Javier A. Montero

Macular Choroidal Thickness in Normal Pediatric Population Measured by Swept-Source Optical Coherence Tomography

PURPOSE To evaluate choroidal thickness in healthy pediatric population by swept-source longer-wavelength optical coherence tomography (SS-OCT). METHODS This was a cross-sectional comparative, noninterventional study. The macular area of 83 eyes from 43 pediatric patients (<18 years) was studied with an SS-OCT prototype system. Macular choroidal thickness was manually determined at 750-μm intervals by measuring the perpendicular distance from the posterior edge of the RPE to the choroid/sclera junction, along a horizontal 4500-μm line centered in the fovea. Three observers independently determined choroidal thickness. Pediatric choroidal thickness was compared with choroidal thickness from 75 eyes from 50 normal healthy adult volunteers (18 years or older). RESULTS Mean age was 10 ± 3 years (3-17) in the pediatric population versus 53 ± 16 (25-85) in the adult population (P < 0.001). Mean spherical equivalent was not different (P = 0.06) between both groups. Mean subfoveal choroidal thickness was 312.9 ± 65.3 μm in the pediatric versus 305.6 ± 102.6 μm in the adult population (P = 0.19). Mean macular choroidal thickness was 285.2 ± 56.7 μm in the pediatric versus 275.2 ± 92.7 μm in the adult population (P = 0.08). The distribution of choroidal thickness along the horizontal line was different for both populations; the temporal choroid was thicker in the pediatric population (320, 322, and 324 μm; P = 0.002, 0.001, and 0.06, respectively), followed by the subfoveal (312 μm) and nasal choroid (281, 239, and 195 μm). CONCLUSIONS Macular choroidal thickness in the pediatric population is not significantly thicker than that of healthy adults. Differences are more remarkable in the temporal side of the fovea.

Direct comparison of spectral-domain and swept-source OCT in the measurement of choroidal thickness in normal eyes

Objective To compare spectral-domain optic coherence tomography (SD-OCT) and swept-source OCT (SS-OCT) in the study of choroidal thickness (CT) in healthy eyes. Methods Prospective, cross-sectional, single-centre study. 82 healthy eyes of 46 patients were included. In a single session, Topcon 3D-2000 SD-OCT and 1050 nm SS-OCT prototype devices were used to perform OCT scans using a single line protocol. Two masked investigators independently, manually determined 13 CT measurements consisting of one subfoveal (SFCT), and six measurements on either side of the fovea (nasal and temporal) taken every 500 microns apart. The mean CT (MCT) was the mean average of these 13 measurements. Results SD-OCT was able to reproducibly measure the CT in 74.4% of eyes vs 100% with SS-OCT (p<0.05; Fishers Exact test). In those eyes measured by both systems, mean SFCT was 279.4±96.9 μm (range, 84–506) with SD-OCT vs 285.7±88.9 μm (range 130–527) with SS-OCT (p=0.11; Students t test paired data). Mean MCT was 243.8±78.8 μm (range 103.6–433.2) with SD-OCT vs 242.2±81.8 μm (range 97.6–459) with SS-OCT (p=0.64; Students t test paired data). The difference in SFCT and MCT was not statistically significant between both devices. Intraclass correlation coefficient was higher than 0.9 interobserver and interdevice measurements. SFCT Bland–Altman plots showed 95% interobserver measurement agreement within ±34 for SD-OCT, ±22 for SS-OCT and ±60 μm intersystems. Conclusions SS-OCT permitted accurate identification of the choroido-scleral border in 100% of normal eyes, suggesting that SS-OCT was the superior modality for the measurement of CT.

