Marcin Stopa

Correlation of pathologic features in spectral domain optical coherence tomography with conventional retinal studies.

Purpose: To delineate pathologic changes in retinal cross sections obtained with spectral (Fourier) domain optical coherence tomography (SDOCT), so that the findings are maintained when collapsed into a two-dimensional fundus image for comparison with conventional retinal studies. Methods: SDOCT of the posterior pole of 12 eyes (5 with neovascular age-related macular degeneration [AMD]; 7 with nonneovascular AMD) produced three-dimensional stacks of scans. Location of pathologic features was delineated with color markings in each scan before the stack was collapsed along the depth axis. This en face image contained retinal vessel shadowing and preserved color markings of delineated pathologic features relative to the vessel pattern and was superimposed onto conventional studies. Results: For patients with neovascular AMD, location and extent of choroidal neovascularization, macular edema, and subretinal fluid were visible on the two-dimensional summed images and, in some cases, involved sites not suspected with conventional imaging. For patients with nonneovascular AMD, the location of drusen and geographic atrophy were correlated with autofluorescence images. For one eye with drusen and three eyes with neovascular AMD, presence or extent of subretinal fluid identified by SDOCT was not visible using other imaging methods. Conclusions: In this pilot AMD study, pathologic features within SDOCT scans were transferred into two-dimensional en face projections, enabling researchers to correlate lateral extent of pathologic features from SDOCT with conventional studies. This integration of SDOCT with other retinal studies is promising and will be useful to study the relationship between local OCT morphology and other parameters of retinal disease or function.

Cutting the encircling band.

Purpose: To report the effect of cutting the encircling band on ocular blood flow. Methods: In an interventional case series of 27 eyes with an encircling band, the ocular pulse amplitude (OPA) was measured and pulsatile ocular blood flow (POBF) derived and compared with fellow eyes. The bands were cut in 11 eyes and the POBF measured at 1 month, 3 months, and 1 year. Changes in POBF, buckle height, and visual acuity were determined. Results: The presence of the encircling band reduced the POBF to a mean of 43% (P < 0.001) of the fellow eye. Cutting the band resulted in a mean recovery to 85.6%. No retina detached after cutting, buckle height was only slightly diminished, and the visual acuity was unaffected. Conclusion: An encircling band diminishes the POBF. Cutting the band restores significant flow.

Analysis of forces acting upon submacular hemorrhage in pneumatic displacement.

Purpose: To analyze the forces affecting pneumatic displacement of submacular hemorrhage and determine an efficient postoperative positioning method for patients. Method: Geometric analysis of the forces that act upon submacular hemorrhage in the absence and presence of a gas bubble. Results: A component of gravity force of the hemorrhage parallel to the subretinal space is responsible for pneumatic displacement. This component is largest when the patient is looking straightforward and is absent when the patient is positioned facedown. Conclusion: Face down positioning is not optimal for pneumatic displacement of submacular hemorrhage and should be avoided.

A 40° GAZE DOWN POSITION FOR PNEUMATIC DISPLACEMENT OF SUBMACULAR HEMORRHAGE: Clinical Application and Results

Purpose: To test the validity of the geometric conclusion that 40° gaze down is optimal for pneumatic displacement of a subretinal hemorrhage (SRH) in the macula. Methods: Nine consecutive patients with SRH in the macula had an intravitreal injection of perfluorocarbon gas sufficient to cover the macula when the patient gazed down 40° below the horizontal. They were asked to maintain the gaze down position for 20 minutes every hour while awake. Results: The SRH in eight of nine patients was displaced rapidly in the first week. Visual acuity improved in seven patients. Visual recovery was limited by the presence of a subpigment epithelial component. Conclusions: Gaze 40° below the horizontal will rapidly displace a subretinal hemorrhage that is covered by a gas bubble.

Ambulatory binocular occlusion.

Purpose: To show the efficacy of ambulatory binocular occlusion in the management of vitreous hemorrhage and rhegmatogenous retinal detachment. Methods: Nine eyes with a vitreous hemorrhage, rhegmatogenous retinal detachment, or both were managed initially by ambulatory binocular occlusion before the definitive treatment of the underlying cause was carried out. Results: In four eyes with a vitreous hemorrhage of rhegmatogenous origin, binocular occlusion resulted in sufficient clearing of the media to allow visualization and treatment of the breaks. In another four eyes with a rhegmatogenous detachment, binocular occlusion reduced the extent of the detachment and made possible a less morbid solution than initially planned. In one eye with a vitreous hemorrhage of diabetic origin, binocular occlusion enabled panretinal photocoagulation. Conclusion: The benefit of binocular occlusion can be obtained on an outpatient regimen that permits moderate ambulation.

PARS PLANA VITRECTOMY IN ADVANCED CASES OF VON HIPPEL-LINDAU EYE DISEASE.

