bluuebunny/crossref_metadata_2025 huggingface dataset:
MACULAR CHOROIDAL VOLUME CHANGES AFTER INTRAVITREAL BEVACIZUMAB FOR EXUDATIVE AGE-RELATED MACULAR DEGENERATION
Authors: Palkovits Stefan , Seidel Gerald , Pertl Laura , Malle Eva M. , Hausberger Silke , Makk Johanna , Singer Christoph , Osterholt Julia , Herzog Sereina A. , Haas Anton , Weger Martin
Published: February 2017

Purpose:

To evaluate the effect of intravitreal bevacizumab on the macular choroidal volume and the subfoveal choroidal thickness in treatment naïve eyes with exudative age-related macular degeneration.

Methods:

The macular choroidal volume and the subfoveal choroidal thickness were measured using enhanced depth imaging optical coherence tomography. After a screening examination, each patient received 3 monthly intravitreal injections of 1.25 mg bevacizumab. One month after the third injection was a final assessment.

Results:

Forty-seven patients with a mean age of 80 ± 6.4 years were included. The macular choroidal volume decreased significantly from median 4.1 mm3 (interquartile range 3.4–5.9) to median 3.9 mm3 (interquartile range 3.1–5.6) between the baseline and final examination (difference −0.46 mm3, 95% confidence interval: −0.57 to 0.35, P < 0.001). Similarly, subfoveal choroidal thickness had decreased from 157.0 μm (interquartile range 116.0–244.5) at baseline to 139.0 μm (interquartile range 102.5–212.0) at the final examination (P < 0.001). Both parameters macular choroidal volume at baseline and subfoveal choroidal thickness at baseline were not associated with the response to treatment.

Conclusion:

The macular choroidal volume and the subfoveal choroidal thickness decreased significantly after 3 monthly bevacizumab injections for exudative age-related macular degeneration.
DETAILED CHARACTERIZATION OF CHOROIDAL MORPHOLOGIC AND VASCULAR FEATURES IN AGE-RELATED MACULAR DEGENERATION AND POLYPOIDAL CHOROIDAL VASCULOPATHY
Authors: Gupta Preeti , Ting Daniel Shu Wei , Thakku Sri GOWTHAM , Wong Tien-Yin , Cheng Ching-Yu , Wong Edmund , Mathur Ranjana , Wong Doric , Yeo Ian , Gemmy Cheung Chui Ming
Published: February 2017

Purpose:

To characterize and compare morphologic and vascular features of the choroid in patients with typical age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) and to determine if PCV subtypes can be identified based on these choroidal features.

Methods:

Choroidal features of patients with AMD and PCV recruited from the prospectively planned Asian AMD Phenotyping Study were analyzed. Patients underwent choroidal imaging using spectral-domain optical coherence tomography with enhanced depth imaging. Raw optical coherence tomographic images were loaded on a custom-written application on MATLAB that enabled delineation for detailed morphologic and vascular analyses, including the curvature of the choroid–sclera interface, number of inflection points, choroidal thickness and choroidal vascular area within the macular (6 mm centered on fovea) and foveal (1.5 mm centered on fovea) regions. An inflection point represents the contour of the choroid–sclera interface, with >1 point signaling irregular shape.

Results:

A total of 156 eyes of 156 patients (78 affected eyes of 78 patients with typical AMD and 78 affected eyes of 78 patients with PCV) were analyzed. Eyes with PCV had thicker baseline choroidal thickness and greater choroidal vascular area compared with those with typical AMD (P < 0.05); these differences were no longer significant after adjusting for age and hypertension (P > 0.05). Typical PCV subtype with choroidal thickness of ≥257 μm had significantly greater choroidal vascular area at macular (mean difference = 0.054 mm2; P < 0.001) and foveal (mean difference = 0.199 mm2; P < 0.001) regions compared with eyes with typical AMD. However, eyes with PCV without thick choroid had similar choroidal vascular area as eyes with typical AMD.

Conclusion:

Based on the choroidal vascular features, two subtypes of PCV can be classified: typical PCV with increased choroid vascularity and polypoidal choroidal neovascularization with low choroidal vascularity. These data provide further understanding of different AMD and PCV subtypes.
AGE, SEX, AND TIME-SPECIFIC TRENDS IN SURGICAL APPROACHES FOR RHEGMATOGENOUS RETINAL DETACHMENT
Authors: Park Sang Jun , Cho Soo Chang , Choi Nam-Kyong , Park Kyu Hyung , Woo Se Joon
Published: February 2017

Purpose:

To investigate the primary surgical approach for rhegmatogenous retinal detachment (RRD) according to age group, sex, and year in Korea.

Methods:

We retrospectively identified patients from the national claims database who underwent primary surgery for RRD from 2007 to 2011 using the diagnostic code and surgical codes for RRD. Patients were categorized into three groups according to surgical treatment; scleral buckling, vitrectomy, and combined operation. We analyzed the frequency and proportion of primary surgical approach for RRD according to age group, sex, and year.

Results:

Of 24,928 RRD patients, 11,372 (45.6%) patients underwent scleral buckling, 10,583 (42.5%) patients underwent vitrectomy, and 2,973 (11.9%) underwent a combined operation. Regression analysis showed that relative proportion of surgical approach had linear relationship with age; the percentage of patients undergoing vitrectomy increased by an average of 7.55% every 10 years (P < 0.001). This age-related trend was observed for both sexes. Scleral buckling tended to be preferred in younger patients (<45 years) and vitrectomy in older patients (≥45 years). Men tended to undergo vitrectomy significantly more than women in patients aged 15 years to 34 years. There was no consistent trend over time in the primary surgical approach during the study period.

