Cystic maculopathy of the inner nuclear layer in glaucoma patients.

PURPOSE: The study aimed to detect and describe glaucoma-related pseudocystic abnormalities at the internal nuclear layer (INL) of the macula using OCT, in relation with visual field defects and other clinical data. PATIENTS AND METHODS: Primary open-angle glaucoma patients presenting for a follow-up visit were consecutively included over 5 months and underwent clinical examination, OCT imaging, and central 10-2 visual field testing. OCT measures included the thickness of the peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC), together with an analysis of B-Scans and en-face images. All data provided by OCT were analyzed and compared with the visual field testing. RESULTS: Fourteen patients out of 216 showed pseudocysts in the INL of the macula. These cysts were hyporeflective, fusiform, and of variable size (15 to 25µm) and were always associated with a thinning of both the RNFL and GCC. En-face OCT showed evidence of a distribution of cysts in the macular region, based on the appearance of numerous, dense hyporeflective pits whose localization matched precisely with the vision loss as assessed by central 10-2 visual field testing. No other correlations were found. DISCUSSION: Pseudocysts of the internal nuclear layer of the macular region are found in some cases of chronic glaucoma. Their presence is always associated with a scotoma in the visual field and appear to constitute a marker for glaucoma progression. Glaucoma-related central pseudocysts could result from Müller cell changes, excitotoxicity, and/or trans-synaptic retrograde degeneration. The presence of pseudocysts could be a marker of a particular subpopulation whose features remain to be determined.

Macular pigment density variation after supplementation of lutein and zeaxanthin using the Visucam® 200 pigment module: Impact of age-related macular degeneration and lens status.

PURPOSE: To assess the evolution of macular pigment optical density (MPOD) following supplementation with various macular formulations obtained with the Visucam® 200, and to study the factors affecting MPOD measurements. MATERIALS AND METHODS: In this prospective, randomized, double-masked multicenter study, patients were divided into 2 groups: group A (patients without retinal pathology who underwent cataract surgery 1 month previously) and group B (patients with neovascular age-related macular degeneration [AMD] in one eye). In each group, half of the patients were randomly assigned to receive a food supplementation either with or without carotenoids (5mg of Lutein and 1mg of Zeaxanthin). Outcome measures included MPOD responses obtained with the Visucam® 200 for one year. RESULTS: In total, 126 subjects (52 men, 74 women) with a mean age of 75.3±7.61 years were enrolled. Mean MPOD values at the time of inclusion were statistically lower in group A (0.088 density unit [DU]) compared to group B (0.163 DU, P<0.05). No statistically significant increase in MPOD was noted in either group, even after discontinuation of the supplementation. By multiple regression analysis, age, female gender, lens status and the presence of AMD seemed to significantly affect MPOD measurements. CONCLUSION: No significant improvement in MPOD seems to be detected with the Visucam® 200 after carotenoid supplementation. The MPOD measurement seems to be highly affected by cataract extraction and the presence of AMD.

[Ranibizumab and exudative age-related macular degeneration: 5-year multicentric functional and anatomical results in real-life practice]. / Ranibizumab et dégénérescence maculaire liée à l'âge exsudative : analyse multicentrique à 5ans des résultats fonctionnels et anatomiques en pratique clinique réelle.

PURPOSE: The goal of this study was to evaluate five year functional and anatomical outcomes of wet AMD patients treated with ranibizumab according to a pro re nata (PRN) regimen in real-life practice. METHODS: A retrospective, multicentric chart review of 201 eyes of 201 patients who underwent their first ranibizumab intravitreal injection (IVT) between January 1, 2007 and December 31, 2008 was performed. Best-corrected visual acuity (BCVA), central macular thickness (CMT) on SD-OCT, number of IVT and follow-up visits were collected at baseline and during the entire follow-up period of 5 years. RESULTS: Mean BCVA at baseline was 52.3±16.5 letters. Mean BCVA change from baseline was respectively +2.8, +2.5, +1.8, -0.6 at 1, 2, 3, 4 years of follow-up. At year 5, 43% of eyes had a stable or improved letter score (≥0 letter gain), whereas 29% declined by 15 letters or more, with an overall significant mean decline of 2.8 letters (P<0.05). No correlation was observed between final visual outcome and age, baseline BCVA, type of neovascularization, naive status, number of IVT or number of follow-up visits. On SD-OCT, mean CMT was 293±96µm at baseline and was significantly reduced compared to baseline at each year end-point (P<0.005). The mean number of IVT was 15±10.4 at year 5, with 55% of eyes still being under active treatment. CONCLUSION: PRN ranibizumab in real-life practice improved or stabilized visual acuity over 4 years. During the 5th year, progressive decline of visual acuity was observed.

