Veit Sturm

Reproducibility of Retinal Thickness Measurements in Healthy Subjects Using Spectralis Optical Coherence Tomography

PURPOSE To test the reproducibility of retinal thickness measurements in healthy volunteers of a new Frequency-domain optical coherence tomography (OCT) device (Spectralis OCT; Heidelberg Engineering, Heidelberg, Germany). DESIGN Prospective, observational study. METHODS Forty-one eyes of 41 healthy subjects were included into the study. Intraobserver reproducibility was tested with 20 x 15 degree raster scans consisting of 37 high-resolution line scans that were repeated three times by one examiner (M.N.M.). Mean retinal thickness was calculated for nine areas corresponding to the Early Treatment Diabetic Retinopathy Study (ETDRS) areas. Coefficients of variation (COV) were calculated. RESULTS Retinal thickness measurements were highly reproducible for all ETDRS areas. Mean total retinal thickness was 342 +/- 15 microm. Mean foveal thickness was 286 +/- 17 microm. COVs ranged from 0.38% to 0.86%. Lowest COV was found for the temporal outer ETDRS area (area 7; COV, 0.38%). Highest COV was found for the temporal inner ETDRS area (area 3; COV, 0.86%). Mean difference between measurement 1 and 2, measurement 1 and 3, and measurement 2 and 3 for all ETDRS areas was 1.01 microm, 0.98 microm, and 0.99 microm, respectively. CONCLUSION Spectralis OCT retinal thickness measurements in healthy volunteers showed excellent intraobserver reproducibility with virtually identical results between retinal thickness measurements performed by one operator.

Reproducibility of Nerve Fiber Layer Thickness Measurements Using 3D Fourier-Domain OCT

PURPOSE Conventional time-domain optical coherence tomography (OCT) has been shown to provide reproducible retinal nerve fiber layer (RNFL) measurements. Recently, high-speed, high-resolution Fourier-domain 3D-OCT has been introduced to improve OCT quality. It can provide 6-mm(2) high-density scans to provide RNFL thickness measurements. The purpose of this study was to test the reproducibility of 3D-OCT RNFL thickness measurements in healthy volunteers. METHODS Thirty-eight eyes were included in the study. High-density 6-mm(2) 3D scans were registered by two independent operators. RNFL thickness was calculated for eight areas corresponding to the ETDRS areas and for two ring areas. The ETDRS grid was centered on the optic disc. Intraclass correlation coefficients (ICC) and coefficients of variation (COV) were calculated. Interobserver reproducibility was visualized by using Bland-Altman analysis. RESULTS Intrasession reproducibility was good with a mean ICC of 0.90. The mean COV for operator 1 and 2 was 4.2% and 4%, respectively (range, 1.9%-6.7%). Highest reproducibility was found for the two ring areas and the superior and inferior quadrants. Mean differences in RNFL thickness measurements for ring 1 and 2 between operator 1 and 2 were 0.9 microm (limits of agreement, -11.4 to +9.6 microm) and 0.1 microm (limits of agreement -4.1 to +3.9 microm), respectively. CONCLUSIONS 3D-OCT RNFL thickness measurements in healthy volunteers showed good intra- and interobserver reproducibility. 3D-OCT provides more RNFL thickness information compared to conventional time-domain OCT measurements and may be useful for the management of glaucoma and other optic neuropathies.

Single motor unit activity in human extraocular muscles during the vestibulo‐ocular reflex

•  While the eye movements have been well characterized during the vestibulo‐ocular reflex, the corresponding motor unit activity in human eye muscles is not well understood. •  The present study describes the first single motor unit recordings during the vestibulo‐ocular reflex in human eye muscles. •  Simultaneous needle and surface recordings identified the inferior oblique as the eye muscle of origin of the ocular vestibular evoked myogenic potential (oVEMP), thus validating the physiological basis of this clinical test of otolith function. •  The results demonstrate short‐latency vestibulo‐ocular projections from the otoliths to individual eye muscles. •  Single motor unit activity of eye muscles provides a window into neural activity of the ocular motor nuclei in humans.

