R Forte

Comparison of time domain Stratus OCT and spectral domain SLO/OCT for assessment of macular thickness and volume

PurposeTo compare retinal thickness and volume measurements obtained with Stratus time domain optical coherence tomography (OCT) and spectral domain scanning laser ophthalmoscope OCT (SD-SLO/OCT).MethodsIn a cross-sectional study, 52 eyes with a normal macula, 30 eyes with retinal oedema, and 10 eyes with a myopia higher than 6u2009D have been evaluated with both time domain OCT (TD-OCT, Stratus OCT, Carl Zeiss Meditec, USA) and SD-SLO/OCT (OTI, Toronto, Canada). Retinal thickness and volume measurements in the nine areas of the 6-mm ETDRS ring were compared. Artefacts were defined as the discordance between the automatically detected anterior and posterior retinal boundaries and the boundaries detected by the examiner.ResultsArtefacts were more frequent with TD-OCT (35 vs26%). Mean retinal thickness was significantly higher with SD-SLO/OCT by 30.1u2009μm (±25.8) (P=0.003) in presence of the artefacts and by 39.2u2009μm (±25.8) (P=0.003) after their exclusion. The correlation between the two retinal thickness data sets before exclusion of the artefacts (r=0.59, P<0.001) increased after their removal (r=0.84, P<0.001). A strong correlation was present between the two retinal volume data sets before (r=0.94, P<0.001) and after exclusion of the artefacts (r=0.96, P<0.001).ConclusionsSD-SLO/OCT produced fewer artefacts than Stratus TD-OCT. This could be attributed to the greater resolution and acquisition speed of SD-SLO/OCT. The macular retinal thickness values measured with SD-SLO/OCT were significantly higher than those measured with Stratus TD-OCT. Retinal volumes measured with Stratus TD-OCT and SD-SLO/OCT were strongly correlated.

Surgical Management of Benign Tumors of the Parotid Gland: Extracapsular Dissection Versus Superficial Parotidectomy—Our Experience in 232 Cases

PURPOSEnThe purpose of this study was to retrospectively analyze all cases of benign parotid tumors treated at our institution from 2002 to 2009.nnnMATERIALS AND METHODSnWe carried out a retrospective review of 232 patients with benign primary parotid tumors. Extracapsular dissection or superficial parotidectomy was performed. Clinical and histopathologic data were analyzed, and management was described. The statistical difference between the 2 techniques as concerns evaluated recurrence rate and complications was measured with the log-rank (Cox-Mantel) test. The chosen level of statistical significance was P < .05.nnnRESULTSnA total of 232 patients were enrolled, 107 women and 125 men, whose mean age was 53.2 ± 11.3 years. Extracapsular dissection was performed in 176 cases (76%) (mean age, 52.82 ± 11.55 years), and superficial parotidectomy was performed in 56 cases (24%) (mean age, 54.59 ± 10.56 years). The mean lesion size was 1.89 ± 0.52 cm for extracapsular dissection and 3.49 ± 0.43 cm for superficial parotidectomy (P < .001). Mean follow-up was 52.6 ± 4.5 months for the group of patients treated with superficial parotidectomy and 46 ± 5.2 months for the group treated with extracapsular dissection. No significant differences as concerns capsular rupture and recurrence were observed after extracapsular dissection and superficial parotidectomy (3.4% vs 1.8% [P = .1] and 4.5% vs 3.6% [P = .1], respectively). Transient facial nerve injury, facial paralysis, and Frey syndrome were significantly more frequent after superficial parotidectomy than after extracapsular dissection (26.8% vs 3.9% [P = .001], 8.9% vs 0% [P < .001], and 5.3% vs 0% [P < .001], respectively).nnnCONCLUSIONSnExtracapsular dissection showed similar effectiveness and fewer side effects than superficial parotidectomy and could be considered as the treatment of choice for tumors located in the superficial portion of the parotid gland.