Intravitreal bevacizumab to treat subfoveal choroidal neovascularisation in highly myopic eyes: 1-year outcome

Aims: The aim of the study was to examine the changes in visual acuity, fluorescein angiography (FA) and optical coherence tomography (OCT) macular thickness of subfoveal, and juxtafoveal choroidal neovascularisation (CNV) in highly myopic eyes treated by intravitreal bevacizumab. Methods: The study was a prospective, non-randomised, multicentre, interventional case series. Twenty-nine highly myopic eyes from 28 patients with subfoveal and juxtafoveal CNV were treated by three monthly intravitreal injections of 1.25 mg bevacizumab. Patients were evaluated for best-corrected visual acuity (BCVA) and OCT at baseline and then monthly for 1 year. FA was performed at baseline, after 3 months, and whenever CNV activity was suspected. Results: The average age was 50 (SD 15, range 29–82) years. The mean LogMAR BCVA at baseline was 0.55 (SD 0.25, range 0.2–1.0) and 0.38 (SD 0.32, range 0.0–1.2) at 1 year. Sixteen eyes were naïve for treatment and 13 eyes had been previously treated by photodynamic therapy (average 2.5 sessions). Leakage from CNV had ceased in all eyes at month 3. OCT central foveal thickness decreased significantly from 282 (SD 68) μm at baseline to 224 (SD 46) μm at month 12 (p = 0.008, Student t test for paired data). Six eyes needed one re-injection during follow-up at month 4 (one eye), month 6 (four eyes) and month 12 (one eye). Neither ocular nor systemic adverse reactions appeared during follow-up. Conclusions: The results of this case series suggest that intravitreal bevacizumab seems to be an effective therapeutic procedure to treat subfoveal and juxtafoveal CNV in highly myopic eyes at 1-year follow-up. Further studies are required to verify the efficacy and usefulness of this therapy compared with established treatments for this condition.

Photodynamic therapy and high-dose intravitreal triamcinolone to treat exudative age-related macular degeneration: 2-year outcome.

Purpose: To evaluate the efficacy of photodynamic therapy with verteporfin (PDT) and high-dose intravitreous triamcinolone acetonide to treat choroidal new vessels (CNVs) associated with age-related macular degeneration (AMD). Methods: In this prospective, consecutive, comparative, nonrandomized, interventional case series, 30 consecutive eyes of 30 patients with subfoveal CNVs associated with AMD were treated with PDT followed by the intravitreal injection of 19.4 ± 2.1 mg /0.1 mL triamcinolone 5 days later. Fifteen eyes had received no previous treatment (group 1), and 15 had been treated previously with PDT alone (group 2). A group of 15 eyes of 15 patients treated with PDT alone, matched for age and CNV composition and size, served as controls. Changes in best-corrected visual acuity (BCVA; logMAR), the number of Snellen lines improved or lost, and the number of PDT sessions were considered as primary outcome indicators. Results: Group 1 improved an average of 0.7 ± 3.7 Snellen lines (range, −5 to 10) (P = 0.62), group 2 lost an average of −0.7 ± 1.5 Snellen lines (range, −5 to 1) (P = 0.08), and the control group lost an average of −2.2 ± 0.4 Snellen lines (range, -9 to 4) (P = 0.06; Wilcoxon signed rank test). The average number of PDT treatments during the 12-month follow-up was 1.6, 1.2, and 2.8 for group 1, group 2, and the control group, respectively. Intraocular pressure rose in 8 (57%) of 14 eyes in group 1 and in 7 (50%) of 14 eyes in group 2. Cataracts developed in 4 eyes (31%) in group 1 and in 4 eyes (33%) in group 2. Conclusion: Combined PDT/intravitreal triamcinolone acetonide as treatment for AMD-associated CNVs was associated with improved final BCVA and reduced the need for retreatment compared with historical controls.

