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ABSTRACT: The aim was to report the evolution of a case of von Hippel-Lindau (VHL) juxtapapillary retinal capillary haemangioblastoma (RCH) by optical coherence tomography (OCT3).
The progress of a 24-year-old man suffering from VHL disease with a juxtapapillary haemangioblastoma and a small peripheral lesion was followed for 26.4 months with fundus photographs and OCT of the optic nerve head using the optic nerve head rim volume, ranging from 1.106 to 1.895 mm(3). Visual acuity remained 6/6 throughout.
OCT can be a useful tool in the follow up and decision-making of patients with small retinal capillary haemangioblastoma of the optic nerve.
Clinical and Experimental Optometry 03/2012; 95(2):237-40. · 1.05 Impact Factor
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ABSTRACT: To investigate by optical coherence tomography (OCT) the evolution of the photoreceptor layer and its association with best-corrected visual acuity (BCVA) in optic disc pit (ODP) maculopathy after successful surgical treatment.
Fourteen eyes of 14 patients were included in this study, and followed up from 36 to 95 months (mean 57.36 ± 18.32 months). The follow-up period started at the time of complete subretinal fluid absorption. Examination was performed by time-domain OCT before and after treatment. Spectral-domain OCT was used after treatment. Parameters assessed were type of elevation, central foveal thickness, time elapsed from onset to treatment, type of treatment, BCVA, and inner segment outer segment (IS/OS) junction line. The IS/OS junction was characterized after treatment as intact, interrupted, or absent (not distinguishable).
Significant restoration of the IS/OS junction line was first noticed between 6 and 12 months after fluid absorption (p = 0.02; Wilcoxon signed rank test). Restoration was continuous up to the 24th month of postoperative examination after fluid absorption (p = 0.14; Wilcoxon signed rank test). BCVA was 0.99 ± 0.38 logMar before treatment, 0.81 ± 0.26 logMar (p = 0.011; paired t-test) immediately after fluid absorption and 0.61 ± 0.33 logMar (p = 0.026; one-way ANOVA) 24 months after fluid resolution. BCVA was significantly positively correlated with the integrity of the IS/OS junction line during follow-up (Pearson r = 0.775; p < 0.001).
The IS/OS junction restoration cannot be detected immediately after fluid resolution in the majority of cases. It became evident 6-12 months later and was completed 24 months after fluid absorption. Improvement in BCVA was noticed only during the first 2 years of follow-up. No significant changes were noticed in BCVA or the IS/OS line after 2 years. Among the studied variables, the final photoreceptor layer condition and BCVA immediately after fluid absorption are the main factors predicting final BCVA after successful surgical treatment of ODP maculopathy.
Albrecht von Graæes Archiv für Ophthalmologie 01/2012; 250(7):971-9. · 2.17 Impact Factor
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ABSTRACT: To evaluate changes in macular thickness measured by optical coherence tomography (OCT) during a hemodialysis (HD) session in diabetic patients with end-stage renal disease.
72 eyes of 36 diabetic patients with and without macular edema were evaluated before and immediately after an HD session. Average and maximum macular thicknesses in the central disk (6 mm in diameter) and total macular volume were measured.
In the eyes with diabetic macular edema, maximum macular thickness within the central disk of 6 mm, and mainly in its peripheral parts, was significantly reduced by 31.18 ± 4.18 μm after HD (p < 0.001). Average macular thickness and total macular volume were also significantly reduced (p = 0.003 and 0.015, respectively). In diabetic eyes without edema, maximum macular thickness decreased significantly by 11.21 ± 1.98 μm after HD (p < 0.001), while average macular thickness and total macular volume decreased slightly (p = 0.034, p = 0.043). Best-corrected visual acuity failed to change. We found a significant association of macular thickness changes with osmolality reduction and the presence of macular edema.
HD decreases macular thickness in diabetic patients with macular edema, while there exists a less-pronounced effect in diabetic eyes without edema.
