Search

Purpose To describe the defining features of incomplete retinal pigment epithelium (RPE) and outer retinal atrophy (iRORA), a consensus term referring to the OCT-based anatomic changes often identified before the development of complete RPE and outer retinal atrophy (cRORA) in age-related macular degeneration (AMD). We provide descriptive OCT and histologic examples of disease progression. Design Consensus meeting. Participants Panel of retina specialists, including retinal imaging experts, reading center leaders, and retinal histologists. Methods As part of the Classification of Atrophy Meeting (CAM) program, an international group of experts analyzed and discussed longitudinal multimodal imaging of eyes with AMD. Consensus was reached on a classification system for OCT-based structural alterations that occurred before the development of atrophy secondary to AMD. New terms of iRORA and cRORA were defined. This report describes in detail the CAM consensus on iRORA. Main Outcome Measures Defining the term iRORA through OCT imaging and longitudinal cases showing progression of atrophy, with histologic correlates. Results OCT was used in cases of early and intermediate AMD as the base imaging method to identify cases of iRORA. In the context of drusen, iRORA is defined on OCT as (1) a region of signal hypertransmission into the choroid, (2) a corresponding zone of attenuation or disruption of the RPE, and (3) evidence of overlying photoreceptor degeneration. The term iRORA should not be used when there is an RPE tear. Longitudinal studies confirmed the concept of progression from iRORA to cRORA. Conclusions An international consensus classification for OCT-defined anatomic features of iRORA are described and examples of longitudinal progression to cRORA are provided. The ability to identify these OCT changes reproducibly is essential to understand better the natural history of the disease, to identify high-risk signs of progression, and to study early interventions. Longitudinal data are required to quantify the implied risk of vision loss associated with these terms. The CAM classification provides initial definitions to enable these future endeavors, acknowledging that the classification will be refined as new data are generated.

ObjectiveThe English Diabetic Eye Screening (DES) programme recommends patients with M1 diabetic maculopathy to be referred to hospital eye services. DES uses flash fundus photography as the reference standard for maculopathy grading. We compared multicolour versus non-stereoscopic fundus photography at identifying M1 maculopathy, with spectral domain optical coherence tomography (SD-OCT) identifying macular thickening.Methods and analysisThis cross-sectional study included 345 patients with R1M1 referred from DES and reviewed in secondary care with fundus photographs, multicolour and SD-OCT. Maculopathy was graded based on DES exudate criteria on both multicolour and fundus photography in a blind fashion by two independent graders. Macular thickness was ascertained on SD-OCT.ResultsIntergrader agreement on grading maculopathy using fundus photography (Cohen’s κ=0.91) and multicolour (Cohen’s κ=0.82) was ‘almost perfect’. Agreement between fundus photography and multicolour on grading maculopathy (Cohen’s κ=0.76) was ‘substantial’. Compared with fundus photography, multicolour had sensitivity of 87% (95% CI 81% to 93%) and specificity of 90% (95% CI 87% to 94%) in detecting M1 maculopathy. SD-OCT identified 84 eyes with macular thickening, 47 of which were graded as M0 by fundus photography. 5 eyes with exudates and severe macular oedema requiring urgent intervention were also missed on fundus photography but not on multicolour. Multicolour, when complemented by SD-OCT, did not miss any clinically significant macular oedema.ConclusionMulticolour integrates synergistically in a single platform with SD-OCT providing effective monitoring of M1 diabetic maculopathy. The need for fundus photography is eliminated by multicolour/SD-OCT in dedicated R1M1 virtual clinics not requiring parallel diabetic retinopathy grading.

