22 results on '"Reichel E"'
Search Results
2. Differentiation of Degenerative Retinoschisis from Retinal Detachment Using Optical Coherence Tomography
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Ip, M., Garza-Karren, C., Duker, J. S., Reichel, E., Swartz, J. C., Amirikia, A., and Puliafito, C. A.
- Published
- 1999
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3. Transpupillary Thermotherapy of Occult Subfoveal Choroidal Neovascularization in Patients with Age-related Macular Degeneration
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Reichel, E., Berrocal, A. M., Ip, M., Kroll, A. J., Desai, V., Duker, J. S., and Puliafito, C. A.
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- 1999
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4. Spectral-domain optical coherence tomography angiography of choroidal neovascularization.
- Author
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de Carlo TE, Bonini Filho MA, Chin AT, Adhi M, Ferrara D, Baumal CR, Witkin AJ, Reichel E, Duker JS, and Waheed NK
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- Adult, Aged, Aged, 80 and over, Blood-Retinal Barrier, Capillary Permeability, Central Serous Chorioretinopathy diagnosis, Female, Humans, Male, Middle Aged, Retinal Vessels pathology, Retrospective Studies, Sensitivity and Specificity, Subretinal Fluid, Young Adult, Choroidal Neovascularization diagnosis, Fluorescein Angiography, Tomography, Optical Coherence
- Abstract
Purpose: To describe the characteristics as well as the sensitivity and specificity of detection of choroidal neovascularization (CNV) on optical coherence tomography angiography (OCTA) using spectral-domain optical coherence tomography., Design: Observational, retrospective study., Participants: Seventy-two eyes of 61 subjects (48 eyes of 43 subjects with CNV, 24 eyes of 18 subjects without CNV)., Methods: Patients imaged using the prototype AngioVue OCTA system (Optovue, Inc, Fremont, CA) between August 2014 and October 2014 at New England Eye Center were assessed. Patients in whom CNV was identified on OCTA were evaluated to define characteristics of CNV on OCTA: size using greatest linear dimension (small, <1 mm; medium, 1-2 mm; large, >2 mm), appearance (well-circumscribed, poorly circumscribed), and presence of subretinal and intraretinal fluid. Concurrently, an overlapping second cohort of patients who underwent same-day OCTA and fluorescein angiography (FA) for suspected CNV was evaluated to estimate sensitivity and specificity of OCTA in detecting CNV using FA as ground truth., Main Outcome Measures: Choroidal neovascularization appearance, CNV size, and presence of subretinal and intraretinal fluid., Results: In 48 eyes, CNV was visualized on OCTA. Thirty-one eyes had CNV associated with neovascular age-related macular degeneration. Size of CNV was small in 23% (7/31), medium in 42% (13/31), and large in 35% (11/31). Poorly circumscribed vessels, subretinal fluid, and intraretinal fluid each were seen in 71% (22/31). Seven eyes had CNV associated with central serous chorioretinopathy. Size of CNV was small in 71% (5/7) and large in 29% (2/7). Seventy-one percent (5/7) had well-circumscribed vessels, 86% (6/7) had subretinal fluid, and 14% (1/7) had intraretinal fluid. Thirty eyes with OCTA and same-day FA were evaluated to determine sensitivity and specificity of CNV detection on OCTA. Sensitivity was 50% (4/8) and specificity was 91% (20/22)., Conclusions: Using OCTA allows the clinician to visualize CNV noninvasively and may provide a method for identifying and guiding treatment of CNV. The specificity of CNV detection on OCTA compared with FA seems to be high. Future studies with larger sample sizes are needed to elaborate better on the sensitivity and specificity of CNV detection and to illustrate clinical usefulness., (Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
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- 2015
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5. Vitreous evaluation: a diagnostic challenge.
