Pia Veronika Vecsei-Marlovits

Management of extensive subfoveal haemorrhage secondary to neovascular age-related macular degeneration

BackgroundTo evaluate the clinical outcomes of subfoveal haemorrhages secondary to neovascular age-related macular degeneration (AMD), which were treated with intravitreal recombinant tissue plasminogen activator (rTPA)/gas and anti-vascular endothelial growth factor (anti-VEGF) drug or with an intravitreal anti-VEGF monotherapy.MethodsThis is a retrospective pilot study. Patients who received intravitreal rTPA/gas and anti-VEGF injections (n=20, bevacizumab or ranibizumab) were included in group A. Patients who refused prone positioning after rTPA/gas injections and were treated with an anti-VEGF monotherapy (bevacizumab) alone were included into group B (n=10). Changes in baseline visual acuity (VA, Snellen), central retinal thickness (CRT) and haemorrhage size were analysed.ResultsMean baseline VA was 0.15±0.2 and 0.25±0.17 in groups A and B, respectively. At month 4, significant improvement in mean VA was observed in group A (mean difference: +0.1±0.14; P=0.003), and a stabilization in group B (mean difference: +0.008±0.2; P=0.94). CRT decreased significantly by 70 μm in group A (P=0.001) and by 84 μm in group B (P=0.03). The mean size of subfoveal haemorrhage in groups A and B was 20.2 mm2 and 19.1 mm2 at baseline and 0.0 mm2 and 2.0 mm2 at month 4, respectively. The anti-VEGF treatmentrate was 1.6 in group A and 3.0 in group B.ConclusionIn patients with extensive subfoveal haemorrhage secondary to neovascular AMD, the combination therapy of rTPA/pneumatic displacement and anti-VEGF results in mean improvement of VA and stabilization of morphological parameters. If rTPA and pneumatic displacement combination is contraindicated, an anti-VEGF monotherapy may be performed to prevent further visual loss.

Time to first treatment: The significance of early treatment of exudative age-related macular degeneration.

Purpose: To determine whether the time span between initial symptoms and treatment with ranibizumab in patients with neovascular age-related macular degeneration has an effect on visual outcome. Method: In this retrospective study, 45 patients with exudative age-related macular degeneration were split into 3 groups depending on the duration of visual symptoms—Group I: <1 month, Group II: 1 month to 6 months, and Group III: >6 months. Best-corrected visual acuity, clinical ophthalmologic examination, and central retinal thickness as measured by optical coherence tomography were recorded at baseline and 2 months later. Fluorescein angiography was performed at baseline. Treatment consisted of 2 intravitreal injections of 1.25 mg of ranibizumab at baseline and after 4 weeks. Results: The mean time span between initial symptoms and treatment was 59 ± 62 days. In all groups, a reduction of retinal thickness was observed. Shorter disease duration, as estimated by persistence of visual symptoms, was correlated with a better visual outcome after treatment. Patients in Group I demonstrated a significant increase in best-corrected visual acuity (P = 0.007). Patients of Group II (P = 0.095) and Group III (P = 0.271) still achieved a visual improvement in best-corrected visual acuity, albeit not significant. The mean change in best-corrected visual acuity was 0.08 ± 0.1 in all patients and was not statistically significant between groups (P = 0.87). Conclusion: Duration of visual symptoms <1 month before treatment is associated with a better visual outcome. Treatment of new-onset wet age-related macular degeneration should be initiated as soon as possible.

Interexaminer and intraexaminer reliability of the microperimeter MP-1

PurposeTo evaluate the interexaminer and intraexaminer reliability of macular microperimetry using the microperimeter MP-1.MethodsParticipants: Fifteen healthy volunteers younger than 40 years of age (Group 1), 15 healthy subjects over 60 years (Group 2), and five patients with age-related macular degeneration (Group 3). Observation procedure: Two examiners (E1 and E2) measured, in random order, interexaminer (E2–E1a) reliability. Another examination was undergone by one of the examiners a week later to evaluate the intraexaminer (E1b–E1a) reliability. Main outcome measures: Macular sensitivity (mean threshold (decibel)) and stability of fixation were determined using MP1 microperimetry. Agreement was analysed by means of Bland–Altman plots and by the determination of the intraclass correlation coefficient.ResultsThe interexaminer (E2–E1a) and the intraexaminer (E1b–E1a) differences in the mean threshold values were not statistically significant (P=0.850, 95% confidence Interval (CI)=−0.265 to 0.319; P=0.246, 95% CI=−0.099 to 0.375, respectively). Limits of agreement and intraclass correlation coefficients also showed good agreement in each group.ConclusionsA good reliability was found for the mean threshold values in all the three groups, indicating examiner-independent measurements.