Evaluation of Morning Glory Syndrome with Spectral Optical Coherence Tomography and Echography

PURPOSEnTo evaluate eyes affected by morning glory syndrome (MGS) with spectral-domain optical coherence tomography (SD OCT) and echography.nnnDESIGNnProspective case series.nnnPARTICIPANTSnNineteen patients (22 eyes) with MGS observed at the Eye Department, University of Naples Federico II, Naples, Italy.nnnMETHODSnAll patients underwent a complete ophthalmologic examination that included best-correct visual acuity, fundus photography, and echography. Nine patients underwent SD OCT and high-frequency B-scan echography (20 MHz).nnnMAIN OUTCOME MEASURESnSpectral-domain optical coherence tomography and echographic findings in MGS.nnnRESULTSnSpectral-domain optical coherence tomography revealed retinal detachment in the conus area of 5 eyes: 4 with noncontractile MGS (NCMGS) and 1 with contractile MGS (CMGS). There was evidence of a retinal break in only 2 cases. All 5 eyes had an abnormal communication between the subarachnoid space and the subretinal space. Spectral-domain optical coherence tomography did not reveal differences between CMGS and NCMGS. Echographic examination did not reveal any anatomic abnormalities of the optic nerve or orbit.nnnCONCLUSIONSnSpectral-domain optical coherence tomography provides more information than echography about the posterior pole, whereas echographic examination is the only technique that can confirm the anatomic integrity of the optic nerve in the orbital wall. Retinal detachment in MGS generally is ascribed to abnormal communication between the subretinal and subarachnoid or vitreous compartments. These data suggest that myopialike retinal detachment without a retinal break may result from tissue stretching around the peripapillary conus.

Visualization of vitreomacular tractions with en face optical coherence tomography.

BackgroundIn vitreomacular traction syndrome, an incomplete vitreous detachment with persistent vitreous traction on the macula is present. This condition may determine formation of epiretinal membranes, macular puckering, macular oedema, and traction macular detachment. Recently introduced en face optical coherence tomography (OCT) provides not only longitudinal B-scan but also coronal C-scan images of the retina.MethodsFifteen eyes of 11 non-diabetic patients presenting vitreomacular traction syndrome have been evaluated with en face OCT (OTI, Toronto, Ontario, Canada).ResultsIn 12 eyes, cystoid macular oedema was detectable at fundus examination and was associated with a broad-based adherence of the posterior hyaloid to the macula. In three eyes, foveal detachment appeared to be associated with focal foveal vitreoretinal traction. In all eyes, the lateral extent of the hyaloidal tractions on the macula was clearly detectable at coronal C-scan. They appeared as sigmoid hyper-reflective bands in the hyporeflective vitreous chamber. Overlay of C-scans on red-free confocal images allowed the visualization of the edges of the adherences in relation to the structures of the posterior pole.ConclusionsThe C-scan images allowed clear visualization of the total extension of the posterior vitreomacular adherences and their relationships with the vascular arcades, the optic disc, and the fovea.

Scanning electron microscopy of corneal epithelium in soft contact lens wearers.

Purpose: To use scanning electron microscopy (SEM) to assess differences in corneal epithelium features between soft contact lens (CL) wearers and non-CL wear control. Methods: In a cross-sectional survey, the corneal epithelium removed before photorefractive keratectomy in 10 soft CL wearers (10 eyes) and in 10 non-CL wearers (10 eyes) was evaluated with SEM. The aim of the study was to assess ultrastructural differences in corneal epithelium between the 2 groups. Results: No statistically significant difference was present between the 2 groups as concerns the number of microvilli (P = 0.19). An amount of epithelial mucus >20% was detected in 20% of soft CL wearers and in 80% of non-CL wearers (P = 0.01). A good tolerance to CL was referred by CL wearers. Conclusion: A significant reduction of epithelial mucus at SEM evaluation was present in the CL wearers even in absence of complaints referred to CL.

Evaluation of peripapillary detachment in pathologic myopia with en face optical coherence tomography

Backgroundu2003A newly recognized lesion in pathologic myopia is peripapillary detachment of the retinal pigment epithelium (RPE) and retina. Recently introduced en face optical coherence tomography (OCT) provides not only cross-sectional but also coronal scans of the retina, and allows lateral extent visualization and thickness measurement of lesions.MethodsThree patients presenting bilateral peripapillary yellow-orange lobulated area in high myopia have been evaluated with fluorescein angiography (FA), indocyanine green angiography (ICGA), en face OCT (OCT/SLO; Ophthalmic Technologies Inc, Toronto, Canada), and Humphrey visual field analyzer.ResultsIn all eyes, en face OCT has shown the presence of a peripapillary sub-RPE nonreflective area. The lateral extent of this area was clearly detectable and the measurement of its thickness was obtained. We detected a cleft in the RPE at one edge of the cavitation in two eyes, vascular tractions and vitreoretinal tractions in two eyes, a macular hole with posterior retinal detachment, and small areas of RPE detachment nonconnected with the peripapillary detachment in one eye. In the four eyes presenting a proper central fixation, glaucomatous visual field defects were evident.ConclusionEn face OCT has allowed to evaluate the thickness and the lateral extent of the peripapillary detachment. Therefore, its use could be important in determining the size and grading of these lesions at first visit, and to detect minimal changes of width and thickness during follow-up as an alternative to fluorescein angiography.

