Vascular density and macular sensitivity in eyes after scleral buckling surgery for macula-on rhegmatogenous retinal detachment.

PURPOSE: To investigate the structure and function of the retina after scleral buckling (SB) surgery due to macula-on rhegmatogenous retinal detachment (RRD). METHODS: Twenty eyes with repaired macula-on RRD and 20 fellow eyes were included. All patients within 6-12 months of the procedure, were examined to evaluate retinal structure using spectral domain optical coherence tomography (SD-OCT) and vessel density (VD) by OCT angiography (OCTA). Best corrected visual acuity (BCVA) and microperimetry (MP) tests were used to assess retinal function. RESULTS: Analysis of the microvascular network using OCTA between the operated and healthy fellow eyes showed a significant reduction on VD in superficial vascular plexus (SVP), deep vascular plexus (DVP) and radial peripapillary capillaries (RPC) (p< 0.001, p = 0.019 and p = 0.008, respectively). Comparison of retinal structure in SD-OCT showed no significant differences on thickness in ganglion cell complex (GCC) and peripaillary retinal nerve fiber layer (pRNFL) (p> 0.05) between examined eyes. Retinal function analysis by MP examination showed a decrease of retinal sensitivity (p = 0.0013) whereas postoperative BCVA showed no differences (p = 0.62) in the operated eyes. Significant Pearson's correlations were observed between retinal sensitivity and VD in SVP, RPC (p< 0.05). CONCLUSION: In the eyes after SB surgery due to macula-on RRD, changes in retinal sensitivity were accompanied by impairment of the microvascular network assessed by the OCTA.

Intraretinal Cysts as a Manifestation of Retinal Angiomatous Proliferation in Optical Coherence Tomography Angiography.

Background and Objectives: Intraretinal cysts are common pathology observed inspectral domain optical coherence tomography (SDOCT) in patients with neovascular form of age-related macular degeneration (AMD). The aim of the study was to determine if the presence of intraretinal cysts is positively correlated with diagnosis of retinal angiomatous proliferation (RAP) in optical coherence tomography angiography (OCTA). Material and Methods: A total of 21 eyes with intraretinal cysts in SDOCT exam (Group1) and 21 eyes with subretinal fluid(Group 2) were enrolled into the study. In each eye, the presence of intraretinal neovascularization (IRN) and chorioretinal anastomosis (CRA) was evaluated in OCTA by two experienced graders. Results: IRN was observed in 20 eyes (95.2%) from Group 1 and 5 eyes (23.8%) from Group 2. Features of CRA were found in 18 eyes (80.95%) and 16 eyes (76.2%) respectively for Group 1 and 2. Patients with cysts are 50 (95% CI: 5.43−460.52) times more likely to have IRN (p < 0.001). Conclusions: The presence of intraretinal cysts on SDOCT retinal sections in eyes with neovascular AMD corresponds to the presence of IRN on OCTA examination. The results indicate that the absence of a cyst does not exclude the presence of IRN and CRA which can be identified on OCTA.

Intrascleral outflow after deep sclerectomy with absorbable and non-absorbable implants in the rabbit eye.

BACKGROUND: The purpose of the study is an analysis of intrascleral drainage vessels formed in rabbits' eyes after non-penetrating deep sclerectomy (NPDS) with absorbable and non-absorbable implants, and comparison to eyes in which surgery was performed without implanted material. MATERIAL/METHODS: NPDS was carried out in 12 rabbits, with implantation of non-absorbable methacrylic hydrogel (N=10 eyes) or absorbable cross-linked sodium hyaluronate (N=6 eyes), or without any implant (N=8 eyes). All the animals were euthanized 1 year after surgery. Twenty-one eyeballs were prepared for light microscopy and 3 were prepared for transmission electron microscope (TEM) analysis. Aqueous humour pathways were stained with ferritin in 6 eyeballs. RESULTS: By light microscopy, small vessels adjacent to the areas of scarring were the most common abnormality. Vessel density was significantly higher in operated sclera compared to normal, healthy tissue, regardless of the type of implant used. The average vessel densities were 2.18±1.48 vessels/mm2 in non-implanted sclera, 2.34±1.69 vessels/mm2 in eyes with absorbable implants, and 3.64±1.78 vessels/mm2 in eyes with non-absorbable implants. Analysis of iron distribution in ferritin-injected eyes showed a positive reaction inside new aqueous draining vessels in all groups. TEM analysis showed that the ultrastructure of new vessels matched the features of the small veins. CONCLUSIONS: Aqueous outflow after NPDS can be achieved through the newly formed network of small intrascleral veins. Use of non-absorbable implants significantly increases vessel density in the sclera adjacent to implanted material compared to eyes in which absorbable implants or no implants were used.

