Effect of vitreomacular adhesion and vitreous gel on age-related reduction of macular thickness: a retrospective observational study.

OBJECTIVE: To investigate the effects of vitreomacular adhesion (VMA), vitreomacular separation (VMS) and absence of vitreous gel due to vitrectomy on macular thickness measured in the spectral domain optical coherence tomographic (SD-OCT) images. DESIGN: A longitudinal, retrospective, observational study. SETTING: Secondary multicentre study. PARTICIPANTS: 218 eyes of 218 healthy patients and 119 vitrectomised eyes of 119 patients were studied. The healthy individuals were classified into a VMA group (54 eyes) and a VMS group (164 eyes), while the vitrectomised patients were classified into an internal limiting membrane (ILM)-on group (26 eyes) and an ILM-off group (93 eyes). In all participants, 2 Cirrus HD-OCT recordings were made with an average interval of 36 months (range 24-60 months). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was the rate of change in macular thickness in the central sector. The secondary outcomes were the rates of change in macular thickness in the inner 4 sectors. RESULTS: The annual rate of change in the macular thickness of the central sector was 0.76±1.8 µm/year in the VMA group, -0.58±2.3 µm/year in the VMS group, -1.57±1.9 µm/year in the ILM-on group and -0.86±3.1 µm/year in the ILM-off group. There was a significant difference between the rate of the central sector thickness change in the VMA and VMS groups (p=0.0001). The presence of VMA was a significant factor associated with an increase in the central sector thickness (p=0.0055). When the healthy and ILM-on groups were compared, the rate of decrease in the central sector thickness was faster in the ILM-on group (p=0.0043). Multiple regression analyses showed that not peeling the ILM during the vitrectomy was a significant factor associated with a decrease in the central sector thickness (p=0.044). CONCLUSIONS: The presence of a VMA and a vitreous gel may help restrain the macular thickness reduction.

Progressive Thinning of Regional Macular Thickness After Epiretinal Membrane Surgery.

PURPOSE: To determine the long-term changes in the regional macular thickness after idiopathic epiretinal membrane (ERM) excision and to determine whether there were correlations between the pre- and postoperative central macular thickness and the best-corrected visual acuity (BCVA). METHODS: This was a prospective, interventional case series study of 53 eyes of 53 patients that underwent ERM removal with internal limiting membrane (ILM) peeling. Examinations were performed before, 1, 2, 3, 6, 9, 12, 24, 36, 48, and 60 months after the surgery. The average macular thicknesses in nine sectors outlined by the Early Treatment Diabetic Retinopathy Study were measured by spectral-domain optical coherence tomography. The final macular thicknesses of nine sectors of the 35 patients were compared with that of the normal fellow eyes. RESULTS: All patients were followed for 36 months, and 21 patients were followed for 48 months. The thicknesses of all sectors progressively decreased for 48 months. The macula at 48 months was thinner than at 36 months (P < 0.0001-0.037) in all sectors. The final central and nasal sectors were significantly thicker than that of the fellow eyes. The final inner and outer temporal sectors were significantly thinner compared with the fellow eyes. There was no significant difference in the other sectors. The pre- and postoperative central macular thickness was significantly correlated with the postoperative BCVA at each examination. CONCLUSIONS: A progressive thinning of the macula occurs with regional differences for at least 48 months. The temporal sector becomes thinner than the normal thickness.

Foveal Photoreceptor Deformation as a Significant Predictor of Postoperative Visual Outcome in Idiopathic Epiretinal Membrane Surgery.

