Dafna Goldenberg

Vitreal, retinal, and choroidal findings in active and scarred toxoplasmosis lesions: a prospective study by spectral-domain optical coherence tomography.

BackgroundThe aim of our study was to investigate vitreal, retinal, and choroidal morphologic changes in active and scarred toxoplasmosis lesions using spectral-domain optical coherence tomography (SD-OCT).MethodsIn this prospective study, 19 eyes of 15 consecutive patients with ocular toxoplasmosis were included. Complete ophthalmologic examination and SD-OCT were done at the initial visit and during follow-up. Retina and choroid SD-OCT protocols directed to macular area and lesions observed on clinical examination were used.ResultsSeventeen active lesions and 56 retinochoroidal scars were studied. In the acute phase, disruption, thickening, and hyper-reflectivity of the neurosensory retina with photoreceptor (PR) interruption and retinal pigment epithelial (RPE) elevation were found. The choroid became thickened and hyporeflective. During follow-up, neurosensory retinal layers thinning and disorganization, PR interruption, and RPE elevation and/or atrophy were demonstrated. The choroid returned to normal thickness and became more hyperreflective. Five active lesions presented with hyperreflective oval deposits within the vitreoretinal interface, adjacent to or far away from the lesions. During follow-up, the deposits became smaller, entered into the inner retina layers and faded with time until complete resolution. Multiple hyperreflective dots in the vitreous cavity, compatible with vitritis, and posterior hyaloid thickening were demonstrated in the acute phase, with complete resolution and detachment of the posterior hyaloid during follow-up. Four types of scars were specified according to outer retina–choroid interface changes; atrophic, elevated, deep, and combined (atrophic & elevated). Epiretinal membrane segments were found over active and scarred lesions.ConclusionsSD-OCT imaging showed toxoplasmic retinochoroidal lesions and scars to be complex and characterized acutely by thickening and disorganization of both the retina and underlying choroid, and following scar formation by varying degrees of thinning, often in conjunction with irregularity of the outer retinal layers.

Choroid Thickness Measurement with RTVue Optical Coherence Tomography in Emmetropic Eyes, Mildly Myopic Eyes, and Highly Myopic Eyes:

Purpose. To evaluate choroid thickness (CT) with RTVue spectral domain optical coherence tomography (SD-OCT) and the effect of age and myopia in eyes without posterior complications. Methods. In this multicenter cross-sectional study, all enrolled patients were over age 18 and divided them in 3 groups based on refraction: emmetropia (+1 D to −1 D), mild myopia (–1 D to −6 D), and high myopia (–6 D to −20 D) groups. Horizontal scans through the fovea were acquired with RTVue OCT (Optovue Inc., Fremont, California, USA). Choroid thickness was measured at 500 µm intervals up to 1,500 µm temporal and nasal to the fovea by 2 graders. Mean CT was calculated based on the average of the 7 locations. Statistical analysis was performed to evaluate CT at each location, the effects of age and myopia, and grader agreement. Results. A total 85 eyes of 85 subjects (30 emmetropic, 24 myopic, and 31 high myopic) were enrolled. Excellent grader agreement was observed with an intraclass correlation coefficient (ICC) >0.97. The mean CT was 248.2±78.5 (µm) for emmetropia (age = 58±18), 247.0±85.4 (µm) for myopia (age = 45±20), and 131.5±70.9 (µm) for high myopia (age = 54±13). The mean CT was not significantly different between emmetropia and myopia groups, which were significantly thicker than high myopia group. The overall slope of age-related change for the mean CT was −1.95 µm/y and the effect of age differed among the groups. Conclusions. Choroid thickness can be measured from RTVue OCT images with good reproducibility. Age and high myopia appear to negatively affect CT. The age effect may vary with refraction groups.

Enhanced Depth Imaging Optical Coherence Tomography: Choroidal Thickness and Correlations With Age, Refractive Error, and Axial Length

BACKGROUND AND OBJECTIVE To evaluate choroidal thickness at five macular locations and assess the correlations between choroidal thickness at these locations with age, refractive error, and axial length. PATIENTS AND METHODS Eighty-four eyes from 42 healthy adult volunteers were included. Enhanced depth imaging by spectral-domain optical coherence tomography was performed, and choroidal thickness was measured at five macular locations: subfoveal and 3 mm nasal, temporal, superior, and inferior. Correlations of choroidal thickness at each location with age, refractive error, and axial length were analyzed. RESULTS Mean choroidal thicknesses at the subfoveal, superior, inferior, temporal, and nasal locations were 293, 308, 264, 263, and 174 μm, respectively. A correlation was found between choroidal thickness, age, refractive error, and axial length at all locations. CONCLUSION Mean subfoveal choroidal thickness in healthy adults is approximately 300 μm. A correlation was found between choroidal thickness and all parameters studied.