Reduced fluence versus standard photodynamic therapy in combination with intravitreal triamcinolone: short-term results of a randomised study

Background: To compare early treatment effect of reduced fluence versus standard photodynamic therapy (rPDT, sPDT, respectively) in combination with intravitreal triamcinolone (IVTA) in neovascular age-related macular degeneration. Methods: Forty patients received either sPDT (group A, n = 20) or rPDT (group B, n = 20) each followed by same-day 4 mg IVTA. Patients were examined at baseline, day 1, week 1, 4 and 12. Main outcomes were visual acuity, central retinal thickness (CRT), choroidal perfusion and macular sensitivity (MS). Results: Baseline characteristics were well balanced in both groups (p>0.05). At week 12, patients in group A had a mean loss of −3.7 letters compared with a gain of 3.4 letters in group B (p = 0.04, between both groups). Both treatment groups showed a similar course regarding CRT as well as MS (p>0.05). In 70% (14/20) of group A and 15% (3/20) of group B, a choroidal hypoperfusion in the area of treatment was observed after treatment (p<0.001). In 70% of group A and 55% of group B, a repeat treatment was indicated at week 12 (p = 0.55). Conclusions: At month 3, the rPDT+IVTA group showed a significantly better visual outcome, less alteration of the choroid and a trend for lower recurrence rate than the sPDT+IVTA group. Further follow-up of this study will provide information on long-term functional results and treatment durability.

Effect of posterior capsule opacification on macular sensitivity

PURPOSE: To evaluate the effect of posterior capsule opacification (PCO) on macular sensitivity. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Macular sensitivity, best corrected visual acuity (BCVA), and PCO intensity were evaluated before and after neodymium:YAG (Nd:YAG) laser capsulotomy in pseudophakic eyes with clinically significant PCO that had a healthy macula or dry age‐related macular degeneration (ARMD). Macular sensitivity was determined using the fundus‐related Microperimeter 1 (Nidek) in a central field of 10 degrees. The intensity of the PCO was assessed objectively in the central 3.0 mm area (score 0 to 10) using quantification software. RESULTS: After Nd:YAG capsulotomy, both groups had a significant improvement in BCVA and mean macular sensitivity; the change in the mean logMAR value was −0.26 in the healthy macula group and −0.23 in the dry ARMD group and the change in mean macular sensitivity, 2.5 dB and 2.0 dB, respectively. Before Nd:YAG capsulotomy, significant correlations were observed between PCO values, BCVA, and macular sensitivity in the healthy macula group only (P<.01). CONCLUSIONS: Neodymium:YAG laser capsulotomy improved BCVA and macular sensitivity. The PCO scores correlated well with the PCO‐induced decrease in BCVA and with PCO‐induced loss of macular sensitivity. Functional macular mapping indicated an overall loss of macular sensitivity in patients with dry ARMD. There was no significant association between PCO values and macular sensitivity in eyes with dry ARMD.

Comparison of posterior capsule opacification between a 1-piece and a 3-piece microincision intraocular lens

Objective To compare the intensity of posterior capsular opacification (PCO) between a 1-piece and a 3-piece microincision cataract surgery intraocular lens (MICS IOL) in a prospective randomised study. Methods 80 eyes of 40 patients with age-related cataract were enrolled in this study. Each patient received a 1-piece MICS IOL (AF-1 NY-60, Hoya, Tokyo, Japan) in one eye and a 3-piece MICS IOL (AF-1 iMICS Y-60H, Tokyo, Hoya) in the other eye. At the 1-year follow-up, the patients were examined at the slit lamp, visual acuity was determined and standardised high-resolution digital retroillumination images were taken for objective quantification of regeneratory PCO using an automated image analysis software (AQUA). Results The mean regeneratory PCO score (1-piece IOL: 0.2, 3-piece IOL 0.3, p=0.7) and the neodymium:yttrium-aluminium-garnet laser capsulotomy rate (two cases in 3-piece IOL group; p=0.5) were comparable low for both IOLs. Capsular folds occurred significantly more often in the 3-piece IOL group (p=0.02). Conclusions Modification of the MICS IOL from a 3-piece to a 1-piece haptic design caused in short term no significant change in PCO amount. Compared with the 3-piece IOL, the 1-piece IOL led to significantly less capsular folds 1 year after surgery.

