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Background and Objectives: Optical coherence tomography angiography (OCTA) is a noninvasive high-resolution imaging technique for assessing the retinal vasculature and is increasingly used in various ophthalmologic, neuro-ophthalmologic, and neurologic diseases. To date, there are no validated consensus criteria for quality control (QC) of OCTA. Our study aimed to develop criteria for OCTA quality assessment., Methods: To establish criteria through (1) extensive literature review on OCTA artifacts and image quality to generate standardized and easy-to-apply OCTA QC criteria, (2) application of OCTA QC criteria to evaluate interrater agreement, (3) identification of reasons for interrater disagreement, revision of OCTA QC criteria, development of OCTA QC scoring guide and training set, and (4) validation of QC criteria in an international, interdisciplinary multicenter study., Results: We identified 7 major aspects that affect OCTA quality: (O) obvious problems, (S) signal strength, (C) centration, (A) algorithm failure, (R) retinal pathology, (M) motion artifacts, and (P) projection artifacts. Seven independent raters applied the OSCAR-MP criteria to a set of 40 OCTA scans from people with MS, Sjogren syndrome, and uveitis and healthy individuals. The interrater kappa was substantial (κ 0.67). Projection artifacts were the main reason for interrater disagreement. Because artifacts can affect only parts of OCTA images, we agreed that prior definition of a specific region of interest (ROI) is crucial for subsequent OCTA quality assessment. To enhance artifact recognition and interrater agreement on reduced image quality, we designed a scoring guide and OCTA training set. Using these educational tools, 23 raters from 14 different centers reached an almost perfect agreement (κ 0.92) for the rejection of poor-quality OCTA images using the OSCAR-MP criteria., Discussion: We propose a 3-step approach for standardized quality control: (1) To define a specific ROI, (2) to assess the occurrence of OCTA artifacts according to the OSCAR-MP criteria, and (3) to evaluate OCTA quality based on the occurrence of different artifacts within the ROI. OSCAR-MP OCTA QC criteria achieved high interrater agreement in an international multicenter study and is a promising QC protocol for application in the context of future clinical trials and studies., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)

Aim: To measure the difference of intraoperative central macular thickness (CMT) before, during, and after membrane peeling and investigate the influence of intraoperative macular stretching on postoperative best corrected visual acuity (BCVA) outcome and postoperative CMT development., Methods: A total of 59 eyes of 59 patients who underwent vitreoretinal surgery for epiretinal membrane was analyzed. Videos with intraoperative optical coherence tomography (OCT) were recorded. Difference of intraoperative CMT before, during, and after peeling was measured. Pre- and postoperatively obtained BCVA and spectral-domain OCT images were analyzed., Results: Mean age of the patients was 70±8.13y (range 46-86y). Mean baseline BCVA was 0.49±0.27 logMAR (range 0.1-1.3). Three and six months postoperatively the mean BCVA was 0.36±0.25 ( P =0.01 vs baseline) and 0.38±0.35 ( P =0.08 vs baseline) logMAR respectively. Mean stretch of the macula during surgery was 29% from baseline (range 2%-159%). Intraoperative findings of macular stretching did not correlate with visual acuity outcome within 6mo after surgery ( r =-0.06, P =0.72). However, extent of macular stretching during surgery significantly correlated with less reduction of CMT at the fovea centralis ( r =-0.43, P <0.01) and 1 mm nasal and temporal from the fovea ( r =-0.37, P =0.02 and r =-0.50, P <0.01 respectively) 3mo postoperatively., Conclusion: The extent of retinal stretching during membrane peeling may predict the development of postoperative central retinal thickness, though there is no correlation with visual acuity development within the first 6mo postoperatively., (International Journal of Ophthalmology Press.)

Purpose: To investigate closure rates and functional outcomes of surgery for refractory and recurrent macular holes (MHs) in a real-world setting., Methods: Retrospective review of secondary MH surgeries., Results: A total of 72 eyes from 72 patients were included. Eyes had a mean of 1.51 surgeries before inclusion into this study with a mean MH size of 762 µ m and a mean baseline logarithm of the minimum angle of resolution best-corrected visual acuity of 1.11 (∼20/260 Snellen). Closure rates were 89.3% for tissue transplantation, 77.3% for internal limiting membrane (ILM) flaps, 92.9% for MH manipulation, and 12.5% for repeat ILM peeling ( P < 0.05). Best-corrected visual acuity changes in logarithm of the minimum angle of resolution from baseline to postoperative month six were +0.29 for ILM peeling alone (15 Early Treatment Diabetic Retinopathy Study letters worse), -0.39 for MH manipulation (20 Early Treatment Diabetic Retinopathy Study letters improved), -0.23 for tissue transplantation (13 Early Treatment Diabetic Retinopathy Study letters improved), and -0.2 for ILM flaps (10 Early Treatment Diabetic Retinopathy Study letters improved; P < 0.05)., Conclusion: Secondary MH closure is possible using various surgical techniques with acceptable anatomical closure rates. Repeat ILM peeling is associated with the lowest closure rates and poorest functional results. To distinguish between techniques would require a large sample size of approximately 750 eyes., Competing Interests: None of the authors has a conflict of interest in connection with the submitted article. There are no competing interests. K. D. Pacheco is a consultant for Alcon.

