Correlation of Retinal Thickness and Swept-Source Optical Coherence Tomography Angiography Derived Vascular Changes in Patients with Neovascular Age-Related Macular Degeneration.

Purpose: The aim of this study was to investigate whether structural OCT changes, in specific retinal thickness, is associated with the vascular response within the nAMD CNV lesion. In other words, whether SSOCTA derived parameters may prove suitable to assess CNV activity in future.Methods: During the first 3 months patients were prospectively followed with visits at days 7, and 14 after each anti-VEGF treatment up to day 90. At baseline, day 30 and 60 Aflibercept was administered. OCT-derrived retinal thickness (RT) and OCTA-derived CNV lesion parameters (vessel area [VA]), total vessel length [TVL], total number of junctions [TNJ], junction density [JD]) were determined. Parameters were exported from SSOCT/A (PlexElite, Zeiss) images using the semi-automated AngioTool software. Additionally, the superficial and deep vascular plexus fractal dimension of the para- and perifoveal region were identified. Consequently, all OCTA derived parameters were correlated with RT.Results: 16 consecutive patients presenting with treatment-naïve, SSOCTA-positive CNV lesions were included. A weak to moderate statistically significant correlation was found between the mean RT of the inner as well as the outer ETDRS ring with the SSOCTA-derived vascular markers vessel area (VA; r2 = -0.38, p < .001; r2 = -0.47, p < .001, respectively), total vessel length, (TVL; r2 = -0.38, p < .001; r2 = -0.48, p < .001, respectively) and total number of junctions (TNJ; r2 = -0.35, p < .001; r2 = -0.44, p < .001, respectively). Junctions density (JD), and all variables based on fractal dimension (FD) did not show statistically significant correlations with retinal thickness measurements.Conclusions: In summary, we could confirm a moderate, however, statistically significant correlation between mean para- and perifoveal retinal thickness and the SSOCTA derived vascular parameters VA, TVL, and TNJ. This leads us to the conclusion that an SSOCTA-based activity analysis of the CNV complex is not yet a substitute for retinal thickness or in-depth fluid analysis in patients with nAMD.

Comparative study between a spectral domain and a high-speed single-beam swept source OCTA system for identifying choroidal neovascularization in AMD.

This comparative study between a SD- and SS-OCTA system for visualizing neovascular patterns in AMD, also assessed the influence of cataract on OCTA imaging. 25 eyes with active CNV (AMD) were documented by FA, ICGA and SD-OCT. Two OCTA devices were used: A custom built SS-OCTA (1050 nm, 400,000 A-scans/s, 5 × 5 mm, no image segmentation); AngioVue (OptoVue, CA, USA) SD-OCTA (840 nm, 70.000 A-scans/s, 3 × 3 mm, SSADA technology). Two retina experts graded CNV types and vascular patterns. Cataract influence on OCTA image quality was reported for the superficial retinal plexus (6 eyes). The SS-OCTA prototype showed more CNV lesions compared to the SD-OCTA system (p = 0.01). Overall sensitivity of SD- and SS-OCTA systems to detect CNV lesions was.32 and.68, respectively. The SS-OCTA system was able to detect discrete lesion characteristics better than the SD-OCTA. No significant difference was found in the ability to identify CNV in treatment-naïve eyes. There was no significant influence of cataract. The SS-OCTA prototype detected CNV-associated vascular patterns more reliably than the SD-OCTA system. This is attributed to the SS-OCTA system's longer center wavelength and higher A-scan rate yielding higher definition and contrast of small neovascular structures. The SS-OCTA system used showed no advantage regarding cataract influence.

[Influence of postoperative oral steroid treatment on retinal sensitivity in patients after macular surgery. A randomized, controlled, clinical trial]. / Einfluss postoperativer oraler Steroidgabe auf die retinale Sensitivität bei Patienten nach Makulachirurgie. Eine randomisierte, kontrollierte, klinische Studie.