Ophthalmologica 09/2011; 227(2):90-4. · 1.42 Impact Factor
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ABSTRACT: To study the prognostic factors that influence best-corrected visual acuity (BCVA) outcome in patients with secondary epiretinal membrane (ERM) after retinal detachment surgery.
Retrospective case series.
Forty-two patients with ERM were divided into macula-on and macula-off groups based on the macular status before retinal detachment surgery and were studied using the same spectral-domain optical coherence tomography device. Several variables, including the integrity of the external limiting membrane (ELM), the status of the photoreceptor inner segment/outer segment (IS/OS) junction line, and central foveal thickness were evaluated in 17 treated and 25 untreated patients. Linear regression analysis was used to determine the best combination of all variables affecting BCVA.
Final BCVA was significantly better in macula-on and macula-off eyes with intact ELMs and IS/OS junction lines (0.35 ± 0.18 logarithm of the minimal angle of resolution [logMAR] and 0.51 ± 0.17 logMAR, respectively) than in macula-off eyes with disrupted or absent ELMs and IS/OS junction lines (0.83 ± 0.17 logMAR and 1.04 ± 0.05 logMAR, respectively; P < .001, analysis of variance). Final BCVA also was better in the treated group than in the controls (0.55 ± 0.31 logMAR and 0.73 ± 0.26 logMAR, respectively; P = .05, t test). ELM and IS/OS junction line integrity were the main variables significantly affecting the final BCVA outcome (β = 0.42; P = .006, linear regression analysis). Disruption of the ELM and IS/OS junction line was observed in 21 of the 42 cases studied.
ERM secondary to retinal detachment surgery is accompanied by a high incidence (50%) of IS/OS junction line and ELM disruption. Among the variables studied, the condition of the IS/OS junction layer and the ELM are the main factors that predict final BCVA after ERM peeling.
American journal of ophthalmology 03/2011; 151(6):973-80. · 3.83 Impact Factor
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ABSTRACT: To evaluate the external limiting membrane (ELM) by spectral domain optical coherence tomography (SDOCT) and its correlation with the inner segment/outer segment (IS/OS) line in patients with successful macular hole surgery.
Forty-five eyes were divided into 3 groups according to the interval between surgery and first examination. In the first group the interval was between 6 and 12 months, in group 2 it was >12 months and ≤ 24 months, and in group 3 it was >24 months. The IS/OS and ELM of participants' eyes were postoperatively assessed using SDOCT in 2008 and 12 months later.
A statistically significant association between the integrity of the ELM and the IS/OS junction line was observed in postoperative examinations in all 3 groups. Eyes with a complete IS/OS junction line had an intact ELM. Between the first and the second examinations, a significant improvement in best-corrected visual acuity (BCVA) was noted only in group 1. A positive statistical association was also observed in group 1 between restoration of the IS/OS junction line and improvement in BCVA over follow-up.
The restoration of the IS/OS junction line is directly related to the integrity of the ELM.
Ophthalmologica 02/2011; 225(3):176-84. · 1.42 Impact Factor
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ABSTRACT: to evaluate the correlation between the extent of the inner/outer segment (IS/OS) defect preoperatively and improvement in postoperative best-corrected visual acuity (BCVA) associated with IS/OS line restoration.
forty-six eyes (46 patients) with successfully operated idiopathic full-thickness macular holes were studied using Stratus OCT3 with a mean follow-up of 34.7 months (range 24-60 months). The preoperative extent of the IS/OS junction defect, macular hole base diameter (MHBD) and BCVA were studied before surgery. The degree of IS/OS line restoration, macular thickness and BCVA were measured after treatment.
the mean preoperative MHBD and IS/OS defect size were 783 and 1,973 μm, respectively. Postoperative continuity of the IS/OS junction was observed in 11 of 46 cases 12 months after treatment. In the remaining 35 patients, the IS/OS line was interrupted at 12 months of follow-up. The size of the preoperative IS/OS defect line was negatively correlated with the size of the postoperative IS/OS line and BCVA at 6 months and 12 months only (p < 0.0001). In all 46 eyes, the mean BCVA before and 12 months after treatment was 10 and 36.7 letters, respectively. BCVA remained almost unchanged after the first postoperative year of observation.
the degree of reorganization of the photoreceptor layer after successful macular hole closure varies and is mostly related to the preoperative extent of the IS/OS defect line and the MHBD. A small-sized IS/OS preoperative defect favors improvement and restoration of the IS/OS line after treatment. The IS/OS junction line and BCVA are mostly restored during the first 12 months after treatment.