Spectral domain optical coherence tomography classification of acute posterior multifocal placoid pigment epitheliopathy.

Purpose: To study the retinal morphologic changes occurring in acute posterior multifocal placoid pigment epitheliopathy using spectral domain optical coherence tomography. Methods: Prospective observational case series of 12 eyes (6 consecutive patients) diagnosed with acute posterior multifocal placoid pigment epitheliopathy. All patients underwent complete ophthalmologic examination, fundus photography, fluorescein angiography, and spectral domain optical coherence tomography at the initial visit. During follow-up, ophthalmologic examination and spectral domain optical coherence tomography scans were performed. The scans were directed to the lesions observed on the clinical examination and fluorescein angiography. Results: Spectral domain optical coherence tomography classification containing four distinct stages for acute posterior multifocal placoid pigment epitheliopathy is proposed. Stage 1 demonstrates a dome-shaped elevation with disruption of the photoreceptor junction that flattens shortly after. Stage 2, occurring 2 weeks later, demonstrates distinct separation between the photoreceptor junction and the retinal pigment epithelium (RPE). Stage 3, visible 6 weeks post disease initiation, demonstrates accentuated RPE hyperreflectivity and union of the RPE and photoreceptor junction. Stage 4, the resolution phase, starts at 3 months demonstrating reformation of 2 distinct visible layers of photoreceptors and RPE. Conclusion: The morphologic retinal findings in acute posterior multifocal placoid pigment epitheliopathy visible by the spectral domain optical coherence tomography occur in the outer retina, mainly the photoreceptors and RPE. Most findings reached nearly complete resolution and were correlated with improvement in visual acuity.

Heidelberg spectral-domain optical coherence tomographic findings in retinal artery macroaneurysm.

Purpose: To describe the morphologic variables of macroaneurysms, to assess their diameter in comparison to their upstream/downstream vessel diameter as visualized on spectral-domain optical coherence tomography, and to describe morphologic changes in the retina adjacent to macroaneurysm. Methods: A retrospective case series of adult patients who were clinically diagnosed with retinal macroaneurysms and who underwent Heidelberg spectral-domain optical coherence tomography (OCT) between June 2009 and October 2010. Results: A total of 12 patients (age range, 31–95 years, 2 men) in whom macroaneurysms were demonstrated by spectral-domain OCT (12 eyes). All the macroaneurysms had a typical OCT appearance, and a diameter of 285.33 ± 76.98 &mgr;m. The diameter of the upstream/downstream vessel was 117.5 ± 17.13 &mgr;m (P = 0.0001 vs. the mean macroaneurysm diameter). Other related OCT findings were superficial retinal hemorrhage, intraretinal lipids, and intraretinal edema prominently involving the outer retinal layers. Conclusion: Spectral-domain OCT is an effective tool for detecting retinal macroaneurysms. It also provides important supplementary clinical information that may be helpful in planning the management of macroaneurysm, without the need for ancillary tests.

Macular findings on optical coherence tomography in cat-scratch disease neuroretinitis

PurposeTo describe the macular findings on optical coherence tomography (OCT) in patients with cat-scratch disease (CSD) neuroretinitis.MethodsMedical records of all patients diagnosed with CSD neuroretinitis at the Tel Aviv Medical Center between April 2006 and May 2010 were retrospectively reviewed. All patients underwent Stratus OCT macular examination.ResultsEight eyes of seven patients with confirmed CSD neuroretinitis, (mean age 33±9.9 years, range 6–48 years) were included in the study. All patients presented clinically with optic nerve swelling and macular edema or macular exudates. OCT demonstrated flattening of the foveal contour, thickening of the neurosensory retina, and accumulation of subretinal fluid (SRF) in all studied eyes. Retinal exudates appeared as multiple hyper-reflective foci in the outer plexiform layer. The average central macular thickness was 460 μm (range 170–906 μm) and the average maximal retinal thickness was 613 μm (range 387–1103 μm), at presentation. The macula appeared normal on repeated exams during follow-up.ConclusionSimilar OCT findings were demonstrated in patients with CSD neuroretinitis. SRF was found in all eyes, although was not visible on clinical examination or fluorescein angiography. OCT may be used as an adjunct imaging tool in the diagnosis and follow-up of patients with CSD neuroretinitis.