Conclusion:

Age and sex of RRD patients influence the selection of primary surgical approaches. Young patients tend to undergo scleral buckling, whereas older patients tend to receive vitrectomy. Among young patients, men are more likely to undergo vitrectomy than women. No discernible trend over time was observed in the surgical approach over the 5-year study period.
ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Heiferman Michael J. , Rahmani Safa , Jampol Lee M. , Nesper Peter L. , Skondra Dimitra , Kim Leo A. , Fawzi Amani A.
Published: February 2017

Purpose:

To investigate choroidal involvement in acute posterior multifocal placoid pigment epitheliopathy (APMPPE).

Methods:

A retrospective observational case series using multimodal imaging including optical coherence tomography (OCT) angiography.

Results:

Five patients with APMPPE were included. In most acute lesions, OCT angiography revealed outer retinal and retinal pigment epithelium (RPE) hyperreflective lesions with attenuated OCT signal in the underlying choroid, but careful examination allowed us to identify a single lesion with decreased choriocapillaris flow outside the signal attenuation. Optical coherence tomography angiography obtained after healing of lesions revealed areas of hypointense circular flow voids clustered in groups surrounded by either isointense or hyperintense signal background. Point-by-point evaluation revealed these flow voids did not correspond to areas of RPE thickening or focal pigmentary changes. Larger hypointense lesions were observed and did correlate with pigmentary changes.

Conclusion:

Our case series demonstrates choriocapillaris flow abnormalities in acute APMPPE extending beyond the OCT lesions, and distinct residual vascular abnormalities in healed APMPPE lesions on OCT angiography. Our findings support a primary ischemic insult to the photoreceptors and RPE, but choriocapillaris flow abnormalities could be secondary to (OCT invisible) retinal and RPE involvement. The lack of understanding of the etiology along with the inability to visualize most of the choroid in acute lesions precludes definite conclusions about the true pathogenesis of APMPPE.
TWO YEAR OUTCOMES OF “TREAT AND EXTEND” INTRAVITREAL THERAPY USING AFLIBERCEPT PREFERENTIALLY FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Barthelmes Daniel , Nguyen Vuong , Daien Vincent , Campain Anna , Walton Richard , Guymer Robyn , Morlet Nigel , Hunyor Alex P. , Essex Rohan W. , Arnold Jennifer J. , Gillies Mark C. ,   the Fight Retinal Blindness Study Group
Published: February 2017

Purpose:

To report 24-month outcomes of a treat and extend (T&E) regimen using aflibercept in eyes with neovascular age-related macular degeneration.

Methods:

This was a database observational study that included treatment-naive eyes with neovascular age-related macular degeneration tracked by the Fight Retinal Blindness! outcome registry completing 24 months of sole monotherapy with aflibercept treatment under a T&E regimen between November 1, 2012 and January 31, 2014. Locally weighted scatterplot smoothing curves were used to display visual acuity outcomes. Main outcome measures were change in visual acuity at 24 months and number of injections and visits during the study period.

Results:

The study population, identified by reviewing the database, consisted of 136 eyes from 123 patients completing 24 months of follow-up on aflibercept. Mean (SD) age was 77.2 (7.0) years, 59% were female. Mean visual acuity increased from 61.4 (∼20/60; SD 17.4) letters at baseline to 67.4 (∼20/45; SD 17.7) letters at 24 months (+6.0 letters [95% confidence interval: 3.3–8.5]; P < 0.001). From baseline to 24 months, the proportion of eyes with visual acuity ≥70 letters (20/40) increased (40%–58%, P < 0.001) and the proportion of eyes with visual acuity ≤35 letters (20/200) remained the same (10%; P = 0.547). Ninety-eight per cent of eyes starting with visual acuity ≥70 letters (20/40) were able to maintain this up to 24 months. From the first to the second year of treatment, the mean number of injections (7.8 [2.1] vs. 5.7 [2.6]; P < 0.001) and visits (8.7 [1.7] vs. 6.5 [2.4]; P < 0.001) decreased for eyes completing 24 months of treatment. When data from 60 eligible eyes that did not complete 2 years follow-up, along with 14 eyes that switched to ranibizumab, were included using last observation carried forward, the mean change in visual acuity from baseline was +5.6 letters (95% confidence interval: 3.3–7.7).

Conclusion:

These data indicate that eyes treated with aflibercept, as a sole therapy, in routine clinical practice with a T&E regimen can achieve good visual outcomes while decreasing the burden of treatments and clinic visits.
LONG-TIME OUTCOME IN PATIENTS TREATED WITH RANIBIZUMAB FOR DIABETIC MACULAR EDEMA
Authors: Epstein David , Amrén Urban
Published: February 2017

Purpose:

To investigate the long-time visual outcome in patients with diabetic macular edema treated with ranibizumab in an ordinary clinical setting.

Methods:

One hundred two eyes of 80 patients were followed for 4 years. All patients received a loading dose of 3 monthly ranibizumab 0.5-mg injections. From Month 3 to Month 48, patients received ranibizumab reinjections pro re nata based on disease activity.

Results:

Excluding deaths, the 4-year visit was completed by 82% of the study eyes. The best-corrected visual acuity improved by 6.6 Early Treatment Diabetic Retinopathy Study letters at 4 years (P < 0.001). The patients received a mean of 7.7 ± 3.4 ranibizumab injections for 4 years. The number of injections (mean ± SD) given were 4.7 (1.1), 1.4 (1.4), 0.7 (1.1), and 0.9 (1.4) during Years 1 to 4, respectively. No difference in the injections needed was seen between patients who had previously received focal/grid laser and treatment-naive subjects.