Ophthalmologica 01/2011; 225(1):47-54. · 1.42 Impact Factor
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ABSTRACT: We report a case of corneal epithelial changes that occurred as ocular side effects of treatment with exemestane, a selective steroidal aromatase inhibitor. A 55-year-old woman presented to our outpatient department for routine eye examination. Clinical examination revealed bilateral corneal gray-white bands appearing as intraepithelial microcysts. Her past medical history included breast cancer, for which she underwent chemotherapy and subsequent treatment with exemestane. She was followed up for 1 year, during which the clinical picture of the cornea remained unchanged in both eyes and visual acuity remained unaffected. A causal connection seems to be possible between systemic treatment with exemestane and persisting corneal intraepithelial cysts.
Cutaneous and Ocular Toxicology 09/2010; 29(3):209-11. · 0.91 Impact Factor
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ABSTRACT: To document and study the spontaneous closure of lamellar macular holes (LMH) by optical coherence tomography (OCT).
Two women with LMH, 62 and 71 years old, respectively, were followed up with fundoscopy, fundus photography and OCT.
In both patients spontaneous closure of LMH was observed 11 and 21 months after baseline examination, respectively. The foveal thickness in case 1 increased from 84 μm at baseline to 162 μm at the final examination. The foveal thickness in case 2 increased from 48 μm at baseline to 148 μm at the final examination. The foveal contour was also restored in both eyes. The foveal morphology was preserved in both eyes during the follow-up period.
In both patients the spontaneous closure of LMH could be attributed to the shrinkage of the hole or the release of the tension on the retinal surface, which followed the complete posterior vitreous detachment and separation of epiretinal membrane from the retina.
Acta ophthalmologica 12/2009; 90(1):96-8. · 2.44 Impact Factor
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ABSTRACT: To present our preliminary experience on intravitreal administration of an anti-tumor necrosis factor (TNF) monoclonal antibody for neovascular age-related macular degeneration (AMD).
Prospective, noncomparative series of 3 patients previously treated with an anti-vascular endothelial growth factor agent.
Two intravitreal injections of 0.05 ml containing infliximab were administered in the first (1 and 2 mg, 2 months apart), second (2 mg each, 2 months apart), and third patient (2 mg each, 3 months apart). Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were monthly assessed for up to 7 months.
In the first patient, BCVA increased from 20/200 to 20/100 and CFT decreased from 462 to 386 microm, 2 months after the first injection. The condition was further improved after the second injection (BCVA, 20/40; CFT, 210 microm), but recurrence occurred 7 months post-baseline. In the second patient, BCVA increased from 20/200 to 20/70 and CFT decreased from 512 to 420 and 184 microm, 2 and 4 months post-baseline, respectively. In the third patient, clinical improvement was documented after the first injection. A second injection attributable to recurrence resulted in improvement of BCVA from 20/100 to 20/30 and decrease of CFT from 388 to 282 microm, 2 months after the second injection.
These findings, although insufficient to consider "off-label" treatment with intravitreal infliximab, provide in vivo evidence of a pathogenetic link of locally produced and/or acting TNF to neovascular AMD. A randomized study of consecutive intravitreal injections of infliximab for AMD may be warranted.
American journal of ophthalmology 03/2009; 147(5):825-30, 830.e1. · 3.83 Impact Factor
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ABSTRACT: To assess vitreous findings in optic disc pit maculopathy using Optical Coherence Tomography (OCT).