BACKGROUND: The aim of this study was to evaluate the effect of postoperative systemic steroid treatment on retinal sensitivity in patients with epiretinal membrane (ERM) after successful surgery. PATIENTS AND METHODS: A total of 28 patients with ERM, macular edema and visual loss were included in this study. All patients were treated with combined 23 gauge vitrectomy and peeling of the ERM and inner limiting membrane (ILM). After randomization the first group (n = 14) was treated with postoperative systemic steroids (100 mg prednisolone per day for 5 days) and the second group (n = 14) served as a control group. Follow-up examinations were performed up to 12 months. RESULTS: After 12 months a statistically significant increase in visual acuity with a gain of 17/10 letters in the steroid/control group as well as significant decrease of the central retinal thickness of 107/128 µm could be observed (p < 0.05). In the steroid/control group mean retinal sensitivity increased from 14.0/14.3 dB after 12 months in comparison to 11.7/11.9 dB at baseline examination (p < 0.05). CONCLUSIONS: Postoperative oral steroid treatment does not seem to be beneficial in patients with macular pucker surgery.

Use of systemic steroid after successful macular surgery in eyes with epiretinal membrane: a randomized, controlled clinical study.

PURPOSE: To evaluate the functional and morphological outcomes of postoperative systemic steroid therapy after successful macular surgery in eyes with macular edema due to idiopathic macular epiretinal membranes (ERMs). DESIGN: Prospective, randomized, investigator-masked, controlled clinical study. METHODS: Twenty-eight patients scheduled for 23-gauge vitrectomy combined with ERM and inner limiting membrane (ILM) peeling for macular edema due to ERM were included in this single center trial. Patients were randomized to receive oral steroid therapy (Prednisolone, 100 mg per day for 5 days) or no oral steroid (control group) after surgery. Main outcome measures included best corrected visual acuity (BCVA; Early Treatment Diabetic Retinopathy Study), central retinal thickness (CRT), retinal volume (RV), and macular morphology as determined by spectral domain optical coherence tomography (SD-OCT, Cirrus). Examinations were carried out preoperatively and at week 1, at months 1 and 3, postoperatively. RESULTS: At month 3, mean BCVA improved to a eight-letter gain in each study group (P<0.01 compared with baseline for both groups), showing no statistically significant difference between both the groups (P=0.19). Morphologically, retinal surface folds resolved within 1 month after surgery in both treatment groups, followed by a progressive recovery of retinal layer integrity and a statistical significant (P<0.01) decrease in CRT and RV without significant differences between both groups (P=0.62, P=0.13, respectively, ANOVA between the groups). CONCLUSION: The early postoperative use of systemic steroid treatment after successful vitrectomy combined with ERM and ILM peeling does not seem to improve significantly the anatomic and functional outcomes in eyes with ERM.

The influence of cortical, nuclear, subcortical posterior, and mixed cataract on the results of microperimetry.

PURPOSE: Microperimetry is a useful instrument for evaluating sensitivity threshold due to retinal pathologies. The aim of the study is to assess the impact of different forms of cataract on microperimetry results. METHODS: In a prospective design, patients were recruited for cataract surgery at the Department of Ophthalmology, Medical University of Vienna. Exclusion criteria were any other ophthalmic disease except cataract, that is, macular pathology. Using the Lens Opacities Classification System III classification, patients were classified into four groups: nuclear, cortical, subcapsular posterior, and mixed cataract. Then patients underwent microperimetry: results were analyzed for magnitude of retinal sensitivity loss and correlated to the forms and density of the cataract. RESULTS: Mean density of cataract was LOCS 3.2-3.5 in the four groups. Differences were not statistically significant. The best-corrected visual acuity (BCVA) was LogMAR 0.5 ± 0.13 in nuclear, LogMAR 0.49 ± 0.21 in cortical, and LogMAR 0.58 ± 0.12 in mixed cataract patients, and significantly worse in patients with subcapsular posterior cataract (LogMAR 0.64 ± 0.12). Microperimetry shows a mean sensitivity of 11.4-12.6 dB without significant group differences. The BCVA is correlated with microperimetry in patients with nuclear and cortical cataract. Density of cataract is highly correlated with microperimetry results in all groups. CONCLUSION: The present study shows a good correlation of microperimetry results with the BCVA of patients with nuclear and cortical cataract. In patients with subcapsular posterior cataract, microperimetry results were better than estimated by BCVA. Density of cataract is highly correlated with macular sensitivity. A reduction of 1 dB in microperimetry per 1 posterior capsule opacification score increase can be estimated for these patients.

