Mónika Ecsedy

Effect of Femtosecond Laser Cataract Surgery on the Macula

PURPOSE To compare the effect of conventional and femtosecond laser-assisted (Alcon LenSx Inc) phacoemulsification on the macula using optical coherence tomography (OCT). METHODS Twenty eyes of 20 patients underwent uneventful cataract surgery in both study groups: femtosecond laser-assisted (laser group) and conventional phacoemulsification (control group). Macular thickness and volume were evaluated by OCT preoperatively and 1 week and 1 month postoperatively. Primary outcomes were OCT retinal thickness in 3 macular areas and total macular volume at 1 week and 1 month postoperative. Secondary outcomes were changes in retinal thickness at 1 week and 1 month postoperatively, with respect to preoperative retinal thickness values and effective phacoemulsification time. RESULTS Multivariable modeling of the effect of surgery on postoperative macular thickness showed significantly lower macular thickness in the inner retinal ring in the laser group after adjusting for age and preoperative thickness across the time course (P=.002). In the control group, the inner macular ring was significantly thicker at 1 week (mean: 21.68 μm; 95% confidence limit [CL]: 11.93-31.44 μm, P<.001). After 1 month, this difference decreased to a mean of 17.56 μm (95% CL: -3.21-38.32 μm, P=.09) and became marginally significant. CONCLUSIONS Results of this study suggest that femtosecond laser-assisted cataract extraction does not differ in postoperative macular thickness as compared with standard ultrasound phacoemulsification.

Macular morphology assessed by optical coherence tomography image segmentation after femtosecond laser–assisted and standard cataract surgery

PURPOSE: To evaluate and compare thickness changes in the retinal layers in the macula with optical coherence tomography (OCT) segmentation software after femtosecond laser–assisted phacoemulsification (study group) and conventional phacoemulsification (control group). SETTING: Department of Ophthalmology, Semmelweis University, Budapest, Hungary. DESIGN: Case‐control study. METHODS: Total retinal thickness of the macula was evaluated using Stratus OCT 4 to 8 weeks postoperatively. The OCT images were segmented using OCT retinal image analysis software. Regional thickness data in the central area, inner rings, and outer rings were obtained and absolute and relative thicknesses of the individual retinal layers in the 2 study groups compared. Relative thickness was calculated as the ratio of the retinal layer to the total retinal thickness. RESULTS: All surgeries were uneventful. Statistically significant differences were found in absolute outer nuclear layer thickness and relative outer nuclear layer thickness in the inner and outer macular rings between the 2 groups. After adjusting for effective phaco time in multivariate modeling, type of surgery showed a significantly lower relative outer nuclear layer ratio in the inner retinal ring (0.26 with 95% confidence interval [CI], 0.25‐0.27 versus 0.28 with 95% CI, 0.27‐0.29; P=.03) and in the outer retinal ring (0.27 with 95% CI, 0.25‐0.28 versus 0.29 with 95% CI, 0.28‐0.31; P=.02) in the study group. CONCLUSION: After cataract surgery, macular edema was detectable mainly in the outer nuclear layer in both groups but was significantly less using the femtosecond laser platform. Financial Disclosure: Dr. Nagy is a consultant to Alcon‐LenSx Lasers, Inc. The University of Miami and Dr. Cabrera DeBuc hold a pending patent used in the study (U.S. patent 61/139,082) and have the potential for financial benefit from its future commercialization. Drs. Ecsedy, Kovács, Takács, Tátrai, and Somfai have no financial or proprietary interest in any material or method mentioned.

The role of reference body selection in calculating posterior corneal elevation and prediction of keratoconus using rotating Scheimpflug camera

Purpose:  To explore the effects of corneal astigmatism and asphericity on posterior elevation values calculated by different reference bodies and to compare their predictive accuracy in the diagnosis of keratoconus.