[Photodynamic therapy for chronic central serous chorioretinopathy and diffuse retinal epitheliopathy]. / Intérêt de la photothérapie dynamique dans les choriorétinopathies séreuses centrales chroniques et les épithéliopathies rétiniennes diffuses exsudatives.

PURPOSE: To report outcomes in patients with long-standing (more than 6 months) chronic central serous chorioretinopathy (CSC) treated with low-fluence Visudyne(®) photodynamic therapy (LFV-PDT). PATIENTS AND METHODS: The clinical, angiographic and optical coherence tomography (OCT) results of patients with long-standing chronic central serous chorioretinopathy (CCSC) treated with LFV-PDT in the Lyon Centre Rabelais between 2002 and 2008 were retrospectively analyzed. A comprehensive check-up (macular syndrome signs, ETDRS best-corrected visual acuity [BCVA], biomicroscopy, fluorescein [FA] and indocyanine green [ICGA] angiographies, OCT scans) was performed before LFV-PDT treatment and 3 months later. Patients were then followed regularly and retreated in case of recurrence. The LFV-PDT treatment, with a fluence of 25 J/cm(2) at an irradiance of 300 mW, was guided by ICGA. RESULTS: Forty-one eyes of 34 patients (27 males; mean age: 53 years) were included, of which 18 eyes had already been treated with laser photocoagulation. Several leaking points were visible on FA in most of the cases (n=38), mainly in the macula (35 cases). Before treatment, metamorphopsia was noted in 51% of the cases, intraretinal edema (IRE) was present on OCT scans in 71%, serous retinal detachment (SRD) in 85%, and pigment epithelial detachment (PED) in 10%. Thirty-nine eyes had only one treatment session and one eye was retreated once. At 3 months after LFV-PDT, IRE was present in 15% of the cases, SRD in 12%, and PED in 2%. At the end of the 20-month follow-up, IRE was present in 14% of the cases, SRD in 15%, and PED in 0%. Macular atrophy was observed on OCT in most of the cases at the end of the follow-up (mean central thickness, 144.5 µm). Compared to the initial BCVA, at 3 months after LFV-PDT, BCVA decreased in 22% of the cases, stabilized in 39%, and increased in 39%, while at the end of the follow-up, BCVA decreased in 12% of the cases, stabilized in 17%, and increased in 71%. No complication was observed. DISCUSSION: LFV-PDT treatment for patients with long-standing chronic central serous chorioretinopathy results in anatomical and functional improvement (sustained disappearance of the exudative phenomenon in most cases and increased BCVA in more than two-thirds of the cases). The macular atrophy observed may be due to the treatment or the natural course of the disease.

[Outer retinal cysts in exudative age-related macular degeneration: a spectral domain OCT study]. / Kystes rétiniens externes dans la dégénérescence maculaire liée à l'âge exsudative: un nouvel aspect de l'OCT.