Purpose: This study aims to compare the improvement of best-corrected visual acuity (BCVA) and the reduction in defect length of external limiting membrane (ELM) and ellipsoid zone (EZ) in small ([Formula: see text] 250 μm), medium ([Formula: see text] 250 μm), and large ([Formula: see text] 400 μm) full-thickness macular holes (FTMH) treated with inverted internal limiting membrane (I-ILM) flap technique over a follow-up period of 12 months., Methods: Ninety-one eyes of 87 patients were enrolled in this retrospective study. BCVA and spectral-domain optical coherence tomography (SD-OCT) were conducted preoperatively as well as after 1, 3, 6, 9, and 12 months postoperatively. The defect length of the ELM and the EZ was measured using the caliper tool at each follow-up time point., Results: BCVA improved significantly in the group of small, medium, and large FTMH over the time of 12 months, whereby the improvement did not depend on FTMH size over 9 months. Only after 12 months, large FTMH showed significantly higher BCVA improvement compared to small and medium FTMH. The closure rate was 100% (91/91). The defect length of ELM and EZ reduced continuously over the period of 12 months. There was a significant correlation between defect length of ELM and EZ with postoperative BCVA., Conclusion: The I-ILM flap technique has very good morphological and functional outcomes in small, medium, and large FTMH over a long-time period, indicating that it can be considered as a treatment option in small and medium FTMH. The defect length of ELM and EZ is directly connected to postoperative BCVA., (© 2022. The Author(s).)

Background: Due to intraoperative optical coherence tomography (iOCT), observation of retinal morphological changes during surgery has become possible., Objective: To analyze the intraoperative morphology of full thickness macular holes (FTMH) and the correlation with the postoperative function, a retrospective, observational clinical study was performed analyzing 32 eyes of patients treated at the hospital of the technical university of Munich., Material and Methods: Using iOCT in 32 eyes of 32 consecutive patients, the operative morphology was analyzed during surgery. These findings were then correlated with the postoperative visual outcome., Results: After posterior vitreous detachment (PVD) the macular hole index (MHI) decreased by -0.05 (p = 0.01) and the base diameter (BD) increased by +99.4 μm (SD = 197.8 μm; p = 0.04). Closure rate was 100% at the first visit after a mean time of 73 days and the postoperative best corrected visual acuity (BCVA) significantly improved (p < 0.05). There were significant correlations between intraoperative morphology and postoperative results indicating a relation between low MHI and better postoperative BCVA (SCC = 0.50; p = 0.02), large BD and better postoperative BCVA (SCC = 0.43; p = 0.05) and large aperture after PVD and higher improvement of BCVA (SCC = 0.44; p = 0.03)., Conclusion: Flattening and broadening of the FTMH occurred as a result of reduction of vitreoretinal traction. The significant correlation between a large operative BD and improved BCVA reveals the importance of intraoperative retinal relaxation., (© 2021. The Author(s).)

Background: Neuromyelitis optica spectrum disorders (NMOSD) are neuroinflammatory diseases of the central nervous system. Patients suffer from recurring relapses and it is unclear whether relapse-independent disease activity occurs and whether this is of clinical relevance., Objective: To detect disease-specific alterations of the retinal vasculature that reflect disease activity during NMOSD., Methods: Cross-sectional analysis of 16 patients with NMOSD, 21 patients with relapsing-remitting multiple sclerosis, and 21 healthy controls using retinal optical coherence tomography (OCT), optical coherence tomography angiography (OCT-A), measurement of glial fibrillary acidic protein (GFAP) serum levels, and assessment of visual acuity., Results: Patients with NMOSD but not multiple sclerosis revealed lower foveal thickness (FT) ( p = 0.02) measures and an increase of the foveal avascular zone (FAZ) ( p = 0.02) compared to healthy controls independent to optic neuritis. Reduced FT ( p = 0.01), enlarged FAZ areas ( p = 0.0001), and vessel loss of the superficial vascular complex ( p = 0.01) were linked to higher serum GFAP levels and superficial vessel loss was associated with worse visual performance in patients with NMOSD irrespective of optic neuritis., Conclusion: Subclinical parafoveal retinal vessel loss might occur during NMOSD and might be linked to astrocyte damage and poor visual performance. OCT-A may be a tool to study subclinical disease activity during NMOSD.

