Differential diagnosis of macular edema of different pathophysiologic origins by spectral domain optical coherence tomography.

PURPOSE: To develop a classification approach based solely on spectral domain optical coherence tomography to differentiate macular edema (ME) of different disease entities and to determine underlying pathology. METHODS: A cross-sectional study including 153 participants: 27 with Irvine-Gass, 31 with uveitic ME, 24 with ME after branch retinal vein occlusion, 13 with central retinal vein occlusion, 44 with diabetic ME, and 14 controls. Spectral domain optical coherence tomography was graded according to a standardized reading protocol. Grading characteristics were: ME pattern in the central line (horizontal/vertical) and in volume scans, distribution of cysts in Early Treatment Diabetic Retinopathy Study grid, morphologic features, and quantitative parameters such as individual layer thickness. The parameters in a best-fitting multivariate model were evaluated for reliability to predict the underlying pathology using a leave-one-out crossover-validation analysis. To evaluate clinical reliability, two masked clinicians graded spectral domain optical coherence tomography images according to the assessed parameters. RESULTS: The best-fitting multivariate model revealed that microfoci, ME pattern in vertical line scan, and foveal retinal nerve fiber layer thickness are the best indicators of the underlying pathology of ME. Classification accuracy of this model was 96%, mean cross-validated test classification accuracy was 84% (r² = 0.95, P < 0.0001). Clinical relevance was examined with 2 independent readers, yielding classification accuracies of 86% in both cases. CONCLUSION: Macular edema demonstrates characteristic patterns, morphologic features, and layer thicknesses dependent on the underlying disease process. Diagnostic recognition of these features may allow clinical and automated disease identification based primarily on spectral domain optical coherence tomography analysis.

Morphologic and functional evaluations during development, resolution, and relapse of uveitis-associated cystoid macular edema.

OBJECTIVES: To describe progression and resolution of uveitis-associated cystoid macular edema (uvCME) using spectral-domain optical coherence tomography and find predictive factors for successful intravitreal triamcinolone acetonide (IVTA) therapy. METHODS: Twenty-nine eyes with treatment-naive uvCME were examined before and at 5 scheduled visits within 3 months after intravitreal triamcinolone acetonide administration. Distribution, resolution, relapse, and development of uvCME were evaluated using spectral-domain optical coherence tomography to describe morphology, progression, and relapse according to a standardized reading protocol. Applying repeated measures analysis of variance, morphologic findings were evaluated as predictive factors of the treatment outcome. RESULTS: At baseline, 89.3% presented with focal CME; 65.6% had outer nuclear/Henley's layer and inner nuclear layer cysts. Following intravitreal triamcinolone acetonide administration, cysts of outer nuclear/Henley's layer diminished before those of inner nuclear layer (P = 0.0004). Small-pointed subretinal detachment (SRD) resolution synchronized with inner nuclear layer cyst extinction, whereas dome-shaped SRD resolution lagged behind (P = 0.014). Relapses of CME appeared in 71.4% of eyes with parafoveal inner nuclear layer cysts. Cysts of outer nuclear/Henley's layer were present in an additional 28.6%. None of the eyes developed SRD during CME relapse. The main effect variables "SRD" and "absence of epiretinal membrane" were associated with greater best-corrected visual acuity improvement (P = 0.05 and P = 0.047), whereas the side effect variables "CME duration", "age," and "uveitis location" had no additional effect on best-corrected visual acuity. Baseline SRD predicted a relapse-free clinical course within the observational period (P = 0.025). CONCLUSION: Different morphologic patterns in uvCME may represent different stages in uvCME progression, and initial morphologic appearance can be linked to the clinical prognosis after the treatment.

Comparing retinal thickness measurements from Cirrus spectral domain- and Stratus time domain-optical coherence tomography.

PURPOSE: The purpose of this study was to compare retinal measurements obtained using spectral domain-optical coherence tomography with measurements obtained using time domain-optical coherence tomography. METHODS: Three hundred and seventy subjects were recruited at three university-based and one community-based retina practice for a cross-sectional observational study. For each subject, one eye was enrolled as the study eye. A Stratus Fast Macular scan was performed, and a Cirrus 200 x 200 Macular Cube scan was performed. Both instruments segment the acquired images to generate retinal thickness values and report averages measured in nine subfields defined by the Early Treatment Diabetic Retinopathy Study. These average values were compared with each other quantitatively using linear regression and Bland-Altman plots. RESULTS: Of the recruited subjects, 283 had acceptable images taken on the same day with both the Cirrus and Stratus devices. Mean differences between the instruments were noted in all subfields for all disease categories and ranged from 29 microm (outer superior subfield) to 54 microm (central subfield). CONCLUSION: Differences between time domain and spectral domain measurements of retinal thickness depend on pathology and location. Comparisons across instruments should be made with caution.

