Abstract: Age-related macular degeneration (ARMD) and stroke are common causes of disability in subjects over 40 years of age. The etiology of ARMD remains unknown and numerous epidemiological studies have suggested a relationship between vascular risk factors and ARMD. A direct relationship between stroke and ARMD has also been suggested. An update on the association between ARMD and stroke is discussed in this article.
Abstract: PURPOSE: To characterize the evolution of serous retinal detachment (SRD) combined with diabetic macular edema (DME) using optical coherence tomography (OCT). DESIGN: Observational retrospective case series. METHODS: In our institution, 64 eyes of 40 diabetic patients who had SRD combined with DME were studied. All patients had fluorescein angiography and several OCT3 examinations during follow-up. Foveolar neuroretinal thickness (NRT) and SRD height were measured. The evolution of OCT macular profiles was qualitatively assessed. RESULTS: Mean follow-up was 11.8 months. DME was focal in 10 eyes (15.6%), diffuse in 17 (26.6%) and both diffuse and focal in 37 (57.8%). Mean initial decimal visual acuity (VA), NRT, and SRD height (+/- standard deviation) were 0.35 +/- 0.21, 346.88 +/- 138.61 and 199.48 +/- 139.8 microm, respectively. SRD height did not correlate with VA (P = .23) or NRT (P = .31). In 13 eyes (20.3%), NRT above the SRD was normal. In the 19 eyes where DME improved during follow-up, SRD disappeared before the maximal reduction of retinal thickness in seven eyes (36.8%) and after or simultaneously with this reduction, in 12 eyes (63.2%). Among the 45 eyes where DME worsened during follow-up, SRD disappeared from 15 eyes (33.3%). CONCLUSION: In this series, SRD height did not correlate with retinal thickening. The latter may appear before central neuroretinal thickening and disappear before or after its regression. Consequently, SRD does not seem to be related either to the severity of DME or to its resorption.
Abstract: PurposeTo describe patients with full-thickness macular holes (FTMHs) and lamellar macular holes (LMHs) in association with type 2 idiopathic macular telangiectasia (type 2 IMT).MethodsSix patients with either FTMH or LMH and type 2 IMT were evaluated by means of optical coherence tomography (OCT) imaging, funduscopy, and fluorescein angiography.ResultsThe age of the examined patients ranged from 57 to 70 years (mean 62.5+/-5.2), and best-corrected visual acuity of the affected eyes ranged from 20/50 to 20/200 (mean 20/100). All eyes showed macular abnormalities typical for nonproliferative type 2 IMT except for one eye with a proliferative disease stage. Three patients had an FTMH, one presenting with bilateral FTMH, and three had an LMH on OCT. In all cases of FTMH, the macular holes did not have elevated margins. Surgery was performed in two patients with a FTHM without subsequent functional improvement.ConclusionsThe altered foveal anatomy with progressive atrophic changes within the neurosensory retina in type 2 IMT may predispose to the development of FTMH and LMH. Type 2 IMT should be considered in the differential diagnosis in patients presenting with macular holes. The association between the two may reflect alternative pathogenetic mechanisms in the development of macular holes.Eye advance online publication, 8 February 2008; doi:10.1038/sj.eye.6703003.
