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PubMed2003

Adult-onset foveomacular vitelliform dystrophy: a study by optical coherence tomography.

PURPOSE: To evaluate the morphology of adult-onset foveomacular vitelliform dystrophy (AFVD) using optical coherence tomography (OCT) and to correlate the OCT findings with those of biomicroscopy and fluorescein angiography (FA). DESIGN: Prospective observational case series. METHODS: A complete ophthalmologic examination, including visual acuity, fundus biomicroscopy, FA, and OCT was performed in 21 eyes of 14 consecutive patients with AFVD. RESULTS: Mean age at presentation was 64 years (range, 39 to 84 years), and best-corrected visual acuity ranged from 20/25 to 20/400 (median 20/50). Sixteen of 21 eyes (11 patients) exhibited late staining of lesions on FA. In these 16 eyes, OCT revealed that AFVD material consists of a hyperreflective structure located between the photoreceptor and the retinal pigment epithelium layers. The retinal pigment epithelium layer was linear and was not elevated, unlike what is observed in retinal pigment epithelium detachment. Five other eyes (x4 patients) without late staining in FA showed, by OCT, a hyperreflective area at the level of the retinal pigment epithelium band, with no material visible between the photoreceptor and retinal pigment epithelium layers. In all 21 eyes, the retina overlying the hyperreflective structure was raised by the pseudovitelliform material and was markedly thinned. CONCLUSIONS: Optical coherence tomography is a noninvasive useful tool that provides new information on the morphology of AFVD. It demonstrates, better than biomicroscopy, the location of the yellowish material under the sensory retina but above the retinal pigment epithelium, corresponding angiographically to the late staining. The foveal thinning found by OCT in all cases probably explains the progressive visual loss and possible evolution toward a full-thickness macular hole.

Adult↗
PubMed2003

Retinal capillary hemangioma treatment by indocyanine green-mediated photothrombosis.

PURPOSE: To describe the clinical, angiographic and optical coherence tomography (OCT) findings of a patient with a large retinal capillary hemangioma who was treated by indocyanine green-mediated photothrombosis. Interventional case report. METHODS: An 18-year-old male patient was treated at a tertiary referral center with a novel laser-dye procedure that uses low-irradiance 810-nm laser and intravenous indocyanine green injection and was prospectively evaluated with fluorescein and indocyanine green angiography, as well as OCT. RESULTS: Vision improved from 20/125 to 20/32 + 1 at 1-year follow-up. Fundus photography showed marked reduction of a 3 disk diameters retinal capillary hemangioma. Both fluorescein and indocyanine green angiography demonstrated reduced tumor perfusion and narrowing of the lesion feeder and draining vessels as early as 5 days after indocyanine green-mediated photothrombosis; OCT showed immediate decrease in retinal elevation and complete resolution of subretinal fluid within 2 months of treatment. Minimal laser-induced effects were noted in the vicinity of the tumor. CONCLUSIONS: Photothrombosis using low-intensity, 810-nm light to direct laser energy continuously at the tumor after intravenous indocyanine green infusion was effective in restoring macular architecture and improving vision in a patient with a large peripheral retinal capillary hemangioma by means of substantial occlusion of the tumor vasculature and resolution of subretinal fluid.

Adolescent↗
PubMed2003

Evaluation of the glaucomatous damage on retinal nerve fiber layer thickness measured by optical coherence tomography.

PURPOSE: To evaluate the relationship between visual field and retinal nerve fiber layer (RNFL) thickness measured by optical coherent tomography (OCT) and to assess the diagnostic ability of OCT to distinguish between early glaucomatous or glaucoma-suspect eyes from normal eyes. DESIGN: Retrospective, non-randomized, cross-sectional study. METHODS: A total of 160 eyes of 120 normal Japanese adults, 23 eyes of 16 patients with ocular hypertension, 38 eyes of 35 glaucoma-suspect patients, and 237 glaucomatous eyes of 140 glaucoma patients were enrolled in the study. The glaucoma group included 89 early glaucomatous eyes. Thickness of the RNFL around the optic disk was determined with three 3.4-mm diameter circle OCT scans. Average and segmental RNFL thickness values were compared among all groups. The correlation between mean deviation and RNFL thickness in glaucomatous eyes was also analyzed. Receiver operating characteristic (ROC) curve area was calculated to discriminate normal eyes from early glaucomatous or glaucoma-suspect eyes. RESULTS: A significant relationship existed between the mean deviation and RNFL thickness in all parameters excluding the 3-o'clock area. The average RNFL thickness had the strongest correlation in all parameters (r = -0.729, P <.001). Retinal nerve fiber layer thickness at the 7-o'clock inferotemporal segment had the widest areas under the ROC curves in all parameters for early glaucomatous eyes (0.873). CONCLUSIONS: Measurement of RNFL thickness by OCT is useful in detecting early RNFL damage. Furthermore, OCT measurements of RNFL thickness may provide clinically relevant information in monitoring glaucomatous changes.