Intravitreal triamcinolone for persistent cystoid macular oedema in eyes with quiescent uveitis.

BACKGROUND: To determine the outcome following injections of triamcinolone acetate (IVTA) in the treatment of persistent cystoid macular oedema (CMO) in quiescent, non-infectious uveitis. METHODS: Retrospective analysis of patients with inactive uveitis requiring/not requiring immunosuppressive therapy who received IVTA because of chronic CMO refractory to previous systemic steroids. Number of IVTA (re-)treatments, distance visual acuity, near visual acuity, mean foveal thickness, intraocular pressure, duration of CMO, type of uveitis and systemic therapy were assessed previous to and 1, 4, 12 weeks following each IVTA treatment. RESULTS: Between March 2003 and May 2006, 24 eyes of 18 patients received between one and three IVTA injections. A resolution of chronic CMO was observed in 7/24 eyes (29.2%, 5 eyes after single injection of IVTA, 1 eye each after two and three injections of IVTA), a significant increase in distance visual acuity in 9/24 eyes (37.5%; 5 eyes with resolution of CMO, 4 eyes despite persistent CMO) and in near visual acuity in 13/24 eyes (54.6%; 6 eyes with resolution of CMO, 7 eyes despite persistent CMO). CONCLUSIONS: IVTA might be considered as a treatment for patients with chronic CMO when persistent despite previous systemic steroid therapy. Even patients without sustained resolution of CMO after IVTA might benefit in terms of transiently increasing visual acuity, but progression of cataract and rise in intraocular pressure limit repeatability.

Anatomy and function of the macula after surgery for retinal detachment complicated by proliferative vitreoretinopathy.

PURPOSE: To investigate the macular changes following silicone oil removal after surgery for complicated retinal detachment (RD) with proliferative vitreoretinopathy (PVR). DESIGN: Retrospective interventional case series. METHODS: setting: Vienna, Austria. study population: Thirty-nine patients with attached retina after silicone oil removal following previous vitrectomy and silicone oil tamponade for complicated RD and PVR grade C3 and worse. observation procedures: Examination of macular anatomy with biomicroscopy, optical coherence tomography (OCT), and fluorescein angiography (FA). Macular function was tested by assessing logMAR distance visual acuity (VA) using Early Treatment Diabetic Retinopathy Study (ETDRS) charts and reading acuity and reading speed using a standardized test (Radner charts). main outcome measures: Macular anatomy, VA, reading acuity, and reading speed. RESULTS: The macula was clinically normal in five patients (12.8%). Retinal pigment epithelium (RPE) irregularities were found in nine patients (23.1%). Eight patients (20.5%) had macular pucker, seven (18.0%) had cystoid macular edema (CME), and 10 (25.6%) had subretinal fibrosis. The mean VA of all patients was logMAR 0.67 +/- 0.68 (range, -0.1 to 3.0). Six eyes did not achieve reading acuity. The distance VA of the remaining 33 eyes was logMAR 0.44 +/- 0.29 and their mean reading acuity was logRAD 0.62 +/- 0.35, with a reading speed ranging from 55 to 240 words per minute. CONCLUSIONS: We found macular changes in 87% of the patients, one-third thereof being eligible for further treatment (macular pucker or CME). Thus, the majority of these patients do not seem to be eligible for a further improvement of anatomic or functional outcome.

Functional macular mapping in patients with vitreomacular pathologic features before and after surgery.

