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BACKGROUND AND OBJECTIVE To determine the prophylactic and therapeutic value of a single subthreshold 810-nanometer laser treatment in patients with high risk drusen as a manifestation of dry age-related macular degeneration in both eyes. PATIENTS AND METHODS The Prophylactic Treatment of Age-related Macular Degeneration study enrolled 1,278 eyes of 639 participants who were 50 years or older with at least 5 drusen 63 µm or more in diameter in each eye. Treatment consisted of the placement of an annular grid of 48 extrafoveal, subthreshold 810-nm diode laser applications centered at but sparing the foveola in one eye of each participant, with the fellow eye serving as a control. Development of choroidal neovascularization and change in best-corrected visual acuity were compared between treated and untreated eyes. RESULTS Subthreshold laser treatment did not decrease the incidence of choroidal neovascularization in treated versus untreated eyes. A modest visual acuity benefit in treated eyes was found at 24 months (1.5 letter difference; P = .04) and in the treated eyes of participants with a baseline visual acuity between 20/32 and 20/63 (4.0 letter difference; P = .0034). However, this treatment effect was not sustained at 3 years. CONCLUSION A single subthreshold 810-nanometer laser treatment to eyes of participants with bilateral high risk drusen is not an effective prophylactic strategy against choroidal neovascularization. [Ophthalmic Surg Lasers Imaging 2009;40:530-538.] AUTHORS From the UPMC Eye Center (TRF, PMB), University of Pittsburgh, Pittsburgh, Pennsylvania; the Shiley Eye Center (WRF), University of California–San Diego, La Jolla, California; and the W. K. Kellogg Eye Center (DCM), University of Michigan, Ann Arbor, Michigan. Accepted for publication December 19, 2008. Supported by Iridex Corporation, Mountain View, California, and the sources listed under the individual center descriptions found at the end of the article; the Eye and Ear Foundation of Pittsburgh, Pittsburgh, Pennsylvania; Research to Prevent Blindness, Inc., New York, New York; and unrestricted funds from several participating centers. Presented in part at the annual meeting of the American Academy of Ophthalmology, October 15-18, 2005, Chicago, Illinois, and the annual meeting of the Association for Research in Vision and Ophthalmology, April 30-May 4, 2006, Ft. Lauderdale, Florida. The authors thank photographic readers Cheryl Hiner, Columbia, MD, Rosemary J. Brothers, Madison, WI, and Linda Huang, MD, and Maria Palaiou, MS, Pittsburgh, PA; the Data and Safety Monitoring Committee voting members Donald J. D’Amico, MD, Mark W. Johnson, MD, J. Richard Landis, PhD, and nonvoting ex-officio member, Dr. Musch; and Giorgio Dorin for his contribution to the manuscript. The authors have no financial or proprietary interest in the materials presented herein. Address correspondence to Thomas R. Friberg, MS, MD, UPMC Eye Center, 203 Lothrop Street, Suite 824, Pittsburgh, PA 15213. doi: 10.3928/15428877-20091030-01

BACKGROUND AND OBJECTIVE The Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA) device is a spectral-domain optical coherence tomography system that allows faster data acquisition than the previous generation StratusOCT (Carl Zeiss Meditec, Dublin, CA), which is a time-domain device. The authors compared images from both units to determine the clinical usefulness of spectral-domain optical coherence tomography technology in patients with macular diseases. PATIENTS AND METHODS Six consecutive patients were imaged with both the Cirrus HD-OCT and the StratusOCT devices and the images were compared. RESULTS Cirrus HD-OCT images were typically more useful than StratusOCT images for assessing fine architectural details in macular pathology. The Cirrus HD-OCT software also facilitated a better understanding of three-dimensional data volumes. CONCLUSIONSCommercially available spectral-domain optical coherence tomography is a clinically useful tool for visualizing and understanding macular diseases and offers benefits not inherent in previous generation machines. [Ophthalmic Surg Lasers Imaging 2009;40:25-31.] AUTHORS From the UPMC Eye Center (PMB, LK, TRF), Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh; and the Department of Bioengineering (LK), Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania. Accepted for publication May 8, 2008. Supported by grant NIH RO1-EY013178-8 from the National Institutes of Health, Bethesda, Maryland. The authors have no financial or proprietary interests in the materials presented herein. The authors thank Hiroshi Ishikawa, MD, for his assistance. Address correspondence to Thomas R. Friberg, MD, UPMC Eye Center, 203 Lothrop Street, Suite 824, Pittsburgh, PA 15213.

Background and Objective:A prototype ultrawide field angiographic system and conventional technology were compared.Patients and Methods:Thirty subjects with diabetic retinopathy were imaged in three centers by conventional (Topcon Inc., Paramus, NJ, or Carl Zeiss Meditec, Dublin, CA) and ultrawide field (Optos P200A; Optos Inc., Dunfermline, Scotland) digital fluorescein angiography units. A calibrated grid was digitally placed on the images to facilitate measurements. Main outcome measures were field of view and the number of grid sectors displaying retinal ischemia and neovascularization. Secondary measures were image quality and patient satisfaction scores.Results:The P200A provided a significantly greater visual field extent of 8.7 ± 1.6 disc diameters (DD) compared to the conventional systems (3.4 ± 0.76 DD) (P < .001). Retinal ischemia was better revealed (16.9 ± 15 vs 3.4 ± 4.26 sectors) with the prototype, but image quality was superior with the conventional system. Patient satisfaction scores did not differ between systems.Conclusion:A prototype ultrawide angle imaging system displayed significantly more diabetic retinal pathology in a single image than conventional systems.