Tolosa-Hunt syndrome: MR imaging features in 15 patients with 20 episodes of painful ophthalmoplegia

PURPOSE (a) To assess MR features in patients with Tolosa-Hunt syndrome (THS) and to (b) correlate MR findings with criteria derived from previously reported pathologic observations. METHODS Fifteen patients with twenty episodes of painful ophthalmoplegia prospectively selected according to International Headache Society (IHS) standards underwent MR examinations focused on the cavernous sinus. Initial examinations in 20 and follow-up MR images in 17 episodes were retrospectively reviewed by 3 independent observers. RESULTS The primary criteria: an enhancing soft tissue lesion within the cavernous sinus, increase in size and lateral bulging of the anterior cavernous sinus contour were consistently present in 15 initial episodes and in 5 recurrences (20/20). Agreement among observers was 100%. The secondary criteria: internal carotid artery narrowing in 7 patients, extension towards the superior orbital fissure in 13 and orbital apex involvement in 8 patients were unanimously agreed upon in 87.5%, 86.6% and 80%. Complete resolution of findings was observed on follow-up studies. CONCLUSION In patients with THS the MR features conform to previously reported pathologic findings. MR features are evocative of THS when an increase in size and bulging of the dural contour of the anterior CS supplemented by carotid artery involvement and extension towards the orbit are present. Resolution of findings within 6 months is required to support the diagnosis.

Optical Coherence Tomography Findings in Shaken Baby Syndrome

PURPOSE To evaluate features of optical coherence tomography (OCT) associated with Shaken Baby syndrome (SBS) in an attempt to gain new insight into the pathophysiology of this phenomenon. DESIGN Institutional prospective observational case series. METHODS We report three infants with SBS. Each patient underwent an ophthalmic examination including slit-lamp biomicroscopy, dilated indirect ophthalmoscopy, color fundus photography, and OCT. RESULTS In all infants, numerous bilateral multilayered retinal hemorrhages were present. In one case, bilateral perimacular folds had occurred. OCT confirmed retinal hemorrhages and perimacular folds. Moreover, OCT revealed vitreoretinal traction in all infants and suspected hemorrhagic macular retinoschisis in one case. Based on OCT findings, a hypothesis of vitreoretinal traction development and retinal fold formation is proposed. CONCLUSIONS OCT provided valuable additional information about the ocular pathology in patients with SBS. Vitreoretinal membrane formation seen in OCT could support the pathophysiological theory of a direct mechanical effect. OCT revealed preretinal blood accumulation as a cause for localized vitreous detachment and vitreoretinal traction. Furthermore, OCT showed persistent attachment of the vitreous to the internal limiting membrane at the apices of perimacular folds and suggested small hemorrhagic macular retinoschisis in one patient. Perimacular folds and hemorrhagic macular retinoschisis are regarded as highly specific for SBS and indicate poor visual outcome. Thus OCT might be of both diagnostic and prognostic value in SBS.

Tunnelled versus straight intravitreal injection: intraocular pressure changes, vitreous reflux, and patient discomfort.

Purpose: To compare tunnelled scleral intravitreal injection with straight scleral intravitreal injection concerning short-term intraocular pressure (IOP) changes, occurrence and amount of vitreous reflux, and patient discomfort. Methods: Sixty patients were randomly allocated to two groups (tunnelled intravitreal injection and straight intravitreal injection). IOP was measured before and directly (<1 minute) after the injection of 0.05 mL of an antivascular endothelial growth factor agent and then every 5 minutes until IOP was <30 mmHg. Occurrence and amount of vitreous reflux were recorded. Patient discomfort during injection was assessed with a Wong-Baker faces pain rating scale. Results: IOP (mmHg ± SD) increased significantly directly after injection to 35.97 ± 8.13 (tunnelled intravitreal injection) and 30.19 ± 12.14 (straight intravitreal injection). These pressure spikes differed significantly between both groups (P = 0.01, mean difference: −7.11). Five minutes after injection, there was no significant difference in IOP increase between the groups. All IOP measurements were <30 mmHg after 15 minutes. Occurrence and amount of vitreous reflux were significantly higher with straight intravitreal injection. There was no significant difference in Wong-Baker faces pain rating scale score between both groups. Conclusion: Tunnelled intravitreal injection seems to be the technique of choice for low-volume intravitreal injection (0.05 mL). There is neither a difference in patient discomfort nor a difference in IOP increase 5 minutes after injection between both groups. Significantly less vitreous reflux with tunnelled intravitreal injection should lead to less postinjectional drug loss.