PURPOSE: The purpose of this study was to determine whether the outer nuclear layer (ONL) deformation detected by spectral-domain optical coherence tomography (SD-OCT) is correlated with visual acuity before and after surgery in patients with idiopathic epiretinal membrane (ERM). METHODS: Forty-four eyes of 44 patients who underwent vitreous surgery for treatment of ERM were included. All patients underwent comprehensive ophthalmologic evaluations including measurement of best corrected visual acuity (BCVA) and SD-OCT before and after surgery. The central foveal thickness (CFT), foveal ONL thickness, juxtafoveal ONL plus outer plexiform layer (OPL) thickness, photoreceptor outer segment thickness, and size of the disrupted interdigitation zone (IZ) line were measured. We defined the "photoreceptor deformation index" (PDI) as the ratio of foveal ONL thickness to the juxtafoveal ONL plus OPL thickness. RESULTS: Multiple regression analysis showed that the only significant predictor of preoperative mean logarithm of the minimum angle of resolution (logMAR) BCVA was preoperative CFT (P < 0.0001). Preoperative PDI (P < 0.0001) and disrupted IZ diameter (P = 0.0242) were positively correlated with logMAR at 3 months after surgery. PDI (P < 0.0001) and disrupted IZ diameter (P = 0.0351) were also positively correlated with logMAR BCVA at 6 months after surgery. The only significant predictor of logMAR at 12 months after surgery was preoperative PDI (P < 0.0001). CONCLUSIONS: Preoperative PDI was most significantly correlated with postoperative BCVA. These results suggest that PDI is a novel parameter predicting visual outcome after surgery in eyes with ERM.

EFFECT OF INTERNAL LIMITING MEMBRANE PEELING ON LONG-TERM VISUAL OUTCOMES FOR DIABETIC MACULAR EDEMA.

PURPOSE: To evaluate the effect of internal limiting membrane (ILM) peeling on the long-term visual outcomes in eyes with diffuse, nontractional diabetic macular edema. METHODS: One hundred and sixteen eyes of 58 patients with the same degree of diabetic macular edema in both eyes underwent pars plana vitrectomy with the creation of a posterior vitreous detachment in both eyes. Internal limiting membrane peeling was performed in one randomly selected eye (ILM-off group), and ILM peeling was not performed (ILM-on group) in the fellow eye. The postoperative follow-up period ranged from 12 months to 161 months (average, 80.4 months). RESULTS: In the ILM-off group, the mean best-corrected visual acuity in logMAR units (Snellen equivalent) increased from 0.55 ± 0.31 (20/71) before surgery to 0.35 ± 0.35 (20/45) at 1 year (P < 0.0001) and 0.46 ± 0.43 (20/59) at the final visit (P = 0.058). In the ILM-on group, the mean best-corrected visual acuity increased from 0.55 ± 0.41 (20/71) before surgery to 0.43 ± 0.38 (20/54) at 1 year (P = 0.010) and 0.44 ± 0.45 (20/56) at the final visit (P = 0.043). The differences in the best-corrected visual acuity between the two groups were not significant at any time point. CONCLUSION: Pars plana vitrectomy with or without ILM peeling improves the long-term visual acuity of nontractional diabetic macular edema. Internal limiting membrane peeling does not affect the postoperative best-corrected visual acuity significantly.

Alterations in the neural and connective tissue components of glaucomatous cupping after glaucoma surgery using swept-source optical coherence tomography.

PURPOSE: To visualize changes in deep optic nerve head (ONH) structures following glaucoma surgery using (3-dimensional [3D]) swept-source optical coherence tomography (SS-OCT) and to determine the clinical and structural factors associated with postoperative lamina cribrosa (LC) and prelaminar neural tissue (PLT) changes. METHODS: In this prospective observational case series, SS-OCT thin-sliced datasets of the ONH covering a 3- × 3-mm area comprised of 256 B-scans (interval between scans = ∼12 µm) were obtained before and 3 months after the surgery and evaluated in 73 eyes of 73 patients with glaucoma. Bruch's membrane opening (BMO) and anterior LC boundary were manually delineated by two methods; one in every four B-scans (64 B-scans per eye) and 15 equally spaced horizontal B-scans in BMO area, excluding both ends (interval between scans = 96-120 µm). After former delineation, the point with maximum LC depth among 64 B-scans was automatically calculated, and LC depth and PLT thickness were averaged among 5 points adding 4 points 100 µm apart from this point vertically and horizontally. Associations between the percent change in LC depth and other clinical and structural parameters were tested for statistical analysis. RESULTS: Lamina cribrosa depth and axial length significantly decreased and PLT thickness significantly increased after surgery. The percent change of maximum LC depth correlated significantly with the percent change of IOP (P = 0.008), baseline LC depth (P = 0.032), and visual field mean deviation (P = 0.035; at the point with maximum LC depth), while the percent change of axial length correlated with IOP reduction (P = 0.002) but not with visual field mean deviation. CONCLUSIONS: Swept-source optical coherence tomography enables 3D analysis of deep ONH structures, and the change in LC depth after glaucoma surgery have association with IOP change and the severity of glaucomatous optic neuropathy.