PURPOSE: To describe the optical coherence tomography (OCT) findings and progression of peculiar retinal cysts that we identified in patients being followed up after anti-vascular endothelial growth factor (anti-VEGF) treatment. METHODS: This is an observational case series. All relevant data (including best-corrected visual acuity and spectral domain OCT scans) concerning exudative age-related macular degeneration (AMD) patients treated with at least three anti-VEGF intravitreal injections (IVT) during the previous 12 months were collected over a period of four months. RESULTS: A total of 376 consecutive choroidal neovascularization (CNV) patients (398 eyes) were examined. Of these patients, 18 (18 eyes, 4.5%), who underwent a mean of five (range, 3 to 15) anti-VEGF IVTs, had a cystic appearance of the retina on OCT scans. These cysts were usually multiple (2 to 7) and presented as optically empty spaces bordered by a mildly reflective rim. Tiny punctate spots were seen inside or along the inner border of the cyst. The presence of these two features allowed the differentiation of these cysts from CME cavities. Usually round, the cysts could be elongated in shape and simulate a serous retinal detachment (SRD). A thin layer of degenerate retina below the cysts helps differentiate them from SRD. The cysts, varying in size from 60 to 600 µm, were always located below the outer plexiform layer and visualized over or contiguous to a fibrous and hyperreflective thickening of the choriocapillary/retinal pigment epithelial (CC/RPE) complex or over an atrophic portion of the CC/RPE complex. Their size did not change over time. CONCLUSIONS: These retinal cysts are a newly reported SD-OCT finding in anti-VEGF-treated exudative AMD. They could correspond to active scavenger macrophages and must be differentiated from CME and SRD in order to avoid unnecessary anti-VEGF retreatment.

[Outcome of photodynamic therapy for subretinal neovascularization secondary to choroidal nevi]. / Résultats de la photothérapie dynamique dans le traitement des néovaisseaux sous-rétiniens secondaires aux naevi choroïdiens.

INTRODUCTION: Choroidal nevi are the most common benign intraocular tumors. However, the occurrence of subretinal neovascularization secondary to choroidal nevus is very rare. Our goal was to assess the efficacy and the safety of photodynamic therapy (PDT) for treatment of subretinal neovascularization related to choroidal nevi. PATIENTS AND METHOD: We conducted a retrospective study including subretinal neovascularization secondary to choroidal nevi treated by PDT from 1999 to 2005. PDT was performed according to the standard protocols used for treating neovascularization due to age-related macular degeneration (ARMD). Post-PDT follow-up was also done according to the guidelines used in ARMD. Moreover, tumors were followed up every 3 months. RESULTS: Six subretinal neovascularizations secondary to choroidal nevi were included in our study. All nevi were localized in the posterior choroids. The median diameter of tumors was 3mm and their thickness was less than 2mm in all cases. Subretinal neovascularizations were classic in five cases. The last case was a small vascularized pigment epithelium detachment. Locations were subfoveal in two cases, juxtafoveal in three cases, and extrafoveal in one case. In half the cases, the size of subretinal neovascularization was 1-disk-diameter or less. A mean of 3.3 sessions of PDT were necessary to obtain the stabilization of subretinal neovascularization on both fluorescein angiography and OCT. The average follow-up period was 35 months with no patients lost to follow-up. Visual outcomes were extremely variable. Large or subfoveal neovascularization but also a history of atrophic ARMD were related to worse functional results. No growth of the nevi was observed. CONCLUSIONS: Subretinal neovascularization is reassuring from the oncologist's point of view because it is considered a relative indicator of benignity of the nevus. However, it often marks a definitive turning point in visual function. PDT appears to be a safe and effective procedure for the treatment subretinal neovascularization secondary to choroidal nevus, with results similar to those observed in ARMD.

Photodynamic therapy with verteporfin in the treatment of exudative idiopathic polypoidal choroidal vasculopathy.