PURPOSE: To evaluate the potential benefit of microperimetry and preferential hyperacuity perimeter (PHP) to document visual performance objectively in patients with macular hole and macular pucker undergoing macular surgery. DESIGN: Observational case series. METHODS: In 19 patients with macular hole and 18 with macular pucker, best-corrected visual acuity (BCVA; in logarithm of the minimum angle of resolution units), central retinal sensitivity, and presence and extent of metamorphopsia were documented before and four and 12 weeks after surgery. Macular sensitivity (mean sensitivity decibel [dB], stability of fixation) was determined using MP1 microperimetry (Nidek, Padova, Italy). The PreView-PHP (Carl Zeiss Meditec, Dublin, California, USA) was used to quantify metamorphopsia. RESULTS: Before surgery, mean BCVA was 0.68 +/- 0.25 (macular holes) and 0.58 +/- 0.25 (macular pucker). Microperimetry demonstrated a mean retinal sensitivity of 11.3 +/- 2.5 dB (macular holes) and 10.7 +/- 2.8 dB (macular pucker). Twelve weeks after surgery, mean BCVA improved to 0.53 +/- 0.26 (macular holes) and 0.33 +/- 0.26 (macular pucker; P = .042 and P = .004). Accordingly, retinal sensitivity increased significantly with 12.8 +/- 1.9 dB (macular holes) and 12.7 +/- 2.5 dB (macular pucker; P = .04 and P = .02) as well as stability of fixation. At 12 weeks, 47.3% of macular hole eyes and 66.7% of macular pucker eyes improved in BCVA, but a significantly higher number (68.4% [macular holes] and 77.8% [macular pucker]) demonstrated improvement in microperimetry results. PHP results showed no significant change of scotomas, patient reliability, or presence of metamorphopsia at any interval. CONCLUSIONS: A higher number of patients improved in microperimetry than in visual acuity testing. Therefore, microperimetry highlights the value of functional macular mapping for these patients and indicates that BCVA may underestimate functional benefit of surgery.

Reading performance of patients with uveitis-associated cystoid macular edema.

PURPOSE: To evaluate the extent of the visual impairment caused by uveitis-associated cystoid macular edema (CME) and compare the results with lesion size. DESIGN: Observational case series. METHODS: setting: Uveitis outpatient clinic of the Department of Ophthalmology and Optometry, Medical University of Vienna. patient population: CME was verified in 30 eyes of 30 consecutive uveitis patients with optical coherence tomography and lesion size was assessed with retinal thickness analyzer. main outcome measures: Distance visual acuity (VA) (measured with Early Treatment Diabetic Retinopathy Study charts), reading acuity, and reading speed (tested with Radner Reading Charts). Results were compared with nonaffected partner eyes. RESULTS: Distance VA was logMAR 0.22 +/- 0.15 in CME eyes vs -0.02 +/- 0.17 in healthy controls. Reading acuity was 75% of logMAR in CME eyes vs 92% of logMAR in control eyes (P = .01). The mean reading speed was 148.4 +/- 36.6 words per minute in patients with CME vs 168.9 +/- 36.3 in patients without CME (P = .04). Reading acuity correlated with both lesion size and distance VA (r = 0.61; P = .01 and r = 0.53; P = .028, respectively). Neither anatomical classification of uveitis nor gender or age had a significant influence on the evaluated parameters. CONCLUSIONS: Reading acuity and reading speed were considerably more impaired than distance visual acuity. The assessed parameters showed a better correlation to lesion size and seem to be a better reflection of macular dysfunction. Analyzing reading function is an important factor when following patients with CME and evaluating success of treatment modalities.

Informed consent and decision making by cataract patients.

OBJECTIVES: To investigate decision making by patients on the day before cataract surgery and to evaluate to what extent the informed consent process influences the patients' decision regarding consent. METHODS: On the day before surgery, 70 patients (mean +/- SD age, 70.3 +/- 10.3 years) underwent a standardized informed consent procedure. They were also invited to answer 15 questions established in interdisciplinary cooperation among clinical psychologists, lawyers, and ophthalmologists. MAIN OUTCOME MEASURES: We assessed presurgical information and personal estimation of risks in cataract surgery; the patient-physician relationship regarding surgery-related decisions; and evaluations of the informed consent procedure and the patients' decision. RESULTS: Questionnaire answers indicated that 28 (40%) of the 70 participating patients arrived for surgery without any information; 16 (23%) believed that there were surgical procedures without risks; and 53 (76%) estimated that there were no risks for their cataract surgery. A physician-dominated decision for surgery was preferred by 31 patients (44%); 16 (26%) wanted to decide together with their ophthalmologist. Possible risks of a sight-threatening complication did not influence 54 patients' (77%) decisions, and 55 patients (78%) said the informed consent process did not influence their decision. The remaining 15 (22%) stated that the informed consent process positively confirmed their decision. CONCLUSIONS: Informed consent 1 day preoperatively does not seem to influence the decision for cataract surgery. Cognitive dissonance as part of a decision-making process makes changes in an already chosen option unlikely. The resulting limited decisive potential is very important for credibility in a trial and has to be considered in ophthalmologic surgery.