[Idiopathic juxtafoveolar teleangiectasia 2a in spectral domain optical coherence tomography (SdOCT)]. / Idiopatyczne teleangiektazje okolodoleczkowe typu 2a w obrazie spektralnej optycznej koherentnej tomografii (SOCT).

PURPOSE: The aim of the study was the evaluation of the changes characteristic for type 2a idiopathic juxtafoveal retinal telangiectasia in spectral domain optical coherence tomography images. MATERIAL AND METHODS: The study covered 23 eyes with diagnosed idiopathic juxtafoveal retinal telangiectasia of type 2a - 5 men and 7 women. Stage 2 was noticed in 9 eyes, stage 3 in 5 eyes, stage 4 in 8 eyes. Stage 5 was noticed in one eye. All the patients included in the study underwent the macula analysis by SdOCT technique. RESULTS: Stage 2 was characterized mainly by the occurrence of small hyporeflective microcysts (in 100% of cases), tiny hyperreflective deposits (in 90% of patients), focal retinal photoreceptor layer damage (in 80%) as well as large hyporeflective cysts (70%). Stage 3 in SdOCT scans showed dominating hyperreflective deposits, including both small ones (100%) and less frequent large shaded deposits (71%), and still numerous microcysts (86%) and larger hyporeflective compartments. Stage 4 was characterized by the occurrence of large spreaded areas of fading retinal photoreceptor layer (in 100% of examined eyes), accompanied by retina architecture disorders. We also noticed numerous tiny hyperreflective deposits (100% of examined eyes), as well as large hyperreflective deposits (80%). Microcysts occurred significantly less frequently than in other stages (60%). The average retina thickness in fovea in all eyes irrespective of the stage of disease amounted to 192.13 +/- 59.1 microm, on the other hand in the nasal and temporal parts of fovea 202.43 +/- 37.75 microm and 262.7 +/- 41.31 microm respectively (p< 0.05). CONCLUSIONS: Thanks to its high resolution, SdOCT examination depicts changes in retina in the course of idiopathic juxtafoveal telangiectasia in great detail. Our study shows certain permanent changes occurring in this disease, characteristic to subsequent stages which allow to make a highly probable diagnosis before fluorescein angiography is carried out.

[Uveal effusion syndrome complicated by anterior ischemic optic neuropathy and cystoid macular edema]. / Zespól wysiekowy naczyniówki powiklany przednia niedokrwienna neuropatia nerwu wzrokowego oraz torbielowatym obrzekiem plamki.

The current paper presents a case of unique presentation of idiopathic uveal effusion syndrome. The 28 years old patient with combined bilateral choroidal and retinal detachment, recurrent in the left eye, underwent surgical procedures. He was treated with lamellar sclerectomy under the scleral flap in both eyes and another sclerectomy in the left eye later on. The apposition of the retina was achieved in both eyes and visual acuity improved significantly. Three months later, the patient developed anterior ischemic optic neuropathy in the right eye. In left eye after cataract phacoemulsification, persisted cystoid macular edema appeared.

[New drug VEGF Trap-Eye--Eylea--and its use in the treatment of age-related macular degeneration, central retinal vein occlusion, diabetic macular edema, and choroidal neovascularization secondary to pathologic myopia]. / Nowy lek VEGF Trap-Eye--Eylea--i jego wykorzystanie w leczeniu zwyrodnienia plamki zwiazanego z wiekiem, zakrzepu zyly srodkowej siatkówki, cukrzycowego obrzeku plamki oraz neowaskularyzacji w przebiegu krótkowrocznosci.

Vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of choroidal and retinal neovascularization. Anti-VEGF therapy changed the standard-of-care for ocular disease with neovascularisation. This article presents one promising new drug--VEGF Trap-Eye--and results of clinical trials evaluating its efficacy in the treatment of wet age-related macular degeneration, central retinal vain occlusion, diabetic macular edema and choroidal neovascularization secondary to pathologic myopia.

Oral acetaminophen (paracetamol) for additional analgesia in phacoemulsification cataract surgery performed using topical anesthesia Randomized double-masked placebo-controlled trial.

PURPOSE: To evaluate the clinical analgesic efficacy of 1.0 g oral acetaminophen (paracetamol) given in addition to topical anesthesia before phacoemulsification cataract surgery. SETTING: Inpatient and outpatient ophthalmology clinics, Bydgoszcz, Poland. METHODS: Consecutive patients with age-related cataract having phacoemulsification under topical anesthesia (tetracaine 0.5%) were enrolled in a prospective double-blind randomized placebo-controlled study. Patients were randomly assigned to preoperative oral administration of a placebo medication or to oral administration of 1.0 g acetaminophen. The main outcome measure was intensity of pain during and after surgery. Pain intensity was measured using a 10 cm baseline visual analog scale and a discrete 5-category verbal rating scale. RESULTS: The study comprised 160 consecutive patients (80 in each group). Intraoperatively, the mean visual analog scale pain intensity score was 2.17 +/- 1.81 in the placebo group and 1.45 +/- 1.17 in the acetaminophen group and the mean verbal rating scale score, 1.11 +/- 0.73 and 0.67 +/- 0.66, respectively (P<.01). Postoperatively, the mean visual analog scale score for pain was 1.47 +/- 1.39 in the placebo group and 0.56 +/- 0.61 in the acetaminophen group and the mean verbal rating scale score, 0.94 +/- 0.79 and 0.28 +/- 0.41, respectively (P<.01). There was no significant difference in patient behavior during surgery and no significant adverse effects of acetaminophen use. CONCLUSION: Preoperative oral administration of acetaminophen 1.0 g was effective, convenient, safe, and cost effective in reducing intraoperative and postoperative pain in phacoemulsification performed using topical anesthesia.

A study of macular hole formation by serial spectral optical coherence tomography.

BACKGROUND: The purpose of this paper is to evaluate changes of the vitreoretinal interface in fellow eyes of eyes with a macular hole and to study early stages of macular hole formation by spectral optical coherence tomography (SOCT). METHODS: A prospective study of 131 consecutive patients with history of macular hole. Serial SOCT examinations were performed on the fellow eyes four times during a 6-month observation period. Progression of foveal changes and formation of macular hole in the fellow eyes were studied. RESULTS: Seven distinct abnormalities in the foveal region were noted in 70 of the fellow eyes (53.4%). Additionally in 18 patients (13.6%) other defects typical for the older population were noted. Gradual evolution to full-thickness macular holes during the 6-month observation period was noted in five eyes. One of these eyes had a previously detected cyst, and four eyes had elevation of the photoreceptor layer. CONCLUSIONS: The high prevalence of macular abnormalities in the fellow eyes particularly epiretinal membranes and vitreous traction with schizis as well as the evolution of these abnormalities over time suggest that diseases of the vitreomacular interface may have similar pathogenesis. Macular hole formation often starts as a triangular elevation of the photoreceptor layer. In some cases, a cyst in the inner retinal layers can be an early step in macular hole formation.

Analysis of the outer retina reconstructed by high-resolution, three-dimensional spectral domain optical coherence tomography.