Conclusion:

The gain in the best-corrected visual acuity achieved after the initial loading dose was sustained over time with a pro re nata regimen. The number of injections needed to maintain the best-corrected visual acuity was low during the study period.
OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN CYTOMEGALOVIRUS RETINITIS
Authors: Invernizzi Alessandro , Agarwal Aniruddha , Ravera Vittoria , Oldani Marta , Staurenghi Giovanni , Viola Francesco
Published: February 2017

Purpose:

To evaluate the vitreal, retinal, and choroidal features using spectral domain optical coherence tomography (SD-OCT) in eyes affected by cytomegalovirus (CMV) retinitis.

Methods:

Patients diagnosed with either active or inactive CMV retinitis were included in the study. Complete ophthalmic examination, serial color fundus photography, and SD-OCT (with and without enhanced depth imaging function) were performed for all the subjects at baseline and follow-up visits. The SD-OCT images were analyzed by two independent graders to evaluate the structural changes in areas of CMV retinitis. Prevalence data for vitreal, retinal, and choroidal SD-OCT features were collected.

Results:

Twelve eyes from 9 patients (6 males, mean age: 52.7 ± 10.3 years) were enrolled. Nine eyes were diagnosed with active CMV retinitis at baseline. Active disease SD-OCT characteristic findings included nebulous vitritis (100%), posterior hyaloid thickening (83.3%), epiretinal membrane (100%), and retinal swelling (100%). Two distinct patterns of chorioretinal involvement were observed in active retinitis: 1) full-thickness retinitis (Full thickness retinitis) (n = 7 eyes) with choriocapillaris alterations and retinal pigment epithelial thickening and 2) cavernous retinitis (n = 3 eyes) characterized by inner retinal hyperreflectivity, large empty spaces in outer nuclear layer, and bridges of retinal tissue but retinal pigment epithelium and choriocapillaris sparing. Patients with cavernous retinitis develop retinal detachment during follow-up. Eyes with Full thickness retinitis developed choriocapillaris atrophy and choroidal thinning and retinal scars as the lesions healed.

Conclusion:

There are two distinct patterns of chorioretinal involvement in CMV retinitis. SD-OCT is a useful tool in the diagnosis, management, and prediction of the outcome of CMV retinitis.
DYNAMISM OF DOT SUBRETINAL DRUSENOID DEPOSITS IN AGE-RELATED MACULAR DEGENERATION DEMONSTRATED WITH ADAPTIVE OPTICS IMAGING
Authors: Zhang Yuhua , Wang Xiaolin , Godara Pooja , Zhang Tianjiao , Clark Mark E. , Witherspoon C. Douglas , Spaide Richard F. , Owsley Cynthia , Curcio Christine A.
Published: February 2017

Purpose:

To investigate the natural history of dot subretinal drusenoid deposits (SDD) in age-related macular degeneration, using high-resolution adaptive optics scanning laser ophthalmoscopy.

Methods:

Six eyes of four patients with intermediate age-related macular degeneration were studied at baseline and 1 year later. Individual dot SDD within the central 30° retina were examined with adaptive optics scanning laser ophthalmoscopy and optical coherence tomography.

Results:

A total of 269 solitary SDD were identified at baseline. Over 12.25 ± 1.18 months, all 35 Stage 1 SDD progressed to advanced stages. Eighteen (60%) Stage 2 lesions progressed to Stage 3 and 12 (40%) remained at Stage 2. Of 204 Stage 3 SDD, 12 (6.4%) disappeared and the rest remained. Twelve new SDD were identified, including 6 (50%) at Stage 1, 2 (16.7%) at Stage 2, and 4 (33.3%) at Stage 3. The mean percentage of the retina affected by dot SDD, measured by the adaptive optics scanning laser ophthalmoscopy, increased in 5/6 eyes (from 2.31% to 5.08% in the most changed eye) and decreased slightly in 1/6 eye (from 10.67% to 10.54%). Dynamism, the absolute value of the areas affected by new and regressed lesions, ranged from 0.7% to 9.3%.

Conclusion:

Adaptive optics scanning laser ophthalmoscopy reveals that dot SDD, like drusen, are dynamic.
ISING MODEL OF CHORIOCAPILLARIS FLOW
Authors: Spaide Richard F.
Published: February 2017

Purpose:

To develop a mathematical model of local blood flow in the choriocapillaris using an Ising model.

Methods:

A JavaScript Ising model was used to create images that emulated the development of signal voids as would be seen in optical coherence tomography angiography of the choriocapillaris. The model was produced by holding the temperature near criticality and varying the field strength. Individual frames were evaluated, and a movie video was created to show the hypothetical development of flow-related signal voids over a lifetime.

Results:

Much the same as actual choriocapillaris images in humans, the model of flow-related signal voids followed a power-law distribution. The slope and intercept both decreased with age, as is seen in human subjects.

Conclusion:

This model is a working hypothesis, and as such can help predict system characteristics, evaluate conclusions drawn from studies, suggest new research questions, and provide a way of obtaining an estimate of behavior in which experimental data are not yet available. It may be possible to understand choriocapillaris blood flow in health and disease states by determining by observing deviations from an expected model.
CHARACTERIZING PHOTORECEPTOR CHANGES IN ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY USING ADAPTIVE OPTICS
Authors: Roberts Philipp K. , Nesper Peter L. , Onishi Alex C. , Skondra Dimitra , Jampol Lee M. , Fawzi Amani A.
Published: February 2017

Purpose:

To characterize lesions of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) by multimodal imaging including adaptive optics scanning laser ophthalmoscopy (AOSLO).

Methods:

We included patients with APMPPE at different stages of evolution of the placoid lesions. Color fundus photography, spectral domain optical coherence tomography, infrared reflectance, fundus autofluorescence, and AOSLO images were obtained and registered to correlate microstructural changes.

