Alleviation of Allergic Rhinoconjunctivitis Symptoms in Participants Treated with a 0.005% Tacrolimus Eye-Drop Solution.

Purpose: This randomized, placebo-controlled, crossover, double-blind trial aimed to evaluate the efficacy and safety of Tacrosolv, a novel 0.005% tacrolimus eye-drop solution, in adults with grass pollen-induced allergic conjunctivitis. Methods: A total of 64 adult participants were randomized to receive 2.5 µg or 5 µg tacrolimus/eye/day or placebo treatment for 8 days, with grass pollen exposure on day 1 and day 8. After a 2-week washout period, placebo participants crossed over to Tacrosolv treatment and vice versa, with repeated treatment and exposure. During exposure, participants recorded ocular, nasal, and respiratory allergy symptoms every 15 minutes. The primary endpoint was the mean total ocular symptom score (TOSS) on day 8. Objective ocular safety parameters were assessed before, during, and after exposure. Adverse events were recorded throughout the study. Results: On day 8, high-dose Tacrosolv reduced the TOSS compared to placebo towards the end of exposure (p<0.05 at time points 3 hours, 45 minutes and 4 hours). A 26% reduction in baseline adjusted TOSS from day 1 to day 8 was observed in participants treated with high-dose Tacrosolv, whereas placebo-treated participants showed no difference in TOSS between day 1 and day 8. Nasal symptoms were reduced on both day 1 and day 8 in participants treated with high-dose Tacrosolv (p<0.05). No safety concerns were raised. All adverse events were resolved within the study period. Conclusion: High-dose Tacrosolv is safe and effective for alleviating symptoms of allergic rhinoconjunctivitis. Trial Registration: NCT04532710; EudraCT No. 2019-002847-62.

The forceps-needle: Combining needle and grasping functions in a single instrument.

A new forceps-needle to facilitate intrascleral haptic fixation surgery is described. In an initial series of 10 cases, the forceps-needle was used to grasp and externalize the haptic of a 3-piece intraocular lens (IOL) for transscleral fixation. The site of perforation was marked at 180 degrees 2.0 mm away from the limbus. Then, the IOL with polypropylene haptics was folded and implanted partially into the anterior chamber. A transconjunctival, scleral tunnel of about 2.0 mm length parallel to the limbus was prepared with the forceps-needle on 1 side, with the second hand holding the leading haptic through a side-port incision. The end of the first haptic was grasped and externalized after which the end of the haptic was flanged. Subsequently, a second scleral tunnel was prepared with the forceps-needle, and the second haptic was externalized and flanged. All procedures could be performed without any intraoperative complication.

High-resolution optical coherence tomography after surgery for vitreomacular traction: a 2-year follow-up.

PURPOSE: To characterize the morphologic changes in vitreomacular traction (VMT) before and after surgery using spectral-domain optical coherence tomography (SD OCT) and to identify patterns relevant to visual function. DESIGN: Prospective, interventional case series. PARTICIPANTS: Thirty eyes of 30 consecutive patients with visual acuity of less than 20/32 resulting from idiopathic VMT. METHODS: A conventional 20-gauge 3-port vitrectomy was performed, including removal of the epiretinal membrane (ERM) and internal limiting membrane. Examinations were performed 1 day before surgery and 1 and 3 days as well as 1, 3, 6, 12, and 24 months after surgery. The SD OCT scan sets were analyzed with regard to central retinal thickness (CRT), retinal volume (RV), graded parameters of inner/outer retinal layer integrity (ILI/OLI), presence of retinal surface folds (RSF), and foveal contour. MAIN OUTCOME MEASURES: Visual acuity and morphologic characteristics of the inner and outer retinal layers revealed by SD OCT. RESULTS: Spectral-domain OCT revealed a complete absence of the ERM and early release of traction forces in each eye. Best-corrected visual acuity increased progressively over 24 months. Morphologically, RSF resolved within 1 month after surgery, followed by a marked decrease in CRT and RV over the next 3 months. There was no significantly correlation between RSF, CRT, or RV with functional improvement, and CRT and RV did not return to physiologic values. Recovery of ILI and OLI proceeded slowly, reaching significance at 12 months, and correlated strongly with visual function. CONCLUSIONS: Spectral-domain OCT seems to be a valuable method for evaluating retinal changes after surgery for VMT. Reconstitution of neurosensory layers was identified as the most relevant parameter for visual improvement.