BACKGROUND AND OBJECTIVE: A retrospective cross-sectional study was conducted to demonstrate an analysis of an outer retinal layer reconstructed by the three-dimensional and high-speed spectral domain optical coherence tomography (SD-OCT) instrument. PATIENTS AND METHODS: New measurement protocols for SD-OCT and methods of analysis and visualization of the individual segmented retinal layer reconstructed by SD-OCT were proposed. Three contour maps representing mutual distances between the basal part of the retinal pigment epithelium, the junction between the inner and outer segments of photoreceptors, and a reference contour representing the shape of a healthy retina were introduced. RESULTS: The analysis of the outer retina was performed on pathological eyes. Three cases of central serous chorioretinopathy, age-related macular degeneration, and acute zonal occult outer retinopathy are demonstrated. CONCLUSION: Three contour maps reconstructed for clinical cases demonstrate high variability of observed patterns depending on analyzed pathology. The authors believe this can help to present OCT data simultaneously in a more comprehensive and convenient way to assist in everyday clinical diagnosis.

Cataract phacoemulsification and intraocular pressure in glaucoma patients.

PURPOSE: To evaluate the influence of recently performed cataract phacoemulsification in glaucomatous eyes on postoperative intraocular pressure (IOP). MATERIAL AND METHODS: 100 eyes of 86 glaucoma patients who underwent cataract phacoemulsification with simultaneous intraocular lens implantation, were retrospectively analyzed. The patients were divided into two groups: I--61 patients (71 eyes) with open angle glaucoma, and II--25 patients (29 eyes) with angle closure glaucoma. Both groups were subdivided into two subgroups, depending on presence of symptoms of pseudoexfoliation (PEX) syndrome (A = with, and B = without symptoms of PEX syndrome). All patients were examined in the department where the surgeries were performed; before surgery, on the first day after the procedure, and again during the last follow-up examinations, 6 to 30 months after the procedure. RESULTS: Before surgery, the intraocular pressure (IOP) was at mean value of 19.02 +/- 4.55 mmHg in group I, and 20.01 +/- 6.43 mmHg in group II. On the first day after surgery, the IOP was 17.42 +/- 7.17 and 20.36 +/- 8.98 mmHg, respectively. lOP exceeding 20 mmHg was found in 7 eyes in group I, and in 6 eyes in group II. During the last follow-up examinations the lOP was 14.59 +/- 3.73 and 14.01 +/- 4.50 mmHg, respectively, and was lower than measured before surgery, by an average of 4.43 mmHg in group I (P < 1 x 10(-5)), and 6.00 mmHg in group II (P < 1 x 10(-4)). In both groups, the reduction of lOP in patients with PEX was even more remarkable. The number of glaucoma medication necessary to control the pressure was reduced on average by 0.28 in group I, and 0.31 in group II. CONCLUSIONS: Phacoemulsification done on glaucomatous eyes results in lowering of lOP, and hence the dosage of glaucoma drugs over the long term can be simplified or even discontinued.

Histological biocompatibility of new, non-absorbable glaucoma deep sclerectomy implant.

We performed this study to compare the intrascleral biocompatibility of three materials: non-absorbable hydrogel contact lens polymer, non-absorbable silicone rubber, and absorbable cross-linked sodium hyaluronate. Intrascleral implantation of three different materials was performed in 13 healthy, pigmented rabbits. Implants of methacrylic hydrogel, silicone rubber, and cross-linked sodium hyaluronate were implanted in 10, 8, and 8 eyes, respectively. The animals were euthanized at 7, 30, 180, and 360 days post implantation. The eyes were enucleated and immediately fixed in 10% buffered formalin. Semithin sections were cut and stained with hematoxylin-eosin. Light microscope analysis of the specimens was performed. The least severe inflammatory reaction was observed with cross-linked sodium hyaluronate implants. The number of inflammatory cells in proximity to methacrylic hydrogel and silicone implants at all periods of follow up was similar. The thickest fibrous capsule was observed with silicone implants (average, 28.38 +/- 11.17 microm). This area was thinner with methacrylic hydrogel implants (average, 14.90 +/- 5.57 microm) and was thinnest around sodium hyaluronate implants (average, 7.21 +/- 2.33 microm). For each type of implant, the wall on the conjunctival side of the fibrous capsule was significantly thicker than the wall on the choiroidal side. The space between the implant, scleral flap, and bed was filled soon after surgery with connective tissue rich in vessels. In our study, cross-linked sodium hyaluronate had the highest intrascleral biocompatibility. Although the inflammatory responses of the sclera to methacrylic hydrogel and silicone rubber were similar in nature, a thicker fibrous capsule was generated around silicone implants.