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Mehta M, Rasheed RA, Duker J, Reichel E, Feinberg E, Husain D, Foster CS, and Laver NV
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- Cytokines metabolism, Endophthalmitis diagnosis, Endophthalmitis metabolism, Eye Diseases metabolism, Eye Infections diagnosis, Eye Infections metabolism, Humans, Immunohistochemistry, Intraocular Lymphoma diagnosis, Intraocular Lymphoma metabolism, Polymerase Chain Reaction, Retrospective Studies, Uveitis diagnosis, Uveitis metabolism, Vitreous Body metabolism, Eye Diseases diagnosis, Vitrectomy, Vitreous Body pathology
- Abstract
Purpose: To categorize vitrectomy cytologic diagnoses and ancillary tests to address appropriate processing of low-volume vitreous samples., Design: Retrospective case series., Participants: Five thousand seven hundred thirty-six vitreous samples., Methods: Cytologic diagnoses of therapeutic and diagnostic vitrectomy samples and their processing protocols from 3 teaching institutions were reviewed., Main Outcome Measures: Diagnostic results were categorized as negative for malignancy, suspicious for malignancy, and positive for malignancy. All ancillary studies performed were documented, including special stains, immunohistochemistry analysis, cytokine levels, and polymerase chain reaction (PCR) analysis., Results: Of the 5736 vitreous samples analyzed, 4683 (81.64%) were from Tufts Medical Center (TMC), 955 (16.65%) were from Boston Medical Center (BMC), and 98 (1.70%) were from Massachusetts Eye Research and Surgery Institution (MERSI). Cases from TMC and BMC were therapeutic and diagnostic vitrectomies, and MERSI cases were diagnostic vitrectomies. Most vitrectomies showed negative results for malignancy: 99.47% of TMC cases, 99.89% of BMC cases, and 79.6% of MERSI cases. These included vitreous hemorrhage and inflammatory or infectious findings. Ancillary studies performed in this category included Periodic Acid-Schiff staining for fungi, PCR analysis for toxoplasmosis, cytomegalovirus, Epstein-Barr virus (EBV), herpes simplex virus I and II, and vitreous cultures for infections (coagulase-negative Staphylococcus, Candida, Fusarium, and Propionibacterium species). Interleukin (IL) 10-to-IL-6 ratios were performed on 38.7% of cases from MERSI. Fourteen cases from TMC were suspicious for malignancy based on cytologic evaluation. Eleven cases from TMC, 1 case from BMC, and 20 cases from MERSI showed positive results for malignancy and included B-cell lymphoma, retinoblastoma, melanoma, and metastatic adenocarcinoma. The ancillary testing included PCR for heavy chain immunoglobulin gene rearrangements, immunohistochemistry for EBV, in situ hybridization for κ and λ light chains, and cytogenetics., Conclusions: This is the largest data pool of reported cytologic diagnoses of diagnostic and therapeutic vitrectomy samples. Cytologic evaluation of therapeutic vitrectomy samples provides a valuable baseline of nonpathologic findings that assist in differentiation between malignancy, infections, and inflammatory conditions. Allocation of small-volume vitreous samples to select ancillary testing from the plethora of available diagnostic tests requires preoperative communication between surgeons and pathologists to ensure appropriate and timely treatment methods., (Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
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6. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole.
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Duker JS, Kaiser PK, Binder S, de Smet MD, Gaudric A, Reichel E, Sadda SR, Sebag J, Spaide RF, and Stalmans P
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- Aging physiology, Databases, Factual, Eye Diseases diagnosis, Eye Diseases surgery, Humans, Retinal Perforations diagnosis, Retinal Perforations surgery, Surveys and Questionnaires, Tissue Adhesions, Tomography, Optical Coherence, Vitreous Detachment diagnosis, Vitreous Detachment surgery, Eye Diseases classification, Retinal Perforations classification, Vitreous Body pathology, Vitreous Detachment classification
- Abstract
Objective: The International Vitreomacular Traction Study (IVTS) Group was convened to develop an optical coherence tomography (OCT)-based anatomic classification system for diseases of the vitreomacular interface (VMI)., Design: The IVTS applied their clinical experience, after reviewing the relevant literature, to support the development of a strictly anatomic OCT-based classification system., Participants: A panel of vitreoretinal disease experts was the foundation of the International Classification System., Methods: Before the meeting, panel participants were asked to review 11 articles and to complete 3 questionnaires. The articles were preselected based on searches for comprehensive reviews covering diseases of the VMI. Responses to questionnaires and the group's opinions on definitions specified in the literature were used to guide the discussion., Main Outcome Measures: Optical coherence tomography-based anatomic definitions and classification of vitreomacular adhesion, vitreomacular traction (VMT), and macular hole., Results: Vitreomacular adhesion is defined as perifoveal vitreous separation with remaining vitreomacular attachment and unperturbed foveal morphologic features. It is an OCT finding that is almost always the result of normal vitreous aging, which may lead to pathologic conditions. Vitreomacular traction is characterized by anomalous posterior vitreous detachment accompanied by anatomic distortion of the fovea, which may include pseudocysts, macular schisis, cystoid macular edema, and subretinal fluid. Vitreomacular traction can be subclassified by the diameter of vitreous attachment to the macular surface as measured by OCT, with attachment of 1500 μm or less defined as focal and attachment of more than 1500 μm as broad. When associated with other macular disease, VMT is classified as concurrent. Full-thickness macular hole (FTMH) is defined as a foveal lesion with interruption of all retinal layers from the internal limiting membrane to the retinal pigment epithelium. Full-thickness macular hole is primary if caused by vitreous traction or secondary if directly the result of pathologic characteristics other than VMT. Full-thickness macular hole is subclassified by size of the hole as determined by OCT and the presence or absence of VMT., Conclusions: This classification system will support systematic diagnosis and management by creating a clinically applicable system that is predictive of therapeutic outcomes and is useful for the execution and analysis of clinical studies., (Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
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7. Epimacular brachytherapy for neovascular age-related macular degeneration: a randomized, controlled trial (CABERNET).