Objective assessment of foveal cone loss ratio in surgically closed macular holes using adaptive optics scanning laser ophthalmoscopy.

PURPOSE: To use adaptive optics scanning laser ophthalmoscopy (AO-SLO) to quantify cone loss ratio in the foveola in order to assess foveal cone status and to investigate relationships between foveal structural abnormalities and visual function in patients with macular hole (MH) after surgery. METHODS: We evaluated 10 normal eyes of 10 healthy volunteers and 19 eyes of 18 patients in whom anatomically successful MH closure had been performed. All subjects underwent a comprehensive ophthalmologic examination that included measurements of spectral-domain optical coherence tomography and AO-SLO. RESULTS: On AO-SLO regular cone mosaic was seen in all normal eyes whereas dark regions suggesting cone loss were seen in all eyes after MH repair. Visual acuity was better in eyes without dark regions at the center of the fovea than in eyes with them (P = 0.001). Cone loss ratio in the foveola correlated with postoperative visual acuity (P<0.001), mean foveal sensitivity (P = 0.029), thinner inner and outer segments at the center of the fovea (P = 0.002), larger size of the disrupted inner and outer segment junction line (P = 0.018), and cone outer segment tip line (P<0.001). Cone loss ratio in the foveola was significantly greater in eyes that had moderately reflective foveal lesions after surgery (P = 0.006). CONCLUSIONS: AO-SLO is a useful means of assessing foveal cone damage objectively and quantitatively. The location and extent of cone damage, especially if it involves the foveola, is an important factor determining visual function after MH surgery.

Progressive changes of regional macular thickness after macular hole surgery with internal limiting membrane peeling.

PURPOSE: To determine the changes of regional macular thickness after successful macular hole surgery (MHS) with internal limiting membrane (ILM) peeling during a 24-month follow-up period. METHODS: In a prospective, interventional case study, the authors evaluated 24 eyes of 24 patients who underwent 23-gauge transconjunctival pars plana vitrectomy with triamcinolone-assisted ILM peeling to treat idiopathic macular hole. Examinations were performed before and 1, 2, 3, 6, 9, 12, and 24 months after surgery. Average regional macular thicknesses in the Early Treatment Diabetic Retinopathy Study sectors were measured by spectral-domain optical coherence tomography. RESULTS: The four inner sectors showed a significant reduction in the average retinal thickness at 1 month after surgery (P ≤ 0.0001-0.020), and the thickness continued to decrease for 24 months except in the nasal sector. The four outer sectors had a significant increase at postoperative 1 month (P = 0.0003-0.029) and then progressively decreased during the postoperative 24 months. The postoperative regional macular thinning was statistically significant even between 12 and 24 months (P = 0.0007-0.026) in all sectors except in the inner nasal sector (P = 0.13). The postoperative percent reduction rate was significantly different among four inner sectors after postoperative 3 months (P = 0.0029-0.039) in the order of temporal > superior > inferior > nasal sectors. CONCLUSIONS: These results suggest that a progressive macular thinning occurs for at least 2 years with different patterns of the changes in the macular regions after successful MHS with ILM peeling.

Tomographic features of macula after successful macular hole surgery.

PURPOSE: We determined the retinal features associated with a dissociated optic nerve fiber layer (DONFL) appearance after successful macular hole surgery with internal limiting membrane (ILM) peeling. METHODS: A tota of 47 eyes of 47 patients who underwent pars plana vitrectomy with ILM peeling was examined by spectral-domain optical coherence tomography (SD-OCT). RESULTS: A DONFL appearance was found in 31 (66.0%) eyes on color fundus photography. The postoperative best-corrected visual acuity and its improvements were not significantly different between eyes with and without this appearance. The SD-OCT images showed small inner retinal defects corresponding to each arcuate stria in all eyes with the DONFL appearance. Of these eyes, 25 (80.6%) included inner retinal defects extending beyond the retinal nerve fiber layer (RNFL) into the ganglion cell layer and inner plexiform layer. Similar inner retinal defects were seen in 14 (87.5%) of the 16 eyes without a DONFL appearance; 10 eyes (62.5%) included the defects that extended deeper than the RNFL. Such deep defects were found more frequently in the temporal than in the other quadrants (P < 0.0001). In 10 eyes that underwent Micro Perimeter-1, a reduction in retinal sensitivity (<10 dB) was found in 20 (10.4%) of the 192 points on arcuate striae, but only in 7 (3.4%) of 208 points away from the striae (P = 0.005). CONCLUSIONS: Macular hole surgery with ILM peeling may lead to deep inner retinal damage regardless of the development of the DONFL appearance detected on color fundus photography.