* BACKGROUND AND OBJECTIVE: A non contact scanning laser-based retinal imaging system produces a 200° wide-field panoramic image of the fundus through the novel use of a large elliptical mirror. The authors investigated whether accurate diagnoses could be made from these images alone. * PATIENTS AND METHODS: Images were obtained from both eyes of arbitrarily selected patients and were retrospectively reviewed by retinal specialists. Each physician made a diagnosis, suggested the follow-up interval, and determined whether any intervention was needed based solely on image review. Diabetic retinopathy was categorized as background retinopathy only, preprolìferative retinopathy, maculopathy, and proliferative retinopathy. The results of the image review were then compared with the results of clinical examination, and the sensitivity and specificity of the review were calculated. * RESULTS: The correct overall diagnosis was made by the two specialists in 87% and 77% of cases, respectively; the specificity and sensitivity each averaged 76%. Follow-up interval recommendations from image review matched those made on clinical examination in 86% of cases. Diabetic retinopathy was correctly identified as a general diagnosis with a sensitivity of 94% and the follow-up recommendations corresponded to the clinical recommendations in 82%. Sixty-two percent of the images were judged to be of good quality or better, with only 6.4% deemed unreadable. Iris color did not influence image quality. * CONCLUSION: The non-contact scanning laser-based retinal imaging system provides images of sufficient resolution and clarity to make accurate general diagnoses in a high percentage of cases. Its use as a screening device for specific diseases is feasible and merits further study. [Ophthalmic Surg Lasers Imaging 2003;34:488497.]

* BACKGROUND: Although pneumatic retinopexy was introduced for the repair of primary retinal detachments, we have had excellent long-term success in employing this technique along with laser photocoagulation following failure of routine scleral buckle surgery in nonvitrectomized eyes over the last 10 years. * PATIENTS AND METHODS: We categorized a consecutive series of 40 eyes that failed primary scleral buckling surgery and had at least six months followup. Eyes were separated into two groups: those with 1) subretinal fluid persisting or developing during the first 14 days after surgery or 2) those accumulating subretinal fluid at least 14 days after initially successful anatomic reattachment of the retina. * RESULTS: In these groups, 36 of the 40 eyes (90%) were successfully reattached using outpatient pneumatic retinopexy alone. Complications were limited to the production of new retinal breaks in 5 patients. The 4 pneumatic retinopexy failures were all subsequently treated successfully with either scleral buckle revision or vitrectomy. * CONCLUSION: We believe that laser pneumatic retinopexy repair of recurrent retinal detachments following scleral buckle and without significant proliferation vitreoretinopathy (PVR) should be considered ahead of conventional surgical intraoperative techniques. Laser pneumatic retinopexy may be a very successful procedure for the treatment of recurrent retinal detachments after failed scleral buckle surgery. In a consecutive series of 40 eyes with recurrent retinal detachment, we were able to repair 36 with pneumatic retinopexy alone. [Ophthalmic Surg Lasers 2001;32:13-18]

* BACKGROUND AND OBJECTIVE: Some patients with macular disease, because of physical infirmity or disability, cannot be treated with laser photocoagulation using a typical slit lamp delivery system. The purpose of this study was to determine whether the binocular indirect ophthalmoscope could be used to deliver treatment to the macula when photocoagulation would otherwise be very difficult, if not impossible, to perform. * MATERIALS AND METHODS: Ten eyes of 10 patients who could not sit for slit lamp laser delivery were treated with binocular indirect ophthalmoscope laser photocoagulation over a 36 month period. Eight had subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD), and 2 patients had clinically significant macular edema (CSME) from diabetes mellitus. Argon laser photocoagulation was delivered to the choroidal neovascular membrane in patients with exudative AMD, and a grid treatment was given to eyes with diabetic macular edema. * RESULTS: Six of 8 patients with exudative AMD were successfully treated with eradication of the CNV. Two required retreatment within 6 months of original treatment. Both patients with CSME had resolution of their edema at 3 and 6 months after treatment. Best corrected visual acuity did not change by more than 2 Snellen lines in any patient with CNV and 1 Snellen line in patients with CSME. No complications of treatment were encountered. * CONCLUSION: In certain circumstances, laser photocoagulation of the macula using the indirect ophthalmoscope laser delivery system should be considered when more conventional treatment strategies cannot be implemented. [Ophthalmic Surg Lasers 1999;30:518-522.]

Six hundred Chinese patients (624 eyes) with clinically diagnosed central serous retinopathy were treated by consecutive courses of acupuncture. Eighty-six percent of patients had resolution of their subretinal fluid within 3 months of treatment, a result similar to the natural history of the disease as reported by others in non-Chinese patients. Central serous retinopathy was most common in the 30 to 50 year age group, occurred in males seven times more frequently than in females, and was bilateral in 4% of patients.

SUMMARY Occasionally a surgeon does not obtain an adequate length of optic nerve during enucleation surgery for a suspected intraocular malignancy. Retrieval of an additional nerve segment can be accomplished rapidly utilizing a glass test tube containing a few milliliters of water as an orbital endoscope. Under direct visualization, the remainder of the optic nerve can be located, grasped with a curved clamp, and sectioned with scissors.