Development of Secondary Choroidal Neovascularization in Focal Choroidal Excavation of Punctate Inner Choroidopathy.

Purpose: To elaborate a case of focal choroidal excavation (FCE) in punctate inner choroidopathy (PIC) complicated by secondary choroidal neovascularization (CNV) based on multimodal imaging findings.Methods: In this retrospective case report, multimodal imaging including near-infrared reflectance, blue peak autofluorescence, spectral domain-optical coherence tomography (OCT), fluorescein and indocyanine green angiography (Heidelberg Engineering GmbH, Germany), and swept source-OCT angiography (SS-OCTA; Topcon Corporation, Japan) was performed.Patients: A 27-year-old moderate myopic woman presented with inactive CNV of unknown origin in her left eye, which had been previously treated with intravitreal anti-vascular endothelial growth factor.Results: Multimodal imaging revealed PIC as the causative disease and systemic corticosteroids were administered. Similar complaints 13 months later showed new CNV formation at the already documented FCE. No sign of PIC could be detected at follow-up.Conclusion: This well-documented case highlighted FCE as the preferential location for CNV development in PIC with multimodal imaging emphasizing a chorioretinal entity.Summary: This case report demonstrated the clinical course of focal choroidal excavation in a patient initially diagnosed with punctate inner choroidopathy complicated by choroidal neovascularization and its treatment response, well documented by multimodal imaging including optical coherence tomography angiography.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FOR THE DETECTION OF SECONDARY CHOROIDAL NEOVASCULARIZATION IN VITELLIFORM MACULAR DYSTROPHY.

PURPOSE: Optical coherence tomography angiography (OCTA) is used to assess vascular abnormality in advanced stage vitelliform macular dystrophy (VMD2). METHODS: Multimodal imaging including spectral domain (SD) OCT, autofluorescence (AF), fluorescein (FA) and indocyanine green angiography (ICGA) as well as optical coherence tomography angiography were performed. PATIENTS: Two eyes in one young patient with diagnosed vitelliform macular dystrophy were investigated for progressive visual dysfunction. RESULTS: Optical coherence tomography angiography identified neovascular formation within the outer retina and the choriocapillaris respectively while all other imaging methods were inconclusive. CONCLUSION: Optical coherence tomography angiography was superior to conventional angiography in the detection of choroidal neovascularization (CNV) in advanced retinal disorders like vitelliform macular dystrophy.

STELLATE NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS ACCOMPANIED BY CONTRALATERAL PERIPHERAL RETINOSCHISIS.

PURPOSE: To present a patient with stellate nonhereditary idiopathic foveomacular retinoschisis on one eye and peripheral retinoschisis without foveal affection on the other eye. METHODS: A case report with complete workup of family history and clinical examination, including multimodal imaging with optical coherence tomography and angiography, fluorescein angiography, and infrared fundus imaging. Genetic testing for gene mutation XRLS1 was performed. RESULTS: A white woman with unremarkable medical history presented with stellate foveal splitting of the outer plexiform layer on the right eye and peripheral splitting of the outer plexiform layer on both eyes. All known allegeable trigger factors for the existence of a hereditary or acquired foveomacular retinoschisis were ruled out either by clinical presentation or genetic testing. This led to the diagnosis of stellate nonhereditary idiopathic foveomacular retinoschisis with central involvement only present on one eye. CONCLUSION: Although peripheral schisis of the outer plexiform layer is often concomitant with central splitting in X-linked juvenile retinoschisis, this is the first known report of nonhereditary cleavage of the outer plexiform layer of the peripheral retina without central affection in a patient with documented stellate nonhereditary idiopathic foveomacular retinoschisis on the other eye. These findings suggest an accurate bilateral examination of the peripheral retina while confirming the diagnose of stellate nonhereditary idiopathic foveomacular retinoschisis.