MINERALOCORTICOID RECEPTOR ANTAGONIST TREATMENT IN BILATERAL CHRONIC CENTRAL SEROUS CHORIORETINOPATHY: A COMPARATIVE STUDY OF EXUDATIVE AND NONEXUDATIVE FELLOW EYES

Purpose: To evaluate the macular thickness, choroidal thickness, and visual acuity changes in eyes of patients with bilateral chronic central serous chorioretinopathy during eplerenone treatment. Methods: This prospective clinical trial was conducted on patients with bilateral chronic central serous chorioretinopathy, who had subretinal fluid (SRF) in 1 eye. Twenty-eight patients were treated with 50 mg/day of oral eplerenone for 3 months and were observed for another 3 months. Twenty-eight eyes with SRF were compared with the 28 fellow eyes with pachychoroid pigment epitheliopathy. Results: The central macular and choroidal thickness showed a significant decrease (P < 0.005) at 3 months in all eyes, but change in choroidal thickness was smaller in nonexudative fellow eyes (P > 0.05 at 6 months). In the exudative eyes, the decrease in choroidal thickness showed a significant correlation with the resolution of SRF (P < 0.001). Visual acuity remained stable in all eyes, with significant improvement only in exudative eyes at 6 months (P < 0.005). Baseline choroidal thickness was a significant positive predictor for SRF decrease (P = 0.003). Conclusion: Patients with chronic central serous chorioretinopathy can safely be treated with eplerenone as it can reverse choroidal vasodilation with an accompanying resolution of the SRF and improvement in visual acuity. These beneficial therapeutic effects are more pronounced in the exudative eyes.

Optical Coherence Tomography Features of POEMS Syndrome and Castleman Disease-associated Papillopathy

Abstract Purpose: To report ocular symptoms and optical coherence tomography (OCT) features of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome. Methods: Case report of two Caucasian patients with POEMS, one of whom also had multicentric Castleman disease. Results: Both patients presented with edema on both optic disks, bilateral macular edema was seen in case 1, and peripapillary choroidal neovascularization was seen on the right side in case 2. OCT confirmed papilledema involving all retinal layers, with additional bilateral peripapillary serous retinal detachment involving the macula in both cases, and peripapillary CNV in case 2. Changes in retinal nerve fiber layer thickness, total peripapillary retinal thickness, and macular detachment were followed with OCT over the course of the disease and after administration of systemic therapy. Conclusion: OCT examination of the optic nerve head and the macula has an important additional role in the diagnosis and follow-up of POEMS syndrome and Castleman disease.

Scheimpflug imaging for long-term evaluation of optical components in Hungarian children with a history of preterm birth.

PURPOSE To determine ocular geometry and refraction in children with a history of preterm birth, and compare them to age-matched full-term children. METHODS In a prospective case-control study, 50 eyes of 27 premature patients 7 to 14 years of age were evaluated with Scheimpflug camera after cycloplegia. Age-matched full-term children comprised the control group (68 eyes of 34 children). All of the eligible eyes had a normal-appearing posterior pole. Anterior segment parameters such as keratometry, anterior chamber volume or thickness, and lens thickness were measured. Corneal thickness, lower- and higher-order aberrations refractive errors of the cornea (root mean square of lower- and higher-order aberrations: RMS LOA, RMS HOA) were also assessed and exported for further analysis. RESULTS In the premature eyes, anterior chamber depth was marginally smaller (P = .06), the lens was significantly thicker (P = .03), and axial length was significantly shorter (P < .001). Scheimpflug imaging showed a significant difference in corneal RMS (P = .03) and an increase in corneal RMS HOA (P = .002) in the premature group. Preterm birth showed significant impact on axial length (P < .01) and lens thickness (P = .05); at the same time, anterior chamber depth was more influenced by retinopathy of prematurity stage (P = .01). Laser treatment showed marginally significant impact (P = .06) on anterior chamber depth. CONCLUSIONS In premature eyes with or without mild retinopathy of prematurity, anterior segment anatomy is slightly different and they have more higher-order corneal aberrations compared to the eyes of term-born children.

Femtosecond laser-assisted cataract surgery in Alport syndrome with anterior lenticonus

Purpose To report the surgical treatment of 3 eyes of 2 patients with bilateral anterior lenticonus due to Alport syndrome using femtosecond laser-assisted cataract surgery (FLACS). Methods Two patients with Alport syndrome presented to our department due to anterior lenticonus in both eyes. We performed FLACS with posterior chamber lens implantation in both eyes of one patient and in one eye of the other patient. Anterior segment morphologic changes were visualized with a Scheimpflug camera, and anterior segment optical coherence tomography preoperatively and 3 months after surgery. Ultrastructure of the cut capsule edges was observed with scanning electron microscopy and compared to the edge of femtosecond laser capsulotomy performed on an otherwise healthy patient with cataract (control). Results The intraocular lens (IOL) postoperative positioning parameters met the international requirements of aspherical and wavefront customized IOLs (tilt <10 degree, decentration <800 μm). Scanning electron microscopy revealed the same characteristics of the cut capsule edges in the Alport and in the control eyes. Conclusions Femtosecond laser cataract surgery can be a safe and successful method for optical rehabilitation of anterior lenticonus in patients with Alport syndrome.

