-Year Safety and Efficacy of Ranibizumab 0.5 mg in Diabetic Macular Edema: Interim Analysis of the RESTORE Extension Study

OBJECTIVEnTo evaluate the 2-year safety and efficacy of ranibizumab 0.5 mg in diabetic macular edema (DME).nnnDESIGNnTwenty-four-month, open-label, multicenter, Phase IIIb extension study.nnnPARTICIPANTSnTwo hundred forty of 303 patients with visual impairment due to DME who completed the RESTORE core study and entered the extension.nnnMETHODSnAll patients were eligible to receive ranibizumab 0.5 mg pro re nata (PRN) from month 12 (end of core study) to month 36 based on best-corrected visual acuity (BCVA) stability and disease progression retreatment criteria. Patients were also eligible to receive laser PRN according to Early Treatment Diabetic Retinopathy Study guidelines. A preplanned interim analysis was performed at month 24, stratifying by treatment groups as in the RESTORE core study and referred to as prior ranibizumab, ranibizumab plus laser, or laser groups in the extension.nnnMAIN OUTCOME MEASURESnIncidence of ocular and nonocular adverse events (AEs) and mean change in BCVA.nnnRESULTSnTwo hundred twenty patients (92%) completed the month 24 visit. Over 2 years, the most frequent ocular serious AE (SAE) and AE were cataract (2.1%) and eye pain (14.6%), respectively. The main nonocular AEs were nasopharyngitis (18.8%) and hypertension (10.4%). There were no cases of endophthalmitis, and the incidences of nonocular SAEs were low. Of the patients entering the extension, 4 deaths were reported in the second year, none of which were related to study drug or procedure. Mean BCVA gain, central retinal thickness (CRT) decrease, and National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) composite score observed at month 12 were maintained at month 24 (prior ranibizumab: +7.9 letters, -140.6 μm, and 5.6, respectively; prior ranibizumab plus laser: +6.7 letters, -133.0 μm, and 5.8, respectively), with an average of 3.9 (prior ranibizumab) and 3.5 ranibizumab injections (prior ranibizumab plus laser). In patients treated with laser alone in the core study, the mean BCVA, CRT, and NEI VFQ-25 composite score improved from month 12 to month 24 (+5.4 letters, -126.6 μm, and 4.3, respectively), with an average of 4.1 ranibizumab injections.nnnCONCLUSIONSnRanibizumab 0.5 mg administered according to prespecified visual stability and disease progression criteria was well tolerated, with no new safety concerns identified over 2 years. Overall, an average of 3.8 ranibizumab injections was sufficient to maintain (prior ranibizumab) or improve (prior laser) BCVA, CRT, and NEI VFQ-25 outcomes through the second year.nnnFINANCIAL DISCLOSURE(S)nProprietary or commercial disclosure may be found after the references.

Glare and halo phenomena after laser in situ keratomileusis

Purpose: To simulate and measure subjectively observed glare and halos after laser in situ keratomileusis (LASIK). Setting: University of Vienna, Medical School, Department of Ophthalmology, Vienna, Austria. Methods: In 16 eyes of 10 patients, the best corrected visual acuity (BCVA) and subjectively observed glare and halo size under mesopic conditions were measured before LASIK and 1, 3, and 6 months postoperatively. Infrared pupillography was used to ensure that all patients had a larger ablation zone than the measured pupil size under mesopic conditions. Results: Preoperatively, the mean Snellen BCVA was 0.88 ± 0.17 (SD) and the mean glare and halo size was 1.97 ± 1.20 square degrees (sqd) before the treatment. One month after LASIK, the BCVA was 0.83 ± 0.29 and the mean glare and halo size, 2.61 ± 3.14 sqd. Three months after LASIK, the mean values were 0.90 ± 0.26 and 1.88 ± 2.37 sqd, respectively. Six months after LASIK treatment, they were 0.85 ± 0.28 and 1.30 ± 1.63 sqd, respectively. The 95% confidence interval for the difference between preoperative glare and halo and glare and halo at 6 months was −1.56 to + 0.51 sqd. Conclusion: Subjectively observed glare and halo size after LASIK reached a peak after 1 month and decreased in the following postoperative period.