DETECTION OF TREATMENT-NAIVE CHOROIDAL NEOVASCULARIZATION IN AGE-RELATED MACULAR DEGENERATION BY SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

PURPOSE: To compare the detection rate of choroidal neovascularization (CNV) in treatment-naive neovascular age-related macular degeneration by swept source optical coherence tomography angiography (SS-OCTA, Topcon's DRI Triton) working at 1,050 nm wavelength versus fluorescence angiography. METHODS: Cross-sectional analysis of 156 eyes (107 neovascular age-related macular degeneration and 49 dry AMD) in 98 patients, previously diagnosed by multimodal imaging using fluorescein (FA) and indocyanine green angiography (Heidelberg's Spectralis) in a tertiary retina center, evaluated by SS-OCTA 4.5 mm × 4.5 mm and 6 mm × 6 mm macular cubes. Main outcome measures were sensitivity and specificity of SS-OCTA in AMD. Potential factors influencing CNV detection rate were analyzed. RESULTS: Swept source optical coherence tomography angiography detected CNV in 81 of 107 eyes, resulting in a sensitivity of 75.7%. In 49 eyes with dry AMD, no CNV could be identified (specificity 100%). A statistical significance was calculated for nondetection of treatment-naive CNV by SS-OCTA in pigment epithelial detachment over 400 µm (P = 0.0238). CONCLUSION: Topcon's SS-OCTA was not able to detect all CNV lesions. Large pigment epithelial detachments were associated with signal loss. Fluorescence angiography still remains the gold standard, but the tested SS-OCTA device can be considered as a feasible additional diagnostic tool in AMD.

Effect of photodynamic therapy on short-wavelength fundus autofluorescence in eyes with acute central serous chorioretinopathy.

PURPOSE: To evaluate short-wavelength FAF as a parameter of retinal pigment epithelium function in eyes with acute symptomatic central serous chorioretinopathy after indocyanine green angiography-guided verteporfin photodynamic therapy with half-fluence rate. METHODS: A retrospective review over a period of 1 year of short-wavelength FAF images of 15 consecutive patients treated with half-fluence rate (25 J/cm) indocyanine green angiography-guided verteporfin photodynamic therapy due to acute symptomatic central serous chorioretinopathy was performed. Short-wavelength (488 nm) FAF gray values were evaluated with a confocal scanning laser ophthalmoscope at a 350-µm diameter and a 1,200-µm diameter circle centered on the fovea. The change in short-wavelength (488 nm) FAF gray values for the 2 circles was evaluated by calculating the differences of respective values between the first month after treatment and the 3, 6, 9, and 12 months follow-up. RESULTS: Mean differences (95% confidence interval) in short-wavelength (488 nm) FAF gray values of the 350-µm and 1,200-µm diameter circle between the 1-month and the 3-month (n = 15) follow-up were -0.03 (-0.11 to 0.05) (P = 0.46) and -0.03 (-0.17 to 0.10) (P = 0.6). Respective differences between the 1 month and the 6 (n = 15), 9 (n = 14), and 12 months (n = 13) of follow-up were -0.03 (-0.11 to 0.05) (P = 0.42) and -0.04 (-0.16 to 0.08) (P = 0.5); -0.05 (-0.12 to 0.03) (P = 0.23) and -0.06 (-0.18 to 0.07) (P = 0.33); -0.03 (-0.12 to 0.07) (P = 0.57) and -0.07 (-0.20 to 0.05) (P = 0.22). CONCLUSION: Half-fluence rate (25 J/cm) indocyanine green angiography-guided verteporfin photodynamic therapy did not significantly affect short-wavelength FAF at a 350-µm diameter and a 1,200-µm diameter circle in eyes with resolved acute symptomatic central serous chorioretinopathy throughout 12 months of follow-up.

Choroidal Haller's and Sattler's layer thickness measurement using 3-dimensional 1060-nm optical coherence tomography.

