Gerlinde Matt

Response of Retinal Vessels and Retrobulbar Hemodynamics to Intravitreal Anti-VEGF Treatment in Eyes with Branch Retinal Vein Occlusion

PURPOSE To investigate whether intravitreal ranibizumab (0.05 mL) treatment affects retinal vessel diameters and retrobulbar blood velocities in patients with acute branch retinal vein occlusion (BRVO). METHODS Thirty patients with clinically significant macular edema secondary to BRVO were included. The duration of the study was three months. Patients were studied before and one week, one month, two months, and three months after the first ranibizumab injection. Depending on the clinical requirements, up to three ranibizumab injections were administered. Retinal vessel diameters were measured using a retinal vessel analyzer. Flow velocities in the retrobulbar central retinal artery were measured using color doppler imaging. Best-corrected visual acuity was assessed using ETDRS charts. Measurements were done in the affected as well as in the contralateral eye. RESULTS Three patients were lost for follow up. In the remaining 27 patients, significant vasoconstriction was observed in retinal veins (P < 0.001 versus baseline) and in retinal arteries (P = 0.001 versus baseline) of the affected eyes. In addition, a significant reduction in flow velocities was observed in the BRVO eyes over time (peak systolic velocity: P = 0.003, end diastolic velocity: P = 0.003). The reduction in retinal vessel diameters and flow velocities did not correlate with changes in visual acuity or number of re-treatments. In the contralateral eyes no change in retinal blood flow parameters was seen. CONCLUSIONS BRVO is an ischemic retinal disease. Given that ranibizumab treatment reduces retinal perfusion in these eyes the potential long-term effects of this vasoconstriction need to be considered.

Performance of OCT segmentation procedures to assess morphology and extension in geographic atrophy

Purpose:  Investigating segmentation procedures and morphological findings in time domain (TD) and current spectral domain (SD) optical coherence tomography (OCT) devices in patients with geographic atrophy (GA).

Thirty-month follow-up after intravitreal bevacizumab in progressive idiopathic macular telangiectasia type 2

AimThe aim of this study is to evaluate the long-term efficacy of intravitreal bevacizumab (IVB) for eyes with non-proliferative idiopathic macular telangiectasia type 2 (IMT2) and acute vision loss.MethodsIn this interventional case series, treatment-naive eyes of 13 consecutive patients with IMT2 were included. Eyes with a recent onset of visual loss were treated with 0.04 ml IVB (n=7). Fellow eyes and eyes of patients without disease progression served as control group (CG) (n=12). Follow-up examinations included ophthalmoscopy, best-corrected visual acuity (BCVA), optical coherence tomography, and fluorescein angiography (FA).ResultsMean follow-up time was 32±5.7 months in the treatment group (TG) (n=7) vs 29±8.8 months in the CG (n=16). Mean BCVA increased from logMAR 0.47±0.32 at baseline to logMAR 0.33±0.31 (P=0.21) at the last visit in the TG and decreased from logMAR 0.25±0.39 to logMAR 0.30±0.40 in the CG (P=0.17). All patients in the TG showed stabilisation or improvement in vision in Snellen lines in contrast to the CG (χ2-test P=0.04). Patients received on average 2.3±1.3 IVB injections. Mean central millimetre thickness in TG and CG was 260±83 and 201±32 μm at baseline vs 237±69 and 199±29 μm at the last visit, respectively (P=0.23 and 0.77). FA revealed a significant decrease of the juxtafoveal staining size at month 3 (P= 0.004) and a slight reduction at the last visit (P= 0.11) in the TG.ConclusionDespite an overall moderate effect of IVB treatment, individual patients experience a marked functional and morphological long-term benefit.

Comparison of retinal thickness values and segmentation performance of different OCT devices in acute branch retinal vein occlusion.

PurposeTo compare retinal thickness (RT) measurement and segmentation performance of time domain (TD, Stratus) and spectral domain (SD) optical coherence tomography (OCT) devices (Cirrus, Spectralis) for imaging macular oedema (ME) secondary to branch retinal vein occlusion (BRVO).MethodsIn this study, 20 eyes of 20 consecutive patients with acute BRVO were included. A total of 18 unaffected fellow eyes served as control group. RT measurement was analysed in the five inner fields of the early-treatment diabetic retinopathy grid, and proportional segmentation errors were evaluated.ResultsCentral millimetre thickness (CMT) showed a mean difference of −64, −74, and −18 μm (P<0.001) in the control group and −31 μm (P=0.107), −92 μm (P<0.001), and −105 μm (P=0.016) in the BRVO group, between Stratus and Cirrus, between Stratus and Spectralis, and between Cirrus and Spectralis, respectively. Mean RT showed the highest variability between different devices in the area most intensively affected by BRVO-related ME. In eyes with BRVO, 14.6% of Spectralis, 20% of Stratus, and 36.6% of Cirrus scans demonstrated moderate and severe segmentation errors.ConclusionRT measurement in eyes with BRVO, by TD and SD OCT, is compromised by a significant rate of segmentation errors. Deviations are most pronounced in the areas most severely affected by ME.