Results:

Eight eyes of four patients (two women) were included and analyzed by multimodal imaging. Photoreceptor reflectivity within APMPPE lesions was more heterogeneous than in adjacent healthy areas. Hyperpigmentation on color fundus photography appeared hyperreflective on infrared reflectance and on AOSLO. Irregularity of the interdigitation zone and the photoreceptor inner and outer segment junctions (IS/OS) on spectral domain optical coherence tomography was associated with photoreceptor hyporeflectivity on AOSLO. Interruption of the interdigitation zone or IS/OS was associated with loss of photoreceptor reflectivity on AOSLO.

Conclusion:

Irregularities in the reflectivity of the photoreceptor mosaic are visible on AOSLO even in inactive APMPPE lesions, where the photoreceptor bands on spectral domain optical coherence tomography have recovered. Adaptive optics scanning laser ophthalmoscopy combined with multimodal imaging has the potential to enhance our understanding of photoreceptor involvement in APMPPE.
SUBTHRESHOLD LASER TREATMENT FOR SEROUS RETINAL DETACHMENT IN DOME-SHAPED MACULA ASSOCIATED WITH PATHOLOGIC MYOPIA
Authors: Battaglia Parodi Maurizio , Iacono Pierluigi , Bandello Francesco
Published: February 2017

Purpose:

To evaluate the effects of the subthreshold laser treatment as a therapeutic option in the treatment of serous retinal detachment secondary to dome-shaped macula.

Methods:

Prospective pilot study with 12-month follow-up. Each patient underwent a complete ophthalmologic examination, including best-corrected visual acuity, fluorescein angiography, indocyanine green angiography, and spectral domain optical coherence tomography. Eyes with persistent serous retinal detachment lasting for a minimum of 12 months and absence of best-corrected visual acuity improvement underwent subthreshold laser treatment in a single session. The laser spots were delivered in a contiguous mode, covering the area of hyperfluorescence recognized on indocyanine green angiography. The primary outcome measure was the best-corrected visual acuity changes at the 12-month examination. Secondary outcomes included changes in central foveal thickness (CFT) and number of eyes achieving a complete serous retinal detachment resolution.

Results:

Twelve eyes (8 patients) were included in the study. Best-corrected visual acuity changed from a baseline value of 0.8 ± 0.2 (±SD, logarithm of the minimum angle of resolution [Snellen equivalent: 20/125]) to 0.48 ± 0.1 (Snellen equivalent: 20/60, P = 0.001). Central foveal thickness decreased from 320 ± 52 μm to a final value of 266 ± 41 μm (P = 0.001). Serous retinal detachment reduced in all cases; however, just one eye (8.3%) showed a complete resolution at the 12-month examination. Fluorescein angiography and indocyanine green angiography showed that the hyperfluorescence had disappeared after subthreshold laser treatment. No adverse event was registered, including enlargement of atrophic alterations and choroidal neovascularization.

Conclusion:

Subthreshold laser treatment can lead to improvements in visual acuity and central foveal thickness in myopic eyes with serous retinal detachment secondary to dome-shaped macula. Further studies are required to confirm our preliminary results.
VISUALIZATION OF MACULAR PUCKER BY MULTICOLOR SCANNING LASER IMAGING
Authors: Kilic Muftuoglu Ilkay , Bartsch Dirk-Uwe , Barteselli Giulio , Gaber Raouf , Nezgoda Joseph , Freeman William R.
Published: February 2017

Purpose:

To compare the visualization of the epiretinal membrane (ERM) using multicolor imaging (MCI) (Heidelberg Engineering, Carlsbad, CA) and conventional white light flood color fundus photography (FP) (Topcon).

Methods:

The paired images of patients with ERM who underwent same-day MCI and FP examinations were reviewed. Visibility of the ERM was graded using a scale (0: not visible, 1: barely visible, and 2: clearly visible) by masked readers, and surface folds were counted to quantify the membrane visibility for each method. Images from individual color channels in MCI (green, blue, and infrared) were also graded using the same method to further investigate MCI images.

Results:

Forty-eight eyes of 42 patients were included. The average ERM visibility score was 1.8 ± 0.37 for MCI and 1.01 ± 0.63 for FP (P < 0.001). The number of the surface folds detected per quadrant was signifi8cantly higher in MCI than that in FP (6.79 ± 3.32 vs. 2.85 ± 2.81, P < 0.001). The ERM was graded with similar scores on the two modalities in 43.8% of the eyes; in 56.2%, the ERM was better visualized on MCI than that on FP. Conventional FP failed to detect ERM in 11.4% of eyes when the mean central retinal thickness was <413 microns. Analysis of laser color reflectance revealed that green reflectance provided better detection of surface folds (5.54 ± 2.12) compared to blue reflectance (4.2 ± 2.34) and infrared reflectance (1.2 ± 0.9).

Conclusion:

Multicolor scanning laser imaging provides superior ERM detection and delineation of surface folds than conventional FP, primarily due to the green channel present in the combination-pseudocolor image in MCI.
RETINAL BLOOD FLOW AFTER INTRAVITREAL BEVACIZUMAB IS A PREDICTIVE FACTOR FOR OUTCOMES OF MACULAR EDEMA ASSOCIATED WITH CENTRAL RETINAL VEIN OCCLUSION
Authors: Matsumoto Makiko , Suzuma Kiyoshi , Yamada Yoshihisa , Tsuiki Eiko , Fujikawa Azusa , Kitaoka Takashi
Published: February 2017

Purpose:

To investigate whether retinal blood flow levels after intravitreal bevacizumab (IVB) treatment are correlated with the outcomes of patients with macular edema secondary to central retinal vein occlusion.

Methods:

This retrospective observational case study enrolled 44 cases nonischemic central retinal vein occlusion. In each patient, visual acuity, central retinal thickness, and mean blur rate, which was measured by laser speckle flowgraphy and represents retinal blood flow velocity, were examined.