OBJECTIVES: To examine the feasibility of automatically segmented choroidal vessels in three-dimensional (3D) 1060-nmOCT by testing repeatability in healthy and AMD eyes and by mapping Haller's and Sattler's layer thickness in healthy eyes. METHODS: Fifty-five eyes (from 45 healthy subjects and 10 with non-neovascular age-related macular degeneration (AMD) subjects) were imaged by 3D-1060-nmOCT over a 36°x36° field of view. Haller's and Sattler's layer were automatically segmented, mapped and averaged across the Early Treatment Diabetic Retinopathy Study grid. For ten AMD eyes and ten healthy eyes, imaging was repeated within the same session and on another day. Outcomes were the repeatability agreement of Haller's and Sattler's layer thicknesses in healthy and AMD eyes, the validation with ICGA and the statistical analysis of the effect of age and axial eye length (AL) on both healthy choroidal sublayers. RESULTS: The coefficients of repeatability for Sattler's and Haller's layers were 35% and 21% in healthy eyes and 44% and 31% in AMD eyes, respectively. The mean±SD healthy central submacular field thickness for Sattler's and Haller's was 87±56 µm and 141±50 µm, respectively, with a significant relationship for AL (P<.001). CONCLUSIONS: Automated Sattler's and Haller's thickness segmentation generates rapid 3D measurements with a repeatability corresponding to reported manual segmentation. Sublayers in healthy eyes thinned significantly with increasing AL. In the presence of the thinned Sattler's layer in AMD, careful measurement interpretation is needed. Automatic choroidal vascular layer mapping may help to explain if pathological choroidal thinning affects medium and large choroidal vasculature in addition to choriocapillaris loss.

Non-responders to treatment with antagonists of vascular endothelial growth factor in age-related macular degeneration.

PURPOSE: Most of the publications on modern therapy of neovascular age-related macular degeneration focus on the effect of the treatment. The purpose of this study is to determine the frequency of non-responders to anti-vascular endothelial growth factor (anti-VEGF) treatment and find possible reasons for their failure to respond. METHODS: The records of patients treated until the end of 2008 the first time with either bevacizumab or ranibizumab were reviewed. Based on the availability of measurable results and according to prior publications showing the effect of the therapy, loss of three lines of distance acuity, increase of retinal thickness or lesion size were identified as indicators of non-responders. Two of these three signs had to be present. RESULTS: 334 eyes of 283 patients were included; 74.55% received bevacizumab and 25.45% received ranibizumab. Overall 14.37% of the eyes were identified as non-responders (14.06% in the bevacizumab group and 15.29% in the ranibizumab group). Baseline distance acuity and vitreo-retinal adhesions were significantly correlated with non-responders. Correlations with age, gender, lesion type, other morphologic features, and the kind of anti-VEGF agent failed to be significant. 10.4% of the non-responders showed a delayed but good response to anti-VEGF treatment. CONCLUSIONS: About 15% did not sufficiently respond to anti-VEGF treatment. Vitreo-retinal adherences were the only ophthalmologic factor which could be identified to be significantly correlated with insufficient response.

Half-fluence photodynamic therapy in chronic central serous chorioretinopathy.

PURPOSE: To evaluate the results of indocyanine green angiography (ICGA)-guided verteporfin (Visudyne®; Novartis Pharma, Switzerland) photodynamic therapy (PDT) with half-fluence rate in the treatment of chronic central serous chorioretinopathy. METHODS: A retrospective review was conducted of 20 eyes of 19 consecutive patients with subfoveal fluid cause by chronic central serous chorioretinopathy with choroidal hyperpermeability on ICGA and symptoms of at least 6 months. ICGA-guided verteporfin (6 mg/m) PDT with half-fluence rate (25 J/cm) was performed. ICGA findings were classified as intense, intermediate, or minimal hyperfluorescence depending on the degree of choroidal hyperpermeability. The resolution of the subretinal fluid and recurrence rates were assessed in relation to the different degrees of choroidal hyperfluorescence. RESULTS: Best-corrected visual acuity at baseline was 40 letters (±13; n = 20) according to the Early Treatment Diabetic Retinopathy Study chart. At 12 months after PDT, the mean best-corrected visual acuity improved to 44 letters (P < 0.01). Pretreatment central foveal thickness 325 µm and decreased by a mean of 103 µm at Month 12 control (P < 0.05). At Month 1 after PDT, subretinal fluid in spectral-domain optical coherence tomography was completely resolved in 100% of eyes regardless to their degree of choroidal hyperfluorescence. Two eyes of the intense hyperfluorescence group and 1 eye of the intermediate hyperfluorescence group developed recurrence of symptoms over 12 months and received another PDT with half-fluence rate within the 12-month control period. Treatment effect was not depending on the degree of choroidal hyperpermeability at baseline. No systemic side effects were observed during the 12-month follow-up. CONCLUSION: ICGA-guided half-fluence PDT with verteporfin is effective in treating chronic symptomatic central serous chorioretinopathy with choroidal hyperpermeability in ICGA, resulting in both visual improvement and reduction of central foveal thickness.

