Thiel cadaver eye as a training model for sub-Tenon's blocks: a feasibility study.

BACKGROUND: Regional anaesthesia education, especially for ocular procedures, necessitates reliable surgical training models. While cadaveric models offer anatomical fidelity, conventional embalming methods may compromise tissue integrity. We aimed to assess the effectiveness of Thiel cadavers for training in sub-Tenon's blocks by evaluating ocular tissues and measuring insertion forces. METHODS: Experimental design, using twenty eyes from ten Thiel cadaver heads. These cadavers were specifically prepared to test the administration of sub-Tenon's blocks. The research was conducted in a controlled laboratory setting appropriate for handling cadaveric materials and conducting precise measurements. Each cadaver eye underwent an initial ultrasound examination, and its axial length was noted. An intravitreal injection of heptastarch solution followed, to re-establish the eye's sphericity. After this volume injection, the axial length and intraocular pressure were measured again. Mock sub-Tenon's blocks were administered in 2 separate quadrants of the eye, with insertion forces measured using a pressure gauge. These were compared to a data set of insertion forces measured in a series of isolated pig's eyes on which STBs had been performed. Main outcome measurements were macroscopic assessment of the ocular tissue layers and the insertion forces required for the sub-Tenon's blocks. In a second set of 10 Thiel cadaver heads, 5 ml of sodium chloride were injected as sub-Tenon's blocks and the emergence of a periocular "T-sign" ascertained and measured by ultrasound. RESULTS: Four of twenty eyes (20%) retained near-natural sphericity, with the remaining requiring volume injection to approximate physiological shape and pressure. The conjunctiva and Tenon's layer were intact, and correct cannula placement was achieved in all cases. In 16 of 20 eyes where T-signs could be measured, the median thickness of the T-sign amounted to 2.72 mm (range 1.34 mm-5.28 mm). The average maximum cannula insertion force was 2.92 Newtons. Insertion forces in intact Thiel cadaver heads were consistently higher than in isolated pig's eyes (3.6 N vs 2.0 N). CONCLUSION: These findings suggest that Thiel cadavers are a promising model for training in sub-Tenon'sblocks, despite the challenge of often desiccated and involuted eyes.

Retinal vessel diameter measurements by spectral domain optical coherence tomography.

PURPOSE: To describe a spectral domain optical coherence (OCT)-assisted method of measuring retinal vessel diameters. METHODS: All Patients with an OCT circle scan centered at the optic nerve head using a Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany) were retrospectively reviewed. Individual retinal vessels were identified on infrared reflectance (IR) images and given unique labels both on IR and spectral domain OCT (SD-OCT). Vessel width and vessel types obtained by IR were documented as ground truth. From OCT, measurements of each vessel, including horizontal vessel contour diameter, vertical vessel contour diameter, horizontal hyperreflective core diameter, and reflectance shadowing width, were assessed. RESULTS: A total of 220 vessels from 13 eyes of 12 patients were labeled, among which, 194 vessels (88 arteries and 65 veins confirmed from IR) larger than 40 microns were included in the study. The mean vessel width obtained from IR was 107.9 ± 36.1 microns. A mean vertical vessel contour diameter of 119.6 ± 29.9 microns and a mean horizontal vessel contour diameter of 124.1 ± 31.1 microns were measured by SD-OCT. Vertical vessel contour diameter did not differ from vessel width in all subgroup analysis. Horizontal vessel contour diameter was not significantly different from vessel width for arteries and had strong or very strong correlation with vessel width for veins. CONCLUSION: In our study, vertical vessel contour diameter measured by current commercially available SD-OCT was consistent with vessel width obtained by IR with good reproducibility. This SD-OCT based method could potentially be used as a standard measurement procedure to evaluate retinal vessel diameters and their changes in ocular and systemic disorders.

Postoperative anatomical and functional outcomes of different stages of high myopia macular hole.