Purpose: To evaluate the value of total keratometry (TK) to estimate corneal power in eyes that underwent SMILE for treatment of myopia or myopic astigmatism in subgroups of low and high astigmatism., Methods: The difference between preoperative and postoperative measurements of corneal power (ΔTCRP, ΔTK) was compared with the surgically induced refractive change at the corneal plane (ΔSE co ) by Pearson correlation. Vector analysis of TCRP- and TK-derived astigmatism was performed to evaluate the corneal astigmatism. Single-angle plots were generated with the AstigMATIC tool for standard astigmatism vector analysis., Results: Paired t -test revealed statistically significant differences in preoperative ( p = .02) and postoperative ( p = .0455) measurements between TK and TCRP in the group of high-level astigmatism and the postoperative low astigmatism group ( p < .01). No significant differences were found in preoperative data in the group of low-level astigmatism ( p = .60). The correlation of ΔSEco and TK (low astigmatism, R 2  = 0.978; high astigmatism R 2  = 0.980) was stronger than the correlation of TCRP 4.0 mm and ΔSEco (low astigmatism, R 2  = 0.743; high astigmatism R 2  = 0.959) in both astigmatic groups. The vector analysis demonstrated nearly identical results concerning the correction index (CI) for TK and TCRP. Comparing the difference vector (DV) between both parameters, TK-derived results were closer to the optimum., Conclusions: The findings endorse TK as a reliable measure of corneal power after SMILE in patients with low and high astigmatism.

Purpose: To gauge the value of total keratometry (TK) to estimate corneal power change in eyes that underwent small-incision lenticule extraction (SMILE) for treatment of myopia or myopic astigmatism., Setting: Department of Ophthalmology, Ludwig-Maximilians-University, and SMILE Eyes Clinic Munich Airport, Munich, Germany., Design: Prospective cross-sectional trial., Methods: A total of 40 eyes of 40 patients who had undergone myopic SMILE were enrolled in this prospective study. Total corneal refractive power (TCRP; Pentacam HR) and TK (IOLMaster 700, Carl Zeiss Meditec AG) values were compared with the clinical history method (CHM). The surgically induced changes in TCRP (ΔTCRP) and TK (ΔTK) were also compared with the changes in spherical equivalent on the corneal plane (ΔSEco)., Results: Of the 40 eyes analyzed, the correlation between TK and CHM (R2 = 0.91, P < .001) was stronger than that between TCRP and CHM (R2 = 0.87, P < .001). When compared with the CHM, TCRP underestimated corneal power by a mean relative error of 0.59 diopter (D) and TK by 0.17 D. Linear regression analysis of ΔTCRP/ΔTK and the difference between preoperative and postoperative manifest refraction spherical equivalent at the corneal plane (ΔSEco) showed stronger correlation in ΔTK (R2 = 0.88) than that in ΔTCRP (R2 = 0.82)., Conclusions: The findings endorse TK as an accurate measure for corneal power after myopic SMILE., (Copyright © 2021 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

To introduce an ETDRS grid-based classification for macula involving retinal detachment (MIRD) with or without center (foveal) involvement and to identify biomarkers in preoperative optical coherence tomography (OCT) associated with a favorable postoperative functional outcome in eyes with center involving retinal detachment (CIRD). One hundred and two eyes of 102 consecutive patients (f/m: 35/67) with primary rhegmatogenous retinal detachment, preoperative evidence of MIRD (perifoveal involvement of ≤ 6.0 mm), and successful retinal surgery were included in this retrospective cohort study. Eyes were assigned to 5 grades of MIRD (G1-G5), based on the extent of detachment in the ETDRS grid. Eyes with a detached foveal status (CIRD) were assigned to G4 or G5. In CIRD, the following OCT biomarkers were quantified and correlated with mean BCVA (logMAR) at 3 months postsurgery, using univariate and multivariable regression models: grade of detachment, extent of intraretinal edema, height of foveal detachment, subretinal folds, and epiretinal membrane. Forty-one of 102 eyes (40.2%) presented with an attached foveal status, defined as either outer (G1: 11.8%) or inner (G2: 18.6%) macular involvement or fovea-threatening MIRD (G3: 9.8%). Sixty-one eyes (59.8%) showed CIRD (G4 or G5). Eyes with CIRD had significantly worse postoperative BCVA than eyes without foveal involvement (0.355 logMAR vs. 0.138 logMAR, p<0.001). If CIRD was limited to three outer ETDRS quadrants (G4), mean BCVA was better compared to CIRD involving all four ETDRS quadrants (G5) (0.254 logMAR vs. 0.522 logMAR, p<0.001). Reading ability (BCVA ≤ 0.4 logMAR) was restored in 97.6% of eyes with G1-G3 compared to 86.9% of eyes with G4 (p=0.072) and 52.4% of eyes with G5 (p<0.001). In multivariable regression analysis of eyes with CIRD, a lower grade of detachment (G4 vs. G5: p<0.05) and lower extent of cystoid edema (focal/none vs. wide: p<0.001) were both associated with better postoperative function. The functional outcome after MIRD may be worse in the presence of foveal involvement (CIRD), but a lower grade of detachment and the absence of intraretinal edema can predict a good recovery in spite of CIRD., (© 2021. The Author(s).)

