Retina-the Journal of Retinal and Vitreous Diseases, Jun 1, 2011
Purpose: X-linked retinoschisis (XLRS) is one of the most common causes of macular degeneration i... more Purpose: X-linked retinoschisis (XLRS) is one of the most common causes of macular degeneration in young men. The purpose of this study was to use optical coherence tomography combined with ophthalmoscopy to study the effects of aging on the morphologic changes associated with XLRS. Methods: Twenty-five eyes of 17 men with XLRS ranging in age from 3 years to 68 years were studied using ophthalmoscopy and optical coherence tomography. Optical coherence tomography was used to measure macular thickness and to evaluate XLRSrelated structural changes. Correlation analyses between the findings and patients' age and visual acuity were performed. Results: Mean visual acuity was 20/100 (range, 20/40 to 20/400). There were no correlations between visual acuity and age or macular thickness. However, there was a significant decrease in macular thickness with age (P , 0.01). Eyes with posterior vitreous detachment had significantly decreased central foveal thickness (P , 0.001). Various retinal morphologic changes could be identified by optical coherence tomography, including epiretinal membranes, intraretinal cysts, tissue pillars bridging the schisis cavities, and tissue hyperreflectivity in collapsed XLRS. These findings were significantly correlated with age. Conclusion: Optical coherence tomography revealed various retinal morphologic changes associated with XLRS. These changes were correlated with age but not with visual acuity. Younger patients showed cystic retinal elevation, whereas older patients showed collapsed retinoschisis with retinal thinning.
Age-related macular degeneration (AMD) leads to morphological changes that can interfere with opt... more Age-related macular degeneration (AMD) leads to morphological changes that can interfere with optical coherence tomography retinal thickness measurements. The effects of AMD on two available retinal thickness scan modes were tested. Ninety-four scans, equally divided into Radial Line Scans (RLS) and Fast Macula Scans (FMS), of 42 patients with AMD were reviewed. Patients were graded into 4 categories regarding AMD severity. Each scan mode was evaluated for each AMD category. In dry moderate AMD, 2% of the RLS and 5% of the FMS thickness measurements failed. In dry progressed AMD, the RLS mode performed better (26% failure rate) than the FMS mode (42% failure rate). However, in exudative AMD the FMS mode performed better (6% failure rate) than the RLS mode (28% failure rate). The difference between the RLS and FMS performance in dry progressed AMD compared with exudative AMD was significant (P < .0001). The optical coherence tomography retinal thickness scan modes perform differently, depending on AMD severity. Retinal thickness algorithms with better performance are needed to facilitate measurements in patients with AMD.
Retina-the Journal of Retinal and Vitreous Diseases, Nov 1, 2019
Purpose: Intraretinal cystoid spaces are commonly found after surgical peeling of epiretinal memb... more Purpose: Intraretinal cystoid spaces are commonly found after surgical peeling of epiretinal membranes. In this study, we explored whether these cysts were associated with ganglion cell loss and thus might be a manifestation of retrograde maculopathy. The latter is a nonvascular edema with a characteristic morphology that is often found in the inner nuclear layer (INL) of patients with optic neuropathy. Methods: In this retrospective case series, we identified consecutive patients who underwent surgical epiretinal membrane peeling. We determined the frequency of microcystic macular edema (MME), defined by vertical cystoid spaces in the INL, and we measured the thickness of individual macular layers before and after surgery. Results: Epiretinal membrane peeling resulted in an improvement of visual acuity and a reduction of retinal thickness by about 15%. In total, 35% of patients with MME before surgery showed no sign of MME postoperatively, whereas edema persisted after surgery in 65% of patients. Interestingly, 29% of the patients without MME before surgery developed MME after surgery. Overall, we found MME in 35% of patients before peeling and in 42% after peeling. After surgery, the mean ganglion cell layer thickness was reduced compared with healthy control eyes. Ganglion cell layer thickness correlated inversely with thickness of the INL. Compared with patients without MME, individuals with MME had a thinner ganglion cell layer and a thicker INL in the affected eye. Conclusion: Our findings indicate that peeling of epiretinal membranes and internal limiting membranes is associated with atrophy of ganglion cells and thickening of the INL. The latter is associated with the presence of MME. Altogether, we assume that surgical treatment of epiretinal membranes induces a variant of a retrograde maculopathy. RETINA 00:1-9, 2018 W e show that surgical peeling of epiretinal membranes is associated with a significant optic neuropathy and subsequent retrograde maculopathy. This mechanism may explain the high frequency of macular edema after surgery. Epiretinal membranes are a common clinical finding, affecting about 1.1% of first eyes. 1 The entity is characterized by fibrocellular tissue that develops at the level of the vitreoretinal interface of the posterior pole. 2 Contraction of this membrane and mechanical deformation of the retina may cause visual loss, retinal aniseikonia, and metamorphopsia. The etiology of epiretinal membranes often remains unknown. Risk factors include age, membrane in the fellow eye, and retinal breaks. 3
Background: The aim of this study is to determine the serum immunoglobulin (Ig) M and serum visco... more Background: The aim of this study is to determine the serum immunoglobulin (Ig) M and serum viscosity (SV) levels at which retinal changes associated with hyperviscosity syndrome (HVS) as a result of Waldenström's macroglobulinemia (WM) occur. In addition, the effect of plasmapheresis on HVS-related retinopathy was tested. Patients and Methods: A total of 46 patients with WM received indirect ophthalmoscopy, laser Doppler retinal blood flow measurements, serum IgM, and SV determinations. A total of 9 patients with HVS were studied before and after plasmapheresis. Results: Mean IgM and SV levels of patients with the earliest retinal changes were 5442 mg/dL and 3.1 cp, respectively. Plasmapheresis improved retinopathy, decreased serum IgM (46.5 ± 18%; P = .0009), SV (44.7 ± 17.3%; P = .002), retinal venous diameter (15.3 ± 5.8%; P = .0001), and increased venous blood speed by +55.2 ± 22.5% (P = .0004). Conclusion: Examination of the retina is useful in identifying the symptomatic threshold of plasma viscosity levels in patients with HVS and can be used to gauge the effectiveness of plasmapheresis treatment.