Thirty-eight eyes of 38 patients (14-51 years of age) with macular detachment associated with optic disc pit maculopathy were included in the study. The patients were divided into two groups. In group 1, 16 eyes were studied by OCT at presentation and after surgical treatment. In group 2, 22 eyes were examined by OCT only after treatment. In both groups thorough vitreous examination was performed over the macula and the optic disc. All patients were operated by the macular buckling procedure.
Vitreous abnormalities were found in 28 out of 38 eyes (74%) of both groups. In group 1, 10 of the 16 eyes had vitreous traction on the macula at presentation. The traction started from the optic disc and terminated to the macula. The posterior hyaloid that exerted the traction between the points of adhesion at the optic disc and the macula had a course parallel to the retinal surface in 9 of the 10 cases. Postoperatively, vitreous traction on the macula was not found. Of the remaining 6 eyes 4 had complete or partial posterior vitreous detachment. In group 2, 8 eyes had vitreous strands over the optic disc and 5 eyes posterior vitreous detachment. In the remaining 9 cases no vitreous involvement was noticed.
OCT was able to detect vitreous abnormalities such as vitreomacular traction, vitreous strands over the optic disc and complete or partial posterior vitreous detachment associated with optic disc pit maculopathy. Our observations support the view that the abnormal vitreous over the macula and optic disc is likely to play a role in the development of macular elevation in cases with optic disc pit. Prospective OCT studies could further assist to better understand the role of vitreous in this disease.
Albrecht von Graæes Archiv für Ophthalmologie 10/2007; 245(9):1311-8. · 2.17 Impact Factor
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ABSTRACT: To describe the macular findings by optical coherence tomography in both eyes of a patient with tilted optic disk and visual decrease.
A 35-year-old woman with bilateral tilted optic disk and serous macular detachment was examined by slit-lamp biomicroscopy, fluorescein angiography, indocyanine green angiography and optical coherence tomography (OCT).
Fluorescein angiography demonstrated staining of the temporal rim of the staphyloma adjacent to the optic disk and hyperfluorescence of the diffuse pigmentary changes in the papillomacular area. Leakage points and serous macular detachment were not observed. The existing neurosensory detachment at the fovea became evident only by OCT.
The existence of subretinal fluid, which became evident only by OCT, supports the view that OCT could further contribute to the study of the asymptomatic pigmentary lesions of the macula that are present in 11% of eyes with tilted optic disk. The reason for the localized macular detachment remains unclear. Dysfunction of the retinal pigment epithelium (RPE) or leakage of the optic disk staphyloma rim could possibly explain the cause of fluid accumulation in the macula.
Albrecht von Graæes Archiv für Ophthalmologie 02/2006; 244(1):122-4. · 2.17 Impact Factor
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ABSTRACT: We sought to investigate contrast sensitivity on the fellow eyes of amblyopic and successfully treated amblyopic subjects.
Contrast sensitivity was tested monocularly on both eyes of 48 amblyopic patients (mean age, 11.51 years) and of 22 successfully treated amblyopic subjects (visual acuity 20/20 in each eye; mean age, 11.22 years). Inclusion criteria were visual acuity in the amblyopic eye 20/40 or better (mild amblyopia) and 20/20 or better in the fellow eye, steady fixation, no signs of congenital, latent or manifest/latent nystagmus on clinical examination. Twenty normal subjects (20 eyes) were used as age-matched controls.
Contrast sensitivity functions from the fellow eye of the 48 amblyopic patients, even those who had never been treated with occlusion therapy before, were significantly decreased (P < 0.001) compared with control subjects. Both the previously amblyopic and the fellow eye of the 22 "cured" amblyopic subjects demonstrated significantly lower values (P < 0.001) compared with control patients.
We suggest that the nonamblyopic, "normal" eye of amblyopic patients behaves abnormally when evaluated for contrast sensitivity functions. Neither the previously amblyopic nor the fellow eyes of successfully treated subjects were comparable with controls. Occlusion therapy may not be implicated for depressed contrast sensitivity of the fellow eye in amblyopia. The assessment of contrast sensitivity can provide important information on the visual function and the influence of occlusion therapy in amblyopia.