Optical coherence tomography predictive factors for macular hole surgery outcome

Aim: To evaluate the use of preoperative optical coherence tomography (OCT) findings as predictive factors for macular hole (MH) surgery outcomes. Methods: 46 eyes from 46 patients with a diagnosis of MH were included in this study. In all cases, a pars plana 25-gauge vitrectomy with peeling of the internal limiting membrane was performed. Before and after surgery, a complete clinical examination and a detailed macular analysis, which included the MH minimum and base diameter, the MH height, the Macular Hole Index (MHI), Diameter Hole Index (DHI) and Tractional Hole Index (THI), were performed. Predictive factors for visual prognosis after surgery were obtained by receiver operating characteristic curve analysis. Results: Minimum and base diameter as well as THI and MHI correlated significantly (p<0.01, p = 0.01, p = 0.04, p = 0.03, respectively) with postoperative best spectacle corrected visual acuity at 3 months, but DHI and MH height did not. Cut-off values of 311 µm and 1.41 were obtained for the minimum diameter and THI, respectively, from receiver operating characteristic curve analysis, providing an acceptable sensitivity and specificity. Conclusion: An MH minimum diameter of <311 µm or a THI >1.41 are predictive factors for a good visual prognosis after MH surgery.

Photodynamic therapy for chronic central serous chorioretinopathy.

Purpose:  This study aimed to evaluate the efficacy of photodynamic therapy (PDT) in treating chronic central serous chorioretinopathy (CSC).

Intravitreal anti-VEGF therapy for choroidal neovascularisation secondary to pathological myopia: 4-year outcome

Objective To report the visual outcome after 4-year follow-up in a series of highly myopic eyes with choroidal neovascularisation (CNV) treated with antivascular endothelial growth factor (anti-VEGF) drugs. Methods A retrospective, non-randomised, multicentre, consecutive, interventional case series study was performed. 92 highly myopic eyes with subfoveal CNV were treated with intravitreal injection (IVI) of anti-VEGF. The initial protocol (1 vs 3 injections) was dictated by surgeons’ preferences and followed by an as-needed monthly regime. Best-corrected visual acuity (BCVA) was evaluated at baseline and then monthly. The primary aim was to analyse BCVA changes. The effect of age, spherical equivalent (SE) and treating drug were evaluated as secondary objectives. Results The mean age of the patients was 57 years (SD 14, range 30–93). The mean number of letters read was 46.1 (SD 16.8, range 5–70) at baseline, 55.5 (SD 18.6, range 10–85) at 12 months, 50.1 (SD 20.1, range 5–82) at 24 months, 54.2 (SD 21.9, range 2–85) at 36 months and 53.1 (SD 22.5, range 1–83) at 48 months (p=0.000, initial vs 12, 24 and 36 months; p=0.01 initial vs 48 months; Student t test for paired data). The mean total number of IVI was 4.9 (SD 5.4, range 1–29). SE and treating drug had no influence on the final visual outcome and number of injections required. Conclusions Intravitreal bevacizumab and ranibizumab are effective therapies and show similar clinical effects in highly myopic CNV. Visual acuity gain is maintained at 4-year follow-up.

Twelve-month outcome after one intravitreal injection of bevacizumab to treat myopic choroidal neovascularization.

Purpose: To report the changes during a 1-year follow-up in visual acuity and macular thickness in a series of highly myopic eyes with choroidal neovascularization treated with bevacizumab. Methods: Retrospective and multicenter study including 107 highly myopic eyes from 107 patients (mean age, 55 years) with subfoveal or juxtafoveal choroidal neovascularization. All cases were treated by one intravitreous injection of 1.25 mg bevacizumab. Best-corrected visual acuity and macular thickness with the optical coherence tomography were evaluated at baseline and then monthly during 1 year. Results: Logarithm of the minimum angle of resolution best-corrected visual acuity at baseline averaged 0.72 (standard deviation [SD], 0.43) versus 0.53 (SD, 0.41) at 1 year after treatment (P < 0.001). Logarithm of the minimum angle of resolution best-corrected visual acuity was 0.30 or better in 49 of 107 eyes (45%) at 1 year. Thirty-three eyes (30%) gained at least 3 Early Treatment Diabetic Retinopathy Study lines (15 letters) during the follow-up. In 43 eyes (40%), reinjections were necessary because signs of choroidal neovascularization activity were still evident. The mean number of reinjections was 0.8 (SD, 1.3). Best-corrected visual acuity improvement was better in the younger group (younger than 50 years). No adverse reactions were reported. Conclusion: One intravitreal bevacizumab injection seems to be an effective therapeutic approach to treat choroidal neovascularization in highly myopic eyes. Careful monitoring is necessary to assess the need for reinjections.

