Optical Coherence Tomography Angiography in Uveitic Glaucoma - A Pilot Study.

Purpose: To compare vessel density (VD) as measured by optical coherence tomography angiography (OCTA), in uveitic eyes with secondary glaucoma (UG) with VD in uveitic eyes without glaucoma (UV), eyes with primary open-angle glaucoma (POAG), and healthy eyes (HY).Methods: VD was measured at the following segmentation areas: radial peripapillary capillaries, superficial (SL) and deep vascular plexus (DL) and choroid.Results: The majority of the measured papillary areas showed significantly lower VD in the UG group than in the HY group. In macular area, in the superficial vascular plexus wholeVD was significantly lower than in the healthy group, as well as in four other quadrants. In DL no significant differences could be found. At choroidal level, the VD of UG group were significantly lower in two quadrants than in UV group.Conclusions: OCTA can be used to detect differences in VD in papillary and macular region of uveitis glaucoma eyes.

[Trabeculectomy with Ologen® implant and bevacizumab]. / Trabekulektomie mit Ologen®-Implantat und Bevacizumab.

BACKGROUND: Trabeculectomy is the most frequent form of glaucoma surgery. Despite the intraoperative use of antimetabolites, such as mitomycin C (MMC) postoperative scarring reactions can cause surgical failure. The subconjunctival placement of an Ologen® implant can avoid wound scarring. The additional application of bevacizumab should reduce angiogenesis and thereby scarring reactions and improve the surgical success rate. METHODS: This was a retrospective single center study of patients with glaucoma after trabeculectomy with MMC. The operation was carried out either without an Ologen® implant (group 1), or with an Ologen® implant as an bevacizumab depot (group 2) or with an Ologen® implant and intrachamber injection of bevacizumab (group 3). The follow-up postoperative observation of intraocular pressure (IOP), complications, subsequent interventions and antiglaucoma treatment was performed for 12 months. RESULTS: There were no significant differences between the groups with respect to IOP, complications, subsequent interventions and postoperative antiglaucoma treatment. The highest success rate (IOP after 12 months ≤15 mm Hg without treatment) was in group 1 (77.5%), followed by group 2 with 63.6% and group 3 with 57.1% (p = 0.34, χ2-test). CONCLUSION: The highest success rate was achieved in group 1 with MMC but without an Ologen® implant or bevacizumab. In this study the additional use of Ologen® implants and bevacizumab in trabeculectomy was found to be a safe operation method but did not provide any additional benefits.

Retinal perfusion 6 months after trabeculectomy as measured by optical coherence tomography angiography.

PURPOSE: To investigate potential changes of vessel density (VD) at the optic nerve head (ONH) and the macula 6 months after trabeculectomy (TE). METHODS: In a prospective monocentric study, 19 eyes with open-angle glaucoma were treated with TE + MMC (mitomycin C). At four different time points multiple morphological papillary parameters were measured by OCT, and the ONH VD in the radial peripapillary capillary layer and the superficial and deep plexuses of the macula was determined by OCTA (optical coherence tomography angiography, RTVue-XR, Optovue). The mean defect was determined by visual field examination (mode 30-2, Humphrey Field Analyzer). The duration of follow-up was 6 months. RESULTS: Nineteen eyes, one each from 19 patients (11 females; 8 males) with a mean age of 66.0 (58.07, 70.94) years and a mean intraocular pressure (IOP) of 21.0 mmHg (17.07, 23.87), were included in the study. All showed a significant reduction in IOP at each follow-up after TE (p < 0.0001). There was no significant change in the peripapillary retinal nerve fiber layer thickness (p = 0.88), the ganglion cell complex (p = 0.97), the cup-disk ratio (p = 0.63), the rim area (p = 0.78), or the mean visual field defect (p = 0.82). With regard to VD, no significant difference could be determined in either the ONH or the macular area. CONCLUSIONS: After significant surgical reduction of IOP by TE, there are no significant detectable morphological changes in the ONH or the ganglion cell complex as measured by OCT, nor does the papillary or macular OCTA-determined VD change significantly. Trial registration 2016-409-f-S Avanti-OCT-A. Registered December 1, 2016.

Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis.

BACKGROUND: Uveitis in juvenile idiopathic arthritis (JIAU) is frequently associated with the development of complications and visual loss. Topical corticosteroids are the first line therapy, and disease modifying anti-rheumatic drugs (DMARDs) are commonly used. However, treatment has not been standardized. METHODS: Interdisciplinary guideline were developed with representatives from the German Ophthalmological Society, Society for Paediatric Rheumatology, Professional Association of Ophthalmologists, German Society for Rheumatology, parents' group, moderated by the Association of the Scientific Medical Societies in Germany. A systematic literature analysis in MEDLINE was performed, evidence and recommendations were graded, an algorithm for anti-inflammatory treatment and final statements were discussed in a consensus meeting (Nominal Group Technique), a preliminary draft was fine-tuned and discussed thereafter by all participants (Delphi procedure). RESULTS: Consensus was reached on recommendations, including a standardized treatment strategy according to uveitis severity in the individual patient. Thus, methotrexate shall be introduced for uveitis not responding to low-dose (≤ 2 applications/day) topical corticosteroids, and a TNFalpha antibody (preferably adalimumab) used, if uveitis inactivity is not achieved. In very severe active uveitis with uveitis-related deterioration of vision, systemic corticosteroids should be considered for bridging until DMARDs take effect. If TNFalpha antibodies fail to take effect or lose effect, another biological should be selected (tocilizumab, abatacept or rituximab). De-escalation of DMARDs should be preceded by a period of  ≥ 2 years of uveitis inactivity. CONCLUSIONS: An interdisciplinary, evidence-based treatment guideline for JIAU is presented.