Optic disc morphology in unilateral branch retinal vein occlusion using spectral domain optical coherence tomography

BackgroundThe aim of this study was to evaluate the association between optic nerve head (ONH) parameters and branch retinal vein occlusion (BRVO) using spectral domain optical coherence tomography (SD-OCT).MethodsBoth eyes of 40 patients with unilateral BRVO (mean age: 67.4 ± 11.4 years, male: female - 18:22) were enrolled in this study. Control group consisted of randomly selected single healthy eyes of 40 age and gender matched volunteers (mean age: 64.7 ± 15.4 years, male: female - 16:24). ONH parameters (including optic disc area, optic cup area, neuroretinal rim area, cup volume, rim volume, cup-disc area ratio, horizontal and vertical cup-disc ratio, average retinal nerve fiber layer) were measured by SD-OCT. Axial length (AL) of the eyes was measured by non-contact optical low coherence reflectometry. The ONH parameters of eyes with BRVO were compared with those of fellow eyes using mixed model, one-way between-groups analysis of covariance was conducted to compare the ONH parameters of affected and unaffected fellow eyes in BRVO patients with those of the control eyes keeping confounding factors, including AL, age and gender under control in the statistical analysis.ResultsNone of the investigated ONH parameters of affected BRVO eyes, unaffected fellow eyes and control eyes were statistically different after controlling for AL, age and gender.ConclusionOptic disc morphology might not be a potential anatomical predisposing factor for development of BRVO.

Intrasession and Between-Visit Variability of Retinal Vessel Density Values Measured with OCT Angiography in Diabetic Patients

In clinical practice the measurement error of an instrument has special importance in analyzing and interpreting data, and acknowledging limitations. The purpose of this study was to evaluate intrasession and between-visit reproducibility of OCT angiography measurements in diabetic patients. A total of 54 eyes of 27 diabetic patients underwent OCT angiography imaging. Foveal avascular zone (FAZ) area and superficial retinal vessel density (VD) at 3 mm were calculated using the AngioAnalytics software. Three consecutive images were acquired at first visit and one image 1 month later. Intrasession and between-visit reproducibility of parameters were characterized by intraclass correlation coefficient (ICC), coefficient of variation (CV), and coefficient of repeatability (CR) values. We measured excellent (>0.90) ICC values both in intrasession and between-visit comparisons. CV was higher for the FAZ area compared to VD both in intrasession (7.79% vs. 2.87%) and in between-visit (12.33% vs. 2.95%) comparisons. Between-visit CR value for VD was 4.53% (95% CI: 3.72–5.79%). These data suggest that OCT angiography shows excellent repeatability in diabetic patients, indicating that this non-invasive technology might be suitable for longitudinal assessment of microvascular complications.

Spontán suprachorioidealis vérzés okozta vakság véralvadásgátló kezelésben részesült időskori makuladegenerációs betegeken

We present cases of blinding spontaneous suprachoroidal haemorrhage in anticoagulant taking wet-AMD patients. A retrospective study has been performed to present the clinical course, management and final outcome of spontaneous suprachoroidal haemorrhage in 7 eyes of six age-related macular degeneration patients seen in our clinic from January 2016 to April 2017. All patients were on chronic oral anticoagulant therapy because of cardiovascular disorder. In one patient, haematological disorder was also present modifying significantly the haemostasis. All eyes received prior anti-VEGF treatment for exsudative AMD. Acute angle closure glaucoma - with no response to topical and oral IOP lowering therapy - was the most frequent ocular complication in our cases. The final visual prognosis was usually very poor. The risk of spontaneous suprachoroidal haemorrhage is increased in wet-AMD patients who are on anticoagulant therapy. To prevent this blinding condition, a stronger communication between ophthalmologists and cardiologists would be beneficial, with an ophthalmological check-up in this group of patients before and during the use of anticoagulants. Orv Hetil. 2018, 159(24): 985-990.