Proliferative vitreoretinopathy--at what risk is the fellow eye?

PURPOSE: To find out if patients with proliferative vitreoretinopathy (PVR) due to complicated retinal detachment are at risk to acquire the same disease or other vision-threatening retinal abnormalities in the fellow eye. To furthermore assess in what time-period they appear and if subgroups of patients have special risks. METHODS: 100 consecutive PVR-patients were studied retrospectively. 21 patients with PVR graded lower than C3, traumatic PVR, diabetic retinopathy or congenital vitreoretinal diseases were excluded. Age, gender, best-corrected visual acuity at the first and last visit, refraction, ocular disease in both eyes and observation-time were recorded. RESULTS: After a mean follow-up of 8.5 years, 42 of 79 patients (53.4%) showed vision-threatening abnormalities in their fellow eyes: among them, 9 patients (11.4%) had PVR, 13 (16%) simple retinal detachments and 14 (17.3%) retinal breaks. Abnormalities in the fellow eye did not develop after a certain time following surgery of the primary eye; 71.4% appeared within 5 years. Aphakic and pseudophakic patients had retinal breaks significantly more often (p = 0.011) than phakic patients. Myopia did not increase the risk for any abnormality. Men developed retinal detachment (p = 0.037) and PVR (p = 0.025) significantly more often than women. CONCLUSION: Patients with PVR have a greater than 50% risk of developing vision-threatening retinal abnormalities in their fellow eye. Because of this increased risk, these patients need regularly-scheduled long-term follow-up. SUMMARY STATEMENT: Patients with PVR have a greater than 50% risk of developing vision-threatening retinal abnormalities in their fellow eye and a 37% risk to develop PVR from rhegmatogenous retinal detachment. More than two thirds of abnormalities in the fellow eye developed within five years of surgery of the primary eye.

Visual acuity and microperimetric mapping of lesion area in eyes with inflammatory cystoid macular oedema.

PURPOSE: To evaluate the effect of fluid accumulation on local visual function in inflammatory cystoid-macular-edema (ICME). METHODS: This cross-sectional study applied optical-coherence-tomography over a 12×12 fovea-centered field in 50 patients with ICME and mapped the extent of fluid-filled spaces in various retinal layers, of subretinal-fluid and of diffuse-edema. Regression analysis examined effect of planimetric fluid-distribution on best-corrected-visual-acuity (BCVA) and mean microperimetric-sensitivity. RESULTS: BCVA decreased with increasing central-neuroretinal-thickness (r= 0.52, p= 0.001), total central-retinal-thickness, including subneuroretinal-fluid (r= 0.41, p= 0.006), total cystoid-and-diffuse edema-area (r= 0.35, p= 0.036) and cystoid inner-nuclear-layer area (r= 0.39, p= 0.02). Mean retinal-sensitivity decreased with increasing diffuse edema-area (r= -0.86, p<0.0001), total cystoid-and-diffuse edema-area (r= -0.54, p= 0.001), cystoid inner-nuclear-layer area (r= -0.46, p= 0.008) and cystoid ganglion-cell-layer area (r= -0.6, p=0.049), central-neuroretinal-thickness (r= -0.42, p= 0.028) and total central-retinal-thickness (r= -0.34, p= 0.039). In multivariate-analyses BCVA was best described by central-neuroretinal-thickness, duration of edema, total cystoid-and-diffuse edema-area and cystoid inner-nuclear-layer area (R(2) = 0.5, p= 0.002). Mean retinal-sensitivity was best described by diffuse edema-area, total cystoid-and-diffuse edema-area and central-neuroretinal-thickness (R(2) = 0.75, p< 0.0001). Subretinal-fluid area and cystoid outer-nuclear/Henle's layer area had no effect on either BCVA or microperimetry. CONCLUSIONS: Thickening of the neurosensory-fovea, not subfoveal-fluid, had major impact on both BCVA and retinal-sensitivity. The extent of edema in inner retinal layers also had major impact on both of these two functional parameters. Visual-impairment seems to differ depending on the layers involved, thus different types of fluid accumulation may potentially be given varying treatment priorities.