PURPOSE: To determine the safety and efficacy of photodynamic therapy with verteporfin (V-PDT) in the treatment of exudative idiopathic polypoidal choroidal vasculopathy (IPCV) lesions that were not suitable for laser photocoagulation. METHODS: This was a prospective, open label study in two centers involving 30 consecutive patients (31 eyes) diagnosed with exudative IPCV using fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). All patients underwent complete ophthalmologic examination including best-corrected visual acuity (VA) measurement, contrast sensitivity (CS) testing, FA, ICGA, and OCT. OCT was used to assess the stage of the polypoidal dilations (active or scarred) and the evolution of the signs associated with exudation. Study patients were treated with V-PDT and followed up at 6 weeks and 3, 6, and 12 months. Re-treatment was applied, at an interval of 3 months, until there was an absence of leakage on FA and hyperfluorescence on ICGA. RESULTS: Thirty eyes (29 patients) completed the 12 months post-treatment visit and were retained for further analysis. The mean number of V-PDT treatments was 2.5 (SD 1.1). At 12 months post-treatment, the mean foveal thickness had significantly (p<0.03) decreased to 224 (SD 104) microm from the baseline 292 (SD 124) microm while the mean VA had significantly (p<0.02) improved to 0.50 (SD O.38) from the baseline 0.38 (SD 0.24). Serous detachment of the macula completely resolved in 83.3% of the eyes while 73.3% of the polypoidal dilations were occluded at 12 months. CONCLUSIONS: The results suggest that V-PDT is effective and relatively safe in treating exudative IPCV.

Anomalous vitreoretinal adhesions in patients with exudative age-related macular degeneration: an OCT study.

PURPOSE: To analyze the relationship between the retina and the vitreous in patients with exudative age-related macular degeneration (ARMD). METHODS: Consecutive patients with exudative ARMD, proven by fluorescein angiography, were recruited. Fundus biomicroscopic examination, color and re d - f ree fundus photographs, and serial scans of the macular region using optical coherence tomography (OCT3, Carl Zeiss) were performed before and after photodynamic therapy (PDT) with verteporfin (Visudyne, Novartis Ophthalmics). Vitreoretinal relationships have been described and compared with fundus photographs and data of fundus biomicroscopy examination. RESULTS: Sixty-six eyes of 52 consecutive patients (33 women, 19 men; mean age 75 years, range 64 to 89 years) with exudative ARMD were studied. Analysis of serial OCT scans showed that 13 eyes (20%) did not present any visible vitreous structures. Two eyes (3%) had the appearance of a complete posterior vitreous detachment (PVD). Fifty-one eyes (77%) exhibited some abnormalities of the vitre o retinal interface including 12 eyes with epiretinal membrane and retinal thickening and distortion. Among the 39 eyes examined before and after PDT with Visudyne, only 3 eyes developed a partial vitreous detachment and 1 eye progressed to a complete PVD. CONCLUSIONS: Eyes with exudative ARMD exhibit a high prevalence of abnormalities of the vitreoretinal interface similar to that observed in many chronic inflammatory diseases. PDT with verteporfin does not modify the observed vitre o retinal adhesions.

Anomalous vitreoretinal adhesions in patients with exudative age-related macular degeneration: An OCT study.

PURPOSE: To analyze the relationship between the retina and the vitreous in patients with exudative age-related macular degeneration (ARMD). METHODS: Consecutive patients with exudative ARMD, proven by fluorescein angiography, were recruited. Fundus biomicroscopic examination, color and re d - f ree fundus photographs, and serial scans of the macular region using optical coherence tomography (OCT3, Carl Zeiss) were performed before and after photodynamic therapy (PDT) with verteporfin (Visudyne, Novartis Ophthalmics). Vitreoretinal relationships have been described and compared with fundus photographs and data of fundus biomicroscopy examination. RESULTS: Sixty-six eyes of 52 consecutive patients (33 women, 19 men; mean age 75 years, range 64 to 89 years) with exudative ARMD were studied. Analysis of serial OCT scans showed that 13 eyes (20%) did not present any visible vitreous structures. Two eyes (3%) had the appearance of a complete posterior vitreous detachment (PVD). Fifty-one eyes (77%) exhibited some abnormalities of the vitre o retinal interface including 12 eyes with epiretinal membrane and retinal thickening and distortion. Among the 39 eyes examined before and after PDT with Visudyne, only 3 eyes developed a partial vitreous detachment and 1 eye progressed to a complete PVD. CONCLUSIONS: Eyes with exudative ARMD exhibit a high prevalence of abnormalities of the vitreoretinal interface similar to that observed in many chronic inflammatory diseases. PDT with verteporfin does not modify the observed vitre o retinal adhesions. (Eur J Ophthalmol 2006; 16: 134-7).