Purpose: To investigate morphological and functional outcomes of the inverted internal limiting membrane (I-ILM) flap technique in large (≥ 400 μm) idiopathic full-thickness macular holes (FTMH) over a follow-up period of 12 months., Methods: In this retrospective study, 55 eyes of 54 consecutive patients were enrolled. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT, Heidelberg, Spectralis) were performed preoperatively as well as 1, 3, 6, 9, and 12 months postoperatively. Special focus was put on the reintegration of outer retinal layers and the different ILM flap appearances., Results: FTMH closure rate was 100% (55/55). BCVA significantly improved over the follow-up period of 12 months from 0.98 ± 0.38 LogMAR preoperatively to 0.42 ± 0.33 LogMAR at 12 months postoperatively (p < 0.001). There was no significant correlation between the three different ILM flap appearances and BCVA. Better preoperative BCVA, complete restoration of the external limiting membrane (ELM), higher macular hole index (MHI), and smaller MH base diameter were associated with higher improvement of BCVA., Conclusion: Our study highlights the favorable morphological and functional outcomes of the I-ILM flap technique in the short as well as in the long term. While complete ELM restoration revealed to be an important factor for improvement in BCVA, the different postoperative ILM flap appearances seem not to be related to BCVA., (© 2021. The Author(s).)

Background: Endogenous endophthalmitis is a rare and severe inflammation of the eye in the context of a systemic infectious disease, which can lead to the loss of the affected eye in the worst case., Material and Methods: In a 5-year period, 20 eyes were treated for endogenous endophthalmitis and evaluated retrospectively. Evaluation parameters were epidemiological data, causes, concomitant diseases, assessment of the pathogen spectrum, therapy and visual acuity., Results: 13.2% (n = 20/152; 20 eyes of 17 patients) of all endophthalmitis cases were of endogenous origin. In 15% (n = 3/20) of the cases, bilateral endogenous endophthalmitis was present. The cause for the endophthalmitis was generalised sepsis in 9 of 17 cases, an infection of the urogenital tract in 2 of 17 cases and endocarditis and liver abscess in 1 of 17 cases, respectively. In 4 of 17 cases, no primary foci were detected. Eight of 17 patients suffered from diabetes mellitus, 6 of 17 from renal insufficiency and 2 of 17 from malignancies, pneumonia or rheumatism. Two of 17 patients had had an organ transplantation, 15 of 17 suffered from cardiovascular diseases, 3 of 17 were immunosuppressed and 2 of 17 reported drug abuse. Four of 17 infections were caused by streptococci, 3 of 17 by Candida, 2 of 17 by herpes viruses and 1 of 17 by Staphylococcus aureus and Bacillus cereus. No pathogen could be found in 5 cases. The time interval between the onset of symptoms and diagnosis and the beginning of the therapy was 4 days (min.: 1 day; max.: 39 days). This was significantly longer in comparison with other causes of endophthalmitis (p < 0.001). Median visual acuity (VA) was 2.0 logMAR (n = 19/20) at the first presentation. One month and three months after initiation of the therapy VA was 1.3 logMAR (both n = 15/20), VA was 0.1 logMAR (n = 9/20) at the one year follow-up. Retinal detachment occurred in 2 of 20 eyes and recurrence of the endophthalmitis in 1 of 20 eyes within the one year follow-up, 5 of 17 patients died. Enucleation was never necessary., Conclusion: Endogenous endophthalmitis is often misdiagnosed due to a severe underlying non-ophthalmological disease. Delayed presentation with consequent late initiation of therapy is an unresolved problem, because colleagues from other fields are often unexperienced in diagnosing the ocular infection. This is also a cause of the already poor visual prognosis. Ophthalmologists can usually only influence the choice of the proper therapy., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Background and Objective: To correlate subfoveal choriocapillaris (CC) flow density with age using spectral-domain optical coherence tomography angiography (SD-OCTA)., Patients and Methods: One hundred eighty-three eyes of 94 subjects (66 female, 28 male) were enrolled. Included were healthy subjects between the ages of 21 and 82 years without any history of vitreoretinal disease. Measurements were obtained with software from the OCT device. Significance was defined as a P value of less than .05., Results: The mean age was 43.43 years ± 17.63 years. Correlation between decreasing CC flow density and increasing age was significant (P < .001), with a mean yearly flow decrease of 0.026%. Subfoveal choroidal thickness decreased with advancing age; however, this did not reach a level of significance (P = .069)., Conclusion: There is a significantly negative correlation between CC flow density and advancing age in healthy subjects, analyzing direct extracted in-built software values from a commercial SD-OCTA device. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:302-308.]., (Copyright 2019, SLACK Incorporated.)

Background and Objective: To investigate choriocapillary blood flow in myopic eyes using optical coherence tomography angiography., Patients and Methods: Seventy-eight myopic and 79 age-matched healthy eyes were included in this study, with myopia defined as a spherical equivalent refraction (SER) between -1 diopters (D) and -6 D. Quantitative measurements of the choriocapillaris were obtained using the Avanti RTVue XR with AngioVue. Choroidal thickness (CT) was assessed using the single-line enhanced high-definition scan of the same device., Results: CT correlated positively with SER (P = .017) and negatively with bulbus axial length (AL) (P = .180). Subfoveal choriocapillary blood flow did not show any significant correlation with any of the parameters SER, AL, or CT (P = .798, P = .269, and P = .820, respectively). The mean flow signal of the myopic group did not differ significantly from the mean flow signal of the emmetropic control group (P = .266)., Conclusion: Choriocapillary blood flow seems to retain a constant level with increasing physiological myopia. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e133-e139.]., (Copyright 2019, SLACK Incorporated.)