Cross-Sectional Studies↗
PubMed2003

Axonal loss after traumatic optic neuropathy documented by optical coherence tomography.

PURPOSE: To report longitudinal retinal nerve fiber layer (RNFL) thickness measurements using optical coherence tomography (OCT) in a patient with traumatic optic neuropathy. DESIGN: Observational case report. METHODS: A 14-year-old boy with severe optic nerve trauma had repeated OCT scans of the peripapillary retinal nerve fiber layer at 3 days, 20 days, 40 days, and 70 days after injury. RESULTS: There was gradual loss of nerve fibers as shown by the OCT color-coded map, RNFL thickness profile, and RNFL thickness measurements around the optic disk. At 70 days of follow-up, severe thinning of the RNFL was observable. CONCLUSIONS: These findings suggest that OCT is able to assess and monitor axonal loss after traumatic optic neuropathy.

Adolescent↗
PubMed2003

Optical coherence tomographic evaluation of a surgically treated traumatic macular hole secondary to Nd:YAG laser injury.

PURPOSE: To report the importance of optical coherence tomographic (OCT) evaluation of a macular hole caused by neodymium:yttrium-aluminum-garnet (Nd:YAG) laser injury. DESIGN: Observational case report. METHODS: A 33-year-old man presented with an accidental Nd:YAG laser-induced macular hole in his right eye. After observing the course of the macular hole by OCT, the macular hole was treated by standard pars plana vitrectomy. The appearance of the macular hole was also followed up postoperatively. RESULTS: Seven days after the injury, OCT showed a full-thickness macular hole without a fluid-cuff or swelling of the surrounding retina. Twenty-one days after the injury, however, OCT disclosed that the retina around the macular hole was swollen. After vitrectomy, OCT showed that the macular hole was closed, and the visual acuity improved from 20/30 to 20/20. CONCLUSIONS: Surgical treatment can improve the visual function of eyes with a Nd:YAG laser-induced macular hole. Optical coherence tomography is valuable in providing precise information about the condition of the macula.

Adult↗
PubMed2003

Scanning laser polarimetry with variable corneal compensation and optical coherence tomography in normal and glaucomatous eyes.

PURPOSE: To evaluate the relationship between visual function and retinal nerve fiber layer (RNFL) measurements obtained with scanning laser polarimetry with variable corneal compensation (SLP-VCC) and optical coherence tomography (OCT). DESIGN: Cross-sectional analysis of normal and glaucomatous eyes in a tertiary care academic referral practice. METHODS: A commercial GDx nerve fiber analyzer was modified to enable the measurement of corneal polarization axis and magnitude so that compensation for corneal birefringence was eye specific. Complete examination, SLP with fixed corneal compensation (FCC) and variable corneal compensation (VCC), optical coherence tomography (OCT) imaging of the peripapillary RNFL, and automated achromatic perimetry were performed in all subjects. Exclusion criteria were visual acuity less than 20/40, diseases other than glaucoma, and unreliable perimetry. RESULTS: Fifty-nine patients (59 eyes; 29 normal, 30 glaucomatous) were enrolled (mean age, 56.7 +/- 20.3 years, range, 20-91). All eyes with glaucoma had associated visual field loss (average mean defect, -8.4 +/- 5.8 dB). Using SLP-FCC, nine of 12 retardation parameters (75%) were significantly less in glaucomatous eyes. Using SLP-VCC, 11of 12 retardation parameters (92%) were significantly less in glaucomatous eyes. Multiple regression models constructed for each retardation parameter with visual field demonstrated that the following VCC parameters were statistically significant whereas FCC parameters were not: ellipse average (FCC, P =.28, VCC, P =.001), superior average (FCC, P =.38, VCC, P <.001), inferior average (FCC, P =.10, VCC, P =.008), average thickness (FCC, P =.30, VCC, P =.031), and superior integral (FCC, P =.43, VCC, P =.001). Similar results were obtained for multiple regression models constructed with OCT-derived RNFL thickness: ellipse average (FCC, P =.99, VCC, P =.002), superior average (FCC, P =.90, VCC, P <.001), inferior average (FCC, P =.61, VCC, P =.007), and superior integral (FCC, P =.92, VCC, P <.001). CONCLUSIONS: Compared with fixed compensation, mean-based SLP parameters generated with SLP-VCC have greater correlation with visual function and RNFL thickness assessments obtained with OCT.

