Fixation stability and macular light sensitivity in patients with diabetic maculopathy: a microperimetric study with a scanning laser ophthalmoscope.

BACKGROUND: In patients with diabetic maculopathy, evaluation of visual acuity alone may not represent central retinal function sufficiently. Despite good visual acuity, patients may suffer from visual disturbances like waviness, relative scotoma, loss of fixation and decrease of contrast sensitivity. The aim of the study was to assess localized light sensitivity in the central visual field and to determine fixation stability in patients with diabetic maculopathy with moderate visual loss in comparison to healthy controls. METHODS: Twenty-seven patients (mean age: 54 +/- 15; range 17-81 years) with diabetic maculopathy and 61 controls (mean age: 45 +/- 22; range 18-85 years) were included in the study. Light sensitivity was quantified by presenting stimuli with different light intensity with simultaneous real-time monitoring of the retina (intensity: 0-27.9 dB; size: Goldmann III, wavelength: 633 nm). Eye movements were controlled by semiautomatic fundus tracking. Fixation stability was quantified by measuring the area within 75% of all points of fixation. RESULTS: Fixation stability was significantly decreased in diabetic patients in comparison to controls (43 +/- 22 vs. 31 +/- 16 arc min, p < 0.01). There was a significant difference in macular light sensitivity in diabetic patients compared to controls (19.6 +/- 0.5 dB), both in mean difference (15.6 +/- 1.4 dB) and if affected with macular edema (16.1 +/- 4.5 dB), hard exudates (13.3 +/- 6.7 dB), nonperfusion areas (10.3 +/- 7.9 dB) and laser burns (3.0 +/- 6.1 dB). Temporal parts of the macula were more affected than other parts. No correlation was found between visual acuity and foveal light sensitivity and foveal fixation, respectively. CONCLUSION: Macular light sensitivity decreased progressively with the kind and severity of retinal alteration independent of visual acuity. The assessment of macular light sensitivity and stability of fixation with automatic threshold microperimetry may help to identify patients with diabetic maculopathy and could improve the management of diabetic maculopathy.

Angiographic findings in arteriovenous dissection (sheathotomy) for decompression of branch retinal vein occlusion.

BACKGROUND: Arteriovenous dissection (sheathotomy) is a new therapeutic option in patients with branch retinal vein occlusion (BRVO) and macular involvement. We present an angiographic follow-up of 22 patients who underwent arteriovenous dissection (AVD). METHODS: Twenty-two patients (15 women; mean age 68.7+/-8.0 years) were examined preoperatively and 6 weeks, 3 months, 6 months, and 1 year after AVD. For assessment of retinal hemodynamics, arteriovenous passage time (AVP) of the affected and unaffected branches at first (AVPe) and at maximal (AVPmax) venous filling were measured. Changes in the foveal avascular zone (FAZ) were calculated to determine foveal structural changes. Visual acuity was assessed as functional parameter. RESULTS: The early AVP (AVPe) of the affected branch increased from 4.4+/-0.8 s preoperatively to 4.9+/-0.6 s 6 weeks after surgery and decreased to 2.7+/-0.4 s 1 year after surgery (p=0.05). When compared to the unaffected control branch, AVPe was significantly increased in the affected branch preoperatively (4.5+/-0.8 s versus 1.5+/-0.2 s, p<0.01), 6 weeks (4.9+/-0.6 s versus 2.1+/-0.3 s, p<0.01), 3 months (2.7+/-0.4 s versus 1.5+/-0.2 s, p<0.01), and 6 months (3.1+/-0.4 s versus 2.2+/-0.3 s, p=0.02) after AVD. After 1 year, AVPe no longer differed between the affected and the control branch (2.7+/-0.4 s versus 2.6+/- 0.3 s). AVPmax was significantly increased in the affected branch preoperatively (11.8+/-0.8 s versus 7.7+/-1.0 s, p<0.05). The AVPmax in the affected branch with the exception of 3 months after surgery (10.2+/-1.1 s, p<0.01) was no longer elevated when compared to preoperative values. The area of the FAZ did not change significantly but showed a trend for enlargement. CONCLUSION: AVD for decompression of BRVO leads to a significant decrease of AVP and may ameliorate retinal perfusion in the affected branch.

[Macular hole surgery: experience with autologous platelet concentrate and indocyanine green-assisted internal limiting membrane peeling]. / Chirurgie des idiopathischen Makulaforamens: Erfahrungen mit autologem Thrombozytenkonzentrat und Indocyaningrünapplikation.

BACKGROUND: To report on our clinical experience with autologous platelet concentrate and indocyanine green(ICG)-assisted internal limiting membrane (ILM) peeling in macular hole surgery. PATIENTS AND METHODS: Standard 3-port vitrectomy was performed in 107 eyes of 101 patients (m: f = 27 : 74; mean age 60 +/- 9, range 30 - 80 years) with idiopathic macular hole stages II - IV. After fluid/air exchange, autologous platelet concentrate was applied (1.9 +/- 0,1 x 10(8) thrombocytes). ILM peeling, which was preceded by ICG staining in 19 eyes, was performed in 34 patients. RESULTS: After one procedure, anatomic success (hole closure) could be achieved in 85 % (n = 68), 75 % (n = 27) and 100 % (n = 3) of the eyes with stage II, III and IV holes, respectively. The mean visual acuity improved by 1 line. The overall initial closure rate of 82 % could be further enhanced to 96 % with a second procedure. In eyes pretreated with ICG, an initial rate of hole closure in 94 % and an improvement of visual acuity by 2 lines was observed. CONCLUSION: Autologous platelet concentrate appears to be a safe and reliable adjunct to improve the anatomical outcome of conventional macular hole surgery. Functional results can be further enhanced by ICG-assisted ILM peeling