[Combination of Intravitreal rTPA, gas and ranibizumab for extensive subfoveal haemorrhages secondary to neovascular age-related macular degeneration].

BACKGROUND The aim of this study was to evaluate the clinical outcomes of the combination therapy with intravitreal recombinant tissue plasminogen activator (rTPA), gas and lucentis for patients with extensive subfoveal haemorrhages secondary to neovascular age-related macular degeneration (AMD). METHODS In this retrospective clinical study 10 eyes with extensive subfoveal haemorrhages secondary to neovascular AMD were included and treated with intravitreal rTPA (0.05 mL; 0.025 mg/0.1 mL in 0.9% NaCl), 100% sulphur hexafluoride (SF(6)) gas (0.5 mL) and lucentis (0.05 mL, 10 mg/mL) within two weeks after the onset of the subretinal haemorrhage. Retreatments with lucentis were performed at 4-week intervals if there were persistent submacular haemorrhages or signs of active choroideal neovascularisation (CNV). The treatment effect was evaluated using best-corrected visual acuity (VA, Snellen), complete ophthalmic examination, fluorescein angiography (FLA) and optical coherence tomography (OCT). RESULTS Mean observation period was 6.4 A+/- 3.7 months (range: 3 - 13 months). With regard to VA, in 7 eyes there was an increase in VA (> or = 1 Snellen lines), in 1 eye a stabilisation and in 2 eyes a decrease in VA (> or = 1 Snellen lines). At the end of follow-up time, with regard to VA no significant difference was observed compared to baseline (p = 0.41). In 1 patient an intra-operative transient central arterial occlusion and in another patient a corneal erosion and an increase of intraocular pressure up to 27 mmHg were observed after initial combination treatment. On average there were 1.9 A+/- 1.3 retreatments indicated after initial treatment. CONCLUSION The combination of rTPA, gas and lucentis is a valuable therapy for extensive subfoveal haemorrhages secondary to neovascular AMD resulting in stabilisation of both VA and morphologic parameters.

Response of retinal sensitivity to ranibizumab treatment of macular edema after acute branch retinal vein occlusion.

Purpose: To evaluate microperimetry changes in patients with acute macular edema secondary to branch retinal vein occlusion during a follow-up period of 12 months with intravitreal ranibizumab treatment (Lucentis; Novartis). Methods: Patients with macular edema secondary to branch retinal vein occlusion received an intravitreous injection of 0.5 mg of ranibizumab (0.05 mL). Best-corrected visual acuity, Spectralis OCT (Heidelberg Engineering), and color fundus photography were performed at monthly intervals over a follow-up period of 1 year. Macular function was documented by microperimetry (Nidek, MP-1) at baseline, 3, and 12 months. Results: Data of 20 patients without lack of microperimetry results were included to the statistical analyses. The size of the area of absolute scotoma was reduced from 16% at baseline to 11.7% at Month 3 and remained stable in the entire study duration (P > 0.05). Mean differential light threshold improved significantly under therapy from 9.47 dB at baseline to 12.53 dB at 12 months (P < 0.001). Best-corrected visual acuity correlated significantly with central millimeter thickness and mean retinal sensitivity at baseline and at 12-month follow-up visits. Conclusion: In addition to anatomical restoration and increased visual acuity, intravitreal ranibizumab also improved the central macular function in patients with acute macular edema after branch retinal vein occlusion.

Use of systemic steroid after successful macular surgery in eyes with epiretinal membrane: a randomized, controlled clinical study

PurposeTo evaluate the functional and morphological outcomes of postoperative systemic steroid therapy after successful macular surgery in eyes with macular edema due to idiopathic macular epiretinal membranes (ERMs).DesignProspective, randomized, investigator-masked, controlled clinical study.MethodsTwenty-eight patients scheduled for 23-gauge vitrectomy combined with ERM and inner limiting membrane (ILM) peeling for macular edema due to ERM were included in this single center trial. Patients were randomized to receive oral steroid therapy (Prednisolone, 100 mg per day for 5 days) or no oral steroid (control group) after surgery. Main outcome measures included best corrected visual acuity (BCVA; Early Treatment Diabetic Retinopathy Study), central retinal thickness (CRT), retinal volume (RV), and macular morphology as determined by spectral domain optical coherence tomography (SD-OCT, Cirrus). Examinations were carried out preoperatively and at week 1, at months 1 and 3, postoperatively.ResultsAt month 3, mean BCVA improved to a eight-letter gain in each study group (P<0.01 compared with baseline for both groups), showing no statistically significant difference between both the groups (P=0.19). Morphologically, retinal surface folds resolved within 1 month after surgery in both treatment groups, followed by a progressive recovery of retinal layer integrity and a statistical significant (P<0.01) decrease in CRT and RV without significant differences between both groups (P=0.62, P=0.13, respectively, ANOVA between the groups).ConclusionThe early postoperative use of systemic steroid treatment after successful vitrectomy combined with ERM and ILM peeling does not seem to improve significantly the anatomic and functional outcomes in eyes with ERM.