Purpose: To investigate spectrum of patients with Von Hippel–Lindau disease (VHL) that required pars plana vitrectomy and evaluate anatomical and functional outcomes of surgery. Methods: Twenty-three patients who underwent surgery for advanced VHL eye disease were assessed by genetic tests, diagnostic tests for systemic lesions, and clinical eye examination. The vitrectomized eyes were divided into two groups: with or without retinotomy (group R vs. NR). Functional and anatomical outcome was analyzed and compared between the groups. Results: All patients had central nervous system hemangioblastomas and 57% had other systemic tumors. Point germline mutations, large partial deletions, and complete vhl gene deletions were found in 64%, 27%, and 9% of patients, accordingly. Destruction of hemangioblastomas by retinotomy, laser, or cryotherapy and anatomical attachment of the retina were achieved in all eyes. Preoperative mean distance best-corrected visual acuity was logarithm of the minimum angle of resolution 2.66 (20/9,140) in group R and 1.76 (20/1,150) in group NR (P < 0.05). At 6 months postoperatively, distance best-corrected visual acuity improved in 20 eyes (83%). After over 24 months postoperatively, distance best-corrected visual acuity remained better than preoperatively in 36% in the R group and in 70% in the NR group of eyes. During 24 months postoperatively in 17 eyes, new retinal capillary hemangiomas developed. The mean number of new retinal capillary hemangiomas per eye was higher in group R than in group NR (3.14 vs. 0.70; P < 0.01). In group R, number of new retinal capillary hemangioblastoma was higher in retinal segments where retinotomy was performed (n = 29) than in other areas (n = 13) (P < 0.01). Conclusion: Advanced VHL eye disease correlates with occurrence of central nervous system and systemic lesions. Spectrum of vhl gene mutation in the patients corresponds to that of the general VHL population. Pars plana vitrectomy in advanced VHL eye disease can improve or preserve visual function, but postoperative progression of ocular VHL disease can be accelerated in cases where retinotomy is performed.

A modified laser test for the identification of retinoschisis.

PURPOSE To describe a modified laser technique for identification of bullous retinoschisis. DESIGN Retrospective interventional case series collected over 10 years. METHODS Forty-one eyes with presumed bullous retinoschisis and breaks in the inner layers underwent a low-energy argon green laser application at the same energy as a control spot in adjacent retina. A gray response in the outer layers equal to the control spot was diagnostic of retinoschisis. RESULTS The laser test was positive for retinoschisis in 40 of 41 eyes. In none of the 40 eyes did the elevation progress. CONCLUSIONS A low-energy argon green laser application through a break in the inner layers of presumed retinoschisis eliminates the attenuation of the beam and can confirm retinoschisis.

Systematic Review of Efficacy and Safety of Surgery for Primary Retinal Detachment

There is currently a debate about whether the buckle operation should be replaced by two intraocular procedures, pneumatic retinopexy and vitrectomy, for the repair of retinal detachment. To obtain comparative results, we examined case series in the literature from 1972 to 2003 that enrolled patients with primary retinal detachment who were treated by either pneumatic retinopexy, vitrectomy, or segmental buckling.

Primary uveal lymphoma effectively managed with oral chlorambucil: a case report

IntroductionOcular lymphomas account for five to 10 percent of all extra-nodal lymphomas. Primary uveal lymphoma is quite a rare entity and usually unilateral. We present a case of a primary uveal lymphoma with conjunctival and orbital extension, successfully managed with oral chlorambucil.Case presentationA 71-year-old Caucasian man presented to our facility with visual loss in his only functioning eye (left). On clinical examination, we found a conjunctival lesion with a choroidal infiltration and a secondary retinal detachment. Ultrasound and magnetic resonance imaging studies revealed a choroidal tumour mass and two other lesions around the optic nerve. Results from an incisional biopsy revealed a low-grade B-cell lymphoma (CD20+, CD43+, bcl2+, CD3-). A diagnosis of primary uveal lymphoma was made. Our patient was started on a chemotherapy regime with no effect, and then oral chlorambucil was administered, with a relatively good result. At 10 months after the start of chlorambucil treatment, a best-corrected visual acuity of 0.4 was recorded, the choroidal mass had practically disappeared and the extra-ocular lesions had shrunk.ConclusionsIn all, 61 to 80 cases of primary uveal lymphoma have already been described in the literature. Generally, it is an indolent tumor with a good prognosis. However, there are some reports of aggressive tumor behavior a few years after initial diagnosis (about eight percent of cases). Other treatment options are orbital irradiation at low doses (20 to 40 Gy) or steroid administration. This is the first documented report of the efficacy of oral chlorambucil in the treatment of primary uveal lymphoma.

Anatomy and function of the macula in patients after retinectomy for retinal detachment complicated by proliferative vitreoretinopathy

Purpose TO investigate the anatomy and function of the macula in patients after retinectomy for retinal detachment complicated by proliferative vitreoretinopathy (PVR) grade C. Methods A prospective study involving 25 patients operated with vitrectomy and retinectomy due to retinal detachment complicated by PVR grade C. Outcome measures included preoperative and postoperative best-corrected visual acuity (BCVA) at 6 months and the difference between preoperative and postoperative BCVA. Furthermore, the macular status was analyzed on postoperative optical coherence tomography (OCT) scans. Results Reattachment was observed in 96% (24/25) of patients. Median BCVA improved from 2.30 logMAR (range 1.00 to 2.69 logMAR) to 1.00 logMAR (range 0.38 to 2.90 logMAR). The change from preoperative visual acuity was statistically significant (p=0.0003, Wilcoxon signed rank test). Macular status with pathologies was observed in 75% of eyes on OCT (retinal pigment epithelium irregularities 37.5%, cystoid macular edema 33%, epiretinal membrane 8.3%, subretinal fluid 4%, and subretinal perfluorocarbon liquid 4%). These eyes had significantly worse final visual acuity (p=0.01, Wilcoxon rank sum test) compared to those with a clinically normal macula. The retinectomy size influenced neither visual acuity (p=0.06, Wilcoxon rank sum test) nor incidence of normal macular status (p=0.14, Fisher exact test). Conclusions Even though retinectomy is an effective technique to reattach the retina in complicated cases of retinal detachment, the functional outcome was found to be influenced by abnormal macular status, observed in 75% of eyes. Moreover, 360-degree retinectomies did not show different anatomic or functional results vs subtotal ones.