- Author
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Dugel PU, Bebchuk JD, Nau J, Reichel E, Singer M, Barak A, Binder S, and Jackson TL
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- Aged, Aged, 80 and over, Angiogenesis Inhibitors administration & dosage, Angiogenesis Inhibitors therapeutic use, Antibodies, Monoclonal, Humanized administration & dosage, Antibodies, Monoclonal, Humanized therapeutic use, Female, Fluorescein Angiography, Follow-Up Studies, Humans, Intravitreal Injections, Male, Middle Aged, Radiotherapy Dosage, Ranibizumab, Strontium Radioisotopes adverse effects, Treatment Outcome, Visual Acuity physiology, Wet Macular Degeneration diagnosis, Wet Macular Degeneration drug therapy, Yttrium Radioisotopes adverse effects, Brachytherapy, Macula Lutea radiation effects, Strontium Radioisotopes therapeutic use, Wet Macular Degeneration radiotherapy, Yttrium Radioisotopes therapeutic use
- Abstract
Purpose: To evaluate the safety and efficacy of epimacular brachytherapy (EMBT) for the treatment of neovascular age-related macular degeneration (AMD)., Design: Multicenter, randomized, active-controlled, phase III clinical trial., Participants: Four hundred ninety-four participants with treatment-naïve neovascular AMD., Methods: Participants with classic, minimally classic, and occult lesions were randomized in a 2:1 ratio to EMBT or a ranibizumab monotherapy control arm. The EMBT arm received 2 mandated, monthly loading injections of 0.5 mg ranibizumab. The control arm received 3 mandated, monthly loading injections of ranibizumab then quarterly injections. Both arms also received monthly as needed (pro re nata) retreatment., Main Outcome Measures: The proportion of participants losing fewer than 15 Early Treatment Diabetic Retinopathy Study (ETDRS) letters from baseline visual acuity (VA) and the proportion gaining more than 15 ETDRS letters from baseline VA., Results: At 24 months, 77% of the EMBT group and 90% of the control group lost fewer than 15 letters. This difference did not meet the prespecified 10% noninferiority margin. This end point was noninferior using a 20% margin and a 95% confidence interval for the group as a whole and for classic and minimally classic lesions, but not for occult lesions. The EMBT did not meet the superiority end point for the proportion of participants gaining more than 15 letters (16% for the EMBT group vs. 26% for the control group): this difference was statistically significant (favoring controls) for occult lesions, but not for predominantly classic and minimally classic lesions. Mean VA change was -2.5 letters in the EMBT arm and +4.4 letters in the control arm. Participants in the EMBT arm received a mean of 6.2 ranibizumab injections versus 10.4 in the control arm. At least 1 serious adverse event occurred in 54% of the EMBT arm, most commonly postvitrectomy cataract, versus 18% in the control arm. Mild, nonproliferative radiation retinopathy occurred in 3% of the EMBT participants, but no case was vision threatening., Conclusions: The 2-year efficacy data do not support the routine use of EMBT for treatment-naïve wet AMD, despite an acceptable safety profile. Further safety review is required., (Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
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- 2013
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8. Sustained delivery fluocinolone acetonide vitreous inserts provide benefit for at least 3 years in patients with diabetic macular edema.