Results:

At the end of the follow-up period (19.8 ± 8.8 months), 4 of 44 eyes (9.1%) converted to the ischemic type (converted group), whereas 40 (90.9%) remained unchanged (nonischemic group). Mean central retinal thickness significantly decreased and mean visual acuity significantly improved at 1 month after the first IVB injection in each group. Mean mean blur rate in the nonischemic group significantly increased, whereas it was unchanged in the converted group. The difference between the two groups was already significant after the first IVB injection. Subsequently, visual acuity worsened in the converted group. Multiple linear regression analysis indicated that the strongest correlation was between the last visual acuity and the last mean blur rate.

Conclusion:

Blood flow measurements are useful for evaluating IVB treatments. Blood flow after IVB can predict outcomes in patients with central retinal vein occlusion.
QUANTITATIVE ANALYSIS OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN ADULT-ONSET FOVEOMACULAR VITELLIFORM DYSTROPHY
Authors: Battaglia Parodi Maurizio , Rabiolo Alessandro , Cicinelli Maria Vittoria , Iacono Pierluigi , Romano Francesco , Bandello Francesco
Published: February 2017

Purpose:

To quantify the foveal avascular zone area at superficial capillary plexus (SCP) and deep capillary plexus (DCP) and the global, parafoveal, and perifoveal vessel densities at SCP, DCP, and choriocapillaris using optical coherence tomography angiography in patients affected by adult-onset foveomacular vitelliform dystrophy (AOFVD).

Methods:

Twenty eyes of 20 consecutive patients (10 females, 50%) with AOFVD and 20 eyes of 20 healthy controls presenting at the Department of Ophthalmology of San Raffaele Hospital, Milan, Italy were enrolled. All patients underwent a complete ophthalmic examination, including 3-mm × 3-mm optical coherence tomography angiography centered on the macula. The vessel density was calculated in the three plexuses (i.e., SCP, DCP, and choriocapillaris) by mean of image binarization, and foveal avascular zone area was manually outlined at SCP and DCP with ImageJ software.

Results:

In the SCP, patients with AOFVD disclosed a significant reduction of global (P < 0.001), parafoveal (P = 0.0017), and perifoveal (P = 0.0019) vessel density. In the DCP, parafoveal vessel density was higher in patients with AOFVD (P = 0.0026), whereas no significant difference was appreciated for both the global image (P = 0.5) and the perifoveal area (P = 0.5). Patients with AOFVD showed less dense choriocapillaris (P = 0.012) and perifoveal circle (P = 0.0152), whereas no difference was observed in the perifoveal zone (P = 0.07). Foveal avascular zone area was significantly enlarged at the DCP (P = 0.0184), but not at the SCP.

Conclusion:

Patients with AOFVD have quantitative vascular alterations in all vascular layers.
PREDICTIVE FACTORS FOR DEVELOPMENT OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Fragiotta Serena , Rossi Tommaso , Cutini Alessandro , Grenga Pier L. , Vingolo Enzo M.
Published: February 2017

Purpose:

To investigate the risk factors predictive for the development of neovascular age-related macular degeneration (NVAMD) by means of spectral-domain optical coherence tomography.

Methods:

Retrospective study of 73 eyes graded Stage 2 and Stage 3 according to the AMD International Grading System with minimum follow-up of 24 months. Drusenoid pigment epithelial detachment, hyperreflective foci, external limiting membrane, inner ellipsoid band, and retinal pigment epithelium integrity were analyzed at baseline and last follow-up. Binary logistic regression model analyzed significant predictors of neovascular conversion.

Results:

The discontinuity of external limiting membrane, inner ellipsoid band, and retinal pigment epithelium bands were significantly more prevalent in the NVAMD group at baseline and last follow-up (P < 0.001). Hyperreflective foci represented the single most important predictor of neovascular conversion (Exp [B], 15.15; P = 0.005) as confirmed by Kaplan–Meier curve (P = 0.002). Drusenoid pigment epithelial detachment width was significantly greater in NVAMD group than control subjects at baseline and last follow-up (P < 0.001), and its delta value also resulted a significant neovascular predictor (Exp [B], 0.99; P = 0.04).

Conclusion:

Hyperreflective foci significantly increase the risk of NVAMD progression. The delta width of drusenoid pigment epithelial detachment also predicts disease progression, integrating the stratification of NVAMD progression risk.
RETINAL CAPILLARY DENSITY IN PATIENTS WITH BIRDSHOT CHORIORETINOPATHY
Authors: Roberts Philipp K. , Nesper Peter L. , Goldstein Debra A. , Fawzi Amani A.
Published: February 2017

Purpose:

To quantify retinal capillary density and determine its correlation with visual acuity in patients with birdshot chorioretinopathy (BCR).

Methods:

Patients with BCR and age-matched controls were imaged using a commercially available spectral domain optical coherence tomography angiography system (RTVue- XR Avanti; Optovue, Inc). We used the integrated software of the optical coherence tomography angiography device to analyze the foveal avascular zone area and the capillary density in the full retina as well as in the superficial capillary plexus and deep capillary plexus. We assessed the correlation between these parameters and visual acuity.

Results:

Seventy-four eyes of 42 study participants (37 eyes of 21 BCR and 37 eyes of 21 healthy subjects) were included in this observational cross-sectional study. Capillary density of the full retina, superficial capillary plexus, and deep capillary plexus were significantly decreased in BCR compared with the healthy control group (P < 0.01). Visual acuity in patients with BCR was significantly associated with the capillary density of the superficial capillary plexus, deep capillary plexus, and full retina (P < 0.01) but not with the area of the foveal avascular zone.

Conclusion:

The decrease in visual acuity in patients with BCR is associated with retinal vascular impairment. Vessel density of the retinal capillary plexuses may be a promising imaging biomarker for BCR disease severity.
IS A POSTOPERATIVE DAY ONE EXAMINATION NEEDED AFTER UNCOMPLICATED VITREORETINAL SURGERY?
Authors: Zick Jon , Joondeph Brian C.
Published: February 2017

Purpose:

To determine whether there were any adverse consequences from seeing vitreoretinal surgery patients on the second rather than the first postoperative day.