Objective To investigate whether there is an association between the magnitude of retinal haemody... more Objective To investigate whether there is an association between the magnitude of retinal haemodynamic abnormalities in patients with age-related macular degeneration (AMD) and the degree of severity of the AMD. Methods A retinal laser Doppler system (Canon CLBF 100) was used to measure retinal arterial haemodynamic parameters in 25 eyes of 25 patients with AMD and nine eyes of nine age-matched control subjects. Severity of AMD was classified into Mild (n ¼ 11), Moderate (n ¼ 7), or Severe (n ¼ 7). The pulsatility ratio (PR), the pulsatility index (PI), and the resistivity index (RI) were determined. Results PR, PI, and RI in the patients with AMD were each significantly higher than in the control group, and increased monotonically with increasing severity of AMD. However, there were no differences in mean blood velocity, arterial diameter, or blood flow rate among the groups. This suggests that the increased blood flow pulsatility in the retinal arteries of the eyes with AMD is not due to increased distal vascular resistance, but instead is likely due to a loss of compliance in the arterial vasculature leading to the eye. Conclusion Our results suggest that an increasing vascular rigidity in the systemic arterial circulation is directly associated with an increasing severity of AMD.
ABSTRACT Purpose In the pathophysiolgy of dry (atrophic) age related macular degeneration (AMD) a... more ABSTRACT Purpose In the pathophysiolgy of dry (atrophic) age related macular degeneration (AMD) aging of the retinal pigment epithelium (RPE) plays a key role. Accumulation of lipofuscin granules in the RPE cells represents a common downstream pathogenetic pathway in AMD. Lipofuscin is derived from chemically modified residues of incompletely digested photoreceptor outer segment discs. Detection of lipofuscin in vivo is possible by using fundus autofluorescence (FAF) imaging. The clinical application and possible implications of autofluorescence imaging in dry AMD will be discussed.Methods When stimulated with light in the blue to green range, lipofuscin granules emit a characteristic yellow fluorescence. FAF imaging using a scanning laser ophthalmoscope allows visualization of the topographic distribution of lipofuscin over large retinal areas. Examples of FAF images will be presented to demonstrate various FAF patterns and to discuss the clinical significance of these findings.Results In areas of geographic atrophy FAF images show very low autofluorescence intensity. This is due to the loss of RPE cells including the lipofuscin granules. In the junctional zone between atrophic and normal retina, levels of increased autofluorescence intensity may occur due to excessive accumulation of lipofuscin in the RPE cells. Longitudinal observations further suggest that the extension of the total area with increased autofluorescence intensity surrounding atrophy at baseline has a strong positive correlation with atrophy progression rate over time.Conclusion FAF imaging is an important diagnostic tool to follow the progression of dry AMD and other degenerative macular diseases and should always be considered in cases were the status of the RPE is unknown.