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Campochiaro PA, Brown DM, Pearson A, Chen S, Boyer D, Ruiz-Moreno J, Garretson B, Gupta A, Hariprasad SM, Bailey C, Reichel E, Soubrane G, Kapik B, Billman K, Kane FE, and Green K
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- Antihypertensive Agents therapeutic use, Cataract etiology, Cataract therapy, Diabetic Retinopathy diagnosis, Double-Blind Method, Drug Implants, Fluocinolone Acetonide adverse effects, Fluorescein Angiography, Follow-Up Studies, Glaucoma etiology, Glaucoma surgery, Glucocorticoids adverse effects, Humans, Macular Edema diagnosis, Phacoemulsification, Tomography, Optical Coherence, Trabeculectomy, Treatment Outcome, Visual Acuity physiology, Vitreous Body, Diabetic Retinopathy drug therapy, Fluocinolone Acetonide administration & dosage, Glucocorticoids administration & dosage, Macular Edema drug therapy
- Abstract
Objective: To assess long-term efficacy and safety of intravitreal inserts releasing 0.2 μg/d (low dose) or 0.5 μg/d (high dose) fluocinolone acetonide (FAc) in patients with diabetic macular edema (DME)., Design: Two randomized, sham injection-controlled, double-masked, multicenter clinical trials., Participants: Subjects with persistent DME despite ≥1 macular laser treatment were randomized 1:2:2 to sham injection (n = 185), low-dose insert (n = 375), or high-dose insert (n = 393)., Methods: Subjects received study drug or sham injection and after 6 weeks were eligible for rescue laser. Based on retreatment criteria, additional study drug or sham injections could be given after 1 year., Main Outcome Measures: Percentage of patients with improvement of ≥15 letters from baseline. Secondary outcomes included other parameters of visual function and foveal thickness., Results: At month 36, the percentage of patients who gained ≥15 in letter score using the last observation carried forward method was 28.7% (low dose) and 27.8% (high dose) in the FAc insert groups compared with 18.9% (P = 0.018) in the sham group, and considering only those patients still in the trial at month 36, it was 33.0% (low dose) and 31.9% (high dose) compared with 21.4% in the sham group (P = 0.030). Preplanned subgroup analysis demonstrated a doubling of benefit compared with sham injections in patients who reported duration of DME ≥3 years at baseline; the percentage who gained ≥15 in letter score at month 36 was 34.0% (low dose; P<0.001) or 28.8% (high dose; P = 0.002) compared with 13.4% (sham). An improvement ≥2 steps in the Early Treatment Diabetic Retinopathy Study retinopathy scale occurred in 13.7% (low dose) and 10.1% (high dose) compared with 8.9% in the sham group. Almost all phakic patients in the FAc insert groups developed cataract, but their visual benefit after cataract surgery was similar to that in pseudophakic patients. The incidence of incisional glaucoma surgery at month 36 was 4.8% in the low-dose group and 8.1% in the high-dose insert group., Conclusions: In patients with DME FAc inserts provide substantial visual benefit for up to 3 years and would provide a valuable addition to the options available for patients with DME., (Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
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- 2012
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9. High-speed ultrahigh resolution optical coherence tomography before and after ranibizumab for age-related macular degeneration.