Acute anterior uveitis is associated with depression and reduction of general health

Aims This study explored the association of active acute anterior uveitis (AAU) with depressive feelings and patients’ general health. Methods This case-control study comprised 80 participants: 35 patients with an active case of AAU and 45 healthy peers were analysed to compare their depressive moods (Beck depression inventory (BDI), Zerssen Mood Scale (ZMS)) and general health (Short form-8 health survey (SF8)). Furthermore, patients were questioned regarding the presence of distress, occupational satisfaction and impairment in performing daily life tasks. Results During an acute attack, AAU patients were shown to suffer from depressive moods more often than their healthy peers (BDI 54% vs 9%, respectively; ZMS 2.7-fold shift in mood levels towards depression) and experienced a reduction in mental and physical scores (SF8). Patients felt impaired reading (94%), driving (69%) and working (69%). In all, 74% of the patients believed that distress was a probable trigger. Lack of occupational satisfaction was associated with a persistence of depressive feelings and a reduction in physical health. Conclusions AAU patients exhibited a significant psychopathology towards depression, a reduction of general health and impairment of performing daily life tasks. Patients who were unsatisfied at work seemed to suffer even more. The results underline the importance of offering psychological support to the patients and providing information to patients and close social contacts.

Effect of a multimedia-assisted informed consent procedure on the information gain, satisfaction, and anxiety of cataract surgery patients

Purpose To assess whether a multimedia‐assisted preoperative informed consent procedure has an effect on patients’ knowledge concerning cataract surgery, satisfaction with the informed consent process, and reduction in anxiety levels. Setting Hietzing Hospital, Vienna, Austria. Design Prospective randomized controlled clinical trial. Methods Patients participated in an informed consent procedure for age‐related cataract surgery that included the standard approach only (reading the information brochure and having a standardized face‐to‐face discussion) or supplemented with a computer‐animated video. The main outcome was information retention assessed by a questionnaire. Further outcome measures used were the State‐Trait Anxiety Inventory, the Visual Function‐14 score, and an assessment of satisfaction. Results The study included 123 patients (64 in standard‐only group; 59 in computer‐animated video group). Both groups scored well on the questionnaire; however, patients who watched the video performed better (82% retention versus 72%) (P = .002). Scores tended to decrease with increasing age (r = −0.25, P = .005); however, this decrease was smaller in the group that watched the video. Both groups had elevated anxiety levels (means in video group: anxiety concerning the current situation [S‐anxiety] = 63.8 ± 9.6 [SD], general tendency toward anxiety [T‐anxiety] = 65.5 ± 7.9; means in control group: S‐anxiety = 61.9 ± 10.3, T‐anxiety = 66.2 ± 7.8). Conclusions A high level of information retention was achieved using an informed consent procedure consisting of an information brochure and a standardized face‐to‐face discussion. A further increase in information retention was achieved, even with increasing patient age, by adding a multimedia presentation. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Clinical risk management - a 3-year experience of team timeout in 18 081 ophthalmic patients.

Clinical risk management aims to identify, analyse and avoid errors and risks systematically to improve patients safety. Preoperative checklists to prevent mistakes have gained importance in the last few years. A so‐called team timeout checklist was introduced in October 2011 at the Department of Ophthalmology, Hietzing Hospital, Vienna. The purpose of the study is to evaluate the benefits and demonstrate the value of team timeout.

Predictors of 1-year visual outcome in OCT analysis comparing ranibizumab monotherapy versus combination therapy with PDT in exsudative age-related macular degeneration

SummaryAimThe aim of this study was to find predictive factors of 1-year visual outcome, analyzing novel optical coherence tomography (OCT) biomarkers in exsudative age-related macular degeneration (choroidal neovascularization (CNV)) in two groups of different treatment modalities.MethodsIn all, 34 consecutive patients with new-onset CNV were randomized 1:1 to receive either ranibizumab monotherapy or ranibizumab combined with photodynamic therapy (PDT) with verteporfin. After three initial injections with ranibizumab, re-treatment was performed according to an as-needed scheme; PDT was performed once at baseline. Best-corrected visual acuity (BCVA) and OCT parameters like central macular volume (CMV), central macular thickness (or central retinal thickness (CRT)), subretinal and intraretinal fluid, fibrovascular lesion thickness, or inner segment/outer segment (IS/OS) junction were analyzed.ResultsAfter 12 months, a visual gain of 6.1 letters was found in the monotherapy group, whereas patients in the combination therapy group lost − 4.8 letters from baseline to the 12-month visit. CMV and CRT decreased considerably between baseline and month 2–3 in both groups, with a following slight increase until month 12. Additional application of PDT had negative effect to 12-month BCVA, whereas higher baseline BCVA and integrity of the IS/OS junction at month 12 had positive effect to 12-month BCVA.ConclusionsBetter baseline BCVA and the integrity of IS/OS junction at 12-month visit were the most important predictive factors for final BCVA. Combination therapy caused worse final BCVA and a higher degree of IS/OS disruption.