Detection and Differentiation of Intraretinal Hemorrhage in Spectral Domain Optical Coherence Tomography

ABSTRACT Purpose: The purpose of this study was to classify and detect intraretinal hemorrhage (IRH) in spectral domain optical coherence tomography (SD-OCT). Methods: Initially the presentation of IRH in BRVO-patients in SD-OCT was described by one reader comparing color-fundus (CF) and SD-OCT using dedicated software. Based on these established characteristics, the presence and the severity of IRH in SD-OCT and CF were assessed by two other masked readers and the inter-device and the inter-observer agreement were evaluated. Further the area of IRH was compared. Results: About 895 single B-scans of 24 eyes were analyzed. About 61% of SD-OCT scans and 46% of the CF-images were graded for the presence of IRH (concordance: 73%, inter-device agreement: k = 0.5). However, subdivided into previously established severity levels of dense (CF: 21.3% versus SD-OCT: 34.7%, k = 0.2), flame-like (CF: 15.5% versus SD-OCT: 45.5%, k = 0.3), and dot-like (CF: 32% versus SD-OCT: 24.4%, k = 0.2) IRH, the inter-device agreement was weak. The inter-observer agreement was strong with k = 0.9 for SD-OCT and k = 0.8 for CF. The mean area of IRH detected on SD-OCT was significantly greater than on CF (SD-OCT: 11.5 ± 4.3 mm2 versus CF: 8.1 ± 5.5 mm2, p = 0.008). Conclusions: IRH seems to be detectable on SD-OCT; however, the previously established severity grading agreed weakly with that assessed by CF.

Morphologic characteristics of idiopathic juxtafoveal telangiectasia using spectral-domain and polarization-sensitive optical coherence tomography.

Purpose Idiopathic juxtafoveal telangiectasia (IJT) is characteristically associated with pigmentary changes. Polarization-sensitive spectral-domain optical coherence tomography (PS-SD-OCT) enables imaging of the retinal pigment epithelium (RPE) and similar melanin-containing structures based on specific polarization properties. This study examined IJT with the latest-generation SD-OCT and PS-SD-OCT, identifying pathophysiologically relevant characteristics of the retinal layers and RPE. Methods Twenty-two eyes of 12 patients with IJT were examined by PS-SD-OCT, with special focus on RPE detection and segmentation. Furthermore, SD-OCT technology (Cirrus, Spectralis, and 3D-OCT-1000) was applied. Characteristics of the retinal layers and RPE were evaluated. A classification system based on OCT characteristics of IJT was suggested. Results Polarization-sensitive spectral-domain optical coherence tomography together with SD-OCT identified characteristic patterns of IJT, used to classify eyes into three distinct groups. Group 1 (5 eyes) revealed discrete alterations in the inner retinal layers; group 2 (12 eyes) showed irregularities of the junction between the inner and outer photoreceptor segments with outer retinal atrophy but an intact RPE. Group 3 (5 eyes) revealed RPE irregularities and loss in addition to intraretinal alterations and photoreceptor abnormalities. Conclusion This study described characteristic morphologic changes in IJT based on PS-SD-OCT and SD-OCT. Morphologic changes were classified, possibly leading to an OCT-based grading scheme. The intensity images of SD-OCT verified intraretinal and photoreceptor irregularities in great detail, whereas PS-SD-OCT additionally showed RPE alterations.

Multimodal Imaging of Cotton Wool Spots in Branch Retinal Vein Occlusion

Purpose: To describe and follow cotton wool spots (CWS) in branch retinal vein occlusion (BRVO) using multimodal imaging. Methods: In this prospective cohort study including 24 patients with new-onset BRVO, CWS were described and analyzed in color fundus photography (CF), spectral domain optical coherence tomography (SD-OCT), infrared (IR) and fluorescein angiography (FA) every 3 months for 3 years. The CWS area on SD-OCT and CF was evaluated using OCT-Tool-Kit software: CWS were marked in each single OCT B-scan and the software calculated the area by interpolation. Results: 29 central CWS lesions were found. 100% of these CWS were visible on SD-OCT, 100% on FA and 86.2% on IR imaging, but only 65.5% on CF imaging. CWS were visible for 12.4 ± 7.5 months on SD-OCT, for 4.4 ± 3 months and 4.3 ± 3.4 months on CF and on IR, respectively, and for 17.5 ± 7.1 months on FA. The evaluated CWS area on SD-OCT was larger than on CF (0.26 ± 0.17 mm2 vs. 0.13 ± 0.1 mm2, p < 0.0001). The CWS area on SD-OCT and surrounding pathology such as intraretinal cysts, avascular zones and intraretinal hemorrhage were predictive for how long CWS remained visible (r2 = 0.497, p < 0.002). Conclusions: The lifetime and presentation of CWS in BRVO seem comparable to other diseases. SD-OCT shows a higher sensitivity for detecting CWS compared to CF. The duration of visibility of CWS varies among different image modalities and depends on the surrounding pathology and the CWS size.