Corneal topographic and tomographic analysis of fellow eyes in unilateral keratoconus patients using Pentacam.

PURPOSE: To evaluate topographic and tomographic changes in fellow eyes in unilateral keratoconus (KCN) patients by comparing them with normal eyes. DESIGN: Retrospective comparative case series. METHODS: Fourteen eyes of 14 patients with unilateral KCN and 34 eyes of 34 refractive surgery candidates were divided into 3 diagnostic groups using a Pentacam rotating Scheimpflug camera: advanced KCN eyes of unilateral KCN (KCN group, 14 eyes), normal fellow eyes of unilateral KCN (fellow eye group, 14 eyes), and refractive surgery candidates (normal group, 34 eyes). Topographic and tomographic parameters, which were obtained from Pentacam using sagittal curvature, elevation, and corneal thickness maps, were compared among the 3 groups. Receiver operating characteristic (ROC) curves were used to identify cutoff points in discriminating between fellow and normal eyes. RESULTS: Keratometric asymmetry, topometric indices, and elevation differences (maximum - minimum) on both the anterior and posterior surfaces were statistically different (P < .05). On ROC curve analysis, keratometric asymmetry and topometric index were best at discriminating fellow eyes from normal, followed by elevation differences (maximum - minimum) on the posterior and anterior cornea surface. CONCLUSIONS: Fellow eyes in unilateral KCN showed differences in several parameters that were not detectable with the Pentacam detection program, when compared with normal. However, each single parameter alone is not sufficient to detect early changes; thus, elevation indices as well as indices of anterior curvature should be considered together.

Vitrectomy combined with intravitreal triamcinolone acetonide injection and macular laser photocoagulation for nontractional diabetic macular edema.

PURPOSE: To evaluate the efficacy of vitrectomy combined with intravitreal injection of triamcinolone acetonide (IVTA) and macular laser photocoagulation for the treatment of nontractional diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy. METHODS: Twenty-eight eyes from 28 subjects who were diagnosed with nontractional DME refractory to three or more sequential anti-VEGF injections underwent sequential vitrectomy, IVTA, and macular laser photocoagulation. Changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST) during the six months following vitrectomy were evaluated. Additionally, the CST and BCVA outcomes were compared with those of 26 eyes treated with the same triple therapy for nontractional DME refractory to conventional treatment, such as IVTA or macular laser photocoagulation, or both. RESULTS: The mean logarithm of the minimum angle of resolution BCVAs before and one, three, and six months after vitrectomy were 0.44 ± 0.15, 0.36 ± 0.18, 0.31 ± 0.14, and 0.34 ± 0.22, respectively. The mean CSTs were 433.3 ± 77.9, 329.9 ± 59.4, 307.2 ± 60.2, and 310.1 ± 80.1 microns, respectively. The values of both BCVA and CST at one, three, and six months were significantly improved from baseline (p < 0.05). The extent of CST reduction during the first month after triple therapy was greater in eyes refractory to conventional treatment than in eyes refractory to anti-VEGF (p = 0.012). CONCLUSIONS: Vitrectomy combined with IVTA and macular laser photocoagulation had a beneficial effect on both anatomical and functional outcomes in eyes with nontractional DME refractory to anti-VEGF therapy.

Healing of conjunctival wounds after 23-gauge sutureless vitrectomy.

PURPOSE: To evaluate the healing course of conjunctival wounds in eyes undergoing 23-gauge sutureless vitrectomy and to determine when the potential for ocular surface fluid contamination is no longer a serious concern. METHODS: Prospective observational case series. Thirty-four eyes from 34 patients that underwent transconjunctival 23-gauge sutureless vitrectomies were included. A total of 102 conjunctival wounds overlaying the sutureless sclerotomies from 34 eyes were evaluated prospectively by slit-lamp biomicroscopic examination using cobalt blue light with fluorescein dye staining. The configuration and size of the conjunctival wounds were measured with fluorescein dye staining postoperatively on Days 1, 4, 8, and 15. RESULTS: Seventy-five conjunctival wounds (73.5%) had not healed completely 4 days after the operation. Eight days after surgery, the proportion of eyes with fluorescein staining at the conjunctival wound decreased to 13.7%. Fifteen days after surgery, there was no fluorescein staining at the conjunctival wound in any case. Combined cataract extraction was a factor that delayed the healing of the conjunctival wound (P = 0.036). CONCLUSION: The results suggest that, regarding conjunctival integrity, patients should be safe from intraocular contamination 15 days after 23-gauge sutureless vitrectomy. Concomitant cataract extraction might lengthen the conjunctival wound healing process in these eyes.