Influence of orthostasis and daytime on retinal thickness in uveitis-associated cystoid macular edema.

AIM: To identify influence of orthostasis and daytime on retinal-thickness in cystoid-macular-edema (CME) using SD-OCT. METHODS: In this cross-sectional study 18 eyes with uveitis-associated CME (uvCME) were included. Orthostatic-changes of retinal-thickness were analyzed using a Cirrus™ SD-OCT. Retinal-thickness was measured with patients lying horizontally on their side, followed by a fast sitting-up and OCT-measurement in sitting-position. Diurnal-change in thicknesses were assessed by Spectralis™ OCT between 8 AM and 8 PM. RESULTS: Approximately 20 s elapsed between position-change and the following OCT-measurement. In horizontal-position, the mean central retinal thickness (CRT) was 496 ± 37 µm, in upright position, the mean CRT was reduced to 412 ± 43 µm (p=0.032), thus position-change led to a 17% decrease in CRT. None of the other ETDRS-subfields showed a statistically significant decrease in thicknesses (p>0.05). In the second experiment, diurnal-CRT decreased over time, whereas the main decrease happened in the morning (8 a.m. 559 ± 35 µm, 12 p.m. 533 ± 36 µm, 4 p.m. 538 ± 32 µm, 8 p.m.551 ± 38 µm, p=0.01). Thicknesses in all other ETDRS-subgrids did not decrease statistically significantly. CONCLUSIONS: Intraretinal-fluid in uvCME may show a high mobility: CRT decreases within seconds after a patient changes position, indicating that position effects retinal-thickness. Main diurnal-decrease in CRT occurs before noon, which is likely due to a position-change in the morning. Patient-population (walk-in patients versus hospitalized, lying patients) and previous waiting-position should be considered when interpreting retinal-thickness in clinical-practice.

A systematic correlation of morphology and function using spectral domain optical coherence tomography and microperimetry in patients with geographic atrophy.

AIMS: This study has been designed to describe the functional impact of distinct pathologies within the retinal layers in patients with geographic atrophy (GA) by means of a point-to-point correlation between optical coherence tomography (OCT) and microperimetry. METHODS: Retinal morphology and function of 23 patients suffering from GA of the retinal pigment epithelium (RPE) have been investigated using the Spectralis OCT (Heidelberg Engineering) and the MP1 microperimeter (Nidek Technologies). The point-to-point overlay of morphology and function has been done using proprietary software, allowing OCT image grading to define distinct alterations of the neurosensory retina, the RPE and the choroid. By overlaying the retinal sensitivity map on the OCT data set, retinal layer alterations could be evaluated regarding their impact on visual function. RESULTS: A total of 1005 stimulation points in the lesion area in 2107 spectral domain OCT B-scans were graded in 43 eyes of 23 patients (mean best corrected visual acuity=20/70). Retinal sensitivity decreases with an increasing number of morphological alterations graded (p<10(-13)). Alterations of the RPE and the external limiting membrane (p<0.02) were associated with absolute scotomas. Furthermore, the loss of the external limiting membrane as the largest area of morphological alteration among our patients with GA (mean area=5.65 mm(2)), had a significant impact (p<10(-4)) on sensitivity (-1.3 dB). CONCLUSIONS: Mapping retinal sensitivity to distinct retinal pathologies revealed outer retinal layers, in addition to the RPE, as significant for sensitivity loss. Therefore in GA the RPE loss and the alteration of outer retinal layers should be analysed, which could also provide insight into lesion progression.

Systematic correlation of morphologic alterations and retinal function in eyes with uveitis-associated cystoid macular oedema during development, resolution and relapse.