Adult↗
PubMed2003

Spontaneous resolution of a shallow detachment of the macula in a highly myopic eye.

PURPOSE: To report a case of pathologic myopia with shallow detachment of the macula and anatomic reattachment after spontaneous posterior vitreous separation. DESIGN: Observational case report. METHODS: A 66-year-old woman with pathologic myopia presented with decreased vision of 20/400 in her left eye. Biomicroscopy showed myopic chorioretinal changes, posterior staphyloma, and a shallow macular elevation. Optical coherence tomography was performed at the initial and follow-up examinations. RESULTS: Initial optical coherence tomography revealed a retinal detachment, retinoschisis, and incomplete posterior vitreous detachment. One and one-half years after the initial visit the patient's best-corrected visual acuity improved to 20/200, and optical coherence tomography disclosed macular reattachment, release of vitreous adhesions, and restoration of normal retinal tomographic appearance. CONCLUSIONS: Spontaneous resolution of chronic shallow detachment of the macula in highly myopic eyes may occur and can be attributed to spontaneous posterior vitreous detachment.

Aged↗
PubMed2003

Comparison of optic nerve head measurements obtained by optical coherence tomography and confocal scanning laser ophthalmoscopy.

PURPOSE: To evaluate the relationship between optic nerve head (ONH) measurements generated by optical coherence tomography (OCT; versions 2 and 3) and confocal scanning laser ophthalmoscopy (CSLO) and to compare the association between OCT and CSLO ONH measurements with glaucoma disease status, as determined by clinical evaluation and perimetry. DESIGN: Cross-sectional study. METHODS: In a prospective study in the glaucoma service of an academic department of ophthalmology, 159 eyes (97 subjects) and 77 eyes (44 subjects) were recruited in two separate periods. All subjects were scanned with a CSLO device. Subjects tested within the first period of recruitment were scanned with OCT version 2 and in the second period with OCT version 3. The main outcome measure was the correlation between automatic and manually defined OCT ONH measurements and the correlation of CSLO and OCT ONH measurements between devices and with glaucoma disease status. RESULTS: A high correlation was found between ONH measurements obtained by the automatic determination of ONH margin and those obtained by manual tracing of the disk margin (r =.93 to.98). Optical coherence tomography and CSLO ONH measurements were highly correlated. Optical coherence tomography-measured mean disk area was significantly larger than that measured by CSLO, as were all other disk size-related parameters. The areas under the receiver operator characteristic (AROC) curves for the associations between CSLO and OCT ONH measurements and clinical diagnosis were found to be similar and in the range of 0.47 to 0.79 for both devices. CONCLUSIONS: Automated OCT ONH measurements correlate highly with those obtained by manual tracing of disk margin. Optical coherence tomography and CSLO ONH analyses are highly correlated and have similar associations with glaucoma disease status.

Cross-Sectional Studies↗
PubMed2003

Foveal thickness in occult macular dystrophy.

PURPOSE: Occult macular dystrophy (OMD) is an inherited macular dystrophy characterized by a progressive macular dysfunction without any visible fundus abnormality. We studied the foveal thickness in patients with OMD using optical coherence tomography (OCT). DESIGN: Observational case series. Foveal thickness by OCT images. METHODS: Foveal thickness obtained from 22 eyes of 11 patients with OMD was compared with that from 27 eyes of 20 age-matched normal controls. RESULTS: Mean foveal thickness in the patients group (96.5 +/- 19.5 microm) was significantly thinner than that in the normal controls (133.3 +/- 9.0 microm, P <.0001, Mann-Whitney U test). Eighteen of 22 eyes with OMD had foveal thickness that were thinner than the lower limit of the normal range. There was no statistically significant correlation between the foveal thickness and visual acuity, age, or duration from onset. CONCLUSION: These results demonstrated that there are significant anatomic changes in the macula of patients with OMD.

Adolescent↗
PubMed2003

Ruptured retinal arterial macroaneurysm associated with a stage IV macular hole.

PURPOSE: To report a case of stage IV macular hole associated with ruptured retinal arterial macroaneurysm. DESIGN: Observational case report. METHOD: The patient's clinical, angiographic, and ophthalmic coherent tomography data were reviewed. RESULTS: A stage IV macular hole was observed in association with a ruptured retinal arterial macroaneurysm in a 79-year-old patient. After vitrectomy surgery, the macular hole closed and vision improved from counting fingers to 20/100. CONCLUSIONS: Macular hole associated with ruptured retinal macroaneurysm can be closed successfully to result in improved vision.