Methods:

A retrospective review of vitreoretinal surgical patients from a single surgeon seen on the second, but not the first day after surgery. Preoperative, intraoperative, and postoperative findings were recorded with attention to adverse or safety events.

Results:

One hundred thirty-four patients were identified, representing a variety of vitreoretinal pathology and surgical procedures. All patients received a technician phone call on the first postoperative day inquiring about pain and vision. Six patients had an intraocular pressure over 30 on the second postoperative day, all managed medically. Only one patient was seen on the first postoperative day because of pain and elevated pressure. There were no cases of endophthalmitis.

Conclusion:

Postoperative vitreoretinal surgical patients can reasonably be seen on the second postoperative day, when logistics dictate, allowing them to be seen by their operative surgeon in a more convenient location.
ASSOCIATION BETWEEN TANGENTIAL CONTRACTION AND EARLY VISION LOSS IN IDIOPATHIC EPIRETINAL MEMBRANE
Authors: Lee Seung Min , Pak Kang Yeun , Kwon Han Jo , Park Sung Who , Lee Ji Eun , Byon Ik Soo
Published: February 2017

Purpose:

To investigate the clinical features associated with early visual loss in patients with idiopathic epiretinal membrane.

Methods:

Patients with idiopathic epiretinal membrane with visual acuity of ≥20/40, intact ellipsoid zone, and follow-up duration of at least 24 months were included in this retrospective age-matched control study. The disk–fovea–vascular (DFV) distance, central macular thickness, membrane configuration, and ellipsoid zone were assessed using fundus photography and spectral domain optical coherence tomography.

Results:

We analyzed the progression group (n = 15; vision loss ≥2 lines because of membrane progression) and the control group (n = 30; age matched). Compared with the controls, the mean DFV distance decreased (P < 0.001), central macular thickness increased (P = 0.017), and the ratio of the follow-up and baseline DFV distances (traction index of membrane) was significantly lower (P = 0.001) in the progression group. No differences were observed in the follow-up membrane configuration and ellipsoid zone. Factors associated with early vision loss were the DFV distance change (ρ = 0.657; P = 0.008) and traction index of membrane (ρ = −0.636; P = 0.011). Their area under receiver-operating characteristic curves were significant (DFV distant change: 0.915, traction index of membrane: 0.910, respectively; P < 0.001, both).

Conclusion:

Assessing the DFV distance is useful in quantifying the tangential contraction of macula and the prediction of vision loss in idiopathic epiretinal membrane.
THERAPEUTIC OUTCOMES AFTER ENDORESECTION OF COMPLEX RETINAL CAPILLARY HEMANGIOBLASTOMA
Authors: Karacorlu Murat , Hocaoglu Mumin , Sayman Muslubas Isil , Ersoz Mehmet Giray , Arf Serra
Published: February 2017

Purpose:

To evaluate the anatomical and functional outcomes after endoresection of complex retinal capillary hemangioblastoma (RCH).

Methods:

Retrospective case series of 12 patients (13 eyes), all treated with pars plana vitrectomy, endodiathermy of feeding and draining vessels, endoresection of RCH and silicone oil injection.

Results:

The mean age at the time of surgery was 32.5 ± 15.9 years. The mean follow-up duration after initial surgery was 50.5 ± 49.4 months. Indications for surgery included RCH with associated complications such as tractional retinal detachment in five eyes (38%), exudative retinal detachment in four eyes (31%), and combination of tractional retinal detachment and exudative retinal detachment in four eyes (31%). The dimensions of the resected RCHs were as follows: >3.0 mm in seven eyes (54%), >3.5 mm in three eyes (23%), and >4.0 mm in three eyes (23%). No tumor was located closer than 10 mm to the optic nerve or fovea. Anatomical success after initial surgery was 92%. One eye had a second vitreoretinal procedure owing to recurrent RD. The mean preoperative Snellen visual acuity was 20/303. The mean Snellen visual acuity at the final visit was 20/73. At the final visit, visual acuity had improved in seven eyes (54%), and six eyes (46%) were stable. Short-term complications included recurrent proliferative vitreoretinopathy in one eye (8%), transient ocular hypertension requiring topical antiglaucoma treatment in four eyes (31%), and long-term complications included progression of cataract in seven eyes (54%).

Conclusion:

Combined pars plana vitrectomy, endodiathermy of feeding and draining vessels, endoresection of RCH, and silicone oil injection may be an effective treatment option for complex RCH, achieving high anatomical success and stable or even improved visual acuity, acceptable rates of disease- and treatment-related complications, and minimal need for retreatment.
GRAM-NEGATIVE BACTERIA FROM PATIENTS WITH ENDOPHTHALMITIS: DISTRIBUTION OF ISOLATES AND ANTIMICROBIAL SUSCEPTIBILITIES
Authors: Wilson Benjamin D. , Relhan Nidhi , Miller Darlene , Flynn Harry W.
Published: February 2017

Purpose:

To study the distribution of isolates and antimicrobial susceptibility of gram-negative bacteria among culture-positive vitreous samples from patients with endophthalmitis.

Methods:

The records from culture-positive vitreous isolates (endophthalmitis cases) during a 24-year period (December 1990 to December 2014), at the Microbiology Department of Bascom Palmer Eye Institute were reviewed.

Results:

In the current study, gram-negative bacteria were reported in 246 (11.5%) of 2,134 vitreous isolates from endophthalmitis patients during 24-year period (December 1990 to December 2014) from a University Referral Center. The antimicrobial susceptibility to fluoroquinolones, aminoglycosides, carbapenems, and ceftazidime remained stable among gram-negative bacteria during the study period.