Neue Perspektiven in der Diagnostik

ZusammenfassungHintergrundDie Weiterentwicklung der optischen Kohärenztomographie (OCT) in den letzten Jahren ermöglichte neben einer Erhöhung der Auflösung immer höhere Scangeschwindigkeiten, mit der das Abtasten größerer zentraler Netzhautareale möglich wird. Ziel dieser Studie war es, die Möglichkeiten dieser neuen Technologie bei altersbedingter Makuladegeneration zu beschreiben.Material und MethodenZwanzig konsekutive Patienten, bei denen sowohl eine aktive choroidale Neovaskularisation (CNV) als auch eine Pigmentepithelabhebung (PED) nachgewiesen wurde, wurden inkludiert. Die 3-dimensionale Bildgebung erfolgte durch ein hochauflösendes, rasterscannendes OCT-System (HD-OCT) mit einer axialen Auflösung von 6xa0μm und einer Scangeschwindigkeit von bis zu 20.000 A-Scans pro Sekunde. Der gescannte Bereich maß 6×6xa0mm bei 2xa0mm Tiefe. Die 2-dimensionale Bildgebung wurde mit einem Stratus®-OCT (Carl Zeiss Meditec) durchgeführt. ErgebnisseDer Vergleich der Einzelschnitte zeigt eine bessere Identifizierung intra- und subretinaler Strukturen durch das HD-OCT. Eine Eingrenzung der Pathologie auf einzelne Netzhautschichten wird im HD-OCT möglich. Summationsbilder erlauben die genaue Lokalisation eines Scans. Topographische und volumetrische Auswertungen ermöglichen die Analyse einzelner Kompartimente im gescannten Areal und eignen sich zur Therapiekontrolle bei CNV unter Anti-VEGF-Therapie. Die Rastermethode reduziert die Abhängigkeit von den bisher zur Erstellung von Netzhautdickenkarten benötigten Extrapolationsmethoden.SchlussfolgerungenDie vorliegende Arbeit präsentiert erste Ergebnisse des Einsatzes eines rasterscannenden, hochauflösenden OCT-Systems bei Patienten mit neovaskulärer altersbedingter Makuladegeneration und stellt neue Auswertungsfunktionen vor, mit deren Hilfe exaktere Aussagen zu Therapieeffekt und dessen Auswirkungen auf die retinale Ultrastruktur gemacht werden können. Die Ergebnisse der vorliegenden Studie verdeutlichen, dass die Entwicklung hochauflösender OCT-Systeme begleitend zur Entwicklung neuartiger Behandlungsoptionen exsudativer Erkrankungen vielversprechende Perspektiven bietet.AbstractBackgroundRecent advances in optical coherence tomography (OCT) have made it possible to increase resolution and scan velocities so that even greater central areas of the retina can be scanned. The aim of this study is to describe the possibilities offered by this new technology for age-related macular degeneration.Material and methodsThe study included 20 patients with confirmed active choroidal neovascularization (CNV) as well as pigment epithelial detachment (PED). Three-dimensional imaging was performed with a high-definition raster scanning OCT system (HD-OCT) with an axial resolution of 6 µm and a scan velocity of up to 20,000 A-scans/s. The scanned area measured 6×6 mm with a depth of 2 mm. Two-dimensional imaging was carried out with a Stratus®OCT (Carl Zeiss Meditec).ResultsComparison of the individual slices showed improved identification of intra- and subretinal structures with the HD-OCT. Demarcation of pathological changes in individual retinal layers is possible with the HD-OCT. Summation images permit accurate localization of a scan. Topographic and volumetric evaluations enable analysis of individual compartments in the entire scanned area and are suitable for monitoring treatment of CNV with anti-VEGF therapy. The raster method decreases the dependence on exploratory methods that have been necessary until now to generate retinal thickness maps.ConclusionsThis report presents initial experience in using a raster scanning HD-OCT system in patients with neovascular age-related macular degeneration and describes new evaluation functions that aid in obtaining more precise assessment of treatment effect and its impact on the retinal ultrastructure. The results of this study clearly show that development of high-resolution OCT systems in conjunction with development of novel treatment options for exudative diseases offers promising perspectives.

[New perspectives in diagnostic. High-resolution optical coherence tomography for age-related macular degeneration].