Comparing retinal thickness measurements from Cirrus spectral domain- and Stratus time domain-optical coherence tomography.

PURPOSE: The purpose of this study was to compare retinal measurements obtained using spectral domain-optical coherence tomography with measurements obtained using time domain-optical coherence tomography. METHODS: Three hundred and seventy subjects were recruited at three university-based and one community-based retina practice for a cross-sectional observational study. For each subject, one eye was enrolled as the study eye. A Stratus Fast Macular scan was performed, and a Cirrus 200 x 200 Macular Cube scan was performed. Both instruments segment the acquired images to generate retinal thickness values and report averages measured in nine subfields defined by the Early Treatment Diabetic Retinopathy Study. These average values were compared with each other quantitatively using linear regression and Bland-Altman plots. RESULTS: Of the recruited subjects, 283 had acceptable images taken on the same day with both the Cirrus and Stratus devices. Mean differences between the instruments were noted in all subfields for all disease categories and ranged from 29 microm (outer superior subfield) to 54 microm (central subfield). CONCLUSION: Differences between time domain and spectral domain measurements of retinal thickness depend on pathology and location. Comparisons across instruments should be made with caution.

Association of retinal sensitivity and morphology during antiangiogenic treatment of retinal vein occlusion over one year.

PURPOSE: Evaluation of the association between functional and anatomic retinal changes during anti-vascular endothelial growth factor (VEGF) therapy with bevacizumab (Avastin) in patients with cystoid macular edema secondary to retinal vein occlusion (RVO) using microperimetry and spectral domain optical coherence tomography (SD-OCT). DESIGN: Prospective, uncontrolled study (EUDRACT NR-2005-003288-21). PARTICIPANTS: Twenty-eight patients with cystoid macular edema secondary to RVO. METHODS: Patients initially received 3 consecutive intravitreal injections of 1.25 mg bevacizumab at 4-week intervals. Further treatment was based on morphologic (OCT) and functional best-corrected visual acuity (BCVA) findings. During the 1-year follow-up, a rigorous standardized evaluation was performed monthly. Macular function was documented by microperimetry (Nidek, MP1 Microperimeter) and BCVA based on the Early Treatment in Diabetic Retinopathy Study (ETDRS). Morphologic parameters included central retinal thickness (CRT) as measured by conventional OCT (Stratus), and central subfield thickness (CST), mean retinal thickness (MRT), and retinal volume (RV) measured by SD-OCT. MAIN OUTCOME MEASURES: Imaging of retinal morphology using OCT and SD-OCT and evaluation of retinal function assessed with microperimetry and ETDRS charts during 12 months of anti-VEGF treatment. RESULTS: Within 6 months, the mean area of absolute scotoma was reduced from 21.4% of the central visual field to 6.4% and remained at this level until month 12 (7.4%). Mean BCVA improved from 51 to 66 letters on ETDRS charts. The CRT, CST, and MRT decreased significantly (P<0.002) and remained stable during the follow-up. The RV values did not improve significantly under therapy. Statistical analysis using a linear effects model revealed significant associations between the functional and morphologic outcomes, most notably between BCVA, macular sensitivity, CRT (Stratus OCT), CST, and MRT (Cirrus OCT) values. CONCLUSIONS: Central retinal morphology, especially CRT and CST measured by conventional and SD-OCT, and retinal function improved significantly during treatment of RVO with a flexible dosing regimen of intravitreal bevacizumab. Functional (central visual acuity and visual field) and morphologic parameters (retinal thickness) were significantly related. These associations highlight the value of OCT imaging for assessing this disease entity.