Abstract: PURPOSE: To describe an unusual feature in myopic eyes responsible for visual loss, which we call a dome-shaped macula. DESIGN: Retrospective, observational case series. METHODS: After observing isolated cases of dome-shaped macula, we analyzed optical coherence tomography (OCT) scans of 140 highly myopic eyes present in our OCT database to find similar cases. Fifteen eyes of 10 patients had a dome-shaped macula. These patients all had undergone fluorescein angiography (FA), indocyanine green angiography (ICGA), and B-scan ultrasonography examinations. RESULTS: The mean refractive error of the affected eyes was -8.25 diopters (D; range, -2 to -15 D). Median visual acuity was 20/50. Recent visual impairment was noted in 11 of the 15 eyes studied, and metamorphopsia was noted in eight eyes. Four eyes were asymptomatic. FA showed atrophic changes in the macular retinal pigment epithelium (RPE) in all eyes, combined with focal points of leakage in seven of the 15 eyes. The dome-shaped appearance of the macula was visible on both B-scan ultrasonography and OCT: a characteristic bulge of the macular retina, RPE, and choroid within the concavity of the moderate posterior staphyloma was present in all eyes. In 10 eyes, OCT also showed a shallow foveal detachment at the top of the dome-shaped macula. CONCLUSIONS: A dome-shaped macula within a myopic staphyloma is an unreported type of myopic posterior staphyloma. The dome-shaped macula often is associated with RPE atrophic changes and foveal retinal detachment, which may explain the visual impairment in these eyes.
Abstract: PURPOSE: To determine the natural evolution and surgical indications of myopic foveoschisis (MF), which are still poorly documented, and the factors that predict poor prognosis. DESIGN: Retrospective observational case series. METHODS: Twenty-nine operated and nonoperated cases of MF (29 eyes of 23 patients) were studied. All eyes underwent repeated examinations, including optical coherence tomographic (OCT) recordings, during a mean follow-up of 31.2 months. Special attention was paid to the evolution of visual acuity (VA) and to the thickness of foveoschisis. RESULTS: Mean refraction was -14.4 diopters, and mean axial length was 29.1 mm. OCT scans revealed that the foveoschisis was associated with macular anomalies: a premacular structure in 13 (44.8%) of 29 eyes, a foveal detachment in 10 (34.5%) of 29 eyes, and a lamellar macular hole in six (20.7%) of 29 eyes. Isolated foveoschisis was found in four eyes (13.8%). During follow-up, foveoschisis and VA worsened in 20 eyes and remained stable in nine. Ten of the 20 eyes that worsened had a premacular structure. A macular hole occurred in nine eyes, six of which had previously exhibited foveal detachment. Eleven eyes with foveoschisis underwent surgery, which improved VA significantly (P = .04, Wilcoxon test), but three eyes developed a macular hole. CONCLUSIONS: MF may remain stable for many years without affecting VA. However, when it is combined with the presence of a premacular structure, the risk of a decrease in VA increases. When it is combined with foveal detachment, a macular hole seems to develop frequently, whether or not surgery is performed.
Abstract: PURPOSE: To assess the optical coherence tomography (OCT) characteristics of spontaneously closed macular hole (MH). DESIGN: Retrospective observational case series. METHODS: Among 510 consecutive eyes examined for an MH before surgery, we retrospectively identified 14 eyes in which the MH closed spontaneously before the operation. At the time of diagnosis, Snellen visual acuity (VA) was measured and all 14 eyes underwent OCT1 or OCT3. The aperture and base diameters of the MHs were recorded. After spontaneous MH closure, VA was measured again and OCT3 was performed in all eyes. The photoreceptor (PR) inner segment-outer segment (IS-OS) junction line was examined to measure any residual defect at the foveal center. RESULTS: Mean MH aperture diameter was small, less than 400 microm (mean +/- standard deviation [SD], 161.8 +/- 83.0 microm). After spontaneous closure, mean VA increased from 0.3 to 0.6. In all 14 eyes, foveal continuity was restored on OCT scans. However, a defect in the photoreceptor IS-OS junction layer ranging from 25 to 110 microm (mean +/- SD, 64.1 +/- 29.6 microm) was present in all eyes. No correlation was found, either between MH aperture diameter and the width of the PR defect (P = .68) or between VA and the width of the defect (P = .09). CONCLUSIONS: In a series of 14 MHs that had closed spontaneously, a defect was seen in the photoreceptor IS-OS junction line, although VA improved in all eyes. When this configuration is seen in elderly patients without a history of MH, it may be taken as evidence of spontaneous closure of an undiagnosed MH.