Graefes Archive for Clinical and Experimental Ophthalmology, Jan 13, 2006
Background: A number of epidemiological studies suggest that age-related macular degeneration (AM... more Background: A number of epidemiological studies suggest that age-related macular degeneration (AMD) and cardiovascular disease share the same risk factors. Systemic arterial stiffness is a clear indicator of cardiovascular disease. We investigated whether there is an association between directly measured systemic arterial stiffness and the presence of AMD. Methods: We used a Sphyg-moCor 2000 system to noninvasively measure two indicators of the systemic arterial stiffness, the arterial pulse wave velocity (PWV) and the central aortic blood pressure waveform, from which the augmentation pressure is determined. We studied 50 patients with AMD (12 men, 38 women, aged 60 to 91 years, mean 77 years) and 11 age-matched control subjects (3 men, 8 women, aged 66 to 92 years, mean 75 years). All study subjects received a complete ophthalmic examination including digital fundus photography. All of the patients with AMD were classified as stage 3 or worse in at least one eye according to the AREDS system. Results: Pulse wave velocity was significantly higher in the patients with AMD (8.2±1.1 m/s, mean ± SD) compared with controls (7.1±0.8 m/s, p=0.0025), indicating increased arterial stiffness. There was no significant difference in PWV in AMD patients with and without choroidal neovascularization. There was no association between PWV and the presence of hypertension in either the patients or the controls. The central aortic augmentation pressure was significantly higher in the AMD patients than in the controls (p=0.040), also indicating increased arterial stiffness. Conclusions: Patients with AMD have increased systemic arterial stiffness compared with age-matched controls. Treatments aimed at preventing or reversing systemic arterial stiffness may also be effective in preventing the onset or slowing the progression of AMD.
Aims To assess the functional and morphological outcome of eyes with neovascular AMD treated with... more Aims To assess the functional and morphological outcome of eyes with neovascular AMD treated with intravitreal ranbizumab following an exit strategy treatment regime. Methods The Bern treatment regime for neovascular AMD has a fixed injection schedule, even in the nonactive stage of the disease. The regimen has been adapted from the PIER study treatment protocol. Eyes with non-active AMD will receive 4 injections in the first year, and 2 injections in the second year of follow-up before treatment stops. Patients that received ranibizumab for treatment and reached the exit criteria were identified, and charts were reviewed to assess functional and morphological outcome. Results Only 2.6% of all patients (15 out of 575 patients) reached the exit criteria. Mean change in best corrected ETDRS visual acuity (VA) was 4.5±16.9 letters when comparing baseline VA to 4 weeks after the last injection (p=0.32). OCT mean foveal thickness was significantly thinner after last treatment (247.9 ±43.0 mm) compared to baseline (332.5±83.1 mm, p=0.002). The mean total number of ranibizumab injections was 15.6±8.0, and the mean total treatment period was 40.9±18.3 months. Twenty percent of eyes had geographic atrophy present at baseline versus 46.6% at the end of treatment. Conclusions Even with a fixed treatment regime and a defined treatment exit strategy, only a small percentage of patients reach exit criteria. Retinal thickness has been significantly reduced by repeated intravitreal ranibizumab injections, and geographic atrophy became more frequent.
Investigative Ophthalmology & Visual Science, Oct 20, 2014
PURPOSE. Optical coherence tomography (OCT) was used to analyze the thickness of various retinal ... more PURPOSE. Optical coherence tomography (OCT) was used to analyze the thickness of various retinal layers of patients following successful macula-off retinal detachment (RD) repair. METHODS. Optical coherence tomography scans of patients after successful macula-off RD repair were reanalyzed with a subsegmentation algorithm to measure various retinal layers. Regression analysis was performed to correlate time after surgery with changes in layer thickness. In addition, patients were divided in two groups. Group 1 had a follow-up period after surgery of up to 7 weeks (range, 21-49 days). In group 2, the follow-up period was >8 weeks (range, 60-438 days). Findings were compared to a group of age-matched healthy controls. RESULTS. Correlation analysis showed a significant positive correlation between inner nuclearouter plexiform layer (INL-OPL) thickness and time after surgery (P ¼ 0.0212; r 2 ¼ 0.1551). Similar results were found for the ellipsoid zone-retinal pigment epithelium complex (EZ-RPE) thickness (P ¼ 0.005; r 2 ¼ 0.2215). Ganglion cell-inner plexiform layer thickness (GCL-IPL) was negatively correlated with time after surgery (P ¼ 0.0064; r 2 ¼ 0.2101). For group comparison, the retinal nerve fiber layer in both groups was thicker compared to controls. The GCL-IPL showed significant thinning in group 2. The outer nuclear layer was significantly thinner in groups 1 and 2 compared to controls. The EZ-RPE complex was significantly thinner in groups 1 and 2 compared to controls. In addition, values in group 1 were significantly thinner than in group 2. CONCLUSIONS. Optical coherence tomography retinal layer thickness measurements after successful macular-off RD repair revealed time-dependent thickness changes. Inner nuclearouter plexiform layer thickness and EZ-RPE thickness was positively correlated with time after surgery. Ganglion cell-inner plexiform layer thickness was negatively correlated with time after surgery.