Local biometric features and visual prognosis after surgery for treatment of myopic foveoschisis.

PURPOSE: To identify the local biometric factors associated with postoperative best-corrected visual acuity (BCVA) after surgical treatment of myopic foveoschisis by using spectral-domain optical coherence tomography. METHODS: Eleven eyes of 10 patients that underwent vitrectomy combined with internal limiting membrane peeling for treatment of myopic foveoschisis were investigated. We measured the height and lateral width of the foveal detachment, subfoveal choroidal thickness, and height of the posterior staphyloma using spectral-domain optical coherence tomography. RESULTS: Foveal detachments found in 8 eyes were not significantly related to postoperative BCVA. Intraclass correlation coefficients of spectral-domain optical coherence tomography measurements were substantial to nearly perfect (0.786-0.951). The postoperative BCVA 12 months after surgery was significantly correlated with age (r(s) = 0.616, P = 0.044), preoperative BCVA (r(s) = 0.833, P = 0.001), preoperative subfoveal choroidal thickness (r(s) = -0.661, P = 0.027), and posterior staphyloma height (r(s) = 0.642, P = 0.033). Neither postoperative BCVA nor changes in BCVA showed significant correlations with the axial length or height or lateral width of the foveal detachment. CONCLUSION: These results at least raise the possibility that a thin choroid and likely severe posterior staphyloma before surgery can predict postoperative BCVA after vitrectomy for the treatment of myopic foveoschisis.

Features and surgical outcome of retinal nerve fiber layer alterations associated with epiretinal membrane.

PURPOSE: In this study, the authors aimed to investigate structural abnormalities in the retinal nerve fiber layer (RNFL) using spectral-domain optical coherence tomography (SD-OCT) and study the surgical outcomes in eyes with such alterations by comparing ultrastructure findings of the surgically excised epiretinal membrane (ERM) and inner limiting membrane (ILM) in patients with idiopathic ERM. METHODS AND PATIENTS: Vitreous surgery was performed on four eyes with idiopathic ERM, of which three had columnar alterations of the nerve fiber layer. The ERM and ILM were dissected and removed, and ultrathin sections were analyzed and imaged completely by using electron microscopy. All the patients underwent a comprehensive ophthalmologic examination, including SD-OCT, fundus-monitoring microperimetry, and red-free scanning laser ophthalmoscopic imaging. RESULTS: Preoperatively, SD-OCT revealed the presence of columnar structures only in the RNFL. Transmission electron microscopy showed that all samples contained retinal cell debris on the outer surface of the ILM. However, adhesion of retinal nerve fibers on the outer surface of the ILM was not observed in any specimen. The columnar alterations in the RNFL observed via SD-OCT resolved completely within 1 month in all eyes. At 6 months after surgery, no eyes showed scotoma on microperimetry. Further, no dissociated nerve fiber layer appearance was identified. CONCLUSION: Vitrectomy with ILM peeling can be safely performed for ERMs with RNFL alterations, detected preoperatively by SD-OCT, without any structural or functional disturbances. The columnar alterations of the RNFL on SD-OCT may be inner retinoschisis.

Oximetry of retinal capillaries by multicomponent analysis.

Retinal oximetry of capillaries was performed for early detection of retinal vascular abnormalities, which are caused predominantly by complications of systemic circulatory diseases. As the conventional method for determining absorbance is not applicable to capillaries, multicomponent analysis was used to estimate the absorbance spectra of the retinal blood vessels. In this analysis, the capillary spectrum was classified as intermediate between those of the retinal arteries and veins, enabling relative estimation of oxygen saturation in the capillaries. This method could be useful for early recognition of disturbances in the peripheral circulation. Furthermore, a spectroscopic ophthalmoscope system based on the proposed method was developed to examine the human retina. A clinical trial of this system demonstrated that oximetry of the retinal capillaries may be an improvement over the present diagnosis for patients of malignant hypertension.

