Uri Soiberman

Heidelberg spectral-domain optical coherence tomographic findings in retinal artery macroaneurysm.

Purpose: To describe the morphologic variables of macroaneurysms, to assess their diameter in comparison to their upstream/downstream vessel diameter as visualized on spectral-domain optical coherence tomography, and to describe morphologic changes in the retina adjacent to macroaneurysm. Methods: A retrospective case series of adult patients who were clinically diagnosed with retinal macroaneurysms and who underwent Heidelberg spectral-domain optical coherence tomography (OCT) between June 2009 and October 2010. Results: A total of 12 patients (age range, 31–95 years, 2 men) in whom macroaneurysms were demonstrated by spectral-domain OCT (12 eyes). All the macroaneurysms had a typical OCT appearance, and a diameter of 285.33 ± 76.98 &mgr;m. The diameter of the upstream/downstream vessel was 117.5 ± 17.13 &mgr;m (P = 0.0001 vs. the mean macroaneurysm diameter). Other related OCT findings were superficial retinal hemorrhage, intraretinal lipids, and intraretinal edema prominently involving the outer retinal layers. Conclusion: Spectral-domain OCT is an effective tool for detecting retinal macroaneurysms. It also provides important supplementary clinical information that may be helpful in planning the management of macroaneurysm, without the need for ancillary tests.

Punctal stenosis: definition, diagnosis, and treatment

Acquired punctal stenosis is a condition in which the external opening of the lacrimal canaliculus is narrowed or occluded. This condition is a rare cause of symptomatic epiphora, but its incidence may be higher in patients with chronic blepharitis, in those treated with various topical medications, including antihypertensive agents, and especially in patients treated with taxanes for cancer. The purpose of this review is to cover the medical literature, focusing in particular on definition, incidence, risk factors, etiology and treatment options.

Preservation of the Photoreceptor Layer Following Subthreshold Laser Treatment for Diabetic Macular Edema as Demonstrated by SD-OCT

PURPOSE Subthreshold laser treatment of diabetic macular edema (DME) may have less deleterious effects on the photoreceptors than regular continuous wave laser. This study aimed to assess whether subthreshold laser causes a long-term damage to the retinal structures, as demonstrated by spectral-domain optical coherence tomography (SD-OCT), and to evaluate the change in the axial diameter of retinal diabetic microaneurysms following treatment. METHODS A retrospective study of eyes that were diagnosed with nonfoveal involving DME and underwent subthreshold laser treatment with the Novus SRT system. Spectral-domain OCT scans of treated retinal areas, performed prior to treatment and approximately 4 months following treatment, were assessed for changes in the continuity of the photoreceptor (PR) layer, the thickness of the PR-RPE layer, the retinal thickness at the treatment sites, and the diameter of the microaneurysms. RESULTS Included in this study were 31 microaneurysms. Following treatment, the continuity of the ellipsoid zone of the inner segments of the photoreceptors was confirmed in all but two cases. The thickness of the PR-RPE layers was 72.32 ± 7.36 and 70.97 ± 7.27 μm prior to and following treatment, respectively (P = 0.061). The retinal thickness at the treatment sites decreased from 398.65 ± 57.89 to 372.74 ± 60.4 μm (P < 0.001). The mean measured diameter of the microaneurysms was 87.32 ± 27.45 and 6.68 ± 26.12 μm, respectively (P < 0.001). CONCLUSIONS In this study, subthreshold laser treatment for DME has been shown to be a safe technology that preserves the photoreceptor layer, as demonstrated by SD-OCT.

Intraocular pressure measurements with Goldmann applanation tonometry and dynamic contour tonometry in eyes after IntraLASIK or LASEK

Background and methods Myopic photorefractive surgery induces a reduction in central corneal thickness, which may lead to underestimation of intraocular pressure. This retrospective clinical study compared intraocular pressure measurements obtained by Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT-Pascal) in eyes undergoing myopic intralaser-assisted in situ keratomileusis (IntraLASIK) or laser-assisted subepithelial keratomileusis (LASEK). Results Of a total of 51 eyes, 21 underwent LASEK and 30 underwent IntraLASIK. By GAT, mean preoperative intraocular pressure was 16.2 ± 1.99 mmHg and postoperatively was 10.84 ± 1.45 mmHg. By DCT, mean preoperative intraocular pressure was 15.9 ± 2.08 mmHg and postoperatively was 16.1 ± 2.3 mmHg. Both preoperative and postoperative differences between measurements made by GAT and DCT were found to be statistically significant (P < 0.04 and P < 0.01, respectively). GAT and DCT readings were unaffected by type of surgery (P = 0.74 and P = 0.46, respectively). Conclusion Postoperative GAT measurements were lower than those obtained by DCT. The difference between preoperative and postoperative DCT measurements was minimal, so DCT may be preferable for the measurement of intraocular pressure in eyes undergoing myopic IntraLASIK or LASEK.

Bevacizumab versus ranibizumab for the treatment of neovascular age-related macular degeneration

Age-related macular degeneration (AMD) is a leading cause of severe visual loss in the elderly. A long path of clinical trials with various treatment modalities has led to novel contemporary treatments, including bevacizumab (Avastin®; Genentech, CA, USA) and ranibizumab (Lucentis®; Genentech). These drugs have revolutionized the approach to neovascular AMD, and today they are one of the major treatments for the disease. While both these drugs are reported to be effective, with somewhat stronger clinical evidence for ranibizumab, debate continues as to which is most effective in the treatment of AMD. Large-scale studies currently underway are expected to shed light on the subject. Based on the evolving data, as well as on our clinical experience, we believe that the two drugs, while harboring different biological characteristics and potential clinical differences, still share many similar characteristics in their efficacy and safety. The similarities and differences in efficacy and safety will be demonstrated in prospective comparative trials currently taking place.

Macular Hole Surgery with Internal Limiting Membrane Peeling Facilitated by Membrane-Blue® versus Membrane-Blue-Dual®: A Retrospective Comparative Study

Background. This study aims to compare the outcome of macular hole (MH) surgery with internal limiting membrane (ILM) peeling facilitated by two different vital dyes. Methods. This was a retrospective chart review. The group designated “group-MB” underwent pars plana vitrectomy with ILM peeling facilitated by Membrane-Blue (MB), whereas in “group-MBD,” the vital dye used was Membrane-Blue-Dual (MBD). Results. Seventy-four eyes comprised the study population: 53 in group-MB and 21 in group-MBD. There was no difference in the rate of macular hole closure in group-MB or group-MBD: 71.2% closed MHs compared to 66.7%, respectively (p = 0.7). Postoperative visual improvement was of a higher magnitude in the MBD group compared to the MB group: −0.34 ± 0.81 logMAR versus 0.01 ± 0.06 logMAR, respectively (p = 0.003). Conclusions. In this study, MBD led to better visual results that may be related to better staining characteristics or lesser toxicity compared to MB.

Serum ischemia modified albumin and vascular endothelial growth factor levels following intravitreal bevacizumab injections

Purpose Previous reports have demonstrated that the serum levels of vascular endothelial growth factor (VEGF) are reduced after intravitreal injections of bevacizumab. This study aimed to determine the serum levels of ischemia-modified albumin (IMA), a marker of ischemia, and VEGF following intravitreal injections of bevacizumab. Methods This was a prospective study. Blood samples were drawn prior to injection and at 1, 7, and 30 days after injection. Results A total of 11 patients participated in this study. Mean serum IMA levels were lower than baseline during follow-up, with statistically significant differences compared to baseline levels at day 1 and day 30 (preinjection: 49.82 ± 15.28 ng/mL; 44.57 ± 12.01 ng/mL, p = 0.007, and 43.71 ± 13.82 ng/mL, p = 0.001, respectively). Mean serum VEGF levels were lower than baseline throughout the follow-up period (from 307.45 ± 273.45 pg/mL at baseline to 159.55 ± 120.68 pg/mL at day 30). Mean serum VEGF levels were significantly lower compared to baseline levels at day 1 and day 7 (147.09 ± 106.08 pg/mL, p = 0.014; 72.91 ± 50 pg/mL, p = 0.011, respectively). Conclusions In this study, mean serum IMA and VEGF levels were lower following intravitreal bevacizumab injections.

Adiponectin concentration in the orbital fat of patients with Graves’ ophthalmopathy

Background “Graves’ ophthalmopathy” (GO), is an inflammatory disease of the orbit, with extensive adipose tissue involvement. Previous studies of orbital fat derived from such patients have demonstrated overexpression of the adiponectin gene and messenger RNA. Aim The study reported here aimed to measure the protein concentration of orbital adipose tissue adiponectin in GO patients, in comparison to healthy controls. Methods This was a prospective study. Orbital samples from ten healthy controls undergoing blepharoplasty and five patients with GO undergoing orbital fat decompression for proptosis were analyzed by enzyme-linked immunosorbent assay. Results The mean adiponectin concentration in samples from GO patients was 121.9 ± 29.5 ng/mL (mean ± standard deviation), versus 107.9 ± 26.6 ng/mL in the control group (P=0.20). Conclusion This study was unable to demonstrate a statistically significant difference in adiponectin protein concentrations between the two studied groups.