Journal of American Association for Pediatric Ophthalmology and Strabismus 11/2005; 9(5):468-74. · 1.03 Impact Factor
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ABSTRACT: To report a case with two optic disk pits which were associated with an optic nerve cyst in the same eye.
Observational case report.
A 47-year-old patient noted visual impairment in the right eye. On examination the best corrected visual acuity in the right eye was 20/80 and in the left eye was 20/20. Biomicroscopy revealed, in the right eye, a very pale optic disk with two optic disk pits without macular elevation. Magnetic resonance imaging (MRI) revealed a well circumscribed 6 x 6-mm(2) round cystic lesion within the right optic nerve sheath adjacent to the temporal aspect of the right optic nerve at its retrobulbar segment, which compressed and displaced the nerve.
In the case of an extremely pale optic disk with congenital pits and visual impairment without macular detachment, radiological examination is indicated in order to exclude the possibility of coexisting optic nerve anomalies.
Albrecht von Graæes Archiv für Ophthalmologie 08/2005; 243(7):718-20. · 2.17 Impact Factor
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Acta Ophthalmologica Scandinavica 03/2005; 83(1):120-2. · 1.85 Impact Factor
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Diabetes Care 03/2005; 28(2):445-7. · 8.09 Impact Factor
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ABSTRACT: To assess the efficacy of the anti-TNF monoclonal antibody infliximab in uveitis patients without clinically evident ocular inflammation and impaired visual acuity because of chronic cystoid macular edema (CME).
Prospective, noncomparative, interventional case series.
Patients with refractory CME (14 eyes, mean duration of 14 months), associated with intermediate uveitis (n = 6), Adamantiades-Behcet disease (n = 2), adult-type vascular pseudotumor (n = 1), and HLAB27+-related uveitis (n = 1) received an intravenous infliximab infusion (5 mg/kg); five patients were retreated after 1 month.
Macular thickness, measured by ocular coherence tomography, was reduced from 428 +/- 138 microm to 219 +/- 51 microm at 2 months postbaseline (P = .0001), while visual acuity increased from 0.41 +/- 0.18 to 0.83 +/- 0.17 (P < .00001). Anatomic and functional improvement was sustained at 6 months in all. No ocular or extra-ocular side effects were noted.
These promising results suggest that TNF may play an important pathogenetic role in chronic CME, thus, a controlled trial is warranted.
American Journal of Ophthalmology 11/2004; 138(4):648-50. · 4.22 Impact Factor
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ABSTRACT: Twenty patients on Plaquenil treatment were evaluated for retinal toxicity using the (EOG) and the mfERG. Group 1 comprises 15 patients (30 eyes) with normal EOG. From these patients 11 (22 eyes) showed normal RRD of mfERG in area 1 and area 2. The rest four patients (8 eyes) the RRD were reduced. Six months after interruption of HC, the mfERG improved in three cases. Group 2 comprises 5 patients (10 eyes) with subnormal EOG. Four (8 eyes) of these showed a decrease of RRD of the mfERG in area 1 and 2. In the rest one (2 eyes) the RRD were normal. Six months after interruption of HC the mfERG and the EOG improved in 2 cases. These results postulate that the mfERG may be used as an alternative method, perhaps more sensitive, for the detection of the HC retinopathy and the follow up of the patients on hydroxychloroquine.
Documenta Ophthalmologica 02/2004; 108(1):47-53. · 2.11 Impact Factor
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ABSTRACT: To present the postoperative optical coherence tomography (OCT) findings of the macula in rhegmatogenous retinal detachment with spared macula preoperatively.
Eleven of 46 patients who underwent surgery for rhegmatogenous retinal detachment had an uninvolved macula preoperatively. Scleral buckling without intravitreous gas injection was the operation used in all eyes. All 11 patients were examined before and after treatment with slit-lamp biomicroscopy, indirect ophthalmoscopy, fundus photography, fluorescein angiography, and OCT.