Ophthalmological findings in Joubert syndrome

PurposeJoubert syndrome (JS) is an autosomal-recessive inherited complex malformation of the midbrain–hindbrain. It has been associated with ocular and oculomotor abnormalities. The aim of our study was to extend the ophthalmic knowledge in JS and to add new findings.MethodsIn a retrospective study, 10 consecutive patients, who met the revised diagnostic criteria of JS were included. Mutation analysis was carried out in all the cases. Each patient underwent a comprehensive neuro-ophthalmological examination.ResultsBilateral drusen of the optic disc were found in two patients. Four patients showed bilateral morphological and functional signs of retinal dystrophy (CEP290mutation in two cases and AHI1mutation in one case). In nine patients performance during smooth pursuit, saccades, and vestibulo-ocular reflex (VOR) cancellation was poor.ConclusionsTo the best of our knowledge, the association of optic disc drusen with JS has not yet been described. In support of the earlier findings, decreased smooth pursuit and VOR cancellation, as well as partial-to-complete oculomotor apraxia seem to be the key oculomotor features of JS. Genotype–phenotype correlations showed the predictive value of CEP290and AHI1mutations for retinal involvement.

Reproducibility of retinal thickness measurements in patients with age-related macular degeneration using 3D Fourier-domain optical coherence tomography (OCT) (Topcon 3D-OCT 1000)

Purpose:  Conventional time‐domain optical coherence tomography (OCT) has become an important tool for following dry or exudative age‐related macular degeneration (AMD). Fourier‐domain three‐dimensional (3D) OCT was recently introduced. This study tested the reproducibility of 3D‐OCT retinal thickness measurements in patients with dry and exudative AMD.

Ocular involvement in paediatric haemolytic uraemic syndrome

Acta Ophthalmol. 2010: 88: 804–807

Repeatability of nerve fiber layer thickness measurements in patients with glaucoma and without glaucoma using spectral-domain and time-domain OCT

BackgroundThe aim of this work is to assess the repeatability of spectral-domain-OCT (SD-OCT) retinal nerve fiber layer thickness (RNFL) thickness measurements in a non-glaucoma group and patients with glaucoma and to compare these results to conventional time-domain-OCT (TD-OCT).MethodsIn a prospective, comparative, observational case-control study, 50 eyes of 25 non-glaucoma and 22 eyes of 11 patients with primary open angle glaucoma (POAG) were included. SD-OCT and TD-OCT circle scans were centered on the optic disc. In each eye, OCT scans were performed three times by two independent observers. RNFL thickness was measured in four quadrants around the optic disc. In addition, the overall mean RNFL thickness was assessed. Intraclass correlation coefficients (ICC) and coefficients of variation (COV) were calculated. Inter-observer and inter-OCT repeatability was visualized by using Bland–Altman analysis.ResultsIntra-observer repeatability for TD- OCT was good with an ICCmean RNFL thickness of 0.939 in non-glaucomas and 0.980 in glaucomatous eyes. For SD-OCT, intra-observer repeatability was higher with an ICC of 0.989 for non-glaucomas and 0.997 for glaucomatous eyes. COVs for TD-OCT ranged from 2.9–7.7% in non-glaucomas and from 6.0–13.3% in glaucoma patients. COVs for SD-OCT ranged from 0.3–1% in non-glaucomas and from 0.9–2.3% in glaucomatous eyes. COVs were influenced by various factors. In the glaucoma group, COVs were significantly higher (p < 0.001) compared to the non-glaucoma group. COVs increased by a mean of 5.1% when TD-OCT was used instead of SD-OCT (p < 0.001).ConclusionsSD-OCT RNFL thickness measurements in healthy volunteers and glaucoma patients showed good intra- and inter-observer repeatability. Especially in glaucomatous eyes, repeatability of SD-OCT was superior to TD-OCT.