BackgroundFirework-related ocular injuries (FWROI) are a major cause of preventable visual impair... more BackgroundFirework-related ocular injuries (FWROI) are a major cause of preventable visual impairment. This study aimed to analyze the occurrence and outcome of FWROI in Switzerland.MethodsThis retrospective multicenter study included patients with FWROI from seven centers in Switzerland from January 2009 to August 2020. Demographic information, type of injuries, medical and surgical treatments, the best corrected visual acuity (BCVA) at baseline and end of follow-up, occurrence and type of secondary complications, and duration of hospitalization were analyzed.ResultsA total of 105 patients (119 eyes) with a mean age of 27.1 ± 15.9 years were included in the study (71.4% male patients; 29.5% underage). Most injuries occurred around New Year’s Eve (32.4%) and the Swiss national holiday on 1 August (60.9%). The most common anterior segment findings were conjunctival or corneal foreign bodies (58%), whereas Berlin’s edema was the most common posterior segment finding (11.4%). Globe rup...
Graefe's Archive for Clinical and Experimental Ophthalmology, 2021
Diagnosis of orbital compartment syndrome is mainly based on clinical findings, such as intraocul... more Diagnosis of orbital compartment syndrome is mainly based on clinical findings, such as intraocular pressure and proptosis, which try to estimate the orbital compartment pressure. However, the reliability of these surrogates is unclear. Current techniques for the direct measurement of orbital compartment pressure are widely experimental and impractical in the clinical setting. Our aim was to explore the feasibility of minimally invasive needle manometry for direct measurement of orbital compartment pressure under reproducible conditions in an in vivo model of orbital congestion. We further sought to evaluate intraocular pressure and proptosis as indicators for elevated orbital compartment pressure. A total of 7 ml of mepivacaine 2% solution was injected into the orbital compartment in 20 patients undergoing cataract surgery under local anesthesia. A commercially available single-use manometer device was inserted between the syringe and the injection needle to measure the orbital compartment pressure for each milliliter of intraorbital volume increment. Additionally, intraocular pressure (subgroup A; n = 10) or axial globe position (subgroup B; n = 10) were measured. Needle manometry allowed for rapid and continuous measurement of orbital compartment pressure. Overall mean orbital compartment pressure increased from 2.5 mmHg pre- to 12.8 mmHg post-interventionally. Both, intraocular pressure (Spearman’s correlation coefficient rs = 0.637, p < 0.0001) and proptosis (rs = 0.675, p < 0.0001) correlated strongly with the orbital compartment pressure. Needle manometry appears to be a feasible minimally invasive instrument to directly measure orbital compartment pressure, showing promises for a more routine application in managing orbital compartment syndrome. The results further suggest that both elevated intraocular pressure and proptosis are valuable indicators for orbital compartment syndrome.
BACKGROUND The aim of this study was to describe the clinical characteristics and surgical outcom... more BACKGROUND The aim of this study was to describe the clinical characteristics and surgical outcome of acquired comitant non-accommodative esotropia without obvious cause in children with an early onset ≤ three years of age. PATIENTS AND METHODS 24 consecutive patients (13 females) with acquired comitant nonaccommodative esotropia underwent strabismus surgery. Outcome measures included amount of deviation and level of binocularity at last follow-up. RESULTS An acute onset of strabismus was observed in 83 % of patients. Accompanying features such as diplopia, covering one eye or stumbling were observed in 40 % of the children. Cycloplegic retinoscopy revealed a mild to moderate
Retina-the Journal of Retinal and Vitreous Diseases, Apr 1, 2006
RETINA ® , The Journal of Retinal and Vitreous Diseases, encourages authors to submit Brief Repor... more RETINA ® , The Journal of Retinal and Vitreous Diseases, encourages authors to submit Brief Reports describing unusual findings, new techniques, and new instruments. Material submitted for consideration in this section of the journal is done so with the assumption that the data provided do not duplicate previously published material and that the material has not been submitted for consideration elsewhere. Each author must sign a disclosure to this effect (see Instructions to Authors for complete wording of transfer letter). Brief Reports submitted for this section of the journal may be subjected to the standard review process that is applied to other material submitted to RETINA ®. Brief Reports should follow the requirements listed in the Instructions to Authors, with the following caveats: Brief Reports should not exceed 4 pages in length; no more than 5 references should be cited; and each Brief Report should include no more than 4 figures.
This work aims to summarize predictive biomarkers to guide treatment choice in DME. Intravitreal ... more This work aims to summarize predictive biomarkers to guide treatment choice in DME. Intravitreal anti-VEGF is considered the gold standard treatment for centers involving DME, while intravitreal steroid treatment has been established as a second-line treatment in DME. However, more than 1/3 of the patients do not adequately respond to anti-VEGF treatment despite up to 4-weekly injections. Not surprisingly, insufficient response to anti-VEGF therapy has been linked to low-normal VEGF levels in the serum and aqueous humor. These patients may well benefit from an early switch to intravitreal steroid treatment. In these patients, morphological biomarkers visible in OCT may predict treatment response and guide treatment decisions. Namely, the presence of a large amount of retinal and choroidal hyperreflective foci, disruption of the outer retinal layers and other signs of chronicity such as intraretinal cysts extending into the outer retina and a lower choroidal vascular index are all si...
Retina-the Journal of Retinal and Vitreous Diseases, Jun 1, 2011
Purpose: X-linked retinoschisis (XLRS) is one of the most common causes of macular degeneration i... more Purpose: X-linked retinoschisis (XLRS) is one of the most common causes of macular degeneration in young men. The purpose of this study was to use optical coherence tomography combined with ophthalmoscopy to study the effects of aging on the morphologic changes associated with XLRS. Methods: Twenty-five eyes of 17 men with XLRS ranging in age from 3 years to 68 years were studied using ophthalmoscopy and optical coherence tomography. Optical coherence tomography was used to measure macular thickness and to evaluate XLRSrelated structural changes. Correlation analyses between the findings and patients' age and visual acuity were performed. Results: Mean visual acuity was 20/100 (range, 20/40 to 20/400). There were no correlations between visual acuity and age or macular thickness. However, there was a significant decrease in macular thickness with age (P , 0.01). Eyes with posterior vitreous detachment had significantly decreased central foveal thickness (P , 0.001). Various retinal morphologic changes could be identified by optical coherence tomography, including epiretinal membranes, intraretinal cysts, tissue pillars bridging the schisis cavities, and tissue hyperreflectivity in collapsed XLRS. These findings were significantly correlated with age. Conclusion: Optical coherence tomography revealed various retinal morphologic changes associated with XLRS. These changes were correlated with age but not with visual acuity. Younger patients showed cystic retinal elevation, whereas older patients showed collapsed retinoschisis with retinal thinning.
Age-related macular degeneration (AMD) leads to morphological changes that can interfere with opt... more Age-related macular degeneration (AMD) leads to morphological changes that can interfere with optical coherence tomography retinal thickness measurements. The effects of AMD on two available retinal thickness scan modes were tested. Ninety-four scans, equally divided into Radial Line Scans (RLS) and Fast Macula Scans (FMS), of 42 patients with AMD were reviewed. Patients were graded into 4 categories regarding AMD severity. Each scan mode was evaluated for each AMD category. In dry moderate AMD, 2% of the RLS and 5% of the FMS thickness measurements failed. In dry progressed AMD, the RLS mode performed better (26% failure rate) than the FMS mode (42% failure rate). However, in exudative AMD the FMS mode performed better (6% failure rate) than the RLS mode (28% failure rate). The difference between the RLS and FMS performance in dry progressed AMD compared with exudative AMD was significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). The optical coherence tomography retinal thickness scan modes perform differently, depending on AMD severity. Retinal thickness algorithms with better performance are needed to facilitate measurements in patients with AMD.
Retina-the Journal of Retinal and Vitreous Diseases, Nov 1, 2019
Purpose: Intraretinal cystoid spaces are commonly found after surgical peeling of epiretinal memb... more Purpose: Intraretinal cystoid spaces are commonly found after surgical peeling of epiretinal membranes. In this study, we explored whether these cysts were associated with ganglion cell loss and thus might be a manifestation of retrograde maculopathy. The latter is a nonvascular edema with a characteristic morphology that is often found in the inner nuclear layer (INL) of patients with optic neuropathy. Methods: In this retrospective case series, we identified consecutive patients who underwent surgical epiretinal membrane peeling. We determined the frequency of microcystic macular edema (MME), defined by vertical cystoid spaces in the INL, and we measured the thickness of individual macular layers before and after surgery. Results: Epiretinal membrane peeling resulted in an improvement of visual acuity and a reduction of retinal thickness by about 15%. In total, 35% of patients with MME before surgery showed no sign of MME postoperatively, whereas edema persisted after surgery in 65% of patients. Interestingly, 29% of the patients without MME before surgery developed MME after surgery. Overall, we found MME in 35% of patients before peeling and in 42% after peeling. After surgery, the mean ganglion cell layer thickness was reduced compared with healthy control eyes. Ganglion cell layer thickness correlated inversely with thickness of the INL. Compared with patients without MME, individuals with MME had a thinner ganglion cell layer and a thicker INL in the affected eye. Conclusion: Our findings indicate that peeling of epiretinal membranes and internal limiting membranes is associated with atrophy of ganglion cells and thickening of the INL. The latter is associated with the presence of MME. Altogether, we assume that surgical treatment of epiretinal membranes induces a variant of a retrograde maculopathy. RETINA 00:1-9, 2018 W e show that surgical peeling of epiretinal membranes is associated with a significant optic neuropathy and subsequent retrograde maculopathy. This mechanism may explain the high frequency of macular edema after surgery. Epiretinal membranes are a common clinical finding, affecting about 1.1% of first eyes. 1 The entity is characterized by fibrocellular tissue that develops at the level of the vitreoretinal interface of the posterior pole. 2 Contraction of this membrane and mechanical deformation of the retina may cause visual loss, retinal aniseikonia, and metamorphopsia. The etiology of epiretinal membranes often remains unknown. Risk factors include age, membrane in the fellow eye, and retinal breaks. 3
Background: The aim of this study is to determine the serum immunoglobulin (Ig) M and serum visco... more Background: The aim of this study is to determine the serum immunoglobulin (Ig) M and serum viscosity (SV) levels at which retinal changes associated with hyperviscosity syndrome (HVS) as a result of Waldenström's macroglobulinemia (WM) occur. In addition, the effect of plasmapheresis on HVS-related retinopathy was tested. Patients and Methods: A total of 46 patients with WM received indirect ophthalmoscopy, laser Doppler retinal blood flow measurements, serum IgM, and SV determinations. A total of 9 patients with HVS were studied before and after plasmapheresis. Results: Mean IgM and SV levels of patients with the earliest retinal changes were 5442 mg/dL and 3.1 cp, respectively. Plasmapheresis improved retinopathy, decreased serum IgM (46.5 ± 18%; P = .0009), SV (44.7 ± 17.3%; P = .002), retinal venous diameter (15.3 ± 5.8%; P = .0001), and increased venous blood speed by +55.2 ± 22.5% (P = .0004). Conclusion: Examination of the retina is useful in identifying the symptomatic threshold of plasma viscosity levels in patients with HVS and can be used to gauge the effectiveness of plasmapheresis treatment.
Objective To investigate whether there is an association between the magnitude of retinal haemody... more Objective To investigate whether there is an association between the magnitude of retinal haemodynamic abnormalities in patients with age-related macular degeneration (AMD) and the degree of severity of the AMD. Methods A retinal laser Doppler system (Canon CLBF 100) was used to measure retinal arterial haemodynamic parameters in 25 eyes of 25 patients with AMD and nine eyes of nine age-matched control subjects. Severity of AMD was classified into Mild (n ¼ 11), Moderate (n ¼ 7), or Severe (n ¼ 7). The pulsatility ratio (PR), the pulsatility index (PI), and the resistivity index (RI) were determined. Results PR, PI, and RI in the patients with AMD were each significantly higher than in the control group, and increased monotonically with increasing severity of AMD. However, there were no differences in mean blood velocity, arterial diameter, or blood flow rate among the groups. This suggests that the increased blood flow pulsatility in the retinal arteries of the eyes with AMD is not due to increased distal vascular resistance, but instead is likely due to a loss of compliance in the arterial vasculature leading to the eye. Conclusion Our results suggest that an increasing vascular rigidity in the systemic arterial circulation is directly associated with an increasing severity of AMD.
ABSTRACT Purpose In the pathophysiolgy of dry (atrophic) age related macular degeneration (AMD) a... more ABSTRACT Purpose In the pathophysiolgy of dry (atrophic) age related macular degeneration (AMD) aging of the retinal pigment epithelium (RPE) plays a key role. Accumulation of lipofuscin granules in the RPE cells represents a common downstream pathogenetic pathway in AMD. Lipofuscin is derived from chemically modified residues of incompletely digested photoreceptor outer segment discs. Detection of lipofuscin in vivo is possible by using fundus autofluorescence (FAF) imaging. The clinical application and possible implications of autofluorescence imaging in dry AMD will be discussed.Methods When stimulated with light in the blue to green range, lipofuscin granules emit a characteristic yellow fluorescence. FAF imaging using a scanning laser ophthalmoscope allows visualization of the topographic distribution of lipofuscin over large retinal areas. Examples of FAF images will be presented to demonstrate various FAF patterns and to discuss the clinical significance of these findings.Results In areas of geographic atrophy FAF images show very low autofluorescence intensity. This is due to the loss of RPE cells including the lipofuscin granules. In the junctional zone between atrophic and normal retina, levels of increased autofluorescence intensity may occur due to excessive accumulation of lipofuscin in the RPE cells. Longitudinal observations further suggest that the extension of the total area with increased autofluorescence intensity surrounding atrophy at baseline has a strong positive correlation with atrophy progression rate over time.Conclusion FAF imaging is an important diagnostic tool to follow the progression of dry AMD and other degenerative macular diseases and should always be considered in cases were the status of the RPE is unknown.