Vessel Density in Glaucoma of Different Entities as Measured with Optical Coherence Tomography Angiography.

PURPOSE: To compare papillary and macular vessel density (VD), as measured by optical coherence tomography angiography (OCTA), in eyes with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG) and exfoliation glaucoma (XFG). METHODS: The papillary and macular VD of 40 eyes with POAG, 19 with NTG and 21 with XFG were examined using OCTA (AngioVue™). The VD was measured at two different layers of segmentation (optic nerve head: radial peripapillary capillary [RPC] and nerve head [NH]; macula: superficial [SL] and deep [DL] retinal vascular plexus) with a 4.5×4.5mm papillary and 6×6-mm macular scan. VD was calculated by an automated density measuring tool in the AngioVue™ software. RESULTS: There were no significant differences in the total value of the papillary, peripapillary and macular VD. A significantly higher VD could be measured for NTG compared to POAG, as well as for XFG in the inferior nasal peripapillary sector at RPC-segmentation and at the NH-level between NDG and XFG. CONCLUSION: OCTA can detect a difference in VD in the nasal inferior peripapillary sector in NTG compared with POAG and XFG. These findings may help to improve the understanding of further pathophysiological mechanisms.

OCTA vessel density changes in the macular zone in glaucomatous eyes.

PURPOSE: To evaluate whether macular optical coherence tomography angiography (OCTA) can detect altered vessel density (VD) in the superficial and deep vascular plexus in glaucomatous eyes and to compare the diagnostic utility of the individual VD parameters. METHODS: The macular VD of 135 eyes, comprising 85 eyes diagnosed with glaucoma and 50 healthy control eyes, was examined using two OCTA devices (AngioPlex-Zeiss Meditec, Inc., Dublin, CA, USA, and AngioVue-OptoVue, Inc., Fremont, CA, USA). All study participants had neither vascular pathology, diabetes, nor vasoactive medication. The macular VD was measured at two different levels of segmentation (superficial [SL] and deep [DL] retinal vascular plexus) with a 6 × 6-mm macula scan, and VD was correlated with various structural and functional measurements. In order to test the accuracy of differentiation between eyes with and without glaucoma, we calculated the receiver operating characteristic (ROC) curve and the area under the curve (AUC). RESULTS: Macular VD was significantly lower in both SL and DL in glaucomatous eyes than in healthy eyes (p = SL < 0.0001; DL = 0.009). There was no significant difference in VD between the SL and the DL (p = 6.60 · 10-18). The greatest reduction of VD in glaucomatous eyes was found in the inferior macular sector. There was no correlation of VD with age or refractive error but moderate to high correlation with intraocular pressure, time of initial diagnosis, mean deviation, ganglion cell complex, peripapillary retinal nerve fiber layer thickness, cup to disc ratio, and rim area. Among the 14 individual features of macular VD, whole VD in the SL had the best diagnostic accuracy (77.6%) as measured by the area under the ROC. CONCLUSION: OCTA detects glaucomatous damage by measuring the macular vessel density in the superficial and deep retinal vascular plexus. It can be an additional diagnostic tool to detect glaucoma independently of the optic nerve.

[OCT Angiography of the Glaucoma Optic Nerve]. / OCT-Angiografie der Glaukompapille.

BACKGROUND: Glaucoma is a major cause of blindness worldwide. One possible pathophysiological cause may be vascular dysregulation. Our aim was to investigate whether OCT angiography (OCTA) can detect modified flow density in glaucoma patients in the area of the optic disc. METHODS: A total of 68 eyes were examined by the OCTA system AngioVue™, including 34 eyes diagnosed with glaucoma and 34 healthy control eyes. Total peripapillary flow density was measured at two different levels of segmentation and also in each optic disc sector. RESULTS: At both segmentation levels, it was demonstrated that peripapillar total flow density was significantly different in glaucoma eyes from healthy eyes. Disease progression was determined from the thickness of the ganglion cell complex and retinal nerve fibre layer. Flow density was reduced with disease progression. There was no significant difference between the optic disc sectors. CONCLUSION: The new technology of OCT angiography enables non-invasive quantification of flow density, which is significantly reduced in glaucomatous eyes. OCTA expands the diagnostic spectrum for the detection and monitoring of glaucoma patients.

[Goodpasture syndrome: ocular manifestation in a young man]. / Goodpasture-Syndrom: Okuläre Manifestation bei einem jungen Mann.

Goodpasture syndrome (GS) is a rare organ-specific autoimmune disease that may consist of glomerulonephritis and pulmonary hemorrhage. Only few case reports have been published on ocular symptoms in the context of GS. This is a case report of a 22-year-old male with GS who was referred to our practice because of visual disturbances. The anamnesis revealed pulmonary hemorrhage, acute renal failure and nephrotic syndrome, which was treated by immunosuppressive therapy with additional plasmapheresis. Ophthalmoscopically, bilateral cotton wool spots were found along the vessels and bilateral retinal hemorrhages predominantly at the posterior pole. By intensifying the existing antihypertensive therapy the eyesight showed significant improvement. Although infrequently seen in Goodpasture syndrome it is important to be aware of ocular symptoms as they may be the initial signs of GS.