A randomised double-masked trial comparing the visual outcome after treatment with ranibizumab or bevacizumab in patients with neovascular age-related macular degeneration.

AIM: The current accepted standard treatment for neovascular age-related macular degeneration (AMD) consists of antivascular endothelial growth factor agents including ranibizumab and bevacizumab. The aim of the study was to examine whether bevacizumab is inferior to ranibizumab with respect to maintaining/improving visual acuity. METHODS: In this prospective randomised parallel group multicentre trial patients aged more than 50 years with treatment naive nAMD were included at 10 Austrian centres. Patients were randomised to treatment either with 0.5 mg ranibizumab or 1.25 mg bevacizumab. Both groups received three initial monthly injections and thereafter monthly evaluation of visual acuity and the activity of the lesion. Re-treatment was scheduled as needed. Outcome measures were early treatment of diabetic retinopathy visual acuity, retinal thickness, lesion size and safety evaluation. RESULTS: A total of 321 patients were recruited of which four had to be excluded due to different reasons. Of the 317 remaining patients 154 were randomised into the bevacizumab group and 163 into the ranibizumab group. At month 12, there was a mean increase of early treatment of diabetic retinopathy visual acuity of 4.9 letters in the bevacizumab and 4.1 letters in the ranibizumab group (p=0.78). Furthermore, there were no significant differences in the decrease of retinal thickness, change of lesion size and number of adverse events between the groups. CONCLUSIONS: Bevacizumab was equivalent to ranibizumab for visual acuity at all time points over 1 year. There was no significant difference of decrease of retinal thickness or number of adverse events.

The effect of photodynamic therapy on macular sensitivity in eyes with acute central serous chorioretinopathy.

BACKGROUND: To evaluate the effect of half-fluence rate indocyanine green angiography (ICGA)-guided verteporfin photodynamic therapy (PDT) on macular sensitivity (MS) in eyes with acute symptomatic central serous chorioretinopathy (CSC). METHODS: Single-center consecutive case series by retrospective chart review. Sixteen eyes of 16 patients with acute CSC of 3 months duration or less, treated with half-fluence (25 mJ/cm(2)) ICGA-guided verteporfin PDT were reviewed. At baseline and after 1, 3, and 6 months, all patients underwent MS testing of the central 20 °, MS testing of the retinal area covered by the PDT laser spot (MSLS), and evaluation of fixation stability (FS) for the central two degrees with the MP-1 microperimeter (Nidek, Vigonza, Italy). RESULTS: Macular sensitivity improved from 16.4 ± 3.0 dB at baseline (n = 16) to 18.2 ± 2.4 dB (p < 0.001) at 1 month (n = 16). At the 3-month (n = 13) and 6-month (n = 12) follow-up, MS stabilized at 19.5 ± 0.9 dB (p = 0.21) and 19.0 ± 1.3 dB (p = 0.74), without changes when compared to respective precedent follow-up. Mean MSLS improved from 12.9 ± 5.4 dB at baseline to 16.4 ± 4.9 dB (p < 0.001) after 1 month. At the 3- and 6-month follow-up, MSLS was 19.1 ± 1.2 dB (p= 0.1) and 18.9 ± 1.9 dB (p = 0.8) respectively. Mean FS at the central 2 ° was 78.8 ± 30.4 % before treatment and 81.8 ± 29.5 % (p = 0.7), 81.9 ± 27.5 % (p = 0.7) and 83.6 ± 17.1 % (p = 0.5) respectively 1, 3 and 6 months after treatment. CONCLUSION: Half-fluence (25 mJ/cm(2)) PDT significantly increased mean MS of central 20 ° and mean MSLS, in eyes with acute symptomatic CSC. Fixation stability was stable at baseline and throughout 6 months of follow-up.

