Risk Factors for Earlier Reexposure of Glaucoma Drainage Devices.

PURPOSE: The purpose of this study was to investigate factors associated with a second exposure of a glaucoma drainage device (GDD) following repair of an initial GDD exposure. MATERIALS AND METHODS: This IRB-approved retrospective cohort study examined the incidence of a second exposure of a GDD following initial repair for exposure. Logistic regression was performed to assess the relationship between demographic and clinical characteristics and a second exposure of the GDD. Kaplan-Meier survival curves were plotted and Cox regression was performed to examine factors impacting the time to a second GDD exposure. RESULTS: Ninety-four eyes of subjects that underwent initial revision for GDD exposure were reviewed. Approximately 44% (N=41/94) of subjects underwent surgical revision for a second exposure. Factors associated with reexposure in multivariate logistic regression included caucasian race (odds ratio, 2.99; P=0.02) and use of a nonscleral patch graft (odds ratio, 2.93; P=0.019). Time from revision of the initial exposure to reexposure was significantly shorter for those with a nonscleral patch graft (hazard ratio, 2.23; P=0.01) and caucasian race (hazard ratio, 2.08; P=0.04). CONCLUSIONS: Caucasian race and use of a nonscleral patch graft during revision surgery was associated with a higher risk of experiencing a sooner reexposure of the GDD following revision of an initial exposure. Future studies should examine whether particular graft materials increase the risk of GDD reexposure.

Effect of anti-vascular endothelial growth factor therapy on choroidal thickness in diabetic macular edema.

PURPOSE: To determine the effect of anti-vascular endothelial growth factor (VEGF) therapy on choroidal thickness in eyes with diabetic macular edema (DME). DESIGN: A retrospective, cohort analysis of 59 eyes from 59 patients with DME without prior anti-VEGF therapy. METHODS: Choroidal thickness was measured using semiautomated segmentation of enhanced depth imaging optical coherence tomography images at 0.5-mm intervals from 2.5 mm nasal to 2.5 mm temporal to the fovea. Changes in choroidal thickness with and without anti-VEGF treatment over 6 months were compared. Best-corrected visual acuity and central foveal thickness were analyzed to evaluate the association of choroidal thickness with functional and anatomic outcomes. RESULTS: Of the 59 eyes with DME, 26 eyes were observed without treatment, whereas 33 underwent intravitreal anti-VEGF therapy (mean number of injections, 2.73) over 6 months. In untreated eyes, there was no significant change in best-corrected visual acuity (P = .098), central foveal thickness (P = .472), or choroidal thickness at all measurements along the macula (P = .057 at the fovea). In eyes treated with anti-VEGF injections, choroidal thickness decreased significantly at the fovea (246.6 to 224.8 µm; P < .001) and at 0.5 mm nasal (240.9 to 221.9 µm; P = .002) and 0.5 mm temporal (249.3 to 224.8 µm; P = .011) to the fovea. The decrease in subfoveal choroidal thickness after anti-VEGF treatment was not associated with the cumulative number of anti-VEGF injections (R(2) = 0.031; P = .327) or to changes in best-corrected visual acuity (R(2) = 0.017; P = .470) or central foveal thickness (R(2) = 0.040; P = .263). CONCLUSIONS: Central choroidal thickness decreases after anti-VEGF therapy for DME after 6 months, but may not be associated with functional or anatomic outcomes in eyes with DME.

Analysis of short-term change in subfoveal choroidal thickness in eyes with age-related macular degeneration using optical coherence tomography.

BACKGROUND AND OBJECTIVE: To measure the subfoveal choroidal thickness in patients with age-related macular degeneration (AMD) over 6 months. PATIENTS AND METHODS: A retrospective, observational study of patients with AMD followed up for 6 months at the New England Eye Center. Baseline and 6-month follow-up subfoveal choroidal thickness was measured using spectral-domain OCT and compared. RESULTS: For the entire cohort, there was statistically significant thinning of the subfoveal choroidal thickness at 6 months compared to baseline that was driven by the cohort of patients with neovascular AMD (181.2 ± 75 µm to 173.4 ± 63 µm; P = .049). CONCLUSION: There was a statistically significant decrease in subfoveal choroidal thickness observed in this cohort of patients with AMD over 6 months, but it was driven by the subgroup of patients with neovascular age-related macular degeneration.

Optical coherence tomography-guided facedown positioning for macular hole surgery.