Diameters of retinal blood vessels in a healthy cohort as measured by spectral domain optical coherence tomography.

Purpose: To describe a method for measuring the diameters of large retinal blood vessels by means of spectral domain optical coherence tomography. Methods: Prospective cohort study of 29 healthy subjects (58 eyes) who underwent a spectral domain optical coherence tomography examination. Two cubes of horizontal scans were placed at the superior and inferior borders of the disk to include the large temporal retinal vessels. Vessels diameters were measured, and an artery-to-vein ratio was calculated at 10 measurement points (480–1440 &mgr;m superiorly and inferiorly from the optic disk border). Results: The mean age of the study subjects was 41.45 ± 15.53 years. Patients had no ocular or systemic pathologies. The mean diameter of the retinal artery was 135.73 ± 15.64 &mgr;m and of the vein 151.32 ± 15.22 &mgr;m at the measurement point of 480 &mgr;m, with a gradual decrease to 123.01 ± 13.43 &mgr;m and 137.69 ± 13.84 &mgr;m, respectively, at 1440 &mgr;m. The artery-to-vein ratio was ∼0.9 at all points of measurement. Conclusion: This is a new noninvasive method for retinal blood vessels diameter measurement using the spectral domain optical coherence tomography imaging modality. This method may aid in evaluation of retinal and systemic vascular diseases.

Long-term outcome of an intravitreal dexamethasone implant for the treatment of noninfectious uveitic macular edema.

Purpose: To report the long-term outcome of an intravitreal dexamethasone drug delivery system (DEX-DDS) injection for noninfectious uveitic macular edema. Methods: This was a retrospective study of 8 eyes (7 patients). Results: The mean follow-up time was 17.3 months. Macular edema resolved in all eyes at 3.9 weeks (range 1-6.9) postinjection. The central point thickness improved from 612 ± 143 to 250 ± 55 µm (p < 0.05). The mean best corrected visual acuity improved by 0.25 logMAR (p < 0.05) at 3.9 weeks (range 1-6.9) postinjection. In 5 eyes, macular edema did not recur after a mean follow-up of 14.5 months. In 3 eyes, macular edema relapsed after 4.7 months (range 3.6-6.3) and resolved again following further injections. Two eyes developed intraocular pressure elevation, which was well controlled with topical treatment. Conclusions: Intravitreal DEX-DDS injections resulted in resolution of macular edema and visual acuity improvement. Some eyes required repeated injections, but most eyes achieved long-term resolution. No significant complications were noticed.

Eplerenone for chronic central serous chorioretinopathy–a randomized controlled prospective study

To evaluate the efficacy and safety of eplerenone for chronic nonresolving central serous chorioretinopathy (CSC).

Switching Treatment For Neovascular Age-related Macular Degeneration From Bevacizumab To Ranibizumab: Who is Likely to Benefit From the Switch?

Purpose: To evaluate the safety and efficacy of switching from bevacizumab to ranibizumab in patients with neovascular age-related macular degeneration. Methods: Retrospective study of patients with neovascular age-related macular degeneration initially treated with bevacizumab and switched to ranibizumab. Visual acuity and central retinal thickness (CRT) were retrieved at four time points: before the last three bevacizumab injections, at the switch, after the first three ranibizumab injections, and at the end of follow-up. Results: One hundred and fourteen eyes of 110 patients were included. Switching from bevacizumab to ranibizumab did not achieve a significant change in visual acuity, and a significant reduction in CRT was achieved after the first three injections but was not maintained by the end of follow-up. Eyes that lost ≥0.1 logMAR before the switch were more likely to improve in visual acuity (P = 0.013), and eyes with ≥10% increase in CRT before the switch were more likely to improve anatomically (P = 0.0003). In 47.3% of the eyes, the CRT was reduced by ≥10% after the first 3 ranibizumab injections, and the reduction was maintained with additional injections. Conclusion: Switching to ranibizumab should be considered in patients with visual acuity decrease or CRT increase, despite monthly bevacizumab injections. The response should be evaluated after the first three injections to guide future treatment.