ZusammenfassungHintergrundDie Weiterentwicklung der optischen Kohärenztomographie (OCT) in den letzten Jahren ermöglichte neben einer Erhöhung der Auflösung immer höhere Scangeschwindigkeiten, mit der das Abtasten größerer zentraler Netzhautareale möglich wird. Ziel dieser Studie war es, die Möglichkeiten dieser neuen Technologie bei altersbedingter Makuladegeneration zu beschreiben.Material und MethodenZwanzig konsekutive Patienten, bei denen sowohl eine aktive choroidale Neovaskularisation (CNV) als auch eine Pigmentepithelabhebung (PED) nachgewiesen wurde, wurden inkludiert. Die 3-dimensionale Bildgebung erfolgte durch ein hochauflösendes, rasterscannendes OCT-System (HD-OCT) mit einer axialen Auflösung von 6xa0μm und einer Scangeschwindigkeit von bis zu 20.000 A-Scans pro Sekunde. Der gescannte Bereich maß 6×6xa0mm bei 2xa0mm Tiefe. Die 2-dimensionale Bildgebung wurde mit einem Stratus®-OCT (Carl Zeiss Meditec) durchgeführt. ErgebnisseDer Vergleich der Einzelschnitte zeigt eine bessere Identifizierung intra- und subretinaler Strukturen durch das HD-OCT. Eine Eingrenzung der Pathologie auf einzelne Netzhautschichten wird im HD-OCT möglich. Summationsbilder erlauben die genaue Lokalisation eines Scans. Topographische und volumetrische Auswertungen ermöglichen die Analyse einzelner Kompartimente im gescannten Areal und eignen sich zur Therapiekontrolle bei CNV unter Anti-VEGF-Therapie. Die Rastermethode reduziert die Abhängigkeit von den bisher zur Erstellung von Netzhautdickenkarten benötigten Extrapolationsmethoden.SchlussfolgerungenDie vorliegende Arbeit präsentiert erste Ergebnisse des Einsatzes eines rasterscannenden, hochauflösenden OCT-Systems bei Patienten mit neovaskulärer altersbedingter Makuladegeneration und stellt neue Auswertungsfunktionen vor, mit deren Hilfe exaktere Aussagen zu Therapieeffekt und dessen Auswirkungen auf die retinale Ultrastruktur gemacht werden können. Die Ergebnisse der vorliegenden Studie verdeutlichen, dass die Entwicklung hochauflösender OCT-Systeme begleitend zur Entwicklung neuartiger Behandlungsoptionen exsudativer Erkrankungen vielversprechende Perspektiven bietet.AbstractBackgroundRecent advances in optical coherence tomography (OCT) have made it possible to increase resolution and scan velocities so that even greater central areas of the retina can be scanned. The aim of this study is to describe the possibilities offered by this new technology for age-related macular degeneration.Material and methodsThe study included 20 patients with confirmed active choroidal neovascularization (CNV) as well as pigment epithelial detachment (PED). Three-dimensional imaging was performed with a high-definition raster scanning OCT system (HD-OCT) with an axial resolution of 6 µm and a scan velocity of up to 20,000 A-scans/s. The scanned area measured 6×6 mm with a depth of 2 mm. Two-dimensional imaging was carried out with a Stratus®OCT (Carl Zeiss Meditec).ResultsComparison of the individual slices showed improved identification of intra- and subretinal structures with the HD-OCT. Demarcation of pathological changes in individual retinal layers is possible with the HD-OCT. Summation images permit accurate localization of a scan. Topographic and volumetric evaluations enable analysis of individual compartments in the entire scanned area and are suitable for monitoring treatment of CNV with anti-VEGF therapy. The raster method decreases the dependence on exploratory methods that have been necessary until now to generate retinal thickness maps.ConclusionsThis report presents initial experience in using a raster scanning HD-OCT system in patients with neovascular age-related macular degeneration and describes new evaluation functions that aid in obtaining more precise assessment of treatment effect and its impact on the retinal ultrastructure. The results of this study clearly show that development of high-resolution OCT systems in conjunction with development of novel treatment options for exudative diseases offers promising perspectives.

[High-resolution optical coherence tomography to evaluate vitreomacular traction before and after membrane peeling].