Comparison of Ranibizumab monotherapy versus combination of Ranibizumab with photodynamic therapy with neovascular age-related macular degeneration.

PURPOSE: Modern therapy of neovascular age-related macular degeneration consists in intravitreal injections of inhibitors of the vascular endothelial growth factor. An increasing number of these injections is required not only in monthly but also in as-needed treatment regimen. In this study, it should be examined whether an additional administered photodynamic therapy (PDT) can considerably reduce the number of injection. METHODS: In this prospective, randomized study carried out in three large hospitals of Vienna eyes with neovascular age-related macula degeneration were included. Patients were randomized to either Ranibizumab monotherapy or combined standard fluence PDT and Ranibizumab therapy. All patients received a loading dose of three intravitreal Ranibizumab injections and were thereafter treated in an as-needed regimen based on distance acuity and retinal thickness values. In the combined treatment group, PDT was administered 1 day after the first Ranibizumab injection. RESULTS: Fifty-one patients were randomized, 44 were finally included (four screening failures and three withdrawals). Twenty-four patients were assigned to the monotherapy and 20 patients to the combined treatment group. Fewer injections were required in the combined treatment group (4.7 versus 6.3). Overall the patients lost 0.5 letters; in the combined treatment group, the patients lost mean 7.1 letters; in the monotherapy group, they gained mean 5.1 letters. Retinal thickness decreased significantly in both groups. CONCLUSION: A significant reduction of the number of required intravitreal injections could be achieved by the additional PDT treatment, but was accompanied by a worse functional outcome in this group.

A prospective, randomised, multicenter trial for surgical treatment of central retinal vein occlusion: results of the Radial Optic Neurotomy for Central Vein Occlusion (ROVO) study group.

BACKGROUND: To compare the surgical outcomes and evaluate the effectiveness of two treatments for central retinal vein occlusion (CRVO), radial optic neurotomy (RON) and intravitreal triamcinolone (IVT), in comparison to natural history. METHODS: A prospective, placebo-controlled, randomised and multi-center study. Patients with CRVO were treated in three groups - with either RON, a single intravitreal injection of 4 mg triamcinolone acetonide, or a placebo treatment. The main outcome measures were change of VA (visual acuity) and proportion of eyes with a significant improvement (defined as > 3 lines logMAR scale) of VA from baseline to month 12. RESULTS: Ninety patients were included. Due to insufficient data, seven were excluded. Forty-seven percent (n = 18) of patients treated with RON showed an increase in VA, in comparison to 10 % (n = 2) of placebo-treated patients, and 20 % (n = 5) of patients treated with IVT. Significantly more patients showed an improvement in VA following RON than in the placebo group (p = 0.009). Significantly more patients showed an improvement in VA following RON than in the IVT group (p = 0.034). No significant difference was found when directly comparing improvement in VA following IVT and placebo (p = 0.667) treatment.Significantly (p = 0.007) more patients in the placebo group (35 %, n = 7) showed a deterioration (defined as > 3 lines LogMAR scale) in VA than patients in the RON group (8 %, n = 3). CONCLUSION: Our study showed that following treatment with RON, patients with CRVO display a significantly better long-term VA than untreated patients and patients treated with a single dose of IVT.

Half-fluence photodynamic therapy in acute central serous chorioretinopathy.

PURPOSE: To evaluate the results of indocyanine green angiography-guided verteporfin (Visudyne; Novartis Pharma AG, Switzerland) photodynamic therapy with half-fluence rate in the treatment of acute symptomatic central serous chorioretinopathy. METHODS: A retrospective review over 12 months was performed of 19 consecutive patients with subfoveal fluid because of acute symptomatic central serous chorioretinopathy proved by spectral-domain optical coherence tomography and fluorescein angiography, treated with indocyanine green angiography-guided verteporfin (6 mg/m) photodynamic therapy with half-fluence rate (25 J/cm). Acute symptomatic central serous chorioretinopathy was defined as first episode of symptoms and duration of symptoms before treatment of ≤12 weeks. RESULTS: Best-corrected visual acuity at baseline was 47 letters (±10; n = 19) according to the Early Treatment Diabetic Retinopathy Study chart. At 12 months after photodynamic therapy, the mean best-corrected visual acuity improved to 56 letters (P = 0.003).Pretreatment central foveal thickness was 406 µm and decreased by a mean of 163 µm at Month 12 control (P < 0.001). At Month 1 after photodynamic therapy, subretinal fluid in spectral-domain optical coherence tomography was completely resolved in all 19 patients. None of the patients developed any recurrence of symptoms over 12 months. No ocular or systemic side effects were observed during 12 months follow-up. CONCLUSION: Indocyanine green angiography-guided half-fluence photodynamic therapy with verteporfin is effective in treating acute symptomatic central serous chorioretinopathy, resulting in visual improvement and complete resolution of exudative macular detachment.