Aged↗
PubMed2003

Spontaneous closure of stage 2 macular hole observed with optical coherence tomography.

PURPOSE: To report the clinical course and images of optical coherence tomography of an eye with a stage 2 macular hole which closed spontaneously. DESIGN: Observational case report. METHODS: Serial optical coherence tomographic images were obtained. RESULTS: A 67-year-old woman received a diagnosis of stage 2 idiopathic macular hole in her right eye. The diagnosis was made with a tomographic image of a full-thickness dehiscence of the neurosensory retina at the fovea. The posterior hyaloid membrane was adhering to the edge of the dehiscence. Four weeks later, the closure of the macular hole was ascertained with optical coherence tomography. The posterior hyaloid membrane was fully separated from the fovea. CONCLUSION: A stage 2 macular hole may close spontaneously with the separation of the hyaloid membrane.

Aged↗
PubMed2003

Selective occlusion of subfoveal choroidal neovascularization in pathologic myopia using a new technique of ingrowth site treatment.

PURPOSE: To evaluate the visual and angiographic effects as well as optical coherence tomography findings after a new technique of ingrowth site treatment of subfoveal choroidal neovascularization (CNV) secondary to pathologic myopia with the use of indocyanine green (ICG)-mediated photothrombosis. DESIGN: Interventional, noncomparative case series. METHOD: In the setting of a tertiary referral center, patients with pathologic myopia in whom fluorescein and conventional ICG angiography demonstrated distinct CNV vessels supplying the subfoveal neovascular complex were submitted to focal ingrowth site treatment using a new therapeutic modality termed ICG-mediated photothrombosis. Prospective evaluation including visual acuity assessment, fluorescein and ICG angiography, and optical coherence tomography (OCT) evaluation was performed at weeks 1, 12, 24, and 48 after treatment. RESULTS: Six consecutive patients (six eyes) had treatment using a single session of ICG-mediated photothrombosis at the CNV ingrowth site. Obliteration of the entire neovascular complex was achieved immediately after treatment in all patients. At last follow-up, visual acuity improvement of 1 or more Early Treatment Diabetic Retinopathy Study lines was observed in five of six patients, and fluorescein angiography showed an absence (four eyes) or minimal leakage (two eyes) from CNV. Indocyanine green angiography demonstrated selective obliteration of the neovascular complex. Accordingly, reduction of retinal edema was observed in the OCT evaluation in all patients. There was no significant complication related to the procedure. CONCLUSIONS: The use of lower irradiances of 810- nm continuous light application and intravenous ICG infusion for neovascular ingrowth site photothrombosis induced selective CNV hypoperfusion, as demonstrated by fluorescein and ICG angiography in patients with pathologic myopia. These findings were either consistent with the visual acuity improvement observed in five of six patients or with the partial restoration of the retinal architecture seen in OCT evaluation 12 months after treatment.

Adult↗
PubMed2003

B-scan ultrasonography for the detection of macular thickening.

PURPOSE: To report the sensitivity and specificity of B-scan ultrasonography to detect macular thickening. DESIGN: Observational case series. METHODS: Seventy-seven eyes of 40 consecutive patients (age range, 7-80 years) in a retinal specialty practice were examined. A single masked ultrasound operator performed B-scan ultrasonography on all eyes and graded macular thickening. The final assessment of macular thickening was based on biomicroscopy findings combined with fluorescein angiography (FA) and optical coherence tomography (OCT). The presence or absence of macular thickening as determined by B-scan ultrasonography was compared with the final clinical assessment, FA findings, and OCT measurements. RESULTS: B-scan ultrasonography detected macular thickening with a high degree of sensitivity (91%) and specificity (96%). There was a high degree of agreement between findings on ultrasonography and FA (kappa = 0.80). Ultrasonographic diagnosis correlated with OCT measurements for both central macular thickness (r =.65, P <.001) and volume (r =.56, P <.001). CONCLUSIONS: Ultrasonographic detection of macular thickening correlates with findings on slit-lamp biomicroscopy, FA, and OCT. B-scan ultrasonography is a potentially useful technique for assessing macular thickness when biomicroscopy is impossible or when patients cannot tolerate FA or OCT.

Adult↗
PubMed2003

Analysis of macular volume in normal and glaucomatous eyes using optical coherence tomography.