ZusammenfassungZielMorphologische Untersuchungen der vitreomakulären Grenzschicht und der intraretinalen Architektur mittels dreidimensionaler hochauflösender Raster-OCT (optische Kohärenztomographie) vor und nach chirurgischer Delamination von epiretinalen Membranen und der Membrana limitans interna (ILM).MethodeBei 14 Augen von 14xa0Patienten wurden präoperativ die Ausdehnung und Intensität der Traktion der epiretinalen Membran (ERM) und die Morphologie der einzelnen Netzhautschichten mittels hochauflösendem Raster OCT (HROCT, Cirrus Prototyp, abgetastete Fläche 6×6xa0mm, 2xa0mm Dicke) dreidimensional dargestellt. Zusätzlich wurden Visus und ophthalmologischer Befund (inklusive Stratus-OCT) dokumentiert. Standardisierte Follow-up-Untersuchungen wurden prospektiv nach einem Protokoll am Tag 1, 4 und 7 sowie 1 und 3xa0Monate postoperativ durchgeführt.ErgebnisseDie ERM war bei 85% dicht an der Netzhaut anliegend und dennoch in 100% im HROCT deutlich von der Netzhautoberfläche abgrenzbar und als separate Struktur erkennbar. Eine durch die ERM wirkende vertikale Traktion bis auf die tiefen Netzhautschichten konnte im HROCT in 93% der Fälle gezeigt werden. Strukturelle Alterationen der Netzhaut waren weder unmittelbar nach der Operation noch in der Folgezeit nachweisbar. Nach durchschnittlich 4xa0Wochen trat eine Reorganisation der Schichtenarchitektur mit vollständigem Rückgang der präoperativen traktiven Abweichungen ein. Der mittlere präoperative Visus von 0,4±0,2 Snellen stieg nach 3xa0Monaten auf durchschnittlich 0,5±0,2 Snellen an. Die mittlere Netzhautdicke betrug präoperativ 482±84xa0µm, nach 3xa0Monaten 328±80xa0µm (HROCT).SchlussfolgerungenDie hochauflösende HROCT-Untersuchung erlaubt eine bisher unerreichte dreidimensionale Darstellung der Dynamik von epiretinalen Traktionen. Epiretinale Membranen können klar abgegrenzt und ihre traktiven Auswirkungen durch alle Netzhautschichten bis zum retinalen Pigmentepithel verfolgt werden. Mit dem postoperativen Eliminieren der Traktionen gehen morphologische Veränderungen der einzelnen Netzhautschichten bereits nach 1xa0Monat zurück.AbstractAimMorphological assessment of the vitreomacular interface and intraretinal architecture using three-dimensional high-resolution optical coherence tomography (HROCT) before and after surgical delamination of epiretinal membranes and the internal limiting membrane (ILM).MethodThe extent and intensity of traction of the epiretinal membrane (ERM) and the morphology of the individual retinal layers were investigated preoperatively in 14 eyes of 14 patients using three-dimensional HROCT (Cirrus prototype, scanned area 6×6xa0mm, depth 2xa0mm). In addition, visual acuity and ophthalmological findings (including stratus OCT) were documented. Standardized follow-up examinations were performed prospectively adhering to a protocol on days 1, 4, and 7 as well as 1 and 3xa0months after surgery.ResultsThe ERM adhered closely to the retina in 85% of cases, but in 100% it was still clearly distinguishable from the retinal surface as a separate structure when using HROCT. Vertical traction through the ERM to the deepest retinal layers could be shown on HROCT in 93% of the cases. Structural alterations of the retina were not detectable either directly after surgery or subsequently. After an average of 4xa0weeks, the architecture of the layers was reorganized with complete regression of the preoperative tractional aberrations. The mean preoperative Snellen visual acuity of 0.4±0.2 increased to an average of 0.5±0.2. The mean preoperative retinal thickness was 482±84xa0µm and after 3xa0months 328±80xa0µm (HROCT).ConclusionsExamination with high-resolution optical coherence tomography allows three-dimensional visualization of the dynamics of epiretinal tractions that had not previously been obtainable. Epiretinal membranes can be clearly distinguished and their tractional effects can be traced through all retinal layers up to the pigment epithelium. As a result of the postoperative elimination of the tractions, the morphological alterations of the individual retinal layers recede already after 1xa0month.AIMnMorphological assessment of the vitreomacular interface and intraretinal architecture using three-dimensional high-resolution optical coherence tomography (HROCT) before and after surgical delamination of epiretinal membranes and the internal limiting membrane (ILM).nnnMETHODnThe extent and intensity of traction of the epiretinal membrane (ERM) and the morphology of the individual retinal layers were investigated preoperatively in 14 eyes of 14 patients using three-dimensional HROCT (Cirrus prototype, scanned area 6x6 mm, depth 2 mm). In addition, visual acuity and ophthalmological findings (including stratus OCT) were documented. Standardized follow-up examinations were performed prospectively adhering to a protocol on days 1, 4, and 7 as well as 1 and 3 months after surgery.nnnRESULTSnThe ERM adhered closely to the retina in 85% of cases, but in 100% it was still clearly distinguishable from the retinal surface as a separate structure when using HROCT. Vertical traction through the ERM to the deepest retinal layers could be shown on HROCT in 93% of the cases. Structural alterations of the retina were not detectable either directly after surgery or subsequently. After an average of 4 weeks, the architecture of the layers was reorganized with complete regression of the preoperative tractional aberrations. The mean preoperative Snellen visual acuity of 0.4+/-0.2 increased to an average of 0.5+/-0.2. The mean preoperative retinal thickness was 482+/-84 microm and after 3 months 328+/-80 microm (HROCT).nnnCONCLUSIONSnExamination with high-resolution optical coherence tomography allows three-dimensional visualization of the dynamics of epiretinal tractions that had not previously been obtainable. Epiretinal membranes can be clearly distinguished and their tractional effects can be traced through all retinal layers up to the pigment epithelium. As a result of the postoperative elimination of the tractions, the morphological alterations of the individual retinal layers recede already after 1 month.

