The significance of external limiting membrane status for visual acuity in age-related macular degeneration.

Department of Ophthalmology, Kobe City Medical Center General Hospital, Japan.
American Journal of Ophthalmology (Impact Factor: 4.02). 07/2010; 150(1):27-32.e1. DOI: 10.1016/j.ajo.2010.02.012
Source: PubMed

ABSTRACT To evaluate status of the external limiting membrane (ELM) as a contributor of visual acuity (VA) in age-related macular degeneration (AMD).
Hospital-based, cross-sectional study.
We retrospectively reviewed spectral-domain optical coherence tomography images of 158 patients with AMD who had undergone photodynamic therapy and classified them based on the status of the ELM: absent, discontinuous, or complete. We simultaneously assessed foveal thickness, presence or absence of subretinal fluid/mass, presence or absence of subretinal pigment epithelium fluid/mass, status of the inner segment/outer segment (IS/OS) junction, and status of the intermediate line between the IS/OS junction and retinal pigment epithelium. Correlation coefficients between each parameter and VA were analyzed.
There was a strong correlation between ELM status and VA (r = -0.75, P < .001), and that was higher than that of the IS/OS (r = -0.69, P < .001). Multivariate analysis showed that ELM status is the most important factor for VA. Other parameters that correlated with VA included age, status of the intermediate line, and presence of subretinal or subretinal pigment epithelium fibrosis. Foveal thickness showed V-shaped correlation, with the dividing line around 200 mum.
ELM status may be more useful than is IS/OS status in evaluation of retinal morphology and function in patients with AMD.

  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE: To study the pathomorphology of subretinal hemorrhage (SRH) seen in eyes with branch retinal vein occlusion (BRVO) and its association with visual prognosis. METHODS: We retrospectively reviewed 42 consecutive patients (42 eyes) with BRVO that affected the fovea. Retinal structural changes were examined by spectral domain optical coherence tomography (SD-OCT). RESULTS: On SD-OCT sections, serous retinal detachment was seen at the fovea in 35 eyes, 18 of which accompanied foveal SRH. While initial detection of foveal SRH had no correlation with initial visual acuity (VA), it was correlated with poorer final VA (r = 0.361, P = 0.019). Our patients were classified into two groups by the initial detection of foveal SRH, and initial VA was not different between these two groups. At the final examination, damaged lengths in the foveal photoreceptor layer were significantly longer in the SRH-positive group than those in the SRH-negative group (P = 0.004), and final VA in the SRH-positive group was significantly worse than that in the SRH-negative group (P = 0.019). CONCLUSION: Foveal SRH is not an uncommon feature in BRVO and may cause subsequent damage to the foveal photoreceptor layer, resulting in poor visual function.
    Japanese Journal of Ophthalmology 03/2013; · 1.27 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE:: Correlating spectral domain optical coherence tomography characteristics with final best-corrected visual acuity (BCVA) in eyes with subfoveal scarring after treatment for wet age-related macular degeneration. METHODS:: Seventy-nine eyes from 64 subjects, who developed subfoveal scarring after treatment of wet age-related macular degeneration, were retrospectively studied. Spectral domain optical coherence tomography characteristics were analyzed, including percentage disruption of inner segment/outer segment junction and external limiting membrane, central macular thickness, subfoveal scar thickness, subretinal scar area, and proximity of retina with intact outer structures to the fovea. A multivariate stepwise regression analysis was performed with the final BCVA logarithm of minimum angle of resolution as a response and the above-identified spectral domain optical coherence tomography variables as predictors. RESULTS:: There was no correlation between the final BCVA and any of the demographic data, treatment modality received, and central macular thickness. The final BCVA was significantly correlated with the percentage of inner segment/outer segment disruption (P = 0.011), external limiting membrane disruption (P = 0.005), and scar area on spectral domain optical coherence tomography (P = 0.018). Multivariate analysis showed that the baseline BCVA and distance between the fovea and nearest retina with intact outer structures are the most predictive of the final BCVA (R = 0.52). CONCLUSION:: Baseline BCVA and integrity of outer retinal structures are good predictors of the final BCVA of wet age-related macular degeneration patients developing scarring after treatment.
    Retina (Philadelphia, Pa.) 02/2013; · 2.93 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE: To evaluate whether the status of the external limiting membrane (ELM) or inner segment/outer segment junction (IS/OS) improves after intravitreal injection of ranibizumab for age-related macular degeneration (AMD). We also evaluated whether the pre-operative values of these parameters are associated with the visual prognosis. METHODS: This was a hospital-based, cross-sectional study. Seventy-six eyes of 76 treatment-naive AMD patients who received three monthly intravitreal injections of ranibizumab followed for more than 6 months with additional as-needed injections were investigated. Spectral domain OCT was used to evaluate the length of ELM, IS/OS, and foveal thickness pre- and post-operatively. Changes of ELM and IS/OS length were evaluated postoperatively. Correlation coefficients between pre-operative parameters and post-operative visual acuity were also analyzed. RESULTS: Significant changes were noted in mean logMAR (0.66 to 0.53), foveal thickness (231.1 to 151.1 μm), and IS/OS length (514.9 to 832.3 μm) after the treatment. ELM length did not improve significantly (1,312.4 to 1,376.7 μm). Restoration of IS/OS occured where ELM is retained. Although pre-operative ELM length, IS/OS length, and foveal thickness showed correlation with post-operative logMAR (R = -0.51, -0.39, and 0.46, respectively), the most powerful predictive factor for visual prognosis was pre-operative logMAR (R = 0.77, p < 0.001). CONCLUSIONS: IS/OS status improves in response to anti-VEGF therapy but ELM seems to have less plasticity. The status of IS/OS and ELM can be used as prognostic factors but the predictive power is inferior to that of baseline visual acuity.
    Albrecht von Graæes Archiv für Ophthalmologie 05/2012; · 1.93 Impact Factor