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Witkin AJ, Vuong LN, Srinivasan VJ, Gorczynska I, Reichel E, Baumal CR, Rogers AH, Schuman JS, Fujimoto JG, and Duker JS
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- Aged, Aged, 80 and over, Antibodies, Monoclonal, Humanized, Female, Fluorescein Angiography, Humans, Image Processing, Computer-Assisted, Imaging, Three-Dimensional methods, Injections, Male, Middle Aged, Ranibizumab, Retrospective Studies, Visual Acuity, Vitreous Body, Angiogenesis Inhibitors therapeutic use, Antibodies, Monoclonal therapeutic use, Macular Degeneration diagnosis, Macular Degeneration drug therapy, Retina pathology, Tomography, Optical Coherence
- Abstract
Objective: To evaluate intraretinal anatomy in patients with exudative age-related macular degeneration (AMD) using high-speed ultrahigh resolution optical coherence tomography (hsUHR-OCT) before and 1 month after intravitreal injection of ranibizumab., Design: Retrospective case series., Participants: Twelve eyes of 12 patients., Methods: A broad bandwidth superluminescent diode laser light source and spectral/Fourier domain signal detection were used to create a prototype hsUHR-OCT instrument with 3.5 mum axial image resolution and approximately 25,000 lines/second acquisition speed. Twelve eyes of 12 patients with exudative AMD were imaged with hsUHR-OCT before and 1 month after intravitreal ranibizumab injection. High pixel density and raster-scanned 3-dimensional (3D) OCT data sets were generated. Three-dimensional imaging software was used to calculate subretinal/retinal pigment epithelium fluid volume and volume of the fibrovascular lesion., Main Outcome Measures: Qualitative and quantitative analysis of hsUHR-OCT images and 3D data sets., Results: All eyes had some degree of normalization of macular contour after intravitreal ranibizumab. The inner/outer photoreceptor segment junction visualized on hsUHR-OCT was discontinuous, overlying the fibrovascular lesion in all 12 of 12 eyes both before and after treatment; 9 of 12 eyes had focal areas of thinning of the outer nuclear layer, which remained after treatment. Volumetric measurements were possible in 8 of 12 eyes with 3D-rendering software. Fibrovascular lesion volume did not change significantly after treatment., Conclusions: hsUHR-OCT is capable of unprecedented imaging speed and resolution, making it a valuable instrument in measuring in vivo intraretinal pathology. All 12 eyes had some normalization of macular contour. Fibrovascular lesion volume did not change significantly 1 month after treatment, suggesting that ranibizumab does not cause much initial regression of preexisting neovascular tissue. Photoreceptor abnormalities remained in all patients after treatment of wet AMD, suggesting that although ranibizumab improves overall retinal architecture, some photoreceptor damage may be irreversible., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
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- 2009
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10. Ultrahigh-resolution optical coherence tomography in patients with decreased visual acuity after retinal detachment repair.
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Schocket LS, Witkin AJ, Fujimoto JG, Ko TH, Schuman JS, Rogers AH, Baumal C, Reichel E, and Duker JS
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- Adult, Aged, Cryosurgery, Diagnostic Techniques, Ophthalmological, Humans, Middle Aged, Retrospective Studies, Scleral Buckling, Vitrectomy, Photoreceptor Cells, Vertebrate pathology, Postoperative Complications, Retinal Detachment diagnosis, Retinal Detachment surgery, Tomography, Optical Coherence, Vision Disorders diagnosis, Visual Acuity
- Abstract
Objective: To assess microstructural changes in the retina that may explain incomplete visual recovery after anatomically successful repair of rhegmatogenous retinal detachments (RD) using ultrahigh-resolution optical coherence tomography (UHR OCT)., Design: Retrospective observational case series., Participants: Seventeen patients with decreased visual acuity after RD repair. Twelve patients had macula-involving and 5 had macula-sparing RDs., Methods: The UHR OCT prototype capable of approximately 3 mum axial resolution was developed for clinical use. The UHR OCT images through the center of the fovea in 17 patients with visual complaints after RD surgery were obtained. Patients were either postoperative patients from the New England Eye Center or tertiary referrals. Baseline visual acuity, preoperative lens status, location of retinal detachment, macular involvement, and postoperative visual acuity were recorded., Main Outcome Measures: The UHR OCT images after RD repair., Results: The UHR OCT images were obtained 1 to 84 months (median, 5 months) postoperatively. The mean preoperative logarithm of the minimum angle of resolution (logMAR) visual acuity was 1.37 (Snellen equivalent, 20/390). The mean postoperative logMAR visual acuity was 0.48 (Snellen equivalent, 20/60). Anatomical abnormalities that were detected included distortion of the photoreceptor inner/outer segments (IS/OS) junction in 14 of 17 patients (82%), epiretinal membranes in 10 of 17 patients (59%), residual subretinal fluid in 3 of 17 patients (18%), and cystoid macular edema in 2 of 17 patients (12%). Of the 5 patients with preoperative macula-on detachments, 4 had distortion of the outer retina after RD repair., Conclusions: The higher resolution of UHR OCT facilitates imaging of the IS/OS junction. Therefore, UHR OCT is able to confirm prior histopathologic findings that damage to photoreceptor outer segments may occur as a consequence of retinal detachment. This may explain poor postoperative visual acuity in eyes with anatomically successful repair.
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- 2006
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11. Redefining lamellar holes and the vitreomacular interface: an ultrahigh-resolution optical coherence tomography study.