Comparison of retinal thickness values and segmentation performance of different OCT devices in acute branch retinal vein occlusion.

PURPOSE: To compare retinal thickness (RT) measurement and segmentation performance of time domain (TD, Stratus) and spectral domain (SD) optical coherence tomography (OCT) devices (Cirrus, Spectralis) for imaging macular oedema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: In this study, 20 eyes of 20 consecutive patients with acute BRVO were included. A total of 18 unaffected fellow eyes served as control group. RT measurement was analysed in the five inner fields of the early-treatment diabetic retinopathy grid, and proportional segmentation errors were evaluated. RESULTS: Central millimetre thickness (CMT) showed a mean difference of -64, -74, and -18 µm (P < 0.001) in the control group and -31 µm (P=0.107), -92 µm (P<0.001), and -105 µm (P=0.016) in the BRVO group, between Stratus and Cirrus, between Stratus and Spectralis, and between Cirrus and Spectralis, respectively. Mean RT showed the highest variability between different devices in the area most intensively affected by BRVO-related ME. In eyes with BRVO, 14.6% of Spectralis, 20% of Stratus, and 36.6% of Cirrus scans demonstrated moderate and severe segmentation errors. CONCLUSION: RT measurement in eyes with BRVO, by TD and SD OCT, is compromised by a significant rate of segmentation errors. Deviations are most pronounced in the areas most severely affected by ME.

[Specific alterations in the retinal microstructure in neovascular age-related macular degeneration under anti-VEGF therapy. A detailed analysis of intraretinal changes and their possible role for follow-up]. / Mikrostrukturelle Veränderungen bei neovaskulärer altersbedingter Makuladegeneration unter Anti-VEGF-Therapie. Eine detaillierte Analyse schichtspezifisch-morphologischer Alterationen und ihre mögliche Eignung im Follow-up.

BACKGROUND: High-definition raster scanning spectral-domain optical coherence tomography (SD-OCT) allows a precise assessment of retinal layers and a more detailed detection of subtle morphological alterations. The aim of this study was to observe such changes in patients with neovascular age-related macular degeneration (nAMD) under anti-VEGF therapy and to evaluate if they show characteristic and reversible properties. METHODS: The study included 20 consecutive patients with untreated nAMD. SD-OCT with an axial resolution of 6 µm and a scan velocity of up to 25,000 A-scans/s was used for high-resolution imaging of the macular region at baseline and at months 1 and 3. Characteristic changes in the retinal microstructure were documented and analyzed. RESULTS: Obvious morphological changes as well as discrete intraretinal alterations showed a clear improvement until the third month following the initial ranibizumab injection. Destructions of the neurosensory retina and the outer retinal layers were partly reversible and significantly reduced after treatment was applied. CONCLUSION: SD-OCT was able to detect additional information on specific morphological alterations within the retina. These changes showed a considerable reduction under consistent treatment indicating their potential value for monitoring treatment success in antiangiogenic strategies.

Thirty-month follow-up after intravitreal bevacizumab in progressive idiopathic macular telangiectasia type 2.