BACKGROUND: Recently it was suggested that high myopia macular holes (HMMH) and macular holes accompanied by retinal detachment occur in the advanced stages of myopia traction maculopathy (MTM), while macular retinoschisis, shallow retinal detachment without holes, and lamellar macular holes occur in the early stages of MTM. Complete vitreous cortex removal associated with internal limiting membrane peeling is now widely used to treat HMMH. However, it remains uncertain at what HMMH stage patients would benefit most from surgical intervention. Our study was aimed to evaluate the postoperative anatomical changes and functional outcomes of high myopia macular holes (HMMH). METHODS: Patients were retrospectively collected between March 2009 and August 2011. Before and 1st, 3rd, and 9th month after 23G pars plana vitrectomy, all patients underwent a complete ophthalmologic examination, spectral domain optical coherence tomography (SD-OCT) and MP-1. At each follow-up, best-corrected visual acuity (BCVA), photoreceptor inner and outer segments (IS/OS) defects, and retinal sensitivity (RS) were investigated. According to different preoperative macular hole morphologies, patients were divided into three groups: Group 1, macular hole with epiretinal membrane (ERM) traction and macular retinoschisis; Group 2, full-thickness macular hole (FTMH); Group 3, FTMH with subretinal fluid. RESULTS: 43 eyes from 43 patients met the inclusion criteria. The mean age was 60 years. BCVA and RS were significantly improved after vitrectomy; the mean IS/OS defect was significantly reduced. At 9 postoperative months, 11 of 43 (25.6 %) eyes achieved IS/OS junction integrity; 9 of these 11 (81.8 %) eyes belonged to Group 1, 2 (18.2 %) belonged to Group 2. CONCLUSIONS: Pars plana vitrectomy combined with ILM peeling and gas tamponade results in limited functional outcomes in patients with HMMH. The appearance of subretinal fluid indicates a worse prognosis for surgical intervention.

Clinical outcomes after switching treatment from intravitreal ranibizumab to aflibercept in neovascular age-related macular degeneration.

PURPOSE: To describe the treatment response to aflibercept in patients with exudative age-related macular degeneration that showed insufficient or diminishing treatment effects under ranibizumab. METHODS: From December 2012 till June 2013 all patients receiving intravitreal injections of aflibercept after previous treatment with ranibizumab were collected in a database and retrospectively reviewed. Clinical data such as visual acuity or central subfield retinal thickness on optical coherence tomography (OCT) scans were analyzed for the time frame before, during, and shortly after the aflibercept injections. Of particular interest was the comparison of clinical features under ongoing ranibizumab treatment to the time during aflibercept treatment. RESULTS: Seventy-one eyes of 65 patients were included in the study. All eyes had previous ranibizumab injections in their medical history, the average number of which was nine (range 3-43). For the total group the mean visual acuity (VA) before the first ranibizumab injection was 0.54 logMAR, and after the last ranibizumab injection was 0.57 logMAR. Mean VA changed from 0.47 logMAR before the first aflibercept injection to 0.25 logMAR after the last aflibercept injection. Central subfield retinal thickness (CSRT) on OCT changed from a mean of 417.28 µm to 349.52 µm under ranibizumab treatment and from 338.76 µm to 272.00 µm under aflibercept treatment. Interestingly, 33 % of cases that did not show a functional improvement under ranibizumab therapy gained visual acuity after aflibercept treatment. CONCLUSION: Aflibercept appears to be an effective choice for patients with neovascular age-related macular degeneration who were resistant to previous therapy of ranibizumab. The longevity of this effect still remains questionable.

Drusen measurements comparison by fundus photograph manual delineation versus optical coherence tomography retinal pigment epithelial segmentation automated analysis.

PURPOSE: To compare drusen measurements obtained from color fundus and infrared retromode photographs with those derived from spectral-domain optical coherence tomography. METHODS: Drusen lesions identified on the planar (color and infrared) imaging modalities were manually segmented by two independent graders using previously described reading center software to produce quantitative measurements of drusen area and number. The corresponding volume Cirrus OCT datasets were analyzed using commercial retinal pigment epithelium analysis algorithms to segment the retinal pigment epithelium band and estimated the drusen area. Drusen numbers were extracted from retinal pigment epithelium elevation maps. Intraclass correlation coefficients assessed agreement between graders; graders' average measurements were compared with optical coherence tomography (OCT) using paired T-tests. RESULTS: Excellent agreement between graders was observed (r = 0.951-0.974). No statistical difference was found in the area values obtained by color (0.85 ± 0.26 mm(2), P = 0.43) or retromode (1.15 ± 0.32 mm(2), P = 0.35) compared with those obtained by OCT (0.98 ± 0.28 mm). The number of drusen identified by OCT (13.15 ± 3.19) was significantly lower than that determined by manual segmentation of color (53.7 ± 13.18) and retromode (100.13 ± 16.18) images. CONCLUSION: Although the number of drusen individualized by commercial OCT algorithms is significantly lower than by planar fundus imaging modalities, the OCT-measured drusen area is not affected, suggesting that the algorithm counts confluent drusen as a single drusen.