Influence of spectacle-related changes in retinal image size on contrast sensitivity function after laser in situ keratomileusis.

Purpose: To evaluate changes in contrast sensitivity after laser in situ keratomileusis (LASIK) for the correction of myopia using a monitor‐based method and considering the preoperative minification effect of high‐diopter spectacles. Setting: Department of Ophthalmology, University of Vienna Medical School, Vienna, Austria. Methods: Fifteen eyes of 11 patients had LASIK to correct myopia. The best corrected visual acuity (BCVA) and contrast sensitivity function (CSF) were measured preoperatively and 1, 3, and 6 months postoperatively using the AcuityMax (Science 2020) computer program. The error in contrast sensitivity measurement due to different angular sizes of the test figures deriving from the spectacle refractions before and after LASIK were considered. Results: Preoperatively, and at 1, 3, and 6 months, the mean Snellen BCVA was 0.93 ± 0.19 (SD), 0.80 ± 0.26, 0.85 ± 0.21, and 0.84 ± 0.27, respectively. The best mean CS (measured at 1.1 logMAR) was 1.17 ± 0.05, 1.12 ± 0.07, 1.13 ± 0.08, and 1.18 ± 0.04, respectively. The strongest CS changes were observed at 0.7 logMAR (6 cycles per degree), where CS was 1.10 ± 0.07 preoperatively and 1.06 ± 0.09, 1.07 ± 0.12, and 1.14 ± 0.07, at 1 month, 3 months, and 6 months, respectively. With correction for the spectacle effect, the preoperative CS was approximately 3% higher and CS at 3 months for intermediate optotype sizes was significantly inferior to preoperatively. Conclusions: With correction of different retinal image sizes before and after LASIK (due to different spectacle refraction), the CS was significantly below the preoperative values at 1 and 3 months and approached the preoperative values at 6 months. The proposed method is potentially capable of quality monitoring and method comparisons after photorefractive surgery.

Untersuchung vitreomakulärer Traktionen vor und nach Membranpeeling mittels hochauflösendem Raster-OCT