Graefes Archive for Clinical and Experimental Ophthalmology, Jan 13, 2006
Background: A number of epidemiological studies suggest that age-related macular degeneration (AM... more Background: A number of epidemiological studies suggest that age-related macular degeneration (AMD) and cardiovascular disease share the same risk factors. Systemic arterial stiffness is a clear indicator of cardiovascular disease. We investigated whether there is an association between directly measured systemic arterial stiffness and the presence of AMD. Methods: We used a Sphyg-moCor 2000 system to noninvasively measure two indicators of the systemic arterial stiffness, the arterial pulse wave velocity (PWV) and the central aortic blood pressure waveform, from which the augmentation pressure is determined. We studied 50 patients with AMD (12 men, 38 women, aged 60 to 91 years, mean 77 years) and 11 age-matched control subjects (3 men, 8 women, aged 66 to 92 years, mean 75 years). All study subjects received a complete ophthalmic examination including digital fundus photography. All of the patients with AMD were classified as stage 3 or worse in at least one eye according to the AREDS system. Results: Pulse wave velocity was significantly higher in the patients with AMD (8.2±1.1 m/s, mean ± SD) compared with controls (7.1±0.8 m/s, p=0.0025), indicating increased arterial stiffness. There was no significant difference in PWV in AMD patients with and without choroidal neovascularization. There was no association between PWV and the presence of hypertension in either the patients or the controls. The central aortic augmentation pressure was significantly higher in the AMD patients than in the controls (p=0.040), also indicating increased arterial stiffness. Conclusions: Patients with AMD have increased systemic arterial stiffness compared with age-matched controls. Treatments aimed at preventing or reversing systemic arterial stiffness may also be effective in preventing the onset or slowing the progression of AMD.
Aims To assess the functional and morphological outcome of eyes with neovascular AMD treated with... more Aims To assess the functional and morphological outcome of eyes with neovascular AMD treated with intravitreal ranbizumab following an exit strategy treatment regime. Methods The Bern treatment regime for neovascular AMD has a fixed injection schedule, even in the nonactive stage of the disease. The regimen has been adapted from the PIER study treatment protocol. Eyes with non-active AMD will receive 4 injections in the first year, and 2 injections in the second year of follow-up before treatment stops. Patients that received ranibizumab for treatment and reached the exit criteria were identified, and charts were reviewed to assess functional and morphological outcome. Results Only 2.6% of all patients (15 out of 575 patients) reached the exit criteria. Mean change in best corrected ETDRS visual acuity (VA) was 4.5±16.9 letters when comparing baseline VA to 4 weeks after the last injection (p=0.32). OCT mean foveal thickness was significantly thinner after last treatment (247.9 ±43.0 mm) compared to baseline (332.5±83.1 mm, p=0.002). The mean total number of ranibizumab injections was 15.6±8.0, and the mean total treatment period was 40.9±18.3 months. Twenty percent of eyes had geographic atrophy present at baseline versus 46.6% at the end of treatment. Conclusions Even with a fixed treatment regime and a defined treatment exit strategy, only a small percentage of patients reach exit criteria. Retinal thickness has been significantly reduced by repeated intravitreal ranibizumab injections, and geographic atrophy became more frequent.
Investigative Ophthalmology & Visual Science, Oct 20, 2014
PURPOSE. Optical coherence tomography (OCT) was used to analyze the thickness of various retinal ... more PURPOSE. Optical coherence tomography (OCT) was used to analyze the thickness of various retinal layers of patients following successful macula-off retinal detachment (RD) repair. METHODS. Optical coherence tomography scans of patients after successful macula-off RD repair were reanalyzed with a subsegmentation algorithm to measure various retinal layers. Regression analysis was performed to correlate time after surgery with changes in layer thickness. In addition, patients were divided in two groups. Group 1 had a follow-up period after surgery of up to 7 weeks (range, 21-49 days). In group 2, the follow-up period was >8 weeks (range, 60-438 days). Findings were compared to a group of age-matched healthy controls. RESULTS. Correlation analysis showed a significant positive correlation between inner nuclearouter plexiform layer (INL-OPL) thickness and time after surgery (P ¼ 0.0212; r 2 ¼ 0.1551). Similar results were found for the ellipsoid zone-retinal pigment epithelium complex (EZ-RPE) thickness (P ¼ 0.005; r 2 ¼ 0.2215). Ganglion cell-inner plexiform layer thickness (GCL-IPL) was negatively correlated with time after surgery (P ¼ 0.0064; r 2 ¼ 0.2101). For group comparison, the retinal nerve fiber layer in both groups was thicker compared to controls. The GCL-IPL showed significant thinning in group 2. The outer nuclear layer was significantly thinner in groups 1 and 2 compared to controls. The EZ-RPE complex was significantly thinner in groups 1 and 2 compared to controls. In addition, values in group 1 were significantly thinner than in group 2. CONCLUSIONS. Optical coherence tomography retinal layer thickness measurements after successful macular-off RD repair revealed time-dependent thickness changes. Inner nuclearouter plexiform layer thickness and EZ-RPE thickness was positively correlated with time after surgery. Ganglion cell-inner plexiform layer thickness was negatively correlated with time after surgery.