An easy method to differentiate retinal arteries from veins by spectral domain optical coherence tomography: retrospective, observational case series.

BACKGROUND: Recently it was shown that retinal vessel diameters could be measured using spectral domain optical coherence tomography (OCT). It has also been suggested that retinal vessels manifest different features on spectral domain OCT (SD-OCT) depending on whether they are arteries or veins. Our study was aimed to present a reliable SD-OCT assisted method of differentiating retinal arteries from veins. METHODS: Patients who underwent circular OCT scans centred at the optic disc using a Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany) were retrospectively reviewed. Individual retinal vessels were identified on infrared reflectance (IR) images and given unique labels for subsequent grading. Vessel types (artery, vein or uncertain) assessed by IR and/or fluorescein angiography (FA) were referenced as ground truth. From OCT, presence/absence of the hyperreflective lower border reflectivity feature was assessed. Presence of this feature was considered indicative for retinal arteries and compared with the ground truth. RESULTS: A total of 452 vessels from 26 eyes of 18 patients were labelled and 398 with documented vessel type (302 by IR and 96 by FA only) were included in the study. Using SD-OCT, 338 vessels were assigned a final grade, of which, 86.4% (292 vessels) were classified correctly. Forty three vessels (15 arteries and 28 veins) that IR failed to differentiate were correctly classified by SD-OCT. When using only IR based ground truth for vessel type the SD-OCT based classification approach reached a sensitivity of 0.8758/0.9297, and a specificity of 0.9297/0.8758 for arteries/veins, respectively. CONCLUSION: Our method was able to classify retinal arteries and veins with a commercially available SD-OCT alone, and achieved high classification performance. Paired with OCT based vessel measurements, our study has expanded the potential clinical implication of SD-OCT in evaluation of a variety of retinal and systemic vascular diseases.

Aflibercept for central retinal vein occlusions: long-term outcomes of a 'Treat-and-Extend' regimen.

BACKGROUND/AIMS: This study reports on the long-term functional and anatomical outcomes of patients with central retinal vein occlusion (CRVO) treated under the Bern treat-and-extend (T&E) protocol. METHODS: Observational study. Treatment-naive patients with CRVO and consecutive macular oedema treated with aflibercept were included. The T&E protocol involved 2 monthly injections followed by an extension based on individual assessments. At each visit, best-corrected visual acuity (BCVA), optical coherence tomography imaging and a 2 mg aflibercept injection were administered. Changes in BCVA, proportion of patients gaining ≥15 letters, central subfield thickness (CST) and treatment intervals were analysed. RESULTS: Out of 173 patients, 64 had a follow-up of at least 2 years. BCVA improved from 46.7±25.3 at baseline to 78.3±0.5 at year 9. The proportion of patients with ≥15 letters gained was 56%, 53%, 56%, 62%, 52%, 52%, 43%, 50% and 33% at years 1-9, respectively. CST decreased significantly from 660±242 µm at baseline to 359±63 µm at year 9. Treatment intervals extended from 4 weeks initially to an average of 13.0±4.1 weeks by year 8. CONCLUSIONS: The T&E regimen for CRVO shows sustained visual improvements and reduced CST over time. Patients maintained stable visual gains for many years, demonstrating the effectiveness of this treatment approach. However, no control group was available to compare our T&E regimen with other strategies.

Comparison of Surgical Times Between Manual and Robot-Assisted Epiretinal Membrane Peeling.