PURPOSE: To evaluate macular volume in normal and glaucomatous eyes using optical coherence tomography (OCT). DESIGN: Case control study. METHOD: The authors assessed 272 eyes of 164 subjects as part of an institutional study at New England Eye Center in Boston, Massachusetts; 202 eyes were in the study group and 70 eyes in the control group. Eyes were categorized as normal (70 eyes of 43 subjects), glaucoma suspect (70 eyes of 44 subjects), early glaucoma (70 eyes of 47 subjects), or advanced glaucoma (62 eyes of 43 subjects). Subjects underwent analysis with the commercially available OCT1 unit. Optical coherence tomography macular neurosensory retinal thickness maps were used to calculate macular volume for comparison to Humphrey visual field testing, intraocular pressure measurement, and stereo biomicroscopy of the optic nerve head and nerve fiber layer. RESULTS: Using repeated measures regression, macular volume in normal (2.37 +/- 0.11 mm(3)) glaucoma suspect (2.33 +/- 0.16 mm(3)), and early glaucoma eyes (2.27 +/- 0.13 mm(3)) was significantly greater than in eyes with advanced glaucoma (2.12 +/- 0.23 mm(3), P =.0001, P =.0001, and P =.0008, respectively). Macular volume in normal eyes was significantly greater than in early glaucoma eyes (P =.01). CONCLUSIONS: Optical coherence tomography retinal macular volume correlates with known structural defects of glaucoma, providing a potential objective and quantitative parameter for evaluation. Our data show a significant difference in macular volume between normal, glaucoma suspect, and early glaucoma eyes, compared with advanced glaucomatous eyes as well as between normal and early glaucomatous eyes. This correlates with a trend of decreasing macular volume in eyes with more advanced disease.

Adolescent↗
PubMed2003

Optical coherence tomography findings in nicotinic acid maculopathy.

PURPOSE: To report optical coherence tomography findings in nicotinic acid maculopathy. DESIGN: Observational case report. METHOD: The patient was examined with ophthalmoscopy, fluorescein angiography, and optical coherence tomography. RESULTS: A 71-year-old man presented with bilateral decreased visual acuity with metamorphopsia. Optical coherence tomography demonstrated cystoid spaces in the outer plexiform layer and inner nuclear layer. Fluorescein angiography did not show leakage. Two weeks after stopping the nicotinic acid, the cystoid spaces resolved. CONCLUSIONS: Niacin maculopathy causes cystoid spaces in the inner nuclear and outer plexiform layers that resolve with discontinuation of the drug.

Aged↗
PubMed2003

Optical coherence tomographic and angiographic findings of a case with subretinal toxocara granuloma.

PURPOSE: To study a case with a subretinal Toxocara granuloma. DESIGN: Interventional case report. METHODS: A patient with a exudative macular lesion, diagnosed as ocular toxocariasis, was examined with optical coherence tomography (OCT) and angiography before and after systemic corticosteroid and anthelminthic therapy. RESULTS: In OCT images, the macular granuloma initially appeared as a highly reflective mass protruding above the retinal pigment epithelium and showed dye leakage by angiography. Posttherapy, the lesion was no longer exudative, was less elevated, and was covered by the retinal pigment epithelium. There was reticular hyperfluorescence surrounded by a hypofluorescent rim in the angiograms. CONCLUSIONS: Subretinal Toxocara granuloma may have a presentation similar to idiopathic choroidal neovascularization (CNV) and should be included in the differential diagnosis of the idiopathic CNV.

Adult↗
PubMed2003

Persistent indocyanine green fluorescence after vitrectomy for macular hole.

PURPOSE: To evaluate the persistence of indocyanine green (ICG) autofluorescence after ICG-assisted internal limiting membrane peeling for macular hole surgery. DESIGN: Interventional case series. METHODS: Retrospective institutional study. Four eyes of four patients who underwent pars plana vitrectomy with ICG-assisted internal limiting membrane peeling for macular hole repair were imaged for ICG autofluorescence at 795 nm with a scanning laser ophthalmoscope. The main outcome measure was persistence of ICG autofluorescence. RESULTS: All four patients demonstrated persistent ICG fluorescence in the central macula up to 8 months postsurgery. CONCLUSIONS: Persistent ICG signal was noted in the macula months after vitrectomy for macular hole surgery. The persistence of ICG autofluorescence could be responsible for delayed photochemical damage to the retinal pigment epithelium. Further studies must quantify the risk of retinal pigment epithelium injury when ICG-assisted internal limiting membrane peeling is used in macular hole surgery.

Aged↗