In 3 of the 11 patients with rhegmatogenous retinal detachment and uninvolved macula preoperatively, fluid was identified with OCT in the macula after successful treatment. OCT showed that the fluid gradually diminished and finally disappeared 5 to 7 months after the scleral buckling procedure. The fluid in the macula became visible with slit-lamp biomicroscopy in only one of the three patients.
Subretinal fluid in a preoperatively uninvolved macula can be found after successful treatment of rhegmatogenous retinal detachment. If the fluid is located in the fovea, the visual acuity decreases and does not reach the preoperative levels. OCT identifies the presence of fluid and contributes to the study of the fluid's evolution.
Retina 03/2003; 23(1):69-75. · 2.81 Impact Factor
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ABSTRACT: To evaluate successful macular hole surgery using optical coherence tomography (OCT) and multifocal electroretinography (MFERG).
Interventional case series.
In a prospective study, 20 eyes of 20 patients with successful surgery for stage II, III, or IV idiopathic macular hole were evaluated by best-corrected visual acuity (BCVA), ocular examination, OCT, and MFERG preoperatively and 1, 3, 6, and 12 months postoperatively. For statistical analysis, the paired t test and nonparametric methods were used, as well as the Spearman analysis.
Postoperatively, all 20 eyes of 20 patients had anatomic closure of the macular hole confirmed by OCT. The center of the fovea, measured by OCT from the retinal pigment epithelium to the inner retinal surface, had a mean +/- SD thickness of 116.5 +/- 30.9 microm (range, 68-175 microm) 1 year postoperatively. Best-corrected visual acuity significantly improved (preoperative mean +/- standard deviation [SD] value, 0.131 +/- 0.081 and 1 year postoperative mean +/- SD value, 0.407 +/- 0.193). Multifocal electroretinography values area 1 (0-2.8 degrees) and area 2 (2.8-9 degrees from the center of the fovea) significantly improved (preoperative mean +/- SD values 3.10 +/- 1.334 nV/deg(2) and 3.573 +/- 1.545 nV/deg(2), respectively, and 1 year postoperative +/- SD mean values, 5.53 +/- 1.208 nV/deg(2) and 4.748 +/- 1.404 nV/deg(2), respectively). The thickness of the fovea, measured by OCT, significantly correlated with the BCVA 1 year postoperatively. One year postoperative MFERG values areas 1 and 2 were not correlated with 12-month BCVA and OCT findings.
Twelve months postoperatively BCVA and MFERG values significantly improved in this series of eyes with successful macular hole surgery. Optical coherence tomography findings were correlated to BCVA, but MFERG values were not correlated to BCVA and OCT findings, 1 year postoperatively.
American Journal of Ophthalmology 12/2002; 134(5):667-74. · 4.22 Impact Factor
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ABSTRACT: To report optical coherence tomography (OCT) of retinal disorders in preeclampsia.
Observational case report.
A 24-year-old woman developed hypertension (190/100 mm Hg), proteinuria, and generalized edema in the 34th week of pregnancy. Soon after undergoing a cesarean section, she noted severe impairment of vision in both eyes.
Ten days after delivery, OCT showed a diffuse intraretinal edema that was still present but in a minor degree 2 months later. Eight months after delivery, macular edema had resolved, but the highly reflective band of retinal pigment epithelium (RPE) and choriocapillaris was thickened with focal elevations corresponding to the Elschnig spots.
In the acute phase of preeclampsia, OCT revealed a diffuse increase in macular thickness. Two months after delivery, macular edema still existed but in a minor degree. Eight months after the first examination, OCT depicted restoration of the contour of the fovea. Moreover, OCT showed the characteristic RPE focal elevations and abnormalities corresponding to the Elschnig spots.
American Journal of Ophthalmology 06/2002; 133(5):707-9. · 4.22 Impact Factor