Conclusion:

Antibiotic susceptibility pattern of gram-negative bacteria from vitreous isolates did not change significantly during the 24-year study period.
RELATION BETWEEN FLUORESCEIN ANGIOGRAPHIC AND SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY FINDINGS OF BLOOD FLOW TURBULENCE AT ARTERIOVENOUS CROSSINGS IN THE RETINA
Authors: Willerslev Anne , Li Xiao Qiang , Munch Inger Christine , Larsen Michael
Published: February 2017

Purpose:

To examine retinal blood flow at arteriovenous crossings using spectral-domain optical coherence tomography (SD-OCT).

Methods:

Retrospective observational case series of 11 arteriovenous crossings in 10 eyes examined by SD-OCT and fluorescein angiography on suspicion of manifest or imminent branch retinal vein occlusion.

Results:

Fluorescein angiographic evidence of turbulence was seen at 5 of 11 arteriovenous crossings, whereas laminar angiographic flow was intact at the crossing and downstream thereof at the remaining 6 crossings. On SD-OCT, chaotic reflectivity patterns were seen at the point of crossing and downstream thereof in all 5 cases with angiographic turbulence, whereas an intravascular trilayer SD-OCT pattern consistent with laminar flow was seen throughout the examined course of the vein in the eyes with laminar angiographic flow.

Conclusion:

We examined retinal blood flow at and near arteriovenous crossings and found that SD-OCT may rival fluorescein angiography in the ability to demonstrate turbulent venous blood flow.
CLINICAL PATHOLOGIC CORRELATION OF SARCOIDOSIS-ASSOCIATED MULTIFOCAL CHORIORETINITIS IN AN ELDERLY PATIENT
Authors: Saleh Mohamed G. A. , O'Donnell John L. , Davis Ronald P. , Wilson David , Lin Phoebe
Published: February 2017

Background/Purpose:

To describe a case of histopathologic clinical correlation of sarcoidosis-related multifocal chorioretinitis in an elderly individual.

Methods:

This is a single case report and review of the pertinent literature. A 72-year-old white woman with a history of asthma was referred with bilateral asymmetric low-grade chronic panuveitis with advancing peripheral punched-out chorioretinal lesions despite systemic corticosteroid treatment.

Results:

Coalescent chorioretinal punched-out lesions on fundus examination in the more severely affected right eye did not respond to corticosteroid treatment, and the refractory nature resulted in a suspicion of intraocular lymphoma despite a previous inconclusive diagnostic vitrectomy result. A transvitreal chorioretinal biopsy in the vitrectomized eye demonstrated a chorioretinal noncaseating granuloma centered on the choriocapillaris and invading Bruch membrane and the outer retina. This case illustrates an example of the second peak of incidence in sarcoidosis that can occur in ages >50 in Caucasians and Japanese patients, as well as a tendency to develop chronic disease in Caucasians, and to have extrapulmonary sarcoidosis in the elderly.

Conclusion:

This case emphasizes the differences in presentation of ocular sarcoid in older Caucasian women as well as the histopathologic findings in multifocal peripheral chorioretinitis associated with sarcoidosis.
CLINICAL FEATURES IN A CASE OF OCCULT MACULAR DYSTROPHY WITH RP1L1 MUTATION
Authors: Fu Yun , Chen Kuan-Jen , Lai Chi-Chun , Wu Wei-Chi , Wang Nan-Kai
Published: February 2017

Purpose:

To investigate appropriate diagnostic testing for occult macular dystrophy (OMD) in a patient with unexplained progressive visual loss.

Methods:

Observational case report.

Results:

Occult macular dystrophy is an uncommon autosomal dominant macular disease, but sporadic occurrences have been noted. We report a patient with progressive visual decline, but with normal findings in fundus photography, visual field, fluorescein angiography, and full-field standard electroretinography. Direct sequencing of the RP1L1 gene showed a c. 133C>T mutation, which confirmed the diagnosis of OMD genetically. The only two ocular examinations that can show abnormal findings in such cases are spectral domain optical coherence tomography and multifocal electroretinography. Therefore, spectral domain optical coherence tomography and multifocal electroretinography are very important in making a diagnosis of OMD before applying expansive techniques such as brain computed tomography or magnetic resonance imaging.

Conclusion:

Spectral domain optical coherence tomography and multifocal electroretinography can serve as diagnostic testings for patients with OMD.
Clinical Significance of Arterial Stiffness and Metabolic Syndrome Scores in Vestibular Neuritis
Authors: Chung Jae Ho , Lee Seung Hwan , Park Chul Won , Jeong Jin Hyeok , Shin Jeong-Hun
Published: February 2017

Objective:

To investigate the clinical significance of cardiovascular factors, including arterial stiffness and metabolic syndrome scores, in the development of vestibular neuritis.

Study Design:

A prospective, case-control study.

Setting:

Tertiary referral center.

Patients:

Fifty-eight adult patients with vestibular neuritis (VN) and 58 age- and sex-matched controls were evaluated between January 2015 and January 2016.

Intervention:

Measurement of arterial stiffness.

Main Outcome Measures:

Arterial stiffness was assessed from brachial-ankle pulse wave velocity (baPWV), and cardiovascular markers including blood pressure, body mass index and lipid profiles, and metabolic syndrome scores were determined. The dizziness handicap inventory (DHI) and vestibular function tests, including the caloric test and video head impulse test were evaluated. The correlations between cardiovascular factors and clinical parameters of VN were assessed.

Results:

Blood pressure, baPWV, and metabolic syndrome scores were higher in the VN group than in the control group (p = 0.002, p = 0.001, and p = 0.001, respectively), whereas comorbidity, anthropometric characteristics, and lipid profiles did not differ significantly. baPWV and metabolic syndrome scores were not correlated with the clinical parameters of the DHI scores, canal paresis, and spontaneous nystagmus duration. In addition, cardiovascular factors did not associate with the vestibular compensation.