AIM: The aim of this study is to evaluate the long-term efficacy of intravitreal bevacizumab (IVB) for eyes with non-proliferative idiopathic macular telangiectasia type 2 (IMT2) and acute vision loss. METHODS: In this interventional case series, treatment-naive eyes of 13 consecutive patients with IMT2 were included. Eyes with a recent onset of visual loss were treated with 0.04 ml IVB (n=7). Fellow eyes and eyes of patients without disease progression served as control group (CG) (n=12). Follow-up examinations included ophthalmoscopy, best-corrected visual acuity (BCVA), optical coherence tomography, and fluorescein angiography (FA). RESULTS: Mean follow-up time was 32±5.7 months in the treatment group (TG) (n=7) vs 29±8.8 months in the CG (n=16). Mean BCVA increased from logMAR 0.47±0.32 at baseline to logMAR 0.33±0.31 (P=0.21) at the last visit in the TG and decreased from logMAR 0.25±0.39 to logMAR 0.30±0.40 in the CG (P=0.17). All patients in the TG showed stabilisation or improvement in vision in Snellen lines in contrast to the CG (χ(2)-test P=0.04). Patients received on average 2.3±1.3 IVB injections. Mean central millimetre thickness in TG and CG was 260±83 and 201±32 µm at baseline vs 237±69 and 199±29 µm at the last visit, respectively (P=0.23 and 0.77). FA revealed a significant decrease of the juxtafoveal staining size at month 3 (P= 0.004) and a slight reduction at the last visit (P= 0.11) in the TG. CONCLUSION: Despite an overall moderate effect of IVB treatment, individual patients experience a marked functional and morphological long-term benefit.

[Combination of Intravitreal rTPA, gas and ranibizumab for extensive subfoveal haemorrhages secondary to neovascular age-related macular degeneration]. / Kombinierte intravitreale Injektion von rTPA, Gas und Ranibizumab zur Behandlung grossflächiger subfovealer Blutungen bei neovaskulärer altersbedingter Makuladegeneration.

BACKGROUND: The aim of this study was to evaluate the clinical outcomes of the combination therapy with intravitreal recombinant tissue plasminogen activator (rTPA), gas and lucentis for patients with extensive subfoveal haemorrhages secondary to neovascular age-related macular degeneration (AMD). METHODS: In this retrospective clinical study 10 eyes with extensive subfoveal haemorrhages secondary to neovascular AMD were included and treated with intravitreal rTPA (0.05 mL; 0.025 mg/0.1 mL in 0.9% NaCl), 100% sulphur hexafluoride (SF(6)) gas (0.5 mL) and lucentis (0.05 mL, 10 mg/mL) within two weeks after the onset of the subretinal haemorrhage. Retreatments with lucentis were performed at 4-week intervals if there were persistent submacular haemorrhages or signs of active choroideal neovascularisation (CNV). The treatment effect was evaluated using best-corrected visual acuity (VA, Snellen), complete ophthalmic examination, fluorescein angiography (FLA) and optical coherence tomography (OCT). RESULTS: Mean observation period was 6.4 A+/- 3.7 months (range: 3 - 13 months). With regard to VA, in 7 eyes there was an increase in VA (> or = 1 Snellen lines), in 1 eye a stabilisation and in 2 eyes a decrease in VA (> or = 1 Snellen lines). At the end of follow-up time, with regard to VA no significant difference was observed compared to baseline (p = 0.41). In 1 patient an intra-operative transient central arterial occlusion and in another patient a corneal erosion and an increase of intraocular pressure up to 27 mmHg were observed after initial combination treatment. On average there were 1.9 A+/- 1.3 retreatments indicated after initial treatment. CONCLUSION: The combination of rTPA, gas and lucentis is a valuable therapy for extensive subfoveal haemorrhages secondary to neovascular AMD resulting in stabilisation of both VA and morphologic parameters.

Effect of intravitreal ranibizumab in avascular pigment epithelial detachment.