ZusammenfassungZielMorphologische Untersuchungen der vitreomakulären Grenzschicht und der intraretinalen Architektur mittels dreidimensionaler hochauflösender Raster-OCT (optische Kohärenztomographie) vor und nach chirurgischer Delamination von epiretinalen Membranen und der Membrana limitans interna (ILM).MethodeBei 14 Augen von 14xa0Patienten wurden präoperativ die Ausdehnung und Intensität der Traktion der epiretinalen Membran (ERM) und die Morphologie der einzelnen Netzhautschichten mittels hochauflösendem Raster OCT (HROCT, Cirrus Prototyp, abgetastete Fläche 6×6xa0mm, 2xa0mm Dicke) dreidimensional dargestellt. Zusätzlich wurden Visus und ophthalmologischer Befund (inklusive Stratus-OCT) dokumentiert. Standardisierte Follow-up-Untersuchungen wurden prospektiv nach einem Protokoll am Tag 1, 4 und 7 sowie 1 und 3xa0Monate postoperativ durchgeführt.ErgebnisseDie ERM war bei 85% dicht an der Netzhaut anliegend und dennoch in 100% im HROCT deutlich von der Netzhautoberfläche abgrenzbar und als separate Struktur erkennbar. Eine durch die ERM wirkende vertikale Traktion bis auf die tiefen Netzhautschichten konnte im HROCT in 93% der Fälle gezeigt werden. Strukturelle Alterationen der Netzhaut waren weder unmittelbar nach der Operation noch in der Folgezeit nachweisbar. Nach durchschnittlich 4xa0Wochen trat eine Reorganisation der Schichtenarchitektur mit vollständigem Rückgang der präoperativen traktiven Abweichungen ein. Der mittlere präoperative Visus von 0,4±0,2 Snellen stieg nach 3xa0Monaten auf durchschnittlich 0,5±0,2 Snellen an. Die mittlere Netzhautdicke betrug präoperativ 482±84xa0µm, nach 3xa0Monaten 328±80xa0µm (HROCT).SchlussfolgerungenDie hochauflösende HROCT-Untersuchung erlaubt eine bisher unerreichte dreidimensionale Darstellung der Dynamik von epiretinalen Traktionen. Epiretinale Membranen können klar abgegrenzt und ihre traktiven Auswirkungen durch alle Netzhautschichten bis zum retinalen Pigmentepithel verfolgt werden. Mit dem postoperativen Eliminieren der Traktionen gehen morphologische Veränderungen der einzelnen Netzhautschichten bereits nach 1xa0Monat zurück.AbstractAimMorphological assessment of the vitreomacular interface and intraretinal architecture using three-dimensional high-resolution optical coherence tomography (HROCT) before and after surgical delamination of epiretinal membranes and the internal limiting membrane (ILM).MethodThe extent and intensity of traction of the epiretinal membrane (ERM) and the morphology of the individual retinal layers were investigated preoperatively in 14 eyes of 14 patients using three-dimensional HROCT (Cirrus prototype, scanned area 6×6xa0mm, depth 2xa0mm). In addition, visual acuity and ophthalmological findings (including stratus OCT) were documented. Standardized follow-up examinations were performed prospectively adhering to a protocol on days 1, 4, and 7 as well as 1 and 3xa0months after surgery.ResultsThe ERM adhered closely to the retina in 85% of cases, but in 100% it was still clearly distinguishable from the retinal surface as a separate structure when using HROCT. Vertical traction through the ERM to the deepest retinal layers could be shown on HROCT in 93% of the cases. Structural alterations of the retina were not detectable either directly after surgery or subsequently. After an average of 4xa0weeks, the architecture of the layers was reorganized with complete regression of the preoperative tractional aberrations. The mean preoperative Snellen visual acuity of 0.4±0.2 increased to an average of 0.5±0.2. The mean preoperative retinal thickness was 482±84xa0µm and after 3xa0months 328±80xa0µm (HROCT).ConclusionsExamination with high-resolution optical coherence tomography allows three-dimensional visualization of the dynamics of epiretinal tractions that had not previously been obtainable. Epiretinal membranes can be clearly distinguished and their tractional effects can be traced through all retinal layers up to the pigment epithelium. As a result of the postoperative elimination of the tractions, the morphological alterations of the individual retinal layers recede already after 1xa0month.AIMnMorphological assessment of the vitreomacular interface and intraretinal architecture using three-dimensional high-resolution optical coherence tomography (HROCT) before and after surgical delamination of epiretinal membranes and the internal limiting membrane (ILM).nnnMETHODnThe extent and intensity of traction of the epiretinal membrane (ERM) and the morphology of the individual retinal layers were investigated preoperatively in 14 eyes of 14 patients using three-dimensional HROCT (Cirrus prototype, scanned area 6x6 mm, depth 2 mm). In addition, visual acuity and ophthalmological findings (including stratus OCT) were documented. Standardized follow-up examinations were performed prospectively adhering to a protocol on days 1, 4, and 7 as well as 1 and 3 months after surgery.nnnRESULTSnThe ERM adhered closely to the retina in 85% of cases, but in 100% it was still clearly distinguishable from the retinal surface as a separate structure when using HROCT. Vertical traction through the ERM to the deepest retinal layers could be shown on HROCT in 93% of the cases. Structural alterations of the retina were not detectable either directly after surgery or subsequently. After an average of 4 weeks, the architecture of the layers was reorganized with complete regression of the preoperative tractional aberrations. The mean preoperative Snellen visual acuity of 0.4+/-0.2 increased to an average of 0.5+/-0.2. The mean preoperative retinal thickness was 482+/-84 microm and after 3 months 328+/-80 microm (HROCT).nnnCONCLUSIONSnExamination with high-resolution optical coherence tomography allows three-dimensional visualization of the dynamics of epiretinal tractions that had not previously been obtainable. Epiretinal membranes can be clearly distinguished and their tractional effects can be traced through all retinal layers up to the pigment epithelium. As a result of the postoperative elimination of the tractions, the morphological alterations of the individual retinal layers recede already after 1 month.