Conclusions:

Higher baPWV, representative of arterial stiffness, and higher metabolic syndrome scores, are associated with the development of VN. This supports the hypothesis of a vascular etiology of the disease. However, cardiovascular risk factors had limited value in predicting the clinical course of VN.
Efficacy of Bone-Anchored Hearing Aids in Single-Sided Deafness: A Systematic Review
Authors: Kim Gaeun , Ju Hyun Mi , Lee Sun Hee , Kim Hee-Soon , Kwon Jeong A. , Seo Young Joon
Published: February 2017

Objectives:

Bone-anchored hearing aids (BAHAs) have been known to partially restore some of the functions lost in subjects with single-sided deafness (SSD). Our aims in this systemic review were to analyze the present capabilities of BAHAs in the context of SSD, and to evaluate the efficacy of BAHAs in improving speech recognition in noisy conditions, sound localization, and subjective outcomes.

Design:

A systematic search was undertaken until August 2015 by two independent reviewers, with disagreements resolved by consensus. Among 286 references, we analyzed 14 studies that used both subjective and objective indicators to assess the capabilities of a total of 296 patients in the unaided and aided situations.

Results:

Although there was “no benefit” of BAHA implantation for sound localization, BAHAs certainly improved subjects’ speech discrimination in noisy circumstances. In the six studies that dealt with sound localization, no significant difference was found after the implantation. Twelve studies showed the benefits of BAHAs for speech discrimination in noise. Regarding subjective outcomes of using the prosthesis in patients with SSD (abbreviated profile of hearing aid benefit [APHAB] and the Glasgow hearing aid benefit profile [GHABP], etc.), we noticed an improvement in the quality of life.

Conclusions:

This systematic review has indicated that BAHAs may successfully rehabilitate patients with SSD by alleviating the hearing handicap to a certain degree, which could improve patients’ quality of life. This report has presented additional evidence of effective auditory rehabilitation for SSD and will be helpful to clinicians counseling patients regarding treatment options for SSD.
The In-Hospital Cost of Ventricular Assist Device Therapy: Implications for Patient Selection
Authors: Iyengar Amit , Kwon Oh Jin , Tamrat Msgana , Salimbangon Anthony , Satou Nancy , Benharash Peyman , Ardehali Abbas , Shemin Richard J. , Kwon Murray H.
Published: February 2017

Ventricular assist device (VAD) therapy is increasingly utilized to support patients in end-stage heart failure. However, VAD programs are resource intensive and demand active monitoring to ensure long-term sustainability. The purpose of this study was to analyze total cost trends of the VAD program at our academic medical center. Retrospective analysis of University of California - Los Angeles’s VAD program between 2013 and 2014 was performed. Total in-hospital costs from the date of VAD surgery admission were queried and normalized to a z score. Multivariable linear regression analysis with step-wise elimination was used to model total costs. Overall, 42 patients received a VAD during the study period, with 19 (45%) receiving biventricular support. On univariate analysis, high body mass index, biventricular support, time between VAD implantation and discharge, and total length of hospital stay were correlated with higher costs (all p < 0.02). On multivariable analysis, time between VAD implantation and discharge and biventricular support remained significantly related to total costs (overall R
2 = 0.831, p < 0.001). The time between VAD implantation and discharge and the use of biventricular support were the most predictive factors of total cost in our VAD population. Reducing hospital stay post-VAD implantation is important in minimizing the cost of VAD care.
Long-Term Pediatric Ventricular Assist Device Therapy: A Case Report of 2100+ Days of Support
Authors: Purkey Neha J. , Lin Aileen , Murray Jenna M. , Gowen Maryalice , Shuttleworth Paul , Maeda Katsuhide , Almond Christopher S. , Rosenthal David N. , Chen Sharon
Published: February 2017

Ventricular assist devices (VADs) have been placed as destination therapy in adults for more than 20 years, but have only recently been considered an option in a subset of pediatric patients. A 2016 report from the Pediatric Interagency Registry for Mechanical Circulatory Support revealed only eight pediatric patients implanted with a VAD as destination therapy. Herein, we report the case of an adolescent male with Becker muscular dystrophy who underwent VAD placement in 2011 as bridge to candidacy. He subsequently decided to remain as destination therapy and so far has accrued more than 2100 days on VAD support, the longest duration of pediatric VAD support reported in the literature to date.
Eisenmenger Syndrome and Pregnancy: Novel ECMO Configuration as a Bridge to Delivery and Recovery Utilizing a Multidisciplinary Team
Authors: Rosenzweig Erika B. , Abrams Darryl , Biscotti Mauer , Kerstein Diane , Drassinower Daphnie , Brodie Daniel , Bacchetta Matthew
Published: February 2017

Pregnancy is typically contraindicated in Eisenmenger syndrome because of its association with excessively high maternal and fetal morbidity and mortality. Here, we report on our novel approach to successfully managing a 29 year old pregnant woman with an unrepaired patent ductus arteriosus (PDA) with Eisenmenger syndrome through delivery and recovery. Venovenous extracorporeal membrane oxygenation (ECMO) was utilized during induction of labor to stabilize maternal hemodynamics and optimize fetal oxygenation by creating an oxygenated right-to-left shunt through the PDA. Delivery ultimately required cesarean section on ECMO support, with her hospital course complicated by intraabdominal hemorrhage and, later, recannulation with venoarterial ECMO for postoperative respiratory failure with decompensated pulmonary hypertension. Ultimately, both the mother and baby were successfully discharged to home. This case highlights not only the potential for ECMO in the peripartum setting for patients with severe pulmonary hypertension, but also the complexity of management and the need for a highly experienced, multidisciplinary team.