PURPOSE: To evaluate long-term morphologic and functional changes after intravitreal ranibizumab in avascular pigment epithelial detachment (PED) secondary to age-related macular degeneration (AMD). PATIENTS AND METHODS: Interventional, prospective case series; the first group of six patients received three and the second group of six patients received six intravitreal injections of ranibizumab (0.5 mg) at monthly intervals. Outcome measures included the change of PED and retinal volume as determined by spectral domain optical coherence tomography (Cirrus), best-corrected visual acuity (BCVA; Early Treatment Diabetic Retinopathy Study), and macular sensitivity using microperimetry (MP-1; Nidek Co. Ltd). RESULTS: The mean baseline PED volume of 1.33 mm3 decreased significantly by 42% at month 6 (-0.55 mm3, P<0.05). Compared to baseline no significant change was observed at months 9 and 12. BCVA, retinal volume, and macular sensitivity remained stable during the entire follow-up. In one case a tear of the retinal pigment epithelium was observed after five injections with a consequent decrease of BCVA of four lines. CONCLUSION: Treatment with intravitreal injections of ranibizumab may temporarily decrease the volume of avascular PED secondary to AMD, however this effect was not maintained over the 1-year study period. The treatment was ineffective for improving retinal function as measured with BCVA and microperimetry.

Ocular hemodynamic effects of nitrovasodilators in healthy subjects.

Nitric oxide (NO) plays a key role in the regulation of ocular blood flow and may be an interesting therapeutic target in ocular ischemic disease. In the present study, we hypothesized that NO-releasing drugs may increase blood flow to the head of the optic nerve and also in the choroid. The study employed a randomized, placebo-controlled, double blind, four-way crossover design. On separate study days, 12 healthy subjects received infusions of nitroglycerin, isosorbide dinitrate, sodium nitroprusside, or placebo. All three study drugs reduced the mean arterial pressure (MAP) and ocular perfusion pressure (OPP) (P < 0.001). None of the administered drugs increased the ocular hemodynamic variables. By contrast, vascular resistance decreased dose dependently during administration of the study drugs (P < 0.001). These results indicate that systemic administration of NO-donor drugs is associated with a decrease in vascular resistance in the ocular vasculature. However, because these drugs also reduce blood pressure, they do not improve perfusion to the posterior eye pole.

Randomised clinical trial of intravitreal Avastin vs photodynamic therapy and intravitreal triamcinolone: long-term results.

PURPOSE: To compare 1-year functional and anatomic outcomes of intravitreal bevacizumab (IVB) and photodynamic therapy plus intravitreal triamcinolone (PDT+IVTA) combination in patients with neovascular age-related macular degeneration (AMD). METHODS: In this prospective, randomised, controlled clinical trial, 28 patients were included. All patients were randomised 1 : 1 to 0.04 ml/1 mg of IVB or PDT plus same day 0.1 ml/4 mg IVTA (PDT+IVTA). Follow-up examinations were performed in monthly intervals in IVB group and every 3 months in PDT+IVTA group. Main outcomes were change in mean visual acuity (VA), mean central retinal thickness (CRT) and the mean number of treatments. RESULTS: At month 12, mean VA improved to a 1.5-line gain in IVB group, and lost three letters in PDT+IVTA group (P=0.02). Mean CRT was reduced from 357 microm at baseline to 244 microm at month 12 in IVB group and from 326 microm to 254 microm, respectively, in PDT+IVTA group (P=0.8). The mean number of treatments was 6.8 in the IVB group vs 1.9 in the PDT+IVTA group. No significant local or systemic safety concerns were detected during follow-up time. CONCLUSIONS: Patients treated with IVB showed a significant better VA outcome compared with the PDT+IVTA group despite the fact that both modalities showed equal potency in reducing CRT during a 12-month period.

Visual performance 3 years after successful macular hole surgery.