Thinner choroid and greater drusen extent in retinal angiomatous proliferation than in typical exudative age-related macular degeneration.

PURPOSE: To compare choroidal thickness and extent and density of drusen between eyes with typical exudative age-related macular degeneration (AMD) and eyes with retinal angiomatous proliferation (RAP). DESIGN: Observational case series. METHODS: Twenty-four eyes with typical exudative AMD and 20 eyes with RAP were included. Subfoveal choroidal thickness was measured using enhanced depth imaging optical coherence tomography. Eyes were classified into 3 groups according to the extent of drusen distribution in the fundus photograph. Density of drusen was estimated based on optical coherence tomography images of the fellow eye. The proportion of the length beneath the drusen per the entire length of the Bruch membrane was defined as the density of drusen. Subfoveal choroidal thickness, extent of drusen distribution, and the density of drusen were compared between typical exudative AMD and RAP. RESULTS: Mean ± standard deviation subfoveal choroidal thickness in eyes with typical exudative AMD and eyes with RAP was 184.9 ± 68.5 µm and 139.0 ± 65.5 µm, respectively (P = .035). The mean density of drusen was 0.06 ± 0.08 and 0.24 ± 0.12, respectively (P < .001). In the typical exudative AMD group, 19, 3, and 2 eyes were included in the small extent group (two thirds), respectively. In the RAP group, 3, 14, and 3 eyes were included in each aforementioned group, respectively (P = .001). CONCLUSIONS: The thinner subfoveal choroidal thickness and greater extent and density of drusen in RAP than the typical exudative AMD may suggest compromised choroidal perfusion in the development of RAP.

Overestimation of subfoveal choroidal thickness by measurement based on horizontally compressed optical coherence tomography images.

PURPOSE: To measure the difference in subfoveal choroidal thickness between 1:1 pixel (horizontally compressed) images and 1:1 micron images in age-related macular degeneration. METHODS: This study included 122 eyes from 122 patients diagnosed with age-related macular degeneration. Choroidal thickness was measured using enhanced-depth imaging optical coherence tomography. The measurement line was drawn as a perpendicular line between Bruch's membrane and the chorio-scleral interface. The thickness was compared between measurements based on a 1:1 pixel image and a 1:1 micron image. Eyes with a straight vertical measurement line and oblique measurement line were classified into vertical measurement group and oblique measurement group, respectively. Intra-group comparisons of subfoveal choroidal thickness measurements based on the 1:1 pixel images and the 1:1 micron images were performed for the two groups. RESULTS: The mean subfoveal choroidal thicknesses measured on the 1:1 pixel images and the 1:1 micron images were 232.3 ± 106.4 µm and 228.9 ± 108.1 µm, respectively (p = 0.003). In the vertical measurement group (86 eyes), the mean subfoveal choroidal thickness was 226.3 ± 109.9 µm and 225.4 ± 112.0 µm, respectively (p = 0.423). In the oblique measurement group (36 eyes), the thickness was 246.5 ± 97.3 µm and 237.5 ± 98.9 µm, respectively (p < 0.001). CONCLUSIONS: Significant overestimation of the subfoveal choroidal thickness was noted when it was measured on a 1:1 pixel image. This finding suggests that the measurement of choroidal thickness should be performed based on a 1:1 micron image, especially if the measurement line is not vertical.

Effect of 2-methylaminoethyl-4,4'-dimethoxy-5,6,5',6'-dimethylenedioxybiphenyl-2-carboxylic acid-2'-carboxylate monohydrochloride (DDB-S) on indocyanine green (ICG) clearance in rats.

The clearance of ICG, a known hepatic blood flow marker was investigated in rats in order to examine whether DDB-S influences hepatic blood flow. The effect of DDB-S on the protein binding and blood-to-plasma partition of ICG was measured. The steady-state plasma concentration of ICG was monitored before and after co-administration of various concentration of DDB-S, and ICG clearance was estimated from the steady-state concentration and the infusion rate of ICG. There was no significant difference in protein binding and blood-to-plasma partition of ICG with and without addition of DDB-S (10, 20, and 40 microg/mL). When ICG was infused into DDB-S pretreated rats, the steady-state concentrations of ICG decreased and the calculated ICG clearance increased. However, no dose-dependency of ICG Css on DDB-S Css was observed. Since DDB-S did not affect the protein binding and blood-to-plasma partition of ICG, the increased clearance of ICG with co-administration of DDB-S seems to be due to the increased hepatic blood flow by DDB-S.