Rolle der makulären Funktionsanalyse für die Bestimmung der Funktionsfähigkeit der Makula bei charakteristischen Makulapathologien

ZusammenfassungHintergrundAufgrund zunehmender Therapieoptionen für unterschiedliche Makulapathologien besteht ein zunehmendes Interesse an einer verlässlichen Bestimmung der Funktionsfähigkeit der Makula. Das Mikroperimeter 1 (MP 1, Nidek) ermöglicht eine fundusorientierte, zentrale Funktionsanalyse und verfugt zudem über eine automatische Schwellenbestimmung und eine automatische Fixationskorrektur („Eye Tracking“).Material und MethodeEs wurden prospektiv standardisierte Untersuchungen mittels makulärer Funktionsanalyse (Nidek MP 1) und optischer Kohärenztomographie (Stratus OCT) bei Patienten mit Makulaforamen und bei Patienten mit altersbedingter Makuladegeneration (AMD) sowie bei gesunden Probanden durchgeführt. Die anatomischen und funktioneilen Befunde wurden korreliert.Wir verwendeten für unsere Untersuchungen mit dem MP 1 Goldmann-III-Stimuli, eine 4-2-1-Strategie und eine unterschiedliche Anzahl von Stimuli (41–61).ErgebnisseAlle Patienten mit durchgreifendem Makulaforamen mit einem Durchmesser > 300 μm zeigten absolute Zentralskotome (ZS). In Augen mit durchgreifendem Makulaforamen mit einem Durchmesser < 300 um hatten 71,4% kein absolutes ZS. Alle durchgreifenden Makulaforamen wurden von einem relativen ZS umgeben. Eine beeinträchtigte Makulafunktion war bei Patienten mit AREDS IV-AMD feststellbar und es bestand eine Korrelation zwischen Unregelmä-ßigkeiten des retinalen Pigmentepithels und beeinträchtigter Makulafunktion. Bei einem Frühstadium einer choroidalen Neovaskularisation mit einem intakten Visus war bereits eine Beeinträchtigung der Funktion der Makula nachweisbar.SchlussfolgerungDie makuläre Funktionsprüfung mittels dem automatisierten MP 1 bietet eine präzise Bestimmung des Funktionsverlustes der Makula bei unterschiedlichen Krankheitsbildern.SummaryBackgroundAn increasing interest exists for a reliable determination of macular function. Determination of macular function provides an additional possibility for diagnostic and therapeutical process. Microperimeter 1 (MPI, Nidek) enables a fundus-orientated, central perimetry and has an automated system to control eye movements named “Eye Tracking”.Material and methodsProspective standardised examinations with Nidek MP 1 functional macular mapping and high resolution radial scans using Stratus OCT were performed in patients with macular holes and in patients with age-related macular degeneration as well as in healthy participants.Functional macular mapping was done using Goldmann III Stimuli, a 4-2-1 strategy and a different number of stimuli (41–61).ResultsAll eyes with macular holes > 300 urn diameter showed a central absolute scotoma. In eyes with macular holes < 300 um diameter 71.4% showed no central absolute scotoma. Eyes with a full-thickness macular hole were associated with a relative scotoma.In patients with AMD AREDS IV we found a diminished macular function as well as correlation between retinal pigment epithelium irregularities and diminished macular function. An impairment of macular function was observed in an early stage of a choroidal neovascularization with no visual impairment.ConclusionFunctional macular mapping provides additional information regarding functional loss in varying macular diseases.