Photoreceptor damage and foveal sensitivity in surgically closed macular holes: an adaptive optics scanning laser ophthalmoscopy study.

PURPOSE: To assess photoreceptor structure using adaptive optics scanning laser ophthalmoscopy (AO SLO) and spectral-domain optical coherence tomography (SD OCT) and to evaluate the relationship between structural abnormalities and foveal sensitivity in eyes with surgically closed macular hole (MH). DESIGN: Prospective, interventional case series. METHODS: Twenty-one eyes of 19 patients with idiopathic MH underwent a full ophthalmologic examination, including SD OCT at baseline. Imaging with SD OCT, an original prototype AO SLO system, and microperimetry were performed at 6 months after surgery. RESULTS: All patients underwent anatomically successful MH closure. On AO SLO, dark areas (0.004 to 0.754 mm(2)) were seen in all eyes after MH repair. Lower cone density correlated with poorer postoperative visual acuity and lower mean foveal sensitivity (both P < .001). Larger dark areas on AO SLO correlated with poorer postoperative visual acuity (P = .003) and lower mean foveal sensitivity (P = .006). Cone density was significantly lower and dark areas were significantly larger in eyes that had defects of the outer segments in the fluid cuff before surgery (P = .018 and P = .001, respectively) and moderately reflective foveal lesions after surgery (P < .001 and P < .001, respectively). Larger dark areas correlated with longer symptom duration before surgery (P < .001). CONCLUSIONS: Structural damage to the photoreceptor layer correlated with greater decreases in visual function in eyes with surgically closed MH. AO SLO imaging is a useful and quantitative tool for detecting photoreceptor abnormalities and their association with visual acuity and retinal sensitivity in eyes with closed MH.

Macular choroidal thickness and volume in eyes with angioid streaks measured by swept source optical coherence tomography.

PURPOSE: To study the mean choroidal thickness and volume of the macula in eyes with angioid streaks using swept source optical coherence tomography (OCT) in the 1050-nm wavelength range. DESIGN: Prospective case series. METHODS: The macular area of 39 eyes of 23 patients with angioid streaks and of 20 normal eyes of 20 matched controls (Group 1) was studied with a swept source OCT prototype system. Eyes with angioid streaks were classified into 1 of 4 groups: those without choroidal neovascularization (CNV) (Group 2); those with CNV that had no history of treatment (Group 3); those with CNV that had previously received only anti-vascular endothelial growth factor treatments (Group 4); and those with CNV that had previously received photodynamic therapy (Group 5). Using a raster scan protocol with 512 × 128 A-scans, we produced a macular choroidal thickness map (6 × 6 mm(2)). RESULTS: There were no significant differences in age, axial length, or refractive error among the 5 groups. Mean choroidal thickness of the macula in Group 2 (218.9 ± 46.8 µm) was as great as that in Group 1 (218.8 ± 69.2 µm). However, the macular choroidal thickness in Group 3 (119.7 ± 49.2 µm), Group 4 (140.1 ± 64.9 µm), and Group 5 (144.0 ± 52.6 µm) was significantly less than that of Group 1 (P < .05). There were no statistical differences between Groups 3 through 5. In each group, the choroid of the nasal quadrant was significantly thinner compared to that in other quadrants (P < .05). CONCLUSIONS: The choroid in eyes with angioid streaks without CNV was as thick as that in normal controls, but was significantly thinner in eyes with angioid streaks that had developed CNV.

Spectral-domain optical coherence tomography of the choroid in choroidal osteoma.

The authors report spectral-domain optical coherence tomography (SD-OCT) findings in a patient with decalcifying choroidal osteoma accompanied by a choroidal neovascular membrane and serous retinal detachment. A 13-year-old girl was found to have a choroidal osteoma in the left eye. The clinical diagnosis was confirmed by B-scan ultrasonography, computed tomography, and fluorescein and indocyanine green angiography. The SD-OCT findings over the decalcified portion included serous retinal detachment, photoreceptor outer segment disorganization, retinal pigment epithelial atrophy, deformed Bruch's membrane, and choroidal neovascular membrane. In contrast, the retinal structures over the calcified portion appeared to be preserved. SD-OCT showed loss of a vascular appearance and increased thickness in the affected choroid, especially in the decalcified portion. Choroidal thickening may be associated not only with choroidal osteomas, but also with tumor decalcification. These unique features on SD-OCT may be important in understanding poor visual prognosis when decalcification involves the fovea.