Purpose: Epiretinal membranes (ERM) pose a common challenge in vitreoretinal pathology, often causing vision impairment in older adults. The Preceyes Surgical System (PSS) supports the surgical removal of ERM through robot-assisted membrane peeling (RA-MP). This study compares surgical times and iatrogenic hemorrhages between manual membrane peeling (MMP) and RA-MP using PSS. Methods: Nine patients underwent RA-MP with PSS, whereas 16 patients (18 eyes) underwent MMP for comparative analysis. Surgical durations were categorized into RA-MP, manual forceps utilization in PSS surgeries (mRA-MP), and traditional MMP. Cumulative manual manipulation duration (cMMP), instrument grasps, and intraoperative hemorrhages were statistically analyzed using the Mann-Whitney U test. Results: RA-MP showed significantly longer peeling times compared to MMP (P < 0.001). Flap initiation grasps were similar between methods (P = 0.86), RA-MP demonstrated a significant reduction in peeling grasps (P = 0.01) and mean grasps per minute (P < 0.001). Although RA-MP resulted in fewer hemorrhages, the difference did not reach statistical significance relative to MMP (P = 0.08). Discussion: Although RA-MP tended to extend surgical time, it offered advantages in reducing tissue trauma and intraoperative hemorrhages. Further research is needed to explore the learning curve for novice surgeons and evaluate the safety profile of RA-MP. Translational Relevance: RA-MP may offer potential advantages over manual surgery, particularly in terms of reduced tissue trauma and intraoperative hemorrhages. Despite its longer duration compared with manual techniques, RA-MP may lead to fewer grasping maneuvers and lower rates of hemorrhages, thereby enhancing the safety and precision of vitreoretinal surgeries.

Optical coherence tomography-based observation of the natural history of drusenoid lesion in eyes with dry age-related macular degeneration.

PURPOSE: To use spectral domain optical coherence tomography (SD-OCT) to investigate risk factors predictive for the development of atrophy of drusenoid lesions (DLs) (drusen and drusenoid pigment epithelium detachment) in eyes with non-neovascular age-related macular degeneration (NNVAMD). DESIGN: Cohort study. PARTICIPANTS: Forty-one eyes from 29 patients with NNVAMD. METHODS: Patients with NNVAMD who underwent registered SD-OCT imaging over a minimum period of 6 months were reviewed. Drusenoid lesions that were accompanied by new atrophy onset at 6 months or last follow-up (FUL) were further analyzed. Detailed lesion change was described throughout the study period. Odds ratios (ORs) and risk for new local atrophy onset were calculated. MAIN OUTCOME MEASURES: Drusenoid lesion features and longitudinal changes in features, including maximum lesion height, lesion diameter, lesion internal reflectivity, and presence and extent of overlying intraretinal hyperreflective foci (HRF). Subfoveal choroidal thickness (SFCT) and choroidal thickness (CT) were measured below each lesion. RESULTS: A total of 543 individual DLs were identified at baseline, and 28 lesions developed during follow-up. The mean follow-up time was 21.3±8.6 months (range, 6-44 months). Some 3.2% of DLs (18/571) progressed to atrophy within 18.3 ± 9.5 months (range, 5-28 months) of the initial visit. Drusenoid lesions with heterogeneous internal reflectivity were significantly associated with new atrophy onset at 6 months (OR, 5.614; 95% confidence interval [CI], 1.277-24.673) and new atrophy onset at FUL (OR, 7.005; 95% CI, 2.300-21.337). Lesions with the presence of HRF were significant predictors of new atrophy onset at 6 months (OR, 30.161; 95% CI, 4.766-190.860) and FUL (OR, 11.211; 95% CI, 2.513-50.019). Lesions with a baseline maximum height >80 µm or CT ≤ 135 µm showed a positive association with the new atrophy onset at FUL (OR, 7.886; 95% CI, 2.105-29.538 and OR, 3.796; 95% CI, 1.154-12.481, respectively). CONCLUSIONS: The presence of HRF overlying DLs, a heterogeneous internal reflectivity of these lesions, was found consistently to be predictive of local atrophy onset in the ensuing months. These findings provide further insight into the natural history of anatomic change occurring in patients with NNVAMD.

Different phenotypes of the appearance of the outer plexiform layer on optical coherence tomography.

PURPOSE: To present a selected case series of different phenotypes of the normal outer plexiform layer (OPL) visualized by optical coherence tomography (OCT). METHODS: Five cases were selected to represent the spectrum of appearances of the OPL in this case series. Categorical descriptions of each manifestation were then developed. Additional SD-OCT scans were obtained from a normal volunteer to further support the hypothesis. RESULTS: The inner one-third of the OPL typically appears hyperreflective on OCT, while the outer two-thirds (Henle fiber layer) may have a more varied appearance. Six different phenotypes of Henle fiber layer reflectivity were noted in this series, and classified as: bright, columnar, dentate, delimited, indistinct, and dark. The brightness of the Henle fiber layer appears to depend on the geometric angle between the OCT light beam and the axonal fibers in this portion of the OPL. This angle appears to be a function of the natural orientation of the Henle fiber layer tissue (θN), the existence of subretinal pathology that alters the angle of the neurosensory retina (θ(P)), and the tilt angle of the tissue on the B-scan (θ(T)) due to decentered OCT acquisition. CONCLUSIONS: Since accurate interpretation of the OPL/ONL boundary is of vital importance to study the thickness of ONL, location of cystoid lesions, hyperreflective crescents over drusen, et al., our case series may aid better understanding of the OPL appearance in SD-OCT. In the absence of clear delineation, it may be most correct to refer to indistinct OPL and ONL together as the photoreceptor nuclear axonal complex (PNAC).