Spectral optical coherence tomography: a novel technique for cornea imaging.

PURPOSE: Spectral optical coherence tomography (SOCT) is a new, noninvasive, noncontact, high-resolution technique that provides cross-sectional images of the objects that weakly absorb and scatter light. SOCT, because of very short acquisition time and high sensitivity, is capable of providing tomograms of substantially better quality than the conventional OCT. The aim of this paper is to show the application of the SOCT to cross-sectional imaging of the cornea and its pathologies. METHODS: Eleven eyes with different corneal pathologies were examined with a slit lamp and the use of a prototype SOCT instrument constructed in the Institute of Physics, Nicolaus Copernicus University, Torun, Poland. RESULTS: Our SOCT system provides high-resolution (4 microm axial, 10 microm transversal) tomograms composed of 3000-5000 A-scans with an acquisition time of 120-200 ms. The quality of the images is adequate for detailed cross-sectional evaluation of various corneal pathologies. Objective assessment of the localization, size, shape, and light-scattering properties of the changed tissue is possible. Corneal and epithelial thickness and the depth and width of lesions can be estimated. CONCLUSION: SOCT technique allows acquiring clinically valuable cross-sectional optical biopsy of the cornea and its pathologies.

In vivo imaging of posterior capsule opacification using Spectral Optical Coherence Tomography.

Three years after uneventful extracapsular cataract extraction with implantation of a poly(methyl methacrylate) (PMMA) intraocular lens (IOL) (MZ60BD, Alcon) in a 74-year-old man, the anterior segment of the right eye was photographed with a Canon EOS 300D digital camera and examined with a slitlamp and a prototype spectral optical coherence tomography (SOCT) instrument. Subsequently, a neodymium:YAG laser posterior capsulotomy was performed, followed by another examination. The quality of the SOCT images was adequate for detailed cross-sectional evaluation of the IOL, posterior capsule opacification (PCO), and morphological changes after laser capsulotomy. En face contour maps of PCO distribution were created from 3-dimensional SOCT data. The results presented indicate future applicability of SOCT technology in evaluating modern IOL designs and investigating the process of PCO formation.

[Patient's pain feeling and surgeon's comfort--ECCE versus phacoemulsification]. / Odczucia bólowe pacjenta i komfort chirurga: ocena porównawcza zewnatrztorebkowego wydobycia i fakoemulsyfikacji zacmy.

PURPOSE: To compare patient's pain and surgeon's comfort during ECCE performed under retrobulbar anesthesia and phacoemulsification under topical anesthesia. MATERIAL AND METHODS: 120 patients scheduled for planned routine cataract extraction were divided in 2 groups: group 1-60 eyes, ECCE under retrobulbar anesthesia and group II-60 eyes, phacoemulsification under topical anesthesia. Immediately after operation patients were asked, to answer questions about their feeling during surgery. Simultaneously, the surgeon filled up the questionnaire, concerning patients behavior during the entire procedure. RESULTS: Statistically significant higher level of pain was reported in group I (ECCE). The most painful moment of the procedure was retrobulbar injection. During surgery pain feeling in both groups was similar. Both types of anesthesia provided very good level of surgeon's comfort. The longer operation, the higher level of pain and lower surgeon's comfort were reported in both groups. CONCLUSIONS: Patients having ECCE performed under retrobulbar anesthesia reported more pain comparing to phacoemulsification under topical anesthesia. Both anesthesia methods provided high level of surgeon's comfort.

[Application of spectral optical coherent tomography (SOCT) in ophthalmology]. / Zastosowanie spektralnej tomografii optycznej (SOCT) w okulistyce.

The article describes spectral optical coherent tomography (SOCT) constructed by Medical Physics Group, Faculty of Physics, Astronomy and Informatics at Nicholas Copernicus University in Torun (Poland). It presents the physical bases for the functioning of the constructed device and includes pictures of optical sections of various elements of the eyeball: an optic disc and the region of central fovea, a cornea and angle structures (trabecular meshwork). The article also discusses potential application of SOCT in ophthalmic diagnosis of anterior and posterior segments of the eye.