Three-dimensional polarization sensitive OCT imaging and interactive display of the human retina.

Polarization sensitive OCT has recently been shown to provide tissue specific contrast, enabling direct identification of retinal layers based on the intrinsic properties of their interaction with light. However, the capabilities of displaying and analyzing 3D datasets in scientific publications were rather limited. Within the framework of the Interactive Science Publishing project, we present new ways of displaying and analyzing 3D sets of various polarization parameters recorded in healthy and diseased human retinas. These datasets can be interactively explored by the reader. Furthermore, we provide data of the 3D distribution of backscattered Stokes vectors to allow the reader to develop and test their own data processing algorithms.

Three-dimensional imaging of an optic disk pit using high resolution optical coherence tomography.

PURPOSE: To clarify the origin of the coexisting fluid in an optic disc pit case by using optical coherence tomography (OCT). METHODS: High resolution OCT (Cirrus prototype, Carl Zeiss Meditec) was used for image acquisition;three dimensional segmentation was performed using Food and Drug Administration-approved imaging software (3D-Doctor V4.0, Able software Corp., Lexington, MA) to demonstrate the structural changes of the optic nerve head and the retina. RESULTS: Using high resolution OCT, the authors demonstrated that this case of optic pit had a possible connection between the subretinal and the intraretinal space. CONCLUSIONS: The authors assume that the intraretinal space is progressively filled with subarachnoidal fluid, leading to a tearing force within the outer neurosensory layers. A connection between the outer nuclear layer and the subretinal space may lead to a serous retinal detachment as a secondary event. Vision loss could consecutively be induced by a serous retinal detachment. High resolution OCT technology is able to visualize discrete changes of the microarchitecture of the optic nerve as well as the retina when combined with appropriate imaging software.

Retinal pigment epithelium segmentation by polarization sensitive optical coherence tomography.

We present a new method for identifying and segmenting the retinal pigment epithelium (RPE) in polarization sensitive optical coherence tomography (PS-OCT) images of the human retina. Contrary to previous, intensity based segmentation algorithms, our method uses an intrinsic tissue property of the RPE: its depolarizing, or polarization scrambling effect on backscattered light. Two different segmentation algorithms are presented and discussed: a simpler algorithm based on retardation data, and a more sophisticated algorithm based on local variations of the polarization state calculated from averaged Stokes vector elements. By using a state of the art spectral domain PS-OCT instrument, we demonstrate the method in healthy and diseased eyes.

Comparison of 2.5 mg/kg and 5 mg/kg systemic bevacizumab in neovascular age-related macular degeneration: twenty-four week results of an uncontrolled, prospective cohort study.

BACKGROUND: To compare safety, visual acuity (VA), and anatomic outcomes of 2.5 mg/kg and 5 mg/kg intravenous bevacizumab in patients with neovascular age-related macular degeneration. METHODS: In an institutional cohort study, 16 patients (2 cohorts, 27 eyes) with neovascular age-related macular degeneration were treated with 5 mg/kg intravenous bevacizumab and 2.5 mg/kg, respectively. All patients received 3 initial intravenous infusions at 2-week intervals. The main outcome measures were VA, optical coherence tomography, and fluorescein angiography. RESULTS: No serious systemic or ocular adverse events were identified. By Day 7, mean VA increased from 56 letters (20/80(+1)) at baseline to 60 letters (20/63) in the 5 mg/kg group and mean central retinal thickness decreased by 83 microm. In the 2.5 mg/kg group, mean VA increased from 55 letters (20/80) to 66 letters (20/50(+1)) and mean central retinal thickness decreased by 93 microm. By Month 3, VA improved by 10 letters compared to baseline in the 5 mg/kg group and by 9 letters in the 2.5 mg/kg group. Central retinal thickness was reduced by 128 microm in the 5 mg/kg group and by 127 microm in the 2.5 mg/kg group. These benefits were sustained through 6 months. No statistically significant difference was found between both treatment groups regarding safety, VA, and anatomic outcomes. CONCLUSION: Similar VA, optical coherence tomography, and angiographic improvements were observed in both treatment groups up to 6 months. Further follow-up is required to evaluate the long-term durability and safety of both treatment regimens.

Effect of systemic bevacizumab therapy on retinal pigment epithelial detachment.

BACKGROUND: To evaluate the effect of systemic bevacizumab (Avastin) therapy on pigment epithelial detachment (PED) secondary to age-related macular degeneration (AMD) and to identify prognostic factors for PED regression and improvement in best corrected visual acuity (BCVA). STUDY DESIGN: Prospective uncontrolled pilot study. METHODS: Nine patients (nine eyes) received three systemic bevacizumab treatments at 2 week intervals and were examined at baseline, weeks 1, 2, 4, 6 and month 3 by using optical coherence tomography (Stratus OC, Carl Zeiss Meditec, Dublin, California, USA). Changes in maximum PED height and greatest linear diameter (GLD) were planimetrically analysed by using Adobe Photoshop CS and correlated with retinal morphological changes and changes in BCVA. RESULTS: Systemic bevacizumab therapy was well tolerated. Mean maximum PED height decreased significantly by 21% as early as 1 week (-96 microm (SD 48.8), p<0.01). At 3 months follow-up, two PEDs resolved completely, mean maximum PED height decreased significantly by 39% (-179 microm (SD 178), p = 0.02) and mean PED GLD by 24% (-714 microm (SD 1010), p = 0.07). Mean BCVA improved significantly by week 2 (+8.7 letters (SD 5.7), p<0.01) and at 3 months with 12.7 letters (SD 6.4) (p<0.01). CONCLUSION: In the examined nine patients, systemic bevacizumab therapy showed evidence for an effect on PED secondary to neovascular AMD in terms of a decrease in lesion height and diameter. A high PED at baseline was found to be a negative predictive factor for visual outcome.

Choroidal neovascularization secondary to Sorsby fundus dystrophy treated with systemic bevacizumab (Avastin).

PURPOSE: A case of choroidal neovascularization (CNV) secondary to Sorsby fundus dystrophy (SFD) treated with systemic bevacizumab (Avastin). METHODS: A 41-year-old woman presented with CNV secondary to SFD in her better eye. The patient received three initial infusions of bevacizumab at a dose of 5 mg/kg at 2 week intervals and one additional infusion because of CNV recurrence at the 7 month follow-up. RESULTS: At 16 month follow-up, visual acuity had improved from 20/50 at baseline to 20/25; optical coherence tomography and fluorescein angiography showed no evidence of CNV activity. CONCLUSION: Systemic bevacizumab seems to be a promising treatment option for CNV secondary to SFD.

Retinal pigment epithelium tears following intravitreal ranibizumab therapy.

Two patients with choroidal neovascularization secondary to age-related macular degeneration (AMD) developed a retinal pigment epithelial (RPE) tear following intravitreal injection of ranibizumab. One patient developed the RPE tear within 2 weeks of the injection, the other within 6 weeks of a second injection. Both patients presented with vision loss of one line at diagnosis of the RPE tear. During long-term follow-up, visual acuity improved in one patient by one line and deteriorated in the second patient by three lines. RPE tears may occur after intravitreal injection of ranibizumab in patients with neovascular AMD, probably because of the rapid regression of the fibrovascular membrane.

Influence of treatment parameters on selectivity of verteporfin therapy.