Evaluation of the axial location of cystoid spaces in retinal vein occlusion using optical coherence tomography.

PURPOSE: To analyze the axial distribution of intraretinal cystoid changes in patients with retinal vein occlusion (RVO), incorporating a new hypothesis about the optical coherence tomographic boundary between the outer nuclear layer and the outer plexiform layer. METHODS: Data were collected from patients with RVO who underwent spectral domain coherence tomography imaging. For each image set, certified graders evaluated each retinal layer for cystoid macular edema, defined as hyporeflective intraretinal cystoid spaces. Subretinal fluid, if present, was also noted. RESULTS: Forty-eight eyes were evaluated (24 branch RVO, 18 central RVO, 6 hemiretinal vein occlusion). Cystoid macular edema was present in 30.8% of eyes in outer nuclear layer, 77.9 % in outer plexiform layer, 77.9 % in inner nuclear layer, 36.9 % in inner plexiform layer, 48.8 % in ganglion cell layer, and 4.9% in nerve fiber layer. Subretinal fluid was assessed as present in 23.8% of patients. The presence of subretinal fluid correlated most strongly with cystoid changes in the outer nuclear layer (r = 0.514, P = 0.001) but was not significantly correlated with these changes in the superficial retina. CONCLUSION: Use of spectral domain coherence tomography allows precise characterization of the axial location of cystoid spaces in RVO and highlights the frequency of fluid accumulation in the outer plexiform layer and inner nuclear layer. Using updated definitions, cystoid macular edema seems to occur less frequently in the outer nuclear layer, but when it does so, it is often associated with subretinal fluid. Future longitudinal studies, documenting the axial progression of such changes, and their response to treatment, may be of clinical relevance as pharmacotherapeutic options evolve.

Robot-Assisted Epiretinal Membrane Peeling: A Prospective Assessment of Pre- and Intra-Operative Times and of Surgeons' Subjective Perceptions.

PURPOSE: The Preceyes Surgical System (PSS) is a robotic assistive device that may enhance surgical precision. This study assessed pre- and intra-operative times and surgeons' perceptions of robot-assisted epiretinal membrane peeling (RA-MP). METHODS: We analyzed the time requirement of three main tasks: the preparation of the PSS (I), patient preparation (II), and surgery (III). Following surgery, the surgeons were asked questions about their experience. RESULTS: RA-MP was performed in nine eyes of nine patients. Task I required an average time of 12.3 min, initially taking 15 min but decreasing to 6 min in the last surgery. Task II showed a mean time of 47.2 (range of 36-65) min. Task III had a mean time of 72.4 (range of 57-100) min. A mean time of 27.9 (range of 9-46) min was necessary for RA-MP. The responses to the questionnaire revealed a trend towards increasing ease and reduced stress as familiarity with the PSS increased. CONCLUSIONS: A substantial reduction in pre- and intra-operative times, decreasing to a total of 115 min, was demonstrated. RA-MP was positively anticipated by the surgeons and led to no hand or arm strain while being more complex than manual MP.

Microperimetry as a routine diagnostic test in the follow-up of retinal vein occlusion?