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Witkin AJ, Ko TH, Fujimoto JG, Schuman JS, Baumal CR, Rogers AH, Reichel E, and Duker JS
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- Aged, Disease Progression, Epiretinal Membrane diagnosis, Epiretinal Membrane physiopathology, Epiretinal Membrane surgery, Female, Humans, Middle Aged, Ophthalmologic Surgical Procedures, Recurrence, Retinal Perforations surgery, Retrospective Studies, Visual Acuity, Vitrectomy, Vitreous Detachment diagnosis, Retinal Perforations diagnosis, Tomography, Optical Coherence methods, Vitreous Body
- Abstract
Objectives: To define optical coherence tomographic (OCT) criteria for the diagnosis of a lamellar macular hole, and to increase understanding of lamellar hole pathogenesis by examining fine anatomic features using ultrahigh-resolution optical coherence tomography (UHR OCT)., Design: Retrospective observational case series., Participants: Nineteen eyes of 18 patients with lamellar holes were imaged with UHR OCT between 2002 and 2004., Methods: A UHR OCT system was developed for use in the ophthalmology clinic. All 6 UHR OCT images for each eye imaged were examined. Lamellar holes were diagnosed based on a characteristic OCT appearance. Criteria for the OCT diagnosis of a lamellar hole were as follows: (1) irregular foveal contour; (2) break in the inner fovea; (3) intraretinal split; and (4) intact foveal photoreceptors. From 1205 eyes of 664 patients imaged with UHR OCT, and retrospectively reviewed, 19 eyes of 18 patients were diagnosed with a lamellar hole based on these criteria. All 19 eyes were also imaged with standard resolution OCT. Their charts were retrospectively reviewed., Main Outcome Measures: Standard and ultrahigh-resolution OCT images., Results: On chart review, clinical diagnosis of a lamellar hole was made in only 7 of 19 eyes (37%). Twelve of 19 eyes (63%) had an epiretinal membrane (ERM) on clinical examination. Ten of 19 eyes (53%) had a posterior vitreous detachment. On UHR OCT, 17 of 19 eyes (89%) had ERMs. Eleven ERMs had an unusual thick appearance on UHR OCT. Due to poor visual acuity, 4 eyes underwent vitrectomy. Only 1 of 4 surgeries (25%) was visually and anatomically successful. Another eye improved visually, but a lamellar hole persisted. One eye progressed to a full-thickness macular hole preoperatively, which reopened after surgery. One eye developed a full-thickness hole postoperatively., Conclusions: The diagnosis of a lamellar hole can be made based on OCT criteria, which could be applied to both standard and ultrahigh-resolution OCT. The increased resolution of UHR OCT sheds light on the pathogenesis of the lamellar hole. Epiretinal membranes were visualized on UHR OCT in the majority of eyes. Many ERMs had an unusual thick appearance on UHR OCT, which may represent either trapped vitreous or posterior hyaloid, and may help stabilize retinal anatomy. Conversely, ERM contraction may play a role in lamellar hole formation. Vitrectomy surgery was anatomically and visually successful in only 1 of 4 patients, suggesting caution when performing vitrectomy on lamellar holes.
- Published
- 2006
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12. Six-week outcomes after pegaptanib.
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Schuman S, Rogers AH, Duker JS, Reichel E, and Baumal CR
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- Aptamers, Nucleotide administration & dosage, Humans, Macular Degeneration diagnosis, Macular Degeneration physiopathology, Time Factors, Tomography, Optical Coherence, Treatment Outcome, Visual Acuity, Vitreous Body, Aptamers, Nucleotide therapeutic use, Macular Degeneration drug therapy
- Published
- 2006
- Full Text
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13. Intravitreal triamcinolone for refractory diabetic macular edema.