BACKGROUND/AIMS: To evaluate the visual performance of patients with successful macular hole surgery with a minimum follow-up of 3 years. Results were compared with the performance of the healthy fellow eyes. METHODS: 15 patients were studied. The healthy fellow eyes of the patients (13 eyes) served as a control group. Age, gender and best-corrected logMAR visual acuity were recorded. Reading acuity (in log reading acuity determination (RAD), reading equivalent of logMAR) and speed were tested monocularly. Scotoma size was measured with SLO perimetry, and hole closure was confirmed with an OCT scan. RESULTS: The mean distance visual acuity of the operated eyes (logMAR 0.32 (SD 0.21)) was significantly lower than that of the healthy fellow eyes (logMAR 0.05 (0.17)), but significantly higher than preoperatively (logMAR 0.71 (0.32)). The mean reading acuity was logRAD 0.47 (0.25) for the operated eyes ( = 77.9% of logMAR), and statistically significantly higher (logRAD 0.16 (0.16)) for the fellow eyes ( = 89.4% of logMAR). The mean maximum reading speeds were comparable for the operated eyes (168.3 (23.1) words per minute (wpm)) and the fellow eyes (178.7 (26.1) wpm) (p = 0.3). Within logRAD 1.3 and 0.5, the mean reading speeds of the two groups were comparable, but critical print size (CPS) for the operated group (logRAD 0.7 (0.2)) was significantly worse than those for the fellow eyes (logRAD 0.4 (0.2)). The SLO analysis showed absence of absolute scotoma in 12 eyes. CONCLUSION: Distance and reading acuity showed remaining deficits compared with the healthy fellow eyes; however, mean maximum reading speeds of the operated eyes achieved results comparable with healthy eyes. The results show a long-term benefit in the visual function of eyes with closed macular holes.

Interexaminer and intraexaminer reliability of the microperimeter MP-1.

PURPOSE: To evaluate the interexaminer and intraexaminer reliability of macular microperimetry using the microperimeter MP-1. METHODS PARTICIPANTS: Fifteen healthy volunteers younger than 40 years of age (Group 1), 15 healthy subjects over 60 years (Group 2), and five patients with age-related macular degeneration (Group 3). OBSERVATION PROCEDURE: Two examiners (E1 and E2) measured, in random order, interexaminer (E2-E1a) reliability. Another examination was undergone by one of the examiners a week later to evaluate the intraexaminer (E1b-E1a) reliability. MAIN OUTCOME MEASURES: Macular sensitivity (mean threshold (decibel)) and stability of fixation were determined using MP1 microperimetry. Agreement was analysed by means of Bland-Altman plots and by the determination of the intraclass correlation coefficient.ResultsThe interexaminer (E2-E1a) and the intraexaminer (E1b-E1a) differences in the mean threshold values were not statistically significant (P=0.850, 95% confidence Interval (CI)=-0.265 to 0.319; P=0.246, 95% CI=-0.099 to 0.375, respectively). Limits of agreement and intraclass correlation coefficients also showed good agreement in each group. CONCLUSIONS: A good reliability was found for the mean threshold values in all the three groups, indicating examiner-independent measurements.

Management of extensive subfoveal haemorrhage secondary to neovascular age-related macular degeneration.

BACKGROUND: To evaluate the clinical outcomes of subfoveal haemorrhages secondary to neovascular age-related macular degeneration (AMD), which were treated with intravitreal recombinant tissue plasminogen activator (rTPA)/gas and anti-vascular endothelial growth factor (anti-VEGF) drug or with an intravitreal anti-VEGF monotherapy. METHODS: This is a retrospective pilot study. Patients who received intravitreal rTPA/gas and anti-VEGF injections (n=20, bevacizumab or ranibizumab) were included in group A. Patients who refused prone positioning after rTPA/gas injections and were treated with an anti-VEGF monotherapy (bevacizumab) alone were included into group B (n=10). Changes in baseline visual acuity (VA, Snellen), central retinal thickness (CRT) and haemorrhage size were analysed. RESULTS: Mean baseline VA was 0.15+/-0.2 and 0.25+/-0.17 in groups A and B, respectively. At month 4, significant improvement in mean VA was observed in group A (mean difference: +0.1+/-0.14; P=0.003), and a stabilization in group B (mean difference: +0.008+/-0.2; P=0.94). CRT decreased significantly by 70 microm in group A (P=0.001) and by 84 microm in group B (P=0.03). The mean size of subfoveal haemorrhage in groups A and B was 20.2 mm(2) and 19.1 mm(2) at baseline and 0.0 mm(2) and 2.0 mm(2) at month 4, respectively. The anti-VEGF treatment rate was 1.6 in group A and 3.0 in group B. CONCLUSION: In patients with extensive subfoveal haemorrhage secondary to neovascular AMD, the combination therapy of rTPA/pneumatic displacement and anti-VEGF results in mean improvement of VA and stabilization of morphological parameters. If rTPA and pneumatic displacement combination is contraindicated, an anti-VEGF monotherapy may be performed to prevent further visual loss.