BACKGROUND: In the follow-up of retinal vein occlusions, a patient's subjective change in vision frequently cannot be confirmed by objective measurements. Furthermore, contradictory results of OCT and distance visual acuity give the impression that current routine diagnostic tests might not be satisfying for patients with retinal vein occlusions. This prospective case series analyses the value of microperimetry as a routine diagnostic test in the follow-up of patients with retinal vein occlusions during therapy. METHODS: In a prospective case series, we tested microperimetry as a functional measure in comparison to distance visual acuity, reading ability, and OCT, on 13 patients treated for central or branch retinal vein occlusions. Treatment consisted of intravitreal bevacizumab injections combined with panretinal laser coagulation in cases of peripheral ischemia. If macular edema persisted, bevacizumab injection was repeated, or instead of this intravitreal triamcinolone or focal laser coagulation was applicated. Follow-up ranged from 6-14 months. An interim analysis was performed for the 6-month follow-up. RESULTS: In the branch retinal vein occlusion group, the average of the retinal thickness measured by OCT was 502.22 µm (±SD 217.75 µm) at baseline and changed to 396.38 ± 154.38 at the 6-month follow-up (p = 0.121). Mean distance visual acuity stayed similar to the study entrance with 0.41 ± 0.34 at the 6-month follow-up (p = 0.944) Mean reading ability improved to 0.51 ± 0.52 at the 6-month follow-up but was not statistically significant (p = 0.435). The mean light sensitivity of microperimetry improved from baseline to the 6-month follow-up: the 40-points group improved from 8.62 ± 5.69 dB to 10.98 ± 5.42 (p = 0.060) and the 8-points group from 6.27 dB to 9.6 dB (p = 0.07) but missed statistical significance. The sector group showed in contrast to this an improvement from 6.02 ± 5.71 dB to 9 ± 6.07 dB (p = 0.025), which was statistically significant. Changes in the central vein occlusion group were not statistically significant but changes for both groups together showed statistical significance. CONCLUSIONS: In the present case series, microperimetry was more convenient to detect, even the subtle functional changes during the disease course of branch retinal vein occlusions than distance and reading visual acuity. This indicates that microperimetry could be a possible valuable tool in the follow-up of branch retinal vein occlusions.

Progression of macular ischemia following intravitreal bevacizumab.

A 37-year-old woman with bilateral obliterative retinal vasculitis and macular ischemia received intravitreal bevacizumab for rapidly progressive neovascularization of the optic disc and vitreous hemorrhage in the left eye. One week after treatment, she presented with central scotoma and fluorescein angiography revealed increased parafoveal capillary dropout and progressive macular ischemia in the treated eye.

Optical coherence tomography angiography (OCTA) as a new diagnostic tool in uveitis.

BACKGROUND: The broad spectrum of uveitis disorders requires a multimodal imaging approach in the daily practice of an ophthalmologist. As inflammatory conditions, they have in common an alteration in leukocyte migration. In this context, optical coherence tomography angiography (OCTA) might be of great value for diagnosing or following up patients with these disorders. To date, OCTA has rather been used as an additional tool besides the well-established diagnostic imaging tools, but its complementary diagnostic features become increasingly relevant, to follow disease activity and treatment response and for the understanding of pathomechanisms of various uveitis types. This review summarizes the possible applications of OCTA and its advantages and disadvantages as opposed to dye-based angiographies in uveitic diseases. MAIN BODY: Hitherto gold standards in the diagnostic workup of posterior or intermediate uveitis have been angiography on a dye-based method, which is fluorescein or indocyanine green. It gives information about the status of the blood-retinal barrier and the retinal and choroidal vasculature by visualizing diffuse leakage as a state of inflammation or complications as an ischemia or choroidal neovascularization. As noninvasive methods, fundus autofluorescence depicts the status of metabolic activity of the retinal pigment epithelium and OCT or enhanced depth imaging OCT, respectively, as a depth-resolving imaging method can supply additional information. OCTA as a non-invasive, depth-resolution imaging tool of retinal and choroidal vessels adds detailed qualitative and quantitative information of the status of retinal and choroidal vessels and bridges the gap between the mentioned conventional diagnostic tools used in uveitis. It is important, though, to be aware of its limitations, such as its susceptibility to motion artifacts, limited comparability among different devices, and restricted contribution of information regarding the grade of disease activity. CONCLUSION: OCTA as a non-invasive, depth-resolution imaging tool can give qualitative and quantitative information about the status of retinal and choroidal vessels, but also has certain limitations. Employing OCTA as a complementary rather than exclusive tool, it can give important additional information about the macro- and microvasculature under inflammatory circumstances. Thereby, it also contributes to the understanding of the pathophysiology of various uveitis entities.

Autologous translocation of the choroid and retinal pigment epithelium in patients with geographic atrophy.