Vitreoretinal interface and foveal deformation in asymptomatic fellow eyes of patients with unilateral macular holes.

PURPOSE: To compare the vitreoretinal interface of the asymptomatic fellow eyes of patients with unilateral macular holes (MHs) with that of the asymptomatic fellow eyes of patients with other retinal diseases and with that of healthy eyes. DESIGN: Retrospective, observational cross-sectional study. PARTICIPANTS: This study included 137 healthy volunteers and 929 eyes of 929 patients with various unilateral retinal diseases. METHODS: We reviewed medical charts, fundus photographs, and spectral-domain optical coherence tomographic (SD OCT) images. The incidence of the features of the vitreoretinal interface and foveal structures in the SD OCT images were compared among the asymptomatic fellow eyes of patients with unilateral MHs (n = 242), age-related macular degeneration (n = 129), epiretinal membrane (n = 185), macular pseudohole (n = 48), rhegmatogenous retinal detachment (n = 68), retinal vein occlusion (n = 257), and 1 of the eyes of healthy individuals (n = 137). MAIN OUTCOME MEASURES: Findings of slit-lamp biomicroscopy and SD OCT B-scan images. RESULTS: The SD OCT B-scan images showed different types of foveal deformations associated with vitreofoveal adhesions in eyes without a posterior vitreous detachment (PVD) in the macular area. The incidence of the foveal deformations associated with vitreofoveal adhesions was significantly higher (P<0.0001) in the fellow eyes of the unilateral MH group (17%) than that in the other groups (0%-2%), except for the macular pseudohole group (8%). The SD OCT B-scan images also showed residual foveal deformations in eyes with a macular PVD. The incidence of a residual foveal deformation in eyes with a macular PVD was significantly higher (P<0.0001) in the MH group (32%) than that in any other group (0%-9%). CONCLUSIONS: The higher incidence of foveal deformations in the fellow eyes of patients with unilateral MHs with and without vitreofoveal adhesions suggests that patients in whom MHs develop have abnormally strong vitreofoveal adhesions sufficient to cause foveal deformation. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Axial length and outcomes of macular hole surgery assessed by spectral-domain optical coherence tomography.

PURPOSE: To use spectral-domain optical coherence tomography (SD OCT) to evaluate macular hole surgery outcomes and features predicting anatomic failure. DESIGN: Retrospective, interventional case series. METHODS: Fifty-two eyes of 50 consecutive patients with macular holes were examined. All eyes underwent 3-port pars plana vitrectomy with internal limiting membrane peeling. Eyes were examined after surgery by dense serial SD OCT scanning over the macula. RESULTS: Eyes with initial anatomic failure were significantly more likely to have greater axial length and refractive error and more posterior staphyloma compared with eyes with initial anatomic success (P = .031 to .0060, < .0001). Overall initial and final anatomic success rates were 92.3% (48 of 52 eyes). In highly myopic eyes with axial lengths of 26.0 mm or more, initial and final success rates were 73.3% (11 of 15 eyes) compared with 100.0% (37 of 37 eyes) of eyes with axial lengths of less than 26.0 mm (P = .0050). In highly myopic eyes, initial and final success rates were 0% (0 of 3 eyes) of eyes with axial lengths of 30.0 mm or more compared with 91.7% (11 of 12 eyes) of eyes with axial lengths of 26.0 mm or more and of less than 30.0 mm (P < .0001). Retinoschisis-like thickening of the outer retina was seen in 3 (75.0%) of 4 eyes with initial failure compared with 3 (6.3%) of 48 eyes with initial success (P = .0030). CONCLUSIONS: Axial length of 30.0 mm or more may increase the risk of anatomic failure of macular hole surgery.

Early trabeculectomy bleb walls on anterior-segment optical coherence tomography.