PURPOSE: To evaluate morphological changes due to uveitis-associated cystoid macular oedema (uvCME) and their impact on central retinal sensitivity (CRS) before and after intravitreal triamcinolone-acetonide (IVTA). METHODS: 28 eyes with uvCME were examined with microperimetry and spectral-domain optical-coherence-tomography (SD-OCT) before and after IVTA. Microperimetry-maps were superimposed on SD-OCT and morphological-alterations were correlated point to point with CRS and followed-up for 3 months. The effects of morphological-alterations on CRS over time were evaluated with a linear mixed-model. RESULTS: Mean-CRS increased significantly after IVTA (p=0.009). Proportion of cysts correlated negatively with corresponding CRS (estimate/95% CI -3.8 dB/-6.6 to -0.9, p=0.011). Proportion of diffuse macular-oedema (DifME) had no significant effect on mean-CRS (-0.76 dB/-4.9 to 3.3, p=0.71). The proportion of serous retinal detachment (SRD) had a borderline significant effect on mean-CRS (-9.5 dB/-19.1 to 0.1, p=0.052), however the initial presence of SRD at baseline had no significant negative effect on mean-CRS (-1.3 dB/-4.9 to 2.3, p=0.46). Patients with epiretinal-membrane showed lower mean-CRS than patients without (-3.3 dB/-6.5 to -0.008, p=0.05). The lowest percentage of morphological-alterations was achieved 30 days post IVTA concordant to best visual-acuity (logMAR 0.16 ± 0.26), while best mean-CRS was achieved 90 days post IVTA (16.9 ± 1.8 dB). Fixation-stability showed no significant improvement. CONCLUSIONS: UvCME Morphological-alterations were associated with specific CRS-decreases. DifME showed no significant- and SRD only a borderline effect on mean-CRS, which implicates that their presence should be considered when interpreting SD-OCT and making treatment-decisions.

Encircling band, laser retinopexy and lens removal as standard procedure in complicated retinal detachment shows a good clinical outcome.

PURPOSE: To evaluate vitrectomy in conjunction with the use of perfluorocarbon, cerclage, laser retinopexy, lens removal and silicone oil as surgical treatment of proliferative vitreoretinopathy associated with retinal detachment. METHODS: Sixty-two eyes of 62 patients were treated for complicated retinal detachment following failed prior scleral buckling. Outcome measures were; retinal reattachment rate 6 months after silicone oil removal, status of the retina, visual acuity (VA), duration of silicone tamponade and frequency of reoperations. RESULTS: The final reattachment rate was 95%. Reoperations had to be performed in 25% of patients. Eighty-one per cent of these patients received one and 19% two or more operations following silicone oil implantation. The mean time to reoperation was 1.8 ± 1.4 months. Silicone oil was removed after 5.6 ± 4.1 months following the last vitreoretinal procedure in 90%, respectively, 95% with attached retina. Five per cent experienced retinal detachment after silicone oil removal. At the end of follow-up, the mean VA was 0.13 ± 0.26 Snellen. Seventy per cent of patients achieved a vision of 20/200 or better (mean 0.25 ± 0.27). CONCLUSION: Our study demonstrates good final outcomes when a rigorous surgical approach was used. Furthermore, this standard procedure reduces the need for reoperations and consequently improves the functional outcome.

Evaluation of ranibizumab-induced changes in high-resolution optical coherence tomographic retinal morphology and their impact on visual function.

PURPOSE: To evaluate the effects of intravitreal ranibizumab on retinal function and morphology and to identify a correlation between anatomy and function by using spectral domain optical coherence tomography (SDOCT). METHODS: Twenty-three patients affected by neovascular AMD received three injections of ranibizumab in three consecutive months and were monitored by assessment of best corrected visual acuity (BCVA), central retinal sensitivity (CRS) and morphologic changes at the level of the retina and the retinal pigment epithelium (RPE). The morphologic changes, identified by SDOCT segmentation, were mean retinal thickness (MRT), central retinal thickness (CRT), and the pathologic area (lesion area) of the RPE. RESULTS: BCVA increased from a mean 60.1 +/- 8.7 letters at baseline to 67.0 +/- 10.9 at month 3 (P = 0.0003). The CRS at the 0 degrees position increased from 2.8 +/- 3.1 dB at baseline to 4.0 +/- 5.7 at week 1, remaining stable until month 3. Absolute scotoma size decreased continuously from baseline to month 3, in a mean of 5.3 +/- 5.8 to 3.6 +/- 4.0 test point locations. By SDOCT, MRT decreased from 308.6 +/- 25.9 microm at baseline to 268.4 +/- 22.4 microm at month 3 (P = 0.0001). CRT was 365.8 +/- 84.9 and 254.9 +/- 95.1 microm at month 3 (P = 0.0002). The mean RPE lesion area was 6.0 +/- 3.0 mm(2) at baseline, which decreased to 5.0 +/- 3.1 mm(2) at month 3 (P = 0.115). The only significant correlation was identified between the lesion area and CRS. CONCLUSIONS: In ranibizumab therapy, the condition of the RPE lesion may be more relevant for visual function than the usual OCT parameters, retinal thickness.