PURPOSE: To describe the defining features of “incomplete retinal pigment epithelial (RPE) and outer retinal atrophy” (iRORA), a consensus term referring to the optical coherence tomography (OCT) based anatomical changes often identified prior to the development of “complete RPE and outer retinal atrophy (cRORA)” in age-related macular degeneration (AMD). We provide descriptive OCT and histological examples of disease progression. DESIGN: Consensus meeting PARTICIPANTS: Panel of retina specialists, including retinal imaging experts, reading center leaders and retinal histologists. METHODS: As part of the Classification of Atrophy Meeting (CAM) program, an international group of experts analysed and discussed longitudinal multimodal imaging of eyes with AMD. Consensus was reached on a classification system for OCT-based structural alterations that occurred prior to the development of atrophy secondary to AMD. New terms of complete and incomplete RPE and outer retinal atrophy (iRORA and cRORA) were defined. This report describes in detail the CAM consensus on iRORA. MAIN OUTCOME MEASURES: Defining the term iRORA through OCT imaging and longitudinal cases showing progression of atrophy, with histologic correlates. RESULTS: OCT was used in cases of early and intermediate AMD as the base imaging modality to identify cases of iRORA. In the context of drusen, iRORA is defined on OCT as (1) a region of signal hypertransmission into the choroid and (2) a corresponding zone of attenuation or disruption of the RPE, and (3) evidence of overlying photoreceptor degeneration. The term iRORA should not be used when there is an RPE tear. Longitudinal studies confirmed the concept of progression from iRORA to cRORA. CONCLUSIONS: An international consensus classification for OCT-defined anatomical features of iRORA, are described and examples of longitudinal progression to cRORA are provided. The ability to identify these OCT changes reproducibly, is essential to better understand the natural history of disease, to identify high risk signs of progression and to study early interventions. Longitudinal data are required to quantify the implied risk of vision loss associated with these terms. The CAM classification provides initial definitions to enable these future endeavours, acknowledging that the classification will be refined as new data are generated.

PURPOSE: To evaluate ranibizumab 0.5 mg using bimonthly monitoring and individualized re-treatment after monthly follow-up for 6 months in patients with visual impairment due to diabetic macular edema (DME). DESIGN: A phase IIIb, 18-month, prospective, open-label, multicenter, single-arm study in the United Kingdom. PARTICIPANTS: Participants (N = 109) with visual impairment due to DME. METHODS: Participants received 3 initial monthly ranibizumab 0.5 mg injections (day 0 to month 2), followed by individualized best-corrected visual acuity (BCVA) and optical coherence tomography-guided re-treatment with monthly (months 3-5) and subsequent bimonthly follow-up (months 6-18). Laser was allowed after month 6. MAIN OUTCOME MEASURES: Mean change in BCVA from baseline to month 12 (primary end point), mean change in BCVA and central retinal thickness (CRT) from baseline to month 18, gain of ≥10 and ≥15 letters, treatment exposure, and incidence of adverse events over 18 months. RESULTS: Of 109 participants, 100 (91.7%) and 99 (90.8%) completed the 12 and 18 months of the study, respectively. The mean age was 63.7 years, the mean duration of DME was 40 months, and 77.1% of the participants had received prior laser treatment (study eye). At baseline, mean BCVA was 62.9 letters, 20% of patients had a baseline BCVA of >73 letters, and mean baseline CRT was 418.1 μm, with 32% of patients having a baseline CRT

To evaluate macular thickness measurements in normal subjects from British origin, to assess interocular asymmetry using optical coherence tomography (OCT) and to establish standard values for macular and foveal thickness.Two hundred eyes of 100 normal individuals underwent serial scans using fast macular thickness map protocol in the Stratus OCT version 3.51, with foveal fixation. Minimum foveal thickness (MFT), central 1 mm average foveal thickness (AFT), total foveal volume (TFV) and total macular volume (TMV at 6 mm) of both eyes were assessed. The interocular asymmetry was measured and statistically analyzed.The mean +/- SD (N = 200) was 173 +/- 23 microm for MFT and 203 +/- 24 microm for AFT. The mean difference +/- SD between the two eyes was (3.5 +/- 14.5 microm at p = 0.17) for MFT, (6.4 +/- 14.7 microm at p = 0.06) for AFT, (0.007 mm3 +/- 0.007 at p = 0.06) for TFV and (0.19 +/- 0.35 at p = 0.07) for TMV.Our study provides a normative database for macular thickness and volume parameters in normal British individuals using Stratus OCT. The MFT, AFT, TMV and TFV measurements were not statistically significant between the two eyes. Hence, the interocular symmetry should be considered on interpretation of macular thickness values especially in cases of uniocular or asymmetrical macular involvement.