Reduced fluence versus standard photodynamic therapy in combination with intravitreal triamcinolone: short-term results of a randomised study.

BACKGROUND: To compare early treatment effect of reduced fluence versus standard photodynamic therapy (rPDT, sPDT, respectively) in combination with intravitreal triamcinolone (IVTA) in neovascular age-related macular degeneration. METHODS: Forty patients received either sPDT (group A, n = 20) or rPDT (group B, n = 20) each followed by same-day 4 mg IVTA. Patients were examined at baseline, day 1, week 1, 4 and 12. Main outcomes were visual acuity, central retinal thickness (CRT), choroidal perfusion and macular sensitivity (MS). RESULTS: Baseline characteristics were well balanced in both groups (p>0.05). At week 12, patients in group A had a mean loss of -3.7 letters compared with a gain of 3.4 letters in group B (p = 0.04, between both groups). Both treatment groups showed a similar course regarding CRT as well as MS (p>0.05). In 70% (14/20) of group A and 15% (3/20) of group B, a choroidal hypoperfusion in the area of treatment was observed after treatment (p<0.001). In 70% of group A and 55% of group B, a repeat treatment was indicated at week 12 (p = 0.55). CONCLUSIONS: At month 3, the rPDT+IVTA group showed a significantly better visual outcome, less alteration of the choroid and a trend for lower recurrence rate than the sPDT+IVTA group. Further follow-up of this study will provide information on long-term functional results and treatment durability.

Intravitreal bevacizumab (Avastin) therapy versus photodynamic therapy plus intravitreal triamcinolone for neovascular age-related macular degeneration: 6-month results of a prospective, randomised, controlled clinical study.

AIMS: To compare functional and anatomical outcomes of intravitreal bevacizumab (Avastin) and verteporfin (photodynamic) therapy (PDT) combined with intravitreal triamcinolone (IVTA) in patients with neovascular age-related macular degeneration (AMD). METHODS: Twenty-eight patients with neovascular AMD were enrolled in a prospective, randomised, controlled clinical trial. All patients randomly assigned to 1 mg intravitreal bevacizumab (0.04 ml) received three initial treatments at 4-week intervals. In further follow-up retreatment was based on optical coherence tomography (OCT). Patients randomly assigned to standard PDT received a same-day intravitreal injection of 4 mg triamcinolone (Kenalog). Retreatment was based on fluorescein angiography at 3-month intervals. Functional and anatomical results were evaluated using the Early Treatment Diabetic Retinopathy Study protocol vision charts, fluorescein angiography and OCT. RESULTS: In the bevacizumab-treated group mean visual acuity (VA) improved to a 2.2 line gain at 6 months follow-up. Eyes treated in the PDT plus IVTA group had a stable mean VA at month 6 compared with baseline. There was a statistically significant difference (p = 0.03, analysis of variance (ANOVA)) between both groups as early as one day after initial treatment. The reduction in central retinal thickness (CRT) showed no significant difference between both groups (p = 0.3, ANOVA). Mean CRT was reduced from 357 microm at baseline to 239 microm at month 6 in bevacizumab-treated patients and from 326 microm to 222 microm, respectively, in PDT plus IVTA-treated patients. No significant local or systemic safety concerns were detected up to month 6. CONCLUSION: Intravitreal bevacizumab showed promising 6-month results in patients with neovascular AMD. Functional outcomes appear not only to be dependent on a reduction in CRT but also on the treatment modality used.