BACKGROUND: To correlate the cross-sectional features of filtering blebs on anterior-segment optical coherence tomography (AS-OCT) 2 weeks after trabeculectomy with bleb function at 6 months. METHODS: Forty-eight eyes followed for 6 months or more after trabeculectomy with mitomycin C were included. Bleb wall reflectivity of developing blebs on AS-OCT 2 weeks postoperatively was correlated with mature bleb function at 6-month postoperative visit. RESULTS: Developing bleb walls at 2 weeks were classified as uniform in 10/48 eyes (20.8%) and multiform in 38/48 eyes (79.2%). Blebs with uniform reflectivity were significantly more likely to have worse function at 6 months (P < 0.001). Multiform bleb walls had hyporeflective areas seeming to represent loosely-arranged connective tissue (multiple-layer structures), subconjunctival separation, and microcysts. Blebs with multiple-layer structures at 2 weeks were associated with better bleb function at 6 months (P = 0.025). Intraocular pressure (IOP) of developing blebs at 2 weeks did not correlate with bleb function at 6 months (P = 0.471). CONCLUSIONS: Bleb wall reflectivity on AS-OCT 2 weeks after surgery may predict bleb function at 6 months, whereas IOP of developing blebs may not.

Acute Vogt-Koyanagi-Harada disease in enhanced spectral-domain optical coherence tomography.

OBJECTIVE: To demonstrate unique membranous structures seen on enhanced spectral domain optical coherence tomography (SD-OCT) images of eyes with acute Vogt-Koyanagi-Harada (VKH) disease. DESIGN: Retrospective, observational case series. PARTICIPANTS: Twenty eyes of 10 consecutive patients diagnosed with acute VKH disease. METHODS: We reviewed fundus photographs, conventional OCT images, fluorescein angiograms (FA), and enhanced SD-OCT images, including serial sections through the macula, obtained at the initial visit and periodically after steroid treatment until complete resolution of serous retinal detachment. MAIN OUTCOME MEASURES: Findings on enhanced SD-OCT imaging and FA in eyes with VKH disease. RESULTS: All 20 eyes had multifocal serous retinal detachment in the posterior fundus that appeared as multilobular dye pooling on late-phase FA. In 17 of the 20 eyes (85%), some areas of dye pooling corresponded to cystoid spaces on enhanced SD-OCT images and in 14 of the 20 (70%) eyes, there were areas of dye pooling and cystoid spaces in the fovea. The floors of the cystoid spaces consisted of a membranous structure of uniform thickness (mean thickness in the fovea of 14 eyes, 62.5+/-3.3 microm). The membranous structure, on SD-OCT, seemed to include a highly reflective line, which was continuous with the line representing the junction of the photoreceptor inner and outer segments (IS/OS) in attached areas of the retina. Intraretinal split was seen to overlie the abnormal IS/OS line in the vicinity of cystoid spaces involving the fovea in 9 of the 20 eyes (45%). During the course of steroid therapy, the membranous structure changed to a granular structure. CONCLUSIONS: The membranous structure that can be seen in eyes with acute VKH disease seems to represent a portion of the outer segment layer that has become separated from the inner segment layer by cystoid spaces. We hypothesize that the membranous form of the outer segment is bound with the action of inflammatory products, such as fibrin, and this membranous structure changes to a granular structure as steroid therapy "dissolves" the fibrin holding the outer segments together. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Comparison of spectral domain optical coherence tomography and color photographic imaging of the optic nerve head in management of glaucoma.

BACKGROUND AND OBJECTIVE: Spectral domain optical coherence tomography (SD-OCT) allows three-dimensional imaging of the optic disc. The objective of this study was to compare optic disc and cup margins between fundus photographs and SD-OCT. PATIENTS AND METHODS: Eighteen eyes with glaucoma were examined by a custom-built SD-OCT OCT fundus images were used to register fundus photographs and SD-OCT volume. RESULTS: Disc margins on fundus photographs corresponded to termination of the highly reflective straight line that represented the retinal pigment epithelium (RPE) or the highly reflective curved line that connected to the RPE on the OCT B-scan images at 99.3% of the positions along the disc edges. Cup margins on fundus photographs corresponded at 73.6% of the positions to the interior border of the hyporeflective regions on the OCT fundus images. CONCLUSIONS: Excellent to fair correspondence in the determination of disc and cup margins between fundus photographs and SD-OCT images was shown.