Abstract: Neovascular age-related macular degeneration is becoming an increasing socio-medical problem as the proportion of the aged population is continuously increasing. However, new insights in the pathogenesis of the disease offer the opportunity to develop targeted therapies that attack the disease process more successfully than ever. This review article will focus on summarizing the actual options in the management of neovascular age-related macular degeneration and provide a short overview about recent therapeutic options in clinical and preclinical evaluation. The recent development of anti-VEGF substances for use in clinical routine has markedly improved the prognosis of patients with neovascular AMD. Intravitreal treatment with substances targeting all isotypes of vascular endothelial growth factor (VEGF), for the first time in the history of AMD treatments, results in a significant increase in visual acuity in patients with neovascular AMD. Overall, antiangiogenic approaches provide vision maintenance in over 90% and substantial improvement in 25-40% of patients. The combination with occlusive therapies like photodynamic therapy (PDT) potentially offers a reduction of re-treatment frequency and long-term maintenance of the treatment benefit. Further developments interacting with various steps in the angiogenic cascade are under clinical or preclinical evaluation and may soon become available. Nevertheless, the growing number of novel therapeutic options will have to provide proof of concept in randomized controlled clinical trials, a major challenge in view of the rapidly evolving field. For those therapies, which are already in clinical use, reasonable diagnostic tools for follow-up need to be developed, as the burden of continuous clinical monitoring of all patients and all indications is significant for patients and doctors. Ultimately, economic issues will be the limiting factor for the clinical availability of different treatment options.
Abstract: AIM: Anti-VEGF drugs are the most recent treatments for choroidal neovascularization, the most severe complication of the age-related macular degeneration (AMD). These drugs are administered by intravitreal injections. Several clinical studies have demonstrated their advantages. However, these same studies have not established the modalities for monitoring their efficacy. The aim of this paper is to provide an in-depth look at the existing practices in monitoring anti-VEGF therapy among different French specialists. METHODS: Several meetings were held with specialists coming from both the hospital setting and private practice to share their practices in monitoring anti-VEGF therapy and to propose more rational monitoring to standardize practices. RESULTS: The physicians attached an increasing importance to optical coherence tomography (OCT) in monitoring anti-VEGF drugs after intravitreal injection. They acknowledged the value of fluorescein angiography when initiating the treatment and 3 months after beginning anti-VEGF therapy. They advise using fluorescein angiography every time that functional results are not at the level expected by the physician or the patient. The authors provide a flow chart that should help in deciding on retreatment. CONCLUSION: The authors suggest the use of a flow chart aimed to define indications of retreatment according to clinical response and OCT results.
Abstract: OBJECTIVE: To describe the changes observed with optical coherence tomography in group 2A idiopathic juxtafoveolar retinal telangiectasis. METHODS: We retrospectively reviewed the medical records of 13 patients (25 eyes). All eyes underwent optical coherence tomography examination consisting of 6 radial scans, fundus color photography, and fluorescein angiography. We calculated retinal foveal and central foveal thicknesses from software mapping results. We compared the optical coherence tomography data with fundus photography and fluorescein angiography findings. RESULTS: Foveal cystoid spaces, very small or more prominent, were present in 20 of 25 eyes. Some degree of disruption of the inner segment/outer segment photoreceptor junction line was observed in 18 eyes as from stage 2 of idiopathic juxtafoveolar retinal telangiectasis, and intraretinal pigmentary proliferation was observed in 9. A foveal detachment without subretinal new vessels was also present in 2 eyes. Despite these abnormalities, central foveal thickness was below or within the range of reference values in all eyes; foveal thickness, in 23 of 25. In the more advanced cases, severe disruption of the inner segment/outer segment photoreceptor junction line and outer retinal atrophy were seen. CONCLUSIONS: Early in the evolution of group 2A idiopathic juxtafoveolar retinal telangiectasis, the optical coherence tomography examination disclosed intraretinal cystoid spaces without foveal thickening and disruption of the inner segment/outer segment photoreceptor junction line. Foveal thinning was present in later stages.