PURPOSE: To evaluate the functional and anatomical outcomes of autologous translocation of peripheral choroid and retinal pigment epithelium (RPE) in patients with geographic atrophy. DESIGN: Prospective nonrandomized study. PARTICIPANTS: Twelve consecutive patients with geographic atrophy secondary to age-related macular degeneration presenting with recent loss of reading vision. METHODS: An autologous peripheral full-thickness graft of RPE, Bruch's membrane, and choroid was positioned under the macula in patients with geographic atrophy. MAIN OUTCOME MEASURES: Functional tests included Early Treatment Diabetic Retinopathy Study distant vision, reading (Radner Test, measured as logarithm of the reading acuity determination [logRAD]), threshold static perimetry, and determination of the point of fixation. Fluorescein and indocyanine green angiography, autofluorescence, and optical coherence tomography served to evaluate the anatomical outcome in a 6-month follow-up (12 months in 7 patients). RESULTS: Preoperative visual acuity (VA) ranged from 20/800 to 20/40 (mean, 0.6+/-0.4 logarithm of the minimum angle of resolution), and reading vision from 1.1 to 0.5 logRAD (mean, 0.8+/-0.2). Three patients were unable to read. Six months after surgery, VA ranged from hand movements to 20/32, with an increase of > or =5 letters in 2 eyes. Two patients without reading ability preoperatively were able to read after surgery. Reading was possible in a total of 8 patients after 6 months (1.3-0.4 logRAD). In 7 patients who were observed for 1 year, VA remained stable (+/-1 line) in 5 eyes and decreased in 2 eyes between 6 months' and 1 year's follow-up. In all eyes but 2, revascularization was visible on indocyanine green angiography as early as 3 weeks after surgery. Autofluorescence of the RPE was independent of revascularization of the graft and persisted throughout follow-up. Four eyes had unstable fixation and/or extrafoveal fixation before surgery. Two of these eyes stabilized during follow-up. Areas overlying atrophic areas demonstrated low threshold sensitivities that persisted after translocation of a free graft with only limited recovery. Revisional surgery due to proliferative vitreoretinopathy was required in 5 eyes. CONCLUSIONS: The translocation of a full-thickness graft usually results in a vascularized and functioning graft in patients with geographic atrophy, although is associated with a high risk of complications and visual loss. Longer follow-up is necessary to learn about the long-term survival and functionality of the graft.

Non-responders to bevacizumab (Avastin) therapy of choroidal neovascular lesions.

AIMS: To determine the characteristics of "non-responders" to intravitreal bevacizumab treatment in choroidal neovascularisation (CNV). METHODS: Forty-three patients with visual loss due to neovascular age-related macular disease (ARMD) (44 eyes) underwent intravitreal injections of 1.25 mg (0.05 ml) bevacizumab and were followed up every 4 weeks for 2, 3 or 6 months. Re-injection was performed when persistent leakage of the CNV was determined by fluorescein angiography and retinal oedema was assessed by optical coherence tomography (OCT). Non-responders were defined as those patients having reduced or stable visual acuity at the last follow-up. RESULTS: 45% of the patients were non-responders. In this group the initial CNV size was significantly larger than in the responders. Initial reading ability was significantly lower in non-responders, but the initial foveal oedema was similar in both groups. Gains in mean visual acuity and reading ability were independent of lesion type. The proportion of non-responders to responders in the different lesion type groups was equally distributed. Only patients with the classic type of CNV seemed to respond better. CONCLUSIONS: In this study initial reasons for non-responders to intravitreal bevacizumab treatment in CNV are given. The efficiency of bevacizumab depends on initial lesion size and initial reading ability, but is independent of the amount of intraretinal and subretinal fluid. There was no general ineffectiveness of bevacizumab with any particular lesion type.

Autologous translocation of the choroid and retinal pigment epithelium in age-related macular degeneration.

PURPOSE: To evaluate the autologous translocation of peripheral choroid and retinal pigment epithelium (RPE) in 45 eyes of 43 patients with age-related macular degeneration (AMD). DESIGN: Prospective nonrandomized study. METHODS: All patients had visual loss due to AMD (n = 5 classic membranes, n = 14 occult, n = 2 mixed, n = 16 pigment epithelial detachment (PED), n = 5 subretinal hemorrhage, n = 3 geographic atrophy). After extraction of the neovascular complex, an autologous peripheral full-thickness explant of RPE, Bruch membrane, and choroid was translocated from the midperiphery to the macula. RESULTS: Preoperative distant visual acuity ranged from 20/800 to 20/40. Reading vision ranged from 1.4 logarithm of reading acuity determination (logRAD) to 0.5 logRAD (0.04 to 0.32 Snellen equivalent). Revision surgery was required in 22 eyes as a result of proliferative vitreoretinopathy (PVR), retinal detachment, macular pucker, or vitreous hemorrhage. In eight patients, the patch was renewed. At six months, distant visual acuity ranged from light perception to 20/50 (increase of 15 letters in four eyes). Reading vision ranged from 1.4 to 0.4 logRAD. Visual outcome was unrelated to the type of AMD. Vascularization of the transplant was visible on indocyanine green (ICG) angiography in 40 of 42 eyes. In most patients, autofluorescence of the pigment epithelium was coincident with revascularization of the graft. Fixation on the patch was positively related to visual acuity. CONCLUSIONS: Autologous translocation of a full-thickness transplant of choroid and RPE usually results in a vascularized and functioning graft. Vascularization was even achieved in patients with geographic atrophy. Fixation stability and microperimetry before the patch translocation may be helpful in selecting patients who will profit from surgery.

Retinal vessel diameter changes in different severities of diabetic retinopathy by SD-OCT.

PURPOSE: To evaluate retinal vessel diameters in relation to different severity grades of diabetic retinopathy (DR) using spectral-domain optical coherence tomography (SD-OCT). METHODS: Patients with varying degrees of nonproliferative DR (NPDR) underwent circular OCT scans centered on the optic nerve head using a SD-OCT. These cases were retrospectively reviewed. The presence and severity of DR was assessed using Early Treatment Diabetic Retinopathy Study protocols. The 5 largest retinal arterioles and venules were labeled and measured on OCT scans for each patient according to previously published methods. Vertical vessel inner contour diameter, vertical vessel outer contour diameter, and reflectance shadowing width were among the documented parameters. RESULTS: Of 59 eyes from 45 patients examined, 30 (50.2%) and 29 (49.8%) had mild and severe NPDR, respectively. Eyes with severe NPDR had narrower mean arteriolar vertical vessel inner diameter (87.9 ± 10.8 µm), vertical vessel outer diameter (119.1 ± 9.7 µm), and vessel shadow width (78.8 ± 10.9 µm) than eyes with mild NPDR (89.8 ± 12.1 µm, 120.9 ± 12.9 µm, 81.3 ± 15.3 µm). However, the differences were not statistically significant (p = 0.53, 0.55, 0.47). No correlation was shown between the severity of NPDR and arteriolar parameters (p = 0.31, 0.59, 0.75). Wider venular diameters were associated with increasing severity of NPDR (p<0.001, <0.001, 0.007, respectively). The association remained after multivariate adjustment for age, sex, eye, and cataract surgery (p = 0.04, 0.01, 0.007, respectively). CONCLUSIONS: Wider retinal venule diameter was significantly associated with the severity of NPDR by SD-OCT-assisted measurement. Prospective studies would be needed to evaluate whether change in retinal venule could be used as a clinical indicator of DR progression.

Non-ocular primary malignancies in patients with uveal melanoma: the Liverpool experience.

AIM: To identify the prevalence of self-reported non-ocular primary malignancies in patients at the time of diagnosis with uveal melanoma (UM) and to describe the cohort's characteristics. METHODS: A data query for cases of UM seen at the Liverpool Ocular Oncology Centre between January 1993 and May 2014 was performed. Only patients who had UM with other non-ocular primary malignancies were included. Demographic and clinical data were analysed. RESULTS: A total of 5042 (2563 males, 50.8%) patients with UM were found in the database; of whom, 216 (4.3%) had at least one other primary non-ocular malignancy. Of these 216 patients, 119 were males (55.1%). Forty five males (37.8%) had been diagnosed with prostate cancer, 30 (25.2%) with unspecified skin cancers, 15 (12.6%) with colon and bowel carcinoma, eight (6.7%) with systemic lymphoma and the remaining patients with less common tumours. Of the 97 females, 45 (46.4%) had been diagnosed with breast carcinoma, 19 (19.6%) had unspecified skin cancers, seven (7.2%) renal cell carcinoma, six (6.2%) colon and bowel carcinoma, and the remaining patients had other less common tumour types. In this cohort, the frequency of the most common additional malignancy in male and female patients with UM was comparable with their prevalence in the general UK population. CONCLUSIONS: Additional primary malignancies can occur in association with UM; therefore, medical history taking in patients with UM should always include this aspect. Apart from providing demographic and clinical data in such cases, future collaborative studies, which would include germline mutational testing, may reveal relevant common patterns.