Reproducibility of segmentation error correction in age-related macular degeneration: Stratus versus Cirrus OCT.

INTRODUCTION: The accuracy of retinal thickness measurement in age-related macular degeneration by optical coherence tomography (OCT) is affected by threshold algorithm line errors. The reproducibility of error correction in Stratus and Cirrus OCT should be examined. METHODS: OCT examinations of a consecutive series of 104 patients with neovascular age-related macular degeneration included in another study were reviewed. 72 eyes exhibited failures in Stratus OCT and 32 eyes in Cirrus OCT and were included in this new study. Algorithm line failures of Stratus OCT (retinal thickness program) and Cirrus OCT (Macular Cube 512×128 program) were corrected independently twice by two ophthalmologists and two residents, respectively, using the Stratus and Cirrus OCT built-in software. Reproducibility was assessed by the interclass correlation coefficient (ICC). RESULTS: The corrected values of central retinal thickness were significantly lower than the automated measured values in Stratus OCT for all examiners (p<0.001), while in Cirrus OCT the differences were not significant (p=0.06-0.09). For Stratus OCT, the ICC for central retinal thickness was 0.991 and 0.997 for the experienced ophthalmologists and 0.89 and 0.97 for the residents. For Cirrus OCT, the ICC was 1.0 and 1.0 for the experienced ophthalmologists and 0.99 and 0.95 for the residents. CONCLUSION: The reproducibility of threshold algorithm line failure correction was good overall in Stratus and Cirrus OCT and can therefore be recommended to improve retinal thickness measurement, particularly when experienced examiners perform the corrections.

Comparing treatment of neovascular age-related macular degeneration with sequential intravitreal Avastin and Macugen versus intravitreal mono-therapy--a pilot study.

PURPOSE: To examine if the sequential treatment of Avastin and Macugen is safe and more efficient than the mono-therapies in a prospective randomized masked pilot study. MATERIALS AND METHODS: Subjects with exudative age-related macular degeneration were randomized to receive three intravitreal injections of either 1 mg of Avastin, 0.3 mg Macugen, or first 1 mg Avastin followed by retreatment of 0.3 mg Macugen. Follow-up examinations were performed after 1, 6, 12 weeks, and 6 months. RESULTS: Forty-eight subjects were included (13:18:17). Avastin resulted in lasting significant changes in visual acuity at 6 weeks, increase in contrast sensitivity at 6 weeks, and a significant decrease in macular thickness after 6 and 12 weeks. Macugen showed a significant decrease in retinal thickness after 6 weeks, but a significant decrease in visual acuity after 6 months, and a significant decrease in contrast sensitivity after 12 weeks and 6 months. The sequential treatment showed a decrease in retinal thickness after 1 and 12 weeks. CONCLUSION: Avastin alone is more effective in increasing visual acuity and contrast sensitivity and decreasing retinal thickness, than Macugen or the sequential treatment. We conclude that the sequential treatment of Avastin with Macugen is safe, but the single treatment of Avastin is more efficient.

Quality and reproducibility of retinal thickness measurements in two spectral-domain optical coherence tomography machines.