- Author
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Martidis A, Duker JS, Greenberg PB, Rogers AH, Puliafito CA, Reichel E, and Baumal C
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- Adult, Aged, Aged, 80 and over, Diabetic Retinopathy diagnosis, Diabetic Retinopathy physiopathology, Drug Evaluation, Humans, Injections, Interferometry, Laser Coagulation, Light, Macular Edema diagnosis, Macular Edema physiopathology, Middle Aged, Prospective Studies, Tomography, Treatment Outcome, Visual Acuity, Vitreous Body, Diabetic Retinopathy drug therapy, Glucocorticoids therapeutic use, Macular Edema drug therapy, Triamcinolone Acetonide therapeutic use
- Abstract
Purpose: To determine if intravitreal injection of triamcinolone acetonide is safe and effective in treating diabetic macular edema unresponsive to prior laser photocoagulation., Design: Prospective, noncomparative, interventional case series., Participants: Sixteen eyes with clinically significant diabetic macular edema (CSME) that failed to respond to at least two previous sessions of laser photocoagulation., Methods: Eyes were diagnosed with CSME and treated with at least two sessions of laser photocoagulation according to Early Treatment Diabetic Retinopathy Study guidelines. At least 6 months after initial laser therapy, the response was measured by clinical examination and optical coherence tomography (OCT). Eyes with a residual central macular thickness of more than 300 microm (normal, 200 microm) and visual loss from baseline were offered intravitreal injection of 4 mg triamcinolone acetonide. The visual and anatomic responses were observed as well as complications related to the injection procedure and corticosteroid medication., Main Outcome Measures: Visual acuity and quantitative change in OCT macular thickening were assessed. Potential complications were monitored, including intraocular pressure response, cataract progression, retinal detachment, vitreous hemorrhage, and endophthalmitis., Results: All patients completed 3 months of follow-up, and 8 of 16 patients (50%) completed 6 or more months of follow-up. Mean improvement in visual acuity measured 2.4, 2.4, and 1.3 Snellen lines at the 1-, 3-, and 6-month follow-up intervals, respectively. The central macular thickness as measured by OCT decreased by 55%, 57.5%, and 38%, respectively, over these same intervals from an initial pretreatment mean of 540.3 microm (+/-96.3 microm). Intraocular pressure exceeded 21 mmHg in 5, 3, and 1 eye(s), respectively, during these intervals. One eye exhibited cataract progression at 6 months. No other complications were noted over a mean follow-up of 6.2 months. Reinjection was performed in 3 of 8 eyes after 6 months because of recurrence of macular edema., Conclusions: Intravitreal triamcinolone is a promising therapeutic method for diabetic macular edema that fails to respond to conventional laser photocoagulation. Complications do not appear to be prohibitive. Further study is warranted to assess the long-term efficacy and safety, and the need for retreatment.
- Published
- 2002
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14. Topography of diabetic macular edema with optical coherence tomography.
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Hee MR, Puliafito CA, Duker JS, Reichel E, Coker JG, Wilkins JR, Schuman JS, Swanson EA, and Fujimoto JG
- Subjects
- Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Fluorescein Angiography, Fundus Oculi, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, Pilot Projects, Retinal Diseases diagnosis, Visual Acuity, Diabetic Retinopathy diagnosis, Edema diagnosis, Macula Lutea pathology, Tomography methods
- Abstract
Objective: This study aimed to develop a protocol to screen and monitor patients with diabetic macular thickening using optical coherence tomography (OCT), a technique for high-resolution cross-sectional imaging of the retina., Design: A cross-sectional pilot study was conducted., Participants: A total of 182 eyes of 107 patients with diabetic retinopathy, 55 eyes from 31 patients with diabetes but no ophthalmoscopic evidence of retinopathy, and 73 eyes from 41 healthy volunteers were studied., Intervention: Six optical coherence tomograms were obtained in a radial spoke pattern centered on the fovea. Retinal thickness was computed automatically from each tomogram at a total of 600 locations throughout the macula. Macular thickness was displayed geographically as a false-color topographic map and was reported numerically as averages in each of nine regions., Main Outcome Measures: Correlation of OCT with slit-lamp biomicroscopy, fluorescein angiography, and visual acuity was measured., Results: Optical coherence tomography was able to quantify the development and resolution of both foveal and extrafoveal macular thickening. The mean +/- standard deviation foveal thickness was 174 +/- 18 microns in normal eyes, 179 +/- 17 microns in diabetic eyes without retinopathy, and 256 +/- 114 microns in eyes with nonproliferative diabetic retinopathy. Foveal thickness was highly correlated among left and right eyes of normal eyes (mean +/- standard deviation difference of 6 +/- 9 microns). Foveal thickness measured by OCT correlated with visual acuity (r2 = 0.79). A single diabetic eye with no slit-lamp evidence of retinopathy showed abnormal foveal thickening on OCT., Conclusions: Optical coherence tomography was a useful technique for quantifying macular thickness in patients with diabetic macular edema. The topographic mapping protocol provided geographic information on macular thickness that was intuitive and objective.
- Published
- 1998
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15. Indocyanine green hyperfluorescence associated with serous retinal pigment epