Varsha Manjunath

Analysis of choroidal thickness in age-related macular degeneration using spectral-domain optical coherence tomography.

PURPOSE To understand the relationship between choroidal thickness and various disease factors in patients with age-related macular degeneration (AMD) using spectral-domain optical coherence tomography. DESIGN Cross-sectional, retrospective analysis. METHODS Fifty-seven eyes of 47 patients with wet and dry AMD seen between November 2009 and January 2010 at the New England Eye Center, Boston, Massachusetts, were analyzed. Choroidal thickness was measured by 2 independent observers at 11 sites with high-definition horizontal 1-line raster scans through the foveal center. A retrospective chart review was performed to obtain data concerning duration of disease, number of intravitreal anti-vascular endothelial growth factor injections, visual acuity, lens status, and concomitant retinal pathologic features. The Pearson correlation and Student t test were used for statistical analysis for assessment of choroidal thickness changes in wet and dry AMD. RESULTS The choroid in eyes with wet and dry AMD demonstrated a wide range of thicknesses above and below the normal mean (range, 77.5 to 399.5 μm; standard deviation [SD], 90.2). Nearly one third (33.3%) of the eyes with AMD measured less than 1 SD below the mean. Eyes with wet AMD demonstrated a mean subfoveal choroidal thickness of 194.6 μm (SD, 88.4; n = 40) compared with 213.4 μm (SD, 92.2; n = 17) in the dry AMD group. The choroidal thickness in eyes with dry AMD was correlated inversely with age (r = -0.703; P = .002); however, analysis of the number of intravitreal anti-vascular endothelial growth factor injections, number of years of disease, and visual acuity failed to demonstrate any significant correlations with choroidal thickness. CONCLUSIONS This study demonstrated that choroidal thickness can be measured by spectral-domain optical coherence tomography and that variable choroidal thickness exists among patients with the clinical diagnosis of wet and dry AMD. However, it is unclear at this time why in some eyes, choroidal thickness either increases or decreases with the disease. Further studies need to be carried out to understand the significance of choroidal thickness with respect to visual function and disease progression over time.

Analysis of peripapillary atrophy using spectral domain optical coherence tomography.

OBJECTIVE To study retinal morphologic changes around the optic disc in patients with peripapillary atrophy (PPA) with high-resolution spectral domain optical coherence tomography (SD OCT). DESIGN Cross-sectional, retrospective analysis. PARTICIPANTS A total of 103 eyes of 73 patients with PPA and 21 eyes of 12 normal patients seen at the New England Eye Center, Tufts Medical Center, between January 2007 and August 2009. METHODS Spectral domain optical coherence tomography images taken through the region of PPA were quantitatively and qualitatively analyzed. Inclusion criteria included eyes with at least 300 μm of temporal PPA as detected on color fundus photographs. The study population was divided into subgroups according to the following clinical diagnoses: glaucoma (n=13), age-related macular degeneration (n=11), high myopia (n=11), glaucoma and high myopia (n=3), and optic neuropathy (n=11). Fifty-four patients were classified with other diagnoses. By using OCT software, retinal thickness and retinal nerve fiber layer (RNFL) thickness were both manually measured perpendicular to the internal limiting membrane and retinal pigment epithelium (RPE) 300 μm temporal to the optic disc, within the region of PPA. Qualitative analysis for morphologic changes in the atrophic area was also performed. MAIN OUTCOME MEASURES Qualitative assessment and quantitative measures of retinal and RNFL thickness in PPA. RESULTS The study group was categorized by 6 characteristics demonstrated in the area of PPA by SD OCT: RPE loss with accompanying photoreceptor loss, RPE disruption, RNFL thickening with plaque-like formation, intraretinal cystic changes, inner and outer retinal thinning, and abnormal retinal sloping. Statistical analysis of measurements revealed a statistically significant difference in the total retinal thickness between normal eyes and eyes with PPA (P=0.0005), with normal eyes 15% thicker than the eyes with PPA; however, the RNFL thickness was not significantly different between the normal eyes and the eyes with PPA (P=0.05). CONCLUSIONS Eyes with PPA manifest characteristic retinal changes that can be described via SD OCT.

Effect of Intravitreous Anti–Vascular Endothelial Growth Factor Therapy on Choroidal Thickness in Neovascular Age-Related Macular Degeneration Using Spectral-Domain Optical Coherence Tomography

A critical method of monitoring patients with neovascular age-related macular degeneration (AMD) being treated with anti–vascular endothelial growth factor (anti-VEGF) is optical coherence tomography (OCT), which uses low-coherence interferometry of light to examine the retina in vivo on a micrometer scale.1 Recent advances in spectral-domain OCT make visualization of the choroid feasible. Using image averaging and enhanced depth imaging, successful examination and measurement of choroidal thickness in normal and pathologic states have been reported.2–4 It has been hypothesized that anti-VEGF may affect choroidal vasculature.5 The goal of this study is to evaluate the effect of anti-VEGF on choroidal thickness using spectral-domain OCT in treatment-naive subjects.