PURPOSE: To evaluate the accuracy and reproducibility of retinal thickness measurements in exudative age-related macular degeneration (AMD) by the Spectralis (Heidelberg Engineering, Heidelberg, Germany) and the Cirrus (Carl Zeiss Meditec, Dublin, CA) optical coherence tomography (OCT) systems. METHODS: Eyes with exudative age-related macular degeneration were randomly assigned to one of eight groups, each different in the sequence of examiner and OCT system. The 512 × 128 cube program of the Cirrus and the 30° × 25° volume scan containing 32 lines of the Spectralis were performed twice. The correlation between the examinations was expressed by the interclass correlation coefficient (ICC). RESULTS: Enrolled in the study were 112 patients and 112 eyes (mean age, 76.5 ± 7.9 years; range 51-89), with 14 patients in each group. The mean error scores per line were 0.53 and 0.52 in the Cirrus, significantly (P < 0.001) lower than in the Spectralis (0.83 and 0.98). For automatic central retinal thickness (CRT), the ICC for Cirrus (all examinations calculated) was 0.61 for groups 1 to 4 (the same examiner) and 0.65 for groups 5 to 8 (two different examiners); for Spectralis (13.4% not calculated) the ICC was 0.93 for groups 1 to 4 and 0.86 for groups 5 to 8. After error correction, the Cirrus ICC improved to 1.0 and 0.99 and the Spectralis ICC to 1.0 in both groups. CONCLUSIONS: Considerable differences were found between the two systems, both of which incorporate the spectral-domain technology. Different positioning of segmentation lines, control of localization, density of included scan lines, and number of available maps explain the differences in segmentation quality and reproducibility. Manual correction of segmentation and centralization improves the reproducibility.

Conversion of Stratus optical coherence tomography (OCT) retinal thickness to Cirrus OCT values in age-related macular degeneration.

AIM: Spectral domain optical coherence tomography (SD OCT) is of increasing importance and is gradually replacing time domain OCT (TD OCT). Our aim was to determine a formula to convert Stratus OCT (TD OCT) to Cirrus OCT (SD OCT) retinal thickness. METHODS: Central retinal thickness (CRT) and retinal volume (RV) were obtained by the macular thickness program of Stratus OCT and the cube 512 × 128 program of Cirrus OCT in patients with exudative age-related macular degeneration (AMD). Algorithm line failures were corrected. A linear model with Stratus OCT CRT as fixed factor and Cirrus OCT CRT as dependent variable was applied to calculate the conversion formula. RESULTS: OCT examinations of 104 eyes of 104 patients were reviewed and corrected when necessary. Stratus and Cirrus OCT CRT were significantly correlated (p<0.0001). For CRT the formula Cirrus CRT=58.63+0.94 × Stratus CRT was calculated. The correlation was significantly influenced by the height of the CRT values (p<0.0001), but not by whether correction was necessary. For RV the formula Cirrus OCT RV=3.098+0.98 × Stratus OCT RV was calculated. CONCLUSION: Stratus OCT and Cirrus OCT use a different posterior reference line within the hyper-reflective band of the outer retina. Therefore a conversion formula is necessary to compare Stratus and Cirrus OCT CRT values, and this has been determined in our study.

Spectral domain optical coherence tomography for higher precision in the evaluation of vitreoretinal adhesions in exudative age-related macular degeneration.

AIM: The role of changes at the vitreoretinal interface and vitreomacular traction forces in pathogenesis, and the course of exudative age-related macular degeneration (AMD) need further exploration. This study examines the localisation of adhesion and the direction of traction lines in eyes with exudative AMD. METHODS: The cubes 512×128 of Cirrus optical coherence tomography (OCT) and volume scans of Spectralis OCT were reviewed in a consecutive series of patients presenting between December 2008 and March 2009 with vitreomacular adhesion in exudative AMD. RESULTS: 30 eyes of 25 patients with exudative AMD and vitreomacular adhesion were studied. 50% had type III lesions, 46.7% occult and 3.3% predominantly classic lesions. The localisation of the adhesion corresponded in 100% with the area of the neovascularisation (CNV), in 73.3% traction directed towards the CNV and in 83.3% towards the optic disc could be noted. Spectral domain OCT and 3D visualisation enabled clearer localisation of vitreomacular adhesion and definition of resulting traction lines. CONCLUSION: There is a high prevalence of type III lesions within eyes with vitreomacular adhesions, and complete correspondence between the location of the adhesion and the CNV. There is also a high incidence of vitreopapillary adhesion in these cases, suggesting a possible role in pathogenesis.