[Three-dimensional optical coherence tomography for evaluating the retinal architecture before and after surgery for vitreomacular traction.]

ZusammenfassungZielMorphologische Untersuchungen der vitreomakulären Grenzschicht und der intraretinalen Architektur mittels dreidimensionaler hochauflösender Raster-OCT (optische Kohärenztomographie) vor und nach chirurgischer Delamination von epiretinalen Membranen und der Membrana limitans interna (ILM).MethodenBei 14 Augen von 14xa0Patienten wurden präoperativ die Ausdehnung und Intensität der Traktion der epiretinalen Membran (ERM) und die Morphologie der einzelnen Netzhautschichten mittels hochauflösendem Raster OCT (HROCT, Cirrus Prototyp, abgetastete Fläche 6×6xa0mm, 2xa0mm Dicke) dreidimensional dargestellt. Zusätzlich wurden Visus und ophthalmologischer Befund (inklusive Stratus-OCT) dokumentiert. Standardisierte Follow-up-Untersuchungen wurden prospektiv nach einem Protokoll am Tag 1, 4 und 7 sowie 1 und 3xa0Monate postoperativ durchgeführt.ErgebnisseDie ERM war bei 85% dicht an der Netzhaut anliegend und dennoch in 100% im HROCT deutlich von der Netzhautoberfläche abgrenzbar und als separate Struktur erkennbar. Eine durch die ERM wirkende vertikale Traktion bis auf die tiefen Netzhautschichten konnte im HROCT in 93% der Fälle gezeigt werden. Strukturelle Alterationen der Netzhaut waren weder unmittelbar nach der Operation noch in der Folgezeit nachweisbar. Nach durchschnittlich 4xa0Wochen trat eine Reorganisation der Schichtenarchitektur mit vollständigem Rückgang der präoperativen traktiven Abweichungen ein. Der mittlere präoperative Visus von 0,4±0,2 Snellen stieg nach 3xa0Monaten auf durchschnittlich 0,5±0,2 Snellen an. Die mittlere Netzhautdicke betrug präoperativ 482±84xa0μm, nach 3xa0Monaten 328±80xa0μm (HROCT).SchlussfolgerungenDie hochauflösende HROCT-Untersuchung erlaubt eine bisher unerreichte dreidimensionale Darstellung der Dynamik von epiretinalen Traktionen. Epiretinale Membranen können klar abgegrenzt und ihre traktiven Auswirkungen durch alle Netzhautschichten bis zum retinalen Pigmentepithel verfolgt werden. Mit dem postoperativen Eliminieren der Traktionen gehen morphologische Veränderungen der einzelnen Netzhautschichten bereits nach einem Monat zurück.AbstractPurposeTo investigate the morphology of the vitreoretinal interface before and after delamination of epiretinal membranes using three-dimensional volumetric high-resolution optical coherence tomography (HROCT).MethodsExtension and intensity of vitreomacular traction due to epiretinal membranes (ERM) and the architecture of retinal layers in 14 eyes of 14 patients were evaluated preoperatively using high-resolution raster scanning OCT (Cirrus prototype, resulting in a 6×6-mm field, 2xa0mm in depth). Additionally, stratus OCT, visual acuity testing, and fundus photography were performed. Standardized prospective follow-up was done continuously at 1, 4, and 7 days and 1 and 3 months postoperatively.ResultsThe ERM appeared tightly adherent to the retinal surface in 85% of cases, but nevertheless could be differentiated from the retinal surface in 100%. Vertical traction forces from the ERM to the intraretinal layers were found in 93% of cases. Structural alteration of the retina was seen neither immediately following surgery nor during follow-up. After a mean of 4 weeks, the retinal structural integrity had recovered with resolution of the traction-induced deviations seen preoperatively. Mean preoperative visual acuity increased from 0.4±0.2 Snellen preoperatively to 0.5±0.2 Snellen after 3 months. Mean retinal thickness decreased from 482±84xa0μm to 328±80xa0μm after 3 months (HROCT).ConclusionsThree-dimensional HROCT imaging enables unprecedented inxa0vivo identification of the extension and dynamics of epiretinal traction. Epiretinal membranes are clearly delineated in the enxa0face view, and the distribution of traction forces throughout the intraretinal layers is identified down to the level of the retinal pigment epithelium. During follow-up, quantification of substantial release in retinal traction was possible and correlated to conventional OCT findings.