Optical coherence tomography-guided facedown positioning for macular hole surgery.

Purpose: To use spectral domain optical coherence tomography–guided duration of facedown positioning to study anatomical macular hole closure rates. Methods: Retrospective review of patients with macular holes undergoing 23-gauge pars plana vitrectomy and intraocular gas tamponade. Spectral domain optical coherence tomography imaging was done on postoperative Day 1. Patients remained facedown for 2 more days if the macular hole was closed or 6 more days facedown if the macular hole was open or indeterminate. Results: There were 8 Stage 2, 12 Stage 3, and 12 Stage 4 macular holes. On postoperative Day 1, 24 holes were closed by spectral domain optical coherence tomography and instructed to remain facedown for two more days. Twenty-three of 24 holes remained closed during the postoperative period. Eight holes were open or indeterminate on postoperative Day 1 and remained facedown for 6 more days. Six of 8 holes (75%) were closed at their last follow-up. The overall closure rate was 29/32 (90.6%). Average follow-up was 334 days. Conclusion: Confirming early closure of macular holes with spectral domain optical coherence tomography imaging can serve as an important guide to significantly shorten the duration of prone positioning while maintaining high closure rates.

Analysis of short-term change in subfoveal choroidal thickness in eyes with age-related macular degeneration using optical coherence tomography.

BACKGROUND AND OBJECTIVE To measure the subfoveal choroidal thickness in patients with age-related macular degeneration (AMD) over 6 months. PATIENTS AND METHODS A retrospective, observational study of patients with AMD followed up for 6 months at the New England Eye Center. Baseline and 6-month follow-up subfoveal choroidal thickness was measured using spectral-domain OCT and compared. RESULTS For the entire cohort, there was statistically significant thinning of the subfoveal choroidal thickness at 6 months compared to baseline that was driven by the cohort of patients with neovascular AMD (181.2 ± 75 μm to 173.4 ± 63 μm; P = .049). CONCLUSION There was a statistically significant decrease in subfoveal choroidal thickness observed in this cohort of patients with AMD over 6 months, but it was driven by the subgroup of patients with neovascular age-related macular degeneration.

Ultra–High-Resolution Optical Coherence Tomographic Findings in Commotio Retinae

Commotio retinae is a self-limited opacification of the retina secondary to direct blunt ocular trauma. Histologic studies of monkeys and humans relate this clinical observation to damaged photoreceptor outer segments and receptor cell bodies.1–3 Reports using time-domain optical coherence tomography (OCT) and spectral-domain OCT support the involvement of the photoreceptor layer, but these techniques lack the resolution necessary to confirm results of histologic analysis.4–6 Prototype high-speed ultra–high-resolution OCT (hs-UHR-OCT) images demonstrate these anatomical changes in a patient with acute commotio retinae.

Posterior lattice degeneration characterized by spectral domain optical coherence tomography.

Purpose: The purpose of this study was to use high-resolution spectral domain optical coherence tomography in the characterization of retinal and vitreal morphological changes overlying posterior lattice degeneration. Methods: A cross-sectional retrospective analysis was performed on 13 eyes of 13 nonconsecutive subjects with posterior lattice degeneration seen at the New England Eye Center, Tufts Medical Center between October 2009 and January 2010. Spectral domain optical coherence tomography images taken through the region of lattice degeneration were qualitatively analyzed. Results: Four characteristic changes of the retina and vitreous were seen in the 13 eyes with lattice degeneration: 1) anterior/posterior U-shaped vitreous traction; 2) retinal breaks; 3) focal retinal thinning; and 4) vitreous membrane formation. The morphologic appearance of vitreous traction and retinal breaks were found to be consistent with previous histologic reports. Conclusion: It is possible to image posterior lattice degeneration in many eyes using spectral domain optical coherence tomography and to visualize the spectrum of retinal and vitreous changes throughout the area of lattice degeneration.

Intraretinal deposition of triamcinolone acetonide after treatment of diabetic macular edema.

PURPOSE To report a case of intraretinal triamcinolone acetonide crystal deposition visualized both clinically and on optical coherence tomography after intravitreal injection for diabetic macular edema refractory to focal/grid laser treatment. METHODS Observational case report. A 46-year-old man with severe bilateral diabetic macular edema underwent focal/grid laser therapy, Avastin (Genetech, Inc., South San Francisco, CA) injections, and multiple intravitreal triamcinolone acetonide treatments but remained refractory to treatment. RESULTS Visual acuity continued to worsen, and clinical and optical coherence tomography examination revealed scattered hyperreflective deposits throughout the retina. CONCLUSION Intravitreal triamcinolone acetonide can deposit within the retina after treatment of refractory diabetic macular edema.