PURPOSE: To improve selectivity of verteporfin therapy (PDT) in neovascular age-related macular degeneration (AMD) using modified treatment parameters. METHODS: Nineteen consecutive patients with predominantly classic choroidal neovascularization (CNV) in AMD were treated with 6 mg/m2 verteporfin given as bolus infusion. Patients received PDT with a fluence of either 25 or 50 J/cm2. Choroidal perfusion changes were evaluated by indocyanine green angiography (ICGA) at baseline, day 1, week 1, week 4, and month 3. Secondary outcomes were CNV closure rate and therapy-induced leakage documented by fluorescein angiography (FA). The safety of the treatment was assessed with ETDRS visual acuity. RESULTS: Complete CNV closure was achieved in all patients at day 1. Choroidal hypoperfusion was minimal in eyes treated with a reduced fluence of 25 J/cm2. Most patients treated with 50 J/cm2 showed significant choriocapillary nonperfusion at week 1, lasting as long as 3 months. A transient PDT-induced increase in leakage area in FA at day 1 was found to be more extensive in the 50-J/cm2 group. CONCLUSIONS: Bolus administration of verteporfin combined with a reduced light dose achieved improved selectivity of photodynamic effects, avoiding collateral alteration of the physiologic choroid while obtaining complete CNV closure. An increased selectivity with decreased effect on the surrounding choroid should be of advantage in verteporfin monotherapy as well as in combination strategies.

Human macula investigated in vivo with polarization-sensitive optical coherence tomography.

PURPOSE: To investigate a depolarizing layer that is visible in polarization-sensitive optical coherence tomography (PS-OCT) images of the retina. To identify this layer and characterize its depolarizing effect quantitatively. METHODS: Ten healthy human subjects (mean age, 31 +/- 8 years) and two patients with RPE diseases participated in the study. The macular region of one eye of each subject was investigated with a phase-resolved PS-OCT system. The instrument measured backscattered intensity (standard OCT), phase retardation, and (cumulative) birefringent axis orientation, simultaneously. For a quantification of the depolarizing layer, plots of the distributions of retardation and axis orientation within and above this layer were analyzed. RESULTS: A polarization-scrambling layer (PSL) was observed at the posterior boundary of the retina in PS-OCT images of all volunteers. It was identified in PS-OCT images by determining random retardation and axis orientation in a transverse direction. Measurements in patients with neurosensory retinal detachment, retinal pigment epithelium (RPE) detachment, and RPE atrophy suggest that the PSL is the RPE. The statistical analysis provided objective discrimination of the RPE from the other retinal structures. CONCLUSIONS: PS-OCT represents a powerful tool for increasing image contrast in ocular tissues. The observed polarization-scrambling nature of the RPE may be used in diseased eyes to locate the RPE or remains of the RPE definitively in OCT images.

Retinal pigment epithelium tears following verteporfin therapy combined with intravitreal triamcinolone.

PURPOSE: To detect patients with neovascular age-related macular degeneration (AMD) who experience retinal pigment epithelium tears after initial verteporfin therapy combined with intravitreal triamcinolone during early follow-up. DESIGN: Prospective interventional case series. METHODS: Forty-five consecutive patients with choroidal neovascularization (CNV) in AMD were treated with verteporfin therapy combined with 4 mg of intravitreal triamcinolone. Optical coherence tomography (OCT), visual acuity, and fluorescein angiography were performed. RESULTS: Two eyes with a predominantly classic CNV developed a retinal pigment epithelium tear. An early onset tear could be differentiated from a delayed onset tear. OCT showed an increased depth signal in areas of missing retinal pigment epithelium and a wavy, contracted, and elevated retinal pigment epithelium band. CONCLUSIONS: Retinal pigment epithelium tears can occur despite adding intravitreal triamcinolone to verteporfin therapy. OCT shows characteristic changes in the evolution of retinal pigment epithelium tears after combination therapy.

Depth of focus in eyes with diffractive bifocal and refractive multifocal intraocular lenses.