Photodynamic therapy for chronic central serous chorioretinopathy: a 4-year follow-up study.

Purpose: To evaluate the efficacy and safety of standard photodynamic therapy with verteporfin at 48 months in patients with chronic central serous chorioretinopathy. Methods: A retrospective, multicenter, interventional case series analysis in patients with chronic central serous chorioretinopathy, treated with standard photodynamic therapy, and with ≥4 years of follow-up. Evaluations were performed every 3 months in the first year, every 6 months in the second year, and thereafter annually. Optical coherence tomography was performed in all visits. Fluorescein angiography and indocyanine green angiography were performed at baseline and thereafter as necessary. Retinal thickness on optical coherence tomography was measured manually, evaluating central macular thickness and neural retina thickness. Main outcomes included the evolution of best-corrected visual acuity, the resolution of subretinal fluid, documented with optical coherence tomography, the number of treatments, and the evaluation of neural retina thickness during the 48 months of follow-up. Results: The study included 46 eyes of 42 patients, 38 men (90.4%) and 4 women (9.5%), with mean age of 49.19 ± 9.9 years (range, 32–70 years), and the minimal follow-up period was 48 months (mean, 56.8 ±10.3 months). Subretinal fluid was observed in all the included eyes at baseline, and 10 eyes (21.7%) had intraretinal diffuse or cystoid fluid. Concerning the mean best-corrected visual acuity, a statistically significant improvement (P < 0.01, Student t-test) was registered from 58.8 ± 18.3 letters at baseline to 66.9 ± 18.6 letters at 48th month. A complete resolution of subretinal fluid was achieved in 93.4%, and resolution of intraretinal fluid occurred in all 10 cases at 48 months. Neural retina thickness remained stable during the 48 months of follow-up (163.8 ± 47 &mgr;m at baseline and 163.8 ± 46 &mgr;m at 48 months). The mean number of treatments was 1.08 ± 0.3. No systemic or ocular side effects were registered. Conclusion: Standard photodynamic therapy with verteporfin was effective and safe in chronic central serous chorioretinopathy treatment with a significant improvement in the long term, both anatomic and visual, without inducing additional retinal atrophy or systemic adverse effects.

Retinal detachment in myopic eyes after phakic intraocular lens implantation.

PURPOSE: To analyze the risk of retinal detachment in highly myopic patients who underwent implantation of phakic intraocular lenses (PIOLs). METHODS: In a retrospective, non-comparative, interventional case series, the occurrence of retinal detachment was analyzed in 522 consecutive highly myopic eyes (323 patients) that underwent PIOL implantation. Treatment and results were reviewed. Parameters evaluated were best corrected visual acuity before and after retinal detachment surgery and time between refractive surgery and retinal detachment. RESULTS: Fifteen (2.87%) eyes presented with retinal detachment after PIOL implantation, with a mean time between surgery and detachment of 24.4 +/- 24.4 months (range: 1 to 92 months). The risk of retinal detachment in patients with high myopia corrected by PIOL implantation was 0.57% at 3 months, 1.64% at 12 months, 2.73% at 36 months, and 4.06% at 92 to 145 months (Kaplan-Meier analysis). A comparative study between the group of patients with retinal detachment and the remaining patients without retinal detachment was performed. Differences were found in axial length (30.65 +/- 1.97 vs 29.51 +/- 2.02; P=.028, one factor-analysis of variance test). CONCLUSIONS: The risk of retinal detachment in eyes implanted with phakic lenses for the correction of high myopia is higher in eyes with axial length >30.24 mm.