We report a case of intraoperative orbital haemorrhage as a complication of endoscopic sinus surgery performed under general anaesthesia. Initial unilateral complete visual loss occurred, but recovered due to accurate and early diagnosis combined with urgent surgical intervention. This patient’s case is reported to illustrate the importance of early recognition of clinical signs and how a stepwise approach to management can result in a favourable visual outcome. Moreover, the mechanisms and pathophysiology of visual loss due to orbital haemorrhage following endoscopic sinus surgery are discussed.

A 19-year-old woman presented with a 4-week history of headache, ataxia, vertigo, confusion, intermittent blurred vision in the right eye and intermittent hearing loss. MRI revealed white matter lesions and ‘pepper pot’ lesions of the corpus callosum. The cerebrospinal fluid had raised protein and lymphocytes. Fundal examination revealed multiple peripheral arterial occlusions in the both eyes confirmed with fundus fluorescein angiography (FFA). A diagnosis of Susac9s syndrome was made. The patient was initially treated with steroids, followed by azathioprine and intravenous immunoglobulins (IVIg). Clinical improvement was noted, associated with improvement of the retinal circulation on FFA.

The hydrodynamic properties of isolated human Bruch's membrane and choroid were investigated as a function of age and retinal location. Macular and peripheral regions of the fundus showed an exponential decline of hydraulic conductivity with half-lives of 15 and 22 years respectively. Comparison of age profiles for hydraulic conductivity and lipid deposits suggests the involvement of two discrete processes for reduction in transport capability. The first appears to involve 'membrane remodelling' with a programmed decay rate leading to a major reduction in hydraulic conductivity by the fifth decade of life. The second commences in the fourth decade and is apparently dependent on the lipid content of Bruch's membrane.

To evaluate whether the measurement of retinal nerve fiber layer (RNFL) thickness using optical coherence tomography (OCT) changes after cataract surgery.This prospective, randomized, observational, cross-sectional clinical study included 24 eyes of 24 patients who underwent phacoemusification with implant. All patients had no preexisting retinal or optic nerve pathology or other media opacities that might influence the RNFL thickness. The classification and the grading of cataract were based on the Lens Opacities Classification System III (LOCS III). All eyes were scanned immediately before cataract surgery with OCT using Fast RNFL program. All eyes had circular scans around the optic disk with a diameter of 3.4 mm. The OCT was repeated 4 weeks after surgery when the patients returned for postoperative check using the same programme.The mean preoperative RNFL thickness was 84.9 +/- 16.5. The postoperative mean RNFL thickness was 93.0 +/- 17.6. The pre-and postoperative values of the mean RNFL and signal/noise ratio (SNR) are statistically significant (P0.05).Lens opacities may affect the image quality of OCT scans used to measure RNFL thickness as indicated by preoperative low SNR. Cataract extraction results in an apparent increase of the RNFL thickness.

We report a complication that occurred during clear corneal phacoemulsification. When saline was injected during hydrodissection with a 27-gauge J-shaped cannula attached to a 2.0 mL luer-lock polypropylene syringe, the cannula dislodged and slipped behind the iris, hooking to the lens equator. Although the cannula was carefully removed, 3 clock hours of zonular dialysis were observed between the 4 o'clock and 7 o'clock meridians. After phacoemulsification, lens aspiration, and in-the-bag intraocular lens implantation, vitreous was noted inferiorly and the anterior vitrectomy was completed.