PURPOSE: To use spectral domain optical coherence tomography-guided duration of facedown positioning to study anatomical macular hole closure rates. METHODS: Retrospective review of patients with macular holes undergoing 23-gauge pars plana vitrectomy and intraocular gas tamponade. Spectral domain optical coherence tomography imaging was done on postoperative Day 1. Patients remained facedown for 2 more days if the macular hole was closed or 6 more days facedown if the macular hole was open or indeterminate. RESULTS: There were 8 Stage 2, 12 Stage 3, and 12 Stage 4 macular holes. On postoperative Day 1, 24 holes were closed by spectral domain optical coherence tomography and instructed to remain facedown for two more days. Twenty-three of 24 holes remained closed during the postoperative period. Eight holes were open or indeterminate on postoperative Day 1 and remained facedown for 6 more days. Six of 8 holes (75%) were closed at their last follow-up. The overall closure rate was 29/32 (90.6%). Average follow-up was 334 days. CONCLUSION: Confirming early closure of macular holes with spectral domain optical coherence tomography imaging can serve as an important guide to significantly shorten the duration of prone positioning while maintaining high closure rates.

Analysis of choroidal thickness in age-related macular degeneration using spectral-domain optical coherence tomography.

PURPOSE: To understand the relationship between choroidal thickness and various disease factors in patients with age-related macular degeneration (AMD) using spectral-domain optical coherence tomography. DESIGN: Cross-sectional, retrospective analysis. METHODS: Fifty-seven eyes of 47 patients with wet and dry AMD seen between November 2009 and January 2010 at the New England Eye Center, Boston, Massachusetts, were analyzed. Choroidal thickness was measured by 2 independent observers at 11 sites with high-definition horizontal 1-line raster scans through the foveal center. A retrospective chart review was performed to obtain data concerning duration of disease, number of intravitreal anti-vascular endothelial growth factor injections, visual acuity, lens status, and concomitant retinal pathologic features. The Pearson correlation and Student t test were used for statistical analysis for assessment of choroidal thickness changes in wet and dry AMD. RESULTS: The choroid in eyes with wet and dry AMD demonstrated a wide range of thicknesses above and below the normal mean (range, 77.5 to 399.5 µm; standard deviation [SD], 90.2). Nearly one third (33.3%) of the eyes with AMD measured less than 1 SD below the mean. Eyes with wet AMD demonstrated a mean subfoveal choroidal thickness of 194.6 µm (SD, 88.4; n = 40) compared with 213.4 µm (SD, 92.2; n = 17) in the dry AMD group. The choroidal thickness in eyes with dry AMD was correlated inversely with age (r = -0.703; P = .002); however, analysis of the number of intravitreal anti-vascular endothelial growth factor injections, number of years of disease, and visual acuity failed to demonstrate any significant correlations with choroidal thickness. CONCLUSIONS: This study demonstrated that choroidal thickness can be measured by spectral-domain optical coherence tomography and that variable choroidal thickness exists among patients with the clinical diagnosis of wet and dry AMD. However, it is unclear at this time why in some eyes, choroidal thickness either increases or decreases with the disease. Further studies need to be carried out to understand the significance of choroidal thickness with respect to visual function and disease progression over time.

Analysis of peripapillary atrophy using spectral domain optical coherence tomography.

OBJECTIVE: To study retinal morphologic changes around the optic disc in patients with peripapillary atrophy (PPA) with high-resolution spectral domain optical coherence tomography (SD OCT). DESIGN: Cross-sectional, retrospective analysis. PARTICIPANTS: A total of 103 eyes of 73 patients with PPA and 21 eyes of 12 normal patients seen at the New England Eye Center, Tufts Medical Center, between January 2007 and August 2009. METHODS: Spectral domain optical coherence tomography images taken through the region of PPA were quantitatively and qualitatively analyzed. Inclusion criteria included eyes with at least 300 µm of temporal PPA as detected on color fundus photographs. The study population was divided into subgroups according to the following clinical diagnoses: glaucoma (n=13), age-related macular degeneration (n=11), high myopia (n=11), glaucoma and high myopia (n=3), and optic neuropathy (n=11). Fifty-four patients were classified with other diagnoses. By using OCT software, retinal thickness and retinal nerve fiber layer (RNFL) thickness were both manually measured perpendicular to the internal limiting membrane and retinal pigment epithelium (RPE) 300 µm temporal to the optic disc, within the region of PPA. Qualitative analysis for morphologic changes in the atrophic area was also performed. MAIN OUTCOME MEASURES: Qualitative assessment and quantitative measures of retinal and RNFL thickness in PPA. RESULTS: The study group was categorized by 6 characteristics demonstrated in the area of PPA by SD OCT: RPE loss with accompanying photoreceptor loss, RPE disruption, RNFL thickening with plaque-like formation, intraretinal cystic changes, inner and outer retinal thinning, and abnormal retinal sloping. Statistical analysis of measurements revealed a statistically significant difference in the total retinal thickness between normal eyes and eyes with PPA (P=0.0005), with normal eyes 15% thicker than the eyes with PPA; however, the RNFL thickness was not significantly different between the normal eyes and the eyes with PPA (P=0.05). CONCLUSIONS: Eyes with PPA manifest characteristic retinal changes that can be described via SD OCT.