[Intravitreal bevacizumab versus verteporfin and intravitreal triamcinolone acetonide in patients with neovascular age-related macula degeneration]. / Intravitreales Bevacizumab vs. Verteporfin und intravitreales Triamcinolon Acetonid bei Patienten mit neovaskulärer AMD.

AIM: The aim of this study was to compare intravitreal bevacizumab (IVB) and verteporfin therapy in combination with 4 mg intravitreal triamcinolone (PDT-IVTA) in patients with neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS: A total of 30 eyes of 30 patients with neovascular AMD were included in a prospective, randomized study. Ten eyes received PDT-IVTA with a standard light fluence of 50 J/cm(2) (SPDT-IVTA), ten were treated with PDT-IVTA with a reduced light fluence of 25 J/cm(2) (RPDT-IVTA) and ten received IVB. The main outcome was evaluated using early treatment diabetic retinopathy study (ETDRS) visual acuity, fluorescein angiography and optical coherence tomography (OCT) at baseline as well as at day 1, week 1, 1 month and 3 months after therapy. RESULTS: At the beginning of therapy, the distribution of the groups was balanced. After 3 months, the SPDT-IVTA group showed a non-significant vision loss of seven letters (p<0.3) while a vision loss of 0.5 letters (p<0.9) was found in the RPDT-IVTA group. At the same time, the IVB group had a vision improvement of 11.8 letters (p<0.001). This vision improvement was statistically significant compared to the results of both PDT-IVTA groups (p<0.005). Central retinal thickness (CRT) decreased up to month 3 in the SPDT-IVTA group by 132 microm, in the RPDT-IVTA group by 78 mum and in the IVB group by 138 microm, (p<0.05 in the three groups). No significant difference in the decrease of CRT was found between the treatment groups after 3 months. CONCLUSION: IVB shows significantly better results in vision improvement in the short-term compared to the two PDT-IVTA groups. Within 3 months, all groups showed a comparable decrease in CRT. Long-term follow-up is required to evaluate the safety and treatment efficacy of all treatment modalities.

Objective assessment of intraocular flare after cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing in adults.

AIM: Combining primary posterior capsulorhexis (PPC) and posterior optic buttonholing (POBH) in cataract surgery is an innovative approach to prevent after-cataract formation effectively and to increase postoperative stability of the intraocular lens (IOL). The present study was designed to compare the postoperative intraocular flare after cataract surgery with combined PPC and POBH to conventional in-the-bag implantation of the IOL. METHODS: Fifty consecutive age-related cataract patients with cataract surgery under topical anaesthesia in both eyes were enrolled prospectively into a prospective, randomised clinical trial. In randomised order, cataract surgery with combined PPC and POBH was performed in one eye; in the other eye cataract surgery was performed conventionally with in-the-bag IOL implantation keeping the posterior lens capsule intact. Intraocular flare was measured 1, 2, 4, 6, 12 and 24 h postoperatively, as well as 1 week and 1 month postoperatively, using a KOWA FC-1000 laser flare cell meter. RESULTS: The peak of intraocular flare was observed in POBH eyes and eyes with in-the-bag IOL implantation 1 h postoperatively. In both groups, the response was steadily decreasing thereafter. During measurements at day 1, small though statistically significant higher flare measurements were observed in eyes with in-the-bag IOL implantation (p<0.05). At 1 week and 1 month postoperatively, intraocular flare measurements were comparable again (p>0.05). CONCLUSION: Cataract surgery with combined PPC/POBH showed slightly lower postoperative anterior chamber reaction compared to conventional in-the-bag implantation during 4-week follow-up, indicating that POBH might trigger somewhat less inflammatory response. This could be explained by the posterior capsule sandwiching between the optic and the anterior capsule, preventing direct contact-mediated myofibroblastic trans-differentiation of anterior lens epithelial cells with consecutive cytokine depletion.