PURPOSE: To evaluate monocular and binocular depth of focus in eyes with different multifocal intraocular lens (IOLs) systems. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: In this comparative interventional study, binocular implantation of multifocal IOLs was performed in 3 groups. In the first group, 26 eyes of 13 patients received asymmetric Acri. Twin (Acri.Tec) IOLs, a near-weighted 733D in 1 eye and a distance-weighted 737D in the fellow eye. In the second group, 26 eyes of 13 patients received a diffractive 811E IOL (Pharmacia). In the third group, 26 eyes of 13 patients received a refractive Array IOL (AMO). The visual acuity was tested monocularly and binocularly starting at 6 m in 0.50 diopter (D) defocusing steps. RESULTS: Distance visual acuity was best in eyes with the distance-dominated 737D IOL; eyes with the other IOLs had comparable results. Binocular distance visual acuity was comparable between the Acri. Twin group and the 811E group. The Acri. Twin group had better distance visual acuity than the Array group (P< or =.048). Near visual acuity was best in eyes with the near-weighted 733D, followed by the 737D and the 811E. Patients with Array IOLs had worse visual acuities at reading distance (between 33 cm and 40 cm) (P< or =.001). Patients with diffractive bifocal IOLs had better results than patients with refractive multifocal IOLs at reading distance (P< or =.018). CONCLUSION: The diffractive IOLs performed better than refractive IOLs. Asymmetric-weighted IOLs provided better binocular depth of field.

Time course and morphology of vascular effects associated with photodynamic therapy.

PURPOSE: To evaluate the time course and morphologic features of verteporfin therapy-induced vascular effects using 3-dimensional topographic angiography (TAG) in patients with choroidal neovascularization (CNV). DESIGN: Prospective observational case series. PARTICIPANTS: Fifty-three eyes of 53 patients with neovascular age-related macular degeneration and Treatment of Age-Related Macular Degeneration with Photodynamic Therapy/Verteporfin in Photodynamic Therapy characteristics were treated with verteporfin therapy using standard parameters. METHODS: Treatment effects were evaluated before and at 5 hours, 1 day, 1 week, and 3 months after treatment by serial confocal fluorescein angiography (FA) and indocyanine green angiography (ICGA). The axial distribution of fluorescence at each x-position and y-position within a tomographic scan of 32 images over a depth of 4 mm was analyzed, and a 3-dimensional profile was generated. Changes at the level of the CNV lesion and the collateral choroid were documented over time with respect to vascular closure, leakage resulting from vascular barrier breakdown, and alteration of physiologic perfusion. MAIN OUTCOME MEASURES: Three-dimensional imaging of exudation and nonperfusion. RESULTS: At baseline, 3-dimensional FA and ICGA imaging demonstrated a well-defined prominent CNV complex. At 5 hours after verteporfin therapy, 3-dimensional FA identified an extensive increase in hyperfluorescent prominence as well as lesion extension in most verteporfin-treated eyes (65%), resulting from increased permeability and leakage due to a vascular barrier breakdown in the collateral choroid. Massive exudation throughout the entire light-exposed area was still noted in most eyes 1 day after treatment. At 1 week, the exudative response, seen in 3-dimensional imaging, had diminished substantially. Simultaneously, documented best by 3-dimensional ICGA, TAG demonstrated perfusion defects within the adjacent choroid, which started as early as 1 day after verteporfin therapy and persisted during extended follow-up. Three-dimensional angiography identified the morphologic features of hyperfluorescence and hypofluorescence more realistically than conventional angiography. CONCLUSIONS: Three-dimensional angiography demonstrates a characteristic sequence of changes in the vascular architecture of the CNV lesion and the collateral choroid after verteporfin therapy. Choroidal neovascularization occlusion is associated with immediate massive exudation and is followed by occlusive effects within the collateral choroid. Knowledge of the time course and mechanisms of phototoxic events should help to develop appropriate combination treatment strategies.

Hypofractionated stereotactic photon radiotherapy of posteriorly located choroidal melanoma with five fractions at ten Gy--clinical results after six years of experience.