Intravitreal bevacizumab vs intravitreal triamcinolone combined with macular laser grid for diffuse diabetic macular oedema

ObjectiveTo evaluate the 12-month clinical outcome of patients with persistent non-ischaemic diffuse diabetic macular oedema (DME) treated with intravitreal bevacizumab (IVB) or with intravitreal injection of triamcinolone combined with macular laser grid (IVTA-MLG) from September 2005 to February 2008.MethodsRetrospective interventional comparative study. Best-corrected visual acuity (BCVA, ETDRS LogMAR scale) and foveal thickness (FT) at optical coherence tomography (OCT) were obtained at baseline and during 12 months after first treatment. Re-treatment was based on clinical or OCT-based evidence of persistent macular oedema or deterioration in visual acuity.ResultsForty-three eyes (32 patients) with DME were treated with IVB. Ninety-six eyes (52 patients) with DME were treated with combined laser grid treatment and intravitreal triamcinolone. At baseline, mean BCVA and FT were 0.92±0.34 LogMAR and 372±22u2009μm in the IVTA-MLG group, and 1.07±0.49 LogMAR and 423±33u2009μm in the IVB group, respectively. At 1- and 3-month visits, BCVA and FT had significantly improved in both groups. After 6 and 12 months, the IVB group experienced a statistically significant improvement in visual acuity (0.83±0.21 LogMAR, P<0.001 at 6 months; BCVA 0.86±0.24 LogMAR, P<0.001 at 12 months) and FT (248±18u2009μm, P<0.001 at 6 months; 262±28u2009μm, P=0.001 at 12 months) when compared with baseline, whereas the IVTA-MLG group did not show statistically significant improvement in vision and FT. An increase in intraocular pressure (IOP) was present in 10 of 96 (10.4%) eyes treated with IVTA-MLG, and in two cases it was resistant to topical treatment. No significant side effects were reported in the IVB group.ConclusionsAt 6 and 12 months after first treatment for chronic DME IVB provided significant improvement of BCVA and FT, whereas improvement after IVTA-MLG was not significant. Increased IOP occurred in 10.4% of patients who received IVTA, with two patients requiring trabeculectomy.

Posterior retinal detachment without macular hole in high myopia : visualization with en face optical coherence tomography

Posterior retinal detachment without macular hole in high myopia: visualization with en face optical coherence tomography

Aberrant congenital macular vessel crossing the fovea: evaluation with optical coherence tomography

Aberrant congenital macular vessel crossing the fovea: evaluation with optical coherence tomography

Functional changes after treatment of optic pathway paediatric low-grade gliomas

ObjectiveTo evaluate the functional changes after treatment of paediatric optic pathway gliomas (OPGs).MethodsAll patients with monofocal OPG seen from January 2004 to January 2011 were included. Best corrected visual acuity (BCVA, LogMAR), contrast sensitivity (Hiding-Heidi low-contrast ‘face’ test (HH) and Pelli−Robson (PR) contrast sensitivity test), and the Color Test (Ishihara plate) were obtained.ResultsTwenty-one patients (10 boys and 11 girls with a mean age of 5.5±4.4 years at diagnosis) were included in the study. Neurofibromatosis was present in four cases. Eighteen patients (85.7%) were treated with initial surgery and three patients (14.3%) with initial chemotherapy. BCVA was 0.67±0.8 LogMAR at baseline and 0.62±0.9 LogMAR at last visit (P=0.41). The Color test was not significantly changed at last visit (P=0.62). Contrast sensitivity with the HH test was 9.1±11.1% at baseline and 3.8±6.4% at last visit (P=0.03). Contrast sensitivity with PR chart was 1.33±0.9log at baseline and 1.05±0.7 log at last visit (P=0.005). A reduction in contrast sensitivity at both tests was significantly greater in patients who relapsed than in patients who did not relapse (P=0.001).ConclusionAfter the treatment of paediatric optic pathway low-grade gliomas, a reduction in contrast sensitivity during follow-up was observed and may be correlated with tumour relapses.