Background: Patients with multiple sclerosis (MS) and clinically isolated syndrome (CIS) may show alterations of retinal layer architecture as measured by optical coherence tomography. Little is known about changes in the retinal vascular network during MS., Objective: To characterize retinal vessel structures in patients with MS and CIS and to test for associations with MS disease activity., Method: In all, 42 patients with MS or CIS and 50 healthy controls underwent retinal optical coherence tomography angiography (OCT-A) with analysis of the superficial and deep vascular plexuses and the choriocapillaries. We tested OCT-A parameters for associations with retinal layer volumes, history of optic neuritis (ON), and the retrospective disease activity., Results: Inner retinal layer volumes correlated positively with the density of both the superficial and deep vascular plexuses. Eyes of MS/CIS patients with a history of ON revealed reduced vessel densities of the superficial and deep vascular plexuses as compared to healthy controls. Higher choriocapillary vessel densities were associated with ongoing inflammatory disease activity during 24 months prior to OCT-A examination in MS and CIS patients., Conclusion: Optic neuritis is associated with rarefaction of the superficial and deep retinal vessels. Alterations of the choriocapillaries might be linked to disease activity in MS.

Introduction: The prospective, non-interventional OCEAN study examined the use of intravitreal ranibizumab injections for the treatment of diabetic macular oedema (DME) in a real-world setting in Germany., Methods: Adults with DME receiving ≥ 1 ranibizumab (0.5 mg) injections were recruited by 250 ophthalmologists. Best-corrected visual acuity (VA) testing, imaging and treatments were performed according to the investigators' routine practice and documented over 24 months., Results: The full analysis set included 1226 participants. Mean baseline VA was 60.6 [95% CI: 59.7; 61.5] Early Treatment Diabetic Retinopathy Study letters. VA improved by ≥ 15 letters in 21.5% and 23.5% of the participants at 12 months and 24 months, respectively. They received a mean number of 4.42 [95% CI: 4.30; 4.54] injections in the first year and 5.52 [95% CI: 5.32; 5.73] injections over 24 months, which was markedly lower than in clinical trials. Only 33.4% of the participants received an upload with four initial monthly injections as recommended by the German ophthalmologic societies. Time-to-event analyses that account for missing data inherent to a non-interventional study design demonstrated that participants receiving ≥ 7 injections in the first year had a faster response, but the duration of the response was shorter compared to the subgroups receiving 1-3 and 4-6 injections. Serious adverse events were reported for 143/1250 (11.4%) participants in the safety population., Conclusion: Under-treatment is a major problem of DME anti- vascular endothelial growth factor therapy under real life conditions. Despite fewer injections given compared to randomised controlled trials with a consequently reduced overall mean visual gain, a profound functional improvement (≥ 15 letters) was achieved over 2 years in 23.5% of eyes with DME., Trial Registration Number: NCT02194803, ClinicalTrials.gov., Funding: Novartis Pharma GmbH, Nuremberg, Germany.

Aim: To describe retinal findings of various imaging modalities in acute retinal ischemia., Methods: Fluorescein angiography (FA), spectral domain optical coherence tomography (SD-OCT), OCT-angiography (OCT-A) and fundus autofluorescence (FAF) images of 13 patients (mean age 64y, range 28-86y) with acute retinal ischemia were evaluated. Six suffered from branch arterial occlusion, 2 had a central retinal artery occlusion, 2 had a combined arteriovenous occlusions, 1 patient had a retrobulbar arterial compression by an orbital haemangioma and 2 patients showed an ocular ischemic syndrome., Results: All patients showed increased reflectivity and thickening of the ischemic retinal tissue. In 10 out of 13 patients SD-OCT revealed an additional highly reflective band located within or above the outer plexiform layer. Morphological characteristics were a decreasing intensity with distance from the fovea, partially segmental occurrence and manifestation limited in time. OCT-A showed a loss of flow signal in the superficial and deep capillary plexus at the affected areas. Reduced flow signal was detected underneath the regions with retinal edema. FAF showed areas of altered signal intensity at the posterior pole. The regions of decreased FAF signal corresponded to peri-venous regions., Conclusion: Multimodal imaging modalities in retinal ischemia yield characteristic findings and valuable diagnostic information. Conventional OCT identifies hyperreflectivity and thickening and a mid-retinal hyperreflective band is frequently observed. OCT-A examination reveals demarcation of the ischemic retinal area on the vascular level. FAF shows decreased fluorescence signal in areas of retinal edema often corresponding to peri-venous regions.

Purpose: High resolution optical coherence tomography (OCT) enables better visualization of ophthalmic microstructures than conventional imaging. When using an ophthalmic microscope, integrated optical coherence tomography (iOCT) high resolution real time visualization is possible., Methods: We report on the first 110 patients operated on using a microscope integrated OCT (iOCT) during surgical procedures for the treatment of various posterior segment pathologies., Results: Microstructural changes that appeared during surgery were depicted precisely by iOCT, and the morphology visualized before and after each surgical step was used to help deciding how to adapt the surgical flow. The iOCT data and real-time imaging of retinal anatomy gives the surgeon the possibility of deploying patient- and operation-specific interventional procedures., Discussion: To date, iOCT is only available in standing microscopes with no measurement or tracking features. Moreover, metal instruments currently obscure the scanned images. In the future, non-metal, transparent instruments (OCT-friendly surgical tools), tracking features, an autofocus and higher resolution could enable full and immediate intraoperative SD-OCT diagnostics in real time., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Retinal artery occlusion (RAO) should be evaluated as an emergency and can be seen as an ocular analogue to the cerebral apoplex. Both have the same arteriosclerotic risk factors, which are also responsible for cardiac, circulatory and cerebrovascular diseases. That is why an intensive interdisciplinary clarification is necessary to recognize possible comorbidities in time and, if necessary, to treat them. The current therapeutic possibilities of an acute RAO are very limited in their efficiency regarding visual improvement. Methods for systemic lysis cannot be recommended in routine care because of their significantly increased side-effect profile. However, there is a limited window of time of up to 6 hours after the onset of symptoms in which an intervention appears to be useful at all. On the other hand, the new therapeutic possibilities of retinal vein occlusions (RVO) led to marked visual improvements, especially due to the intravitreal application of anti-VEGF. Safety and efficiency of the individual anti-VEGF drugs are comparable according to clinical trials. Alternatively, the use of intravitreal steroids can be considered, whereby the side-effect profile should be carefully weighed. In the presence of retinal ischaemia, peripheral laser coagulation can have a stabilizing effect on visual acuity and prevents neovascularization. It is postulated that the combination of anti-VEGF and laser therapy might have a symbiotic effect., Competing Interests: Moritz Pettenkofer: keine Interessenkonflikte. Nicolas Feltgen: Novartis, Alimera, Bayer (Beratertätigkeit), Novartis, Alimera, Bayer, Allergan, Heidelberg Engineering (Referententätigkeit), Novartis, Allergan, Bayer, Roche (Studienteilnahme). Nikolaus Feucht: Bayer, Novartis, Allergan, Heidelberg Engineering (Referententätigkeit). Mathias Maier: Allergan, Bayer, Novartis, Heidelberg Engineering, Zeiss (Referententätigkeit), Novartis, Bayer, Alcon, Roche (Studienteilnahme). Chris Lohmann: keine Interessenkonflikte., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: To evaluate symptoms, therapies and outcomes in rare microbial keratitis-induced endophthalmitis., Methods: Retrospective study with 11 patients treated between 2009 and 2014. Clinical findings, corneal diseases, history of steroids and trauma, use of contact lenses, number and type of surgical interventions, determination of causative organisms and visual acuity (VA) were evaluated., Results: The incidence of transformation from microbial keratitis to an endophthalmitis was 0.29% (n = 11/3773). In 90.9% (n = 10/11), there were pre-existent eyelid and corneal problems, in 45.5% (n = 5/11) rubeosis iridis with increased intraocular pressure and corneal decompensation, and in 18.2% (n = 2/11), ocular trauma. Specimens could be obtained in 10 of 11 samples: 33.3% of those 10 specimens were Gram-positive coagulase-negative Staphylococci (n = 3/10) or Gram-negative rods (n = 3/10) and 10.0% Staphylococcus aureus (n = 1/10). In 30% (n = 3/10), no pathogens were identifiable. 72.7% (n = 8/11) of all keratitis-induced endophthalmitis were treated with vitrectomy and 9.1% (n = 1/11) with amniotic-membrane transplantation. In 27.3% (n = 3/11) the infected eye had to be enucleated - 18.2% (n = 2/11) primarily, 9.1% (n = 1/11) secondarily. No patient suffered from sympathetic ophthalmia. The median initial VA was 2.1 logMAR (n = 11/11). At one month, median VA was 2.0 logMAR (n = 7/11), after three months 2.0 logMAR (n = 6/11), and after one year 2.05 logMAR (n = 6/11). The change in VA was not significant (p > 0.99). 36.4% (n = 4/11) of the cases resulted in blindness., Conclusions: The overall outcome is poor. Enucleation should be weighed against the risk of local and systemic spread of the infection, prolonged rehabilitation and sympathetic ophthalmia.

Aim: To evaluate and compare structural optical coherence tomography (OCT)-based parameters, such as Bruch's membrane opening-minimum rim width (BMO-MRW), and retinal nerve fiber layer (RNFL) thickness in glaucoma patients with visual field (VF) defects, and to correlate both to mean deviation (MD) values of obtained standard achromatic perimetry (SAP) examinations., Methods: Patients with glaucoma and glaucomatous VF defects were enrolled in this prospective study and compared to age-matched healthy individuals. All study participants underwent a full ophthalmic examination and VF testing with SAP. Peripapillary RNFL thickness and BMO-MRW were acquired with SD-OCT. Correlation analyses between obtained global functional and global as well as sectorial structural parameters were calculated., Results: A consecutive series of 30 glaucomatous right eyes of 30 patients were included and compared to 36 healthy right eyes of 36 individuals in the control group. Global MD of values correlated significantly with global RNFL (Pearson corr. coeff: 0.632, P =0.001) and global BMO-MRW (Pearson corr. coeff: 0.746, P <0.001) values in the glaucoma group. Global MD and sectorial RNFL or BMO-MRW values correlated less significantly. In the control group, MD values did not correlate with RNFL or BMO-MRW measurements. A subgroup analysis of myopic patients (>4 diopters) within the glaucoma group ( n =6) revealed a tendency for higher correlations between MD and BMO-MRW than MD and RNFL measurements., Conclusion: In a clinical setting, RNFL thickness and BMO-MRW correlate similarly with global VF sensitivity in glaucoma patients with BMO-MRW showing higher correlations in myopic glaucoma patients.

Background and Objective: To describe optical coherence tomography angiography (OCTA) findings in patients with acute central serous chorioretinopathy (CSC) compared to conventional imaging methods., Patients and Methods: A consecutive series of 11 eyes from 10 healthy patients with acute CSC were included and underwent fluorescein angiography (FA), indocyanine green angiography (ICGA), OCT, fundus autofluorescence (FAF), and OCTA. Obtained OCTA images were evaluated for the presence of serous detachments of the neurosensory retina, leakage points, or other altered findings and compared to conventional imaging devices., Results: In four out of 11 eyes, it was possible to detect detached retina adjacent to the leakage point in OCTA images, compared with four of 11 eyes using FA, five of 11 eyes using ICGA, 11 of 11 eyes using SD-OCT, and four of 11 eyes using FAF. In five out of 11 eyes, irregular flow patterns were observed on OCTA images through the choriocapillaris. OCTA images could not identify leakage points in any of the included eyes, compared with 11 out of 11 eyes on FA, five out of 11 eyes on ICGA, eight out of 11 eyes on SD-OCT, and zero out of 11 eyes on FAF., Conclusion: OCTA images of the superficial and deep retinal plexus, outer retina, and choriocapillaris did not reveal altered flow patterns directly associated with the leakage point in acute CSC. However, OCTA was able to visualize altered choroidal flow in some of the included eyes., (Copyright 2016, SLACK Incorporated.)

Objective: The standard measure for the assessment of functional vision in the central retina is best corrected visual acuity (VA). Our aim was to investigate whether it is an advantage to include tests for functional changes in the near retinal periphery to monitor treatment effects in patients receiving multiple injections of anti-vascular endothelial growth factor (anti-VEGF) agents for advanced exudative age-related macular degeneration (AMD)., Design: Prospective pilot study., Participants: Our cohort consisted of 24 patients with exudative AMD (mean age ± SD: 77.46 ± 7.82 years) treated at an ophthalmology clinic., Methods: We compared data from standard functional measurements, VA-near, and contrast sensitivity (CS), with results from the macular mapping test (MMT) at 10% and 100% contrast. Measurements of retinal thickness by optical coherence tomography (OCT) were used to document the morphologic efficacy of the anti-VEGF agent. Tests were performed at baseline and 4 weeks after 3 monthly ranibizumab injections., Results: All 4 functional tests yielded successes (equal or better visual performance after treatment) in 79.2% to 83.3% of cases. Including test locations in the near periphery yielded the highest success rate in the MMT at 10% contrast. Values for VA-near and CS also improved in a majority of cases. OCT measurements of retinal thickness indicated that the agent was effective in the fovea and near periphery., Conclusions: Our findings indicate that using the MMT adds information about functional changes in the near periphery of the retina and allows more sensitive assessment of treatment effects or disease progression without the high expense of other techniques., (Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate changes in the area of the foveal avascular zone (FAZ) in patients with retinal vascular disease., Patients and Methods: This retrospective, consecutive study examined 53 eyes of 53 patients with macular edema due to branch retinal vein occlusion in 25 patients (47.2%) and nonproliferative diabetic retinopathy in 28 patients (52.8%). The macular edema was treated with an intravitreal injection of 0.05 mL equal to 1.25 mg bevacizumab. Before and 6-8 weeks after the injection, best corrected visual acuity, slit lamp biomicroscopy of the anterior segment and fundus, optical coherence tomography, and fluorescein angiography were conducted. The FAZ was manually circumscribed on early-phase angiography images and the area of the FAZ was measured., Results: The preoperative overall mean FAZ area was 0.327 ± 0.126 mm(2) (median 0.310 mm(2)). At the control consultation, the overall mean area was significantly larger (0.422 ± 0.259 mm(2); median 0.380 mm(2); P < 0.001). In the nonproliferative diabetic retinopathy subpopulation, the mean area was 0.361 ± 0.129 mm(2) (median 0.330 mm(2)) before bevacizumab application and 0.434 mm(2) at the follow-up visit (mean increase 0.071 mm(2)/19.7%). In the branch retinal vein occlusion group, the baseline FAZ area was 0.290 ± 0.115 mm(2) and 0.407 ± 0.350 mm(2) at follow-up (median 0.330 mm(2); mean increase 0.117 mm(2)/40.3%). No cases of severe operation-associated complications were observed., Conclusion: The results confirm the safety of intravitreal bevacizumab injection in patients with macular edema due to nonproliferative diabetic retinopathy and branch retinal vein occlusion. The enlargement of the FAZ could be equivalent to an increase in retinal ischemia. These results may be transient; a potential vascular risk, however, when applying antivascular endothelial growth factor therapy in eyes with preexistent vascular disease must be considered.

Objective: To compare efficacy of intravitreal bevacizumab versus triamcinolone in the treatment of diffuse diabetic macular oedema (DME)., Methods: This retrospective nonrandomized study includes 60 patients with diffuse DME treated with at least one intravitreal triamcinolone injection (ITA) or intravitreal bevacizumab injection (IBe). Regression analysis was performed for pretreatment, glycosylated haemoglobin level, visual acuity (VA) at baseline and central macular thickness (CMT) at baseline., Results: After 1-, 3-, 6- and 9-month follow-up, there was no significant change in either VA or CMT treatment in the ITA and IBe groups. There was no statistically significant difference between the two treatment groups. Changes in CMT and VA in the subgroups were not significant. Only predictive factor independent of HbA1c level and VA was CMT at baseline in both treatment groups. The thicker CMT at baseline, the higher was reduction in CMT. After 1 month, the IBe group had a significantly higher decrement than the ITA group., Conclusion: In our study collective, neither IBe nor ITA treatment was able to improve VA during follow-up, significantly. CMT was reduced in both treatment groups, however not significantly. Our data demonstrates that reduction in CMT with either IBe or ITA treatment was significantly influenced by degree of CMT at baseline., (© 2010 The Authors. Journal compilation © 2010 Acta Ophthalmol.)

Background: The VEGF Inhibition Study In Ocular Neovascularisation (VISION) reported the efficacy of intravitreal (ITV) vascular endothelial growth factor (VEGF) inhibition with pegaptanib sodium (Macugen((R))) for the treatment of neovascular age-related macular degeneration (AMD). This paper reports clinical experience with pegaptanib sodium for the treatment of occult or minimally classic choroidal neovascularization (CNV) due to AMD., Material and Methods: The study included 50 eyes (in 49 patients) with either occult CNV or minimally classic CNV secondary to neovascular AMD who were not eligible for photodynamic therapy (PDT). Study data were analyzed retrospectively. During the 6-month study, patients were administered an average 2.74 injections of 0.3 mg ITV pegaptanib sodium. Angiography and optical coherence tomography (OCT) examinations were carried out and intraocular pressure (IOP) and visual acuity (VA) were measured at baseline, at 3 months and at 6 months. An eye examination was performed and VA was measured the 2 days following treatment and then again at weeks 4-6, and at 3 and 6 months. OCT, VA, and IOP were also assessed at 1 month., Results: ITV pegaptanib sodium was well tolerated and no treatment complications arose. Mean VA was measured as: 0.37 +/- 0.24 at baseline; 0.37 +/- 0.25 at 1 month; 0.37 +/- 0.25 at 3 months and 0.40 +/- 0.26 at 6 months. VA was stabilized in approximately 90% of eyes treated with pegaptanib sodium. OCT examination showed a minimal change in central retinal thickness (CRT) during the course of the study, from 251.19 mum at baseline to 251.63 mum at 6 months. No elevation in IOP was measured during treatment at 4-6 months in patients receiving pegaptanib sodium., Conclusions: ITV therapy with pegaptanib sodium for occult and minimally classic CNV secondary to neovascular AMD offered good efficacy with a favorable adverse events profile. The majority of patients showed stabilization in all assessed parameters. In clinical practice, careful consideration should be given to the use of nonselective VEGF inhibition in patients with a high cardiovascular risk profile or in those with a history of thromboembolic events.

Purpose: Intravitreal injections are used extensively to treat retinal diseases. Performing an intravitreal injection increases intraocular volume by the amount of fluid brought into the eye. Whether this influences intraocular pressure (IOP) was investigated here., Methods: A biomechanical model relying on 3-dimensional elasticity theory was developed to determine the short-term effect of volume changes on IOP. We calculated the effect for intravitreal injections of 0.1 ml in myopic, emmetropic and hyperopic eyes. Our calculations were compared with IOP measurements obtained immediately after intravitreal injection of 4 mg triamcinolone in 0.1 ml solution (IVTA) in 22 patients. Shortly after the measurement had been taken, IOP was reduced by paracentesis., Results: Immediately after IVTA, measured IOP was elevated by a mean of 40.6 +/- 12.1 mmHg compared with initial pressure (p < 0.001). Measured and calculated IOP were comparable. Eyes with shorter axial length had higher IOP immediately after the injection (p < 0.05)., Conclusions: The effect of injected volumes on IOP can be calculated with a biomechanical model. Our results show that paracentesis might be recommended when injecting 0.1 ml of a substance to avoid a short-term increase in IOP. As intravitreal injections are mostly applied in diseases that are due to vascular compromise, it might be prudent not to impair perfusion in those eyes, even for short periods of time.