PURPOSE: To evaluate long-term safety and efficacy of hypofractionated stereotactic photon radiotherapy with 5 five fractions at 10 Gy each in patients with centrally located choroidal melanoma. MATERIALS AND METHODS: Ninety-one patients with centrally located choroidal melanoma were treated stereotactically at a linear accelerator with 6 MV photon beams with 5 fractions at 10 Gy each. Examinations were performed at baseline and every 3 months in the first 2 years, then every 6 months until 5 years and yearly thereafter. Median follow-up was 37.8 months (IQR 19.2-49.9). They included visual acuity assessment, routine ophthalmological examinations with fundoscopy, echography for measurement of tumor dimensions, medical examinations and, if necessary, fluorescein angiography. RESULTS: Initial tumor base diameters, height and volume were 11.20mm (IQR 9.10-13.70), 9.80 mm (IQR 7.80-11.70), 4.53 mm (IQR 3.33-6.43) and 253.8mm(3) (IQR 127.5-477.0). Local tumor control and eye retention rates were 97.7% and 86.4% after 5 years, respectively. Eight patients developed metastatic disease and 3 of them died due to metastatic disease during the follow-up period. Median visual acuity decreased from 0.67 initially to 0.05 at the last individual follow-up (p<0.001). The most common toxicities (any grade) were radiation retinopathy (n=39), optic neuropathy (n=32), radiogenic cataract (n=21), neovascular glaucoma (n=15) and dry eye syndrome (n=10). The 5 year probabilities to remain free of these side effects (any grade) were 26.0%, 45.4%, 55.4%, 72.6% and 80.5%, respectively. The most important prognostic factors for toxicities were the largest tumor base diameter, tumor height and tumor distance to the optic disk. CONCLUSION: Hypofractionated stereotactic photon radiotherapy with a total dose of 50 Gy delivered in 5 fractions is a highly effective treatment option in patients with centrally located choroidal melanoma and has a moderate toxicity profile.

The role of the optical coherence tomography in identifying shape and size of idiopathic epiretinal membranes.

AIM: Currently, the border of idiopathic epiretinal membranes (iERM) is outlined intraoperatively using vital dyes. Therefore, the authors set out to investigate the role of the preoperative retinal thickness map (RTM) of the optical coherence tomography (OCT) in identifying the shape and the size of the iERMs. METHODS: 15 eyes of 15 patients with iERM who underwent vitrectomy with indocyanine green-assisted membrane peeling were included in this study. The authors analysed the intraoperative fundus images and preoperative Cirrus HD-OCT to detect the shape and the size of the iERM as well as the shape and the size of each thickness-indicating colour (white, red, orange and yellow) on the RTM, respectively. The correlation of areas and morphologic characteristics between both groups was explored. RESULTS: Analysis of iERM morphologic characteristics (shape) showed a similarity between the iERM contour and the corresponding RTM in 13 cases (86.6%). Furthermore, retinal folds were found in six iERMs and in their corresponding RTMs. Analysis of iERM size (area) revealed a positive correlation between the iERM area and each studied coloured area in RTM. The most significant correlation was between iERM and the red area (440-480 µm; r=0.87, p<0.0001). CONCLUSION: The iERM-related retinal folds are clearly distinguishable on the HD-OCT. The red area in RTM representing the 440-480 µm retinal thickness can be a reliable predictor of the extent and the shape of the iERM.

Retinal optical coherence tomography: past, present and future perspectives.

Optical coherence tomography (OCT) has undergone substantial changes since its first use in the 1990s. Although the first generation of OCT systems heralded a new era in the non-invasive diagnostic options in ophthalmology, they did not reveal much detail. Later devices offered more information and helped in the diagnosis and treatment of a variety of pathological conditions, primarily of the retina. With today's spectral-domain type models ophthalmologists are offered a comprehensive tool with the opportunity for early diagnosis and precise monitoring of patients with retinal and glaucomatous pathologies. However, as experience with these new devices grows and demands by clinicians and researchers rise, further improvements need to be addressed. Future developments in the improvement of the transverse resolution and extension of the penetration depth are to be expected. New modalities such as polarisation sensitive OCT (PS-OCT) or Doppler OCT are now in use and promise additional insights in the properties of physiological and pathological tissue. While PS-OCT reveals further detail in alterations of the retinal pigment epithelium, Doppler OCT gives additional information about blood flow measurements. With these and further new developments, OCT will continue to be an invaluable instrument in the armamentarium of modern ophthalmology.