Topographic angiography and optical coherence tomography: a correlation of imaging characteristics.

PURPOSE: Topographic angiography (TAG) using confocal scanning laser angiography and optical coherence tomography (OCT) are new imaging modalities that have been introduced during recent years. OCT and TAG imaging were compared to specify the characteristics of each imaging modality. METHODS: TAG using fluorescein angiography (FA) provides a three-dimensional profile of the vascular structures based on the analysis of a set of 32 confocal images over a depth of 4 mm. OCT provides cross-sectional images of the neurosensory retina and the retinal pigment epithelium-choriocapillary complex (RPE-CC). The authors compared and evaluated both modalities in 10 patients with predominantly classic choroidal neovascularization (CNV), 10 patients with serous pigment epithelial detachment (PED), and 10 patients with geographic RPE atrophy, all secondary to age-related macular degeneration (ARMD). RESULTS: In patients with classic CNV, TAG detected neovascular structures and delineated their configuration. In PEDs pooling of extravascular fluid is demonstrated, and in geographic RPE atrophy TAG showed reduced choroidal perfusion. Classic CNV was demonstrated by OCT as a hyperreflective band at the level of the RPE-CC, and PED showed a dome-shaped RPE detachment. In geographic RPE atrophy, OCT imaged loss of the RPE band and had an increased depth resolution. CONCLUSIONS: TAG and OCT are useful imaging modalities in the evaluation of ARMD cases. TAG visualizes the vascular configuration and dynamic perfusion and leakage changes. OCT is able to document intra-, subretinal, and sub-RPE fluid accumulation secondary to CNV. Both modalities may provide further valuable insight into ARMD pathogenesis, enhance diagnostic quality, and improve the assessment of therapeutic effects.

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.

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.

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.

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.