BackgroundFirework-related ocular injuries (FWROI) are a major cause of preventable visual impair... more BackgroundFirework-related ocular injuries (FWROI) are a major cause of preventable visual impairment. This study aimed to analyze the occurrence and outcome of FWROI in Switzerland.MethodsThis retrospective multicenter study included patients with FWROI from seven centers in Switzerland from January 2009 to August 2020. Demographic information, type of injuries, medical and surgical treatments, the best corrected visual acuity (BCVA) at baseline and end of follow-up, occurrence and type of secondary complications, and duration of hospitalization were analyzed.ResultsA total of 105 patients (119 eyes) with a mean age of 27.1 ± 15.9 years were included in the study (71.4% male patients; 29.5% underage). Most injuries occurred around New Year’s Eve (32.4%) and the Swiss national holiday on 1 August (60.9%). The most common anterior segment findings were conjunctival or corneal foreign bodies (58%), whereas Berlin’s edema was the most common posterior segment finding (11.4%). Globe rup...
Graefe's Archive for Clinical and Experimental Ophthalmology, 2021
Diagnosis of orbital compartment syndrome is mainly based on clinical findings, such as intraocul... more Diagnosis of orbital compartment syndrome is mainly based on clinical findings, such as intraocular pressure and proptosis, which try to estimate the orbital compartment pressure. However, the reliability of these surrogates is unclear. Current techniques for the direct measurement of orbital compartment pressure are widely experimental and impractical in the clinical setting. Our aim was to explore the feasibility of minimally invasive needle manometry for direct measurement of orbital compartment pressure under reproducible conditions in an in vivo model of orbital congestion. We further sought to evaluate intraocular pressure and proptosis as indicators for elevated orbital compartment pressure. A total of 7 ml of mepivacaine 2% solution was injected into the orbital compartment in 20 patients undergoing cataract surgery under local anesthesia. A commercially available single-use manometer device was inserted between the syringe and the injection needle to measure the orbital compartment pressure for each milliliter of intraorbital volume increment. Additionally, intraocular pressure (subgroup A; n = 10) or axial globe position (subgroup B; n = 10) were measured. Needle manometry allowed for rapid and continuous measurement of orbital compartment pressure. Overall mean orbital compartment pressure increased from 2.5 mmHg pre- to 12.8 mmHg post-interventionally. Both, intraocular pressure (Spearman’s correlation coefficient rs = 0.637, p < 0.0001) and proptosis (rs = 0.675, p < 0.0001) correlated strongly with the orbital compartment pressure. Needle manometry appears to be a feasible minimally invasive instrument to directly measure orbital compartment pressure, showing promises for a more routine application in managing orbital compartment syndrome. The results further suggest that both elevated intraocular pressure and proptosis are valuable indicators for orbital compartment syndrome.
BACKGROUND The aim of this study was to describe the clinical characteristics and surgical outcom... more BACKGROUND The aim of this study was to describe the clinical characteristics and surgical outcome of acquired comitant non-accommodative esotropia without obvious cause in children with an early onset ≤ three years of age. PATIENTS AND METHODS 24 consecutive patients (13 females) with acquired comitant nonaccommodative esotropia underwent strabismus surgery. Outcome measures included amount of deviation and level of binocularity at last follow-up. RESULTS An acute onset of strabismus was observed in 83 % of patients. Accompanying features such as diplopia, covering one eye or stumbling were observed in 40 % of the children. Cycloplegic retinoscopy revealed a mild to moderate
Retina-the Journal of Retinal and Vitreous Diseases, Apr 1, 2006
RETINA ® , The Journal of Retinal and Vitreous Diseases, encourages authors to submit Brief Repor... more RETINA ® , The Journal of Retinal and Vitreous Diseases, encourages authors to submit Brief Reports describing unusual findings, new techniques, and new instruments. Material submitted for consideration in this section of the journal is done so with the assumption that the data provided do not duplicate previously published material and that the material has not been submitted for consideration elsewhere. Each author must sign a disclosure to this effect (see Instructions to Authors for complete wording of transfer letter). Brief Reports submitted for this section of the journal may be subjected to the standard review process that is applied to other material submitted to RETINA ®. Brief Reports should follow the requirements listed in the Instructions to Authors, with the following caveats: Brief Reports should not exceed 4 pages in length; no more than 5 references should be cited; and each Brief Report should include no more than 4 figures.
This work aims to summarize predictive biomarkers to guide treatment choice in DME. Intravitreal ... more This work aims to summarize predictive biomarkers to guide treatment choice in DME. Intravitreal anti-VEGF is considered the gold standard treatment for centers involving DME, while intravitreal steroid treatment has been established as a second-line treatment in DME. However, more than 1/3 of the patients do not adequately respond to anti-VEGF treatment despite up to 4-weekly injections. Not surprisingly, insufficient response to anti-VEGF therapy has been linked to low-normal VEGF levels in the serum and aqueous humor. These patients may well benefit from an early switch to intravitreal steroid treatment. In these patients, morphological biomarkers visible in OCT may predict treatment response and guide treatment decisions. Namely, the presence of a large amount of retinal and choroidal hyperreflective foci, disruption of the outer retinal layers and other signs of chronicity such as intraretinal cysts extending into the outer retina and a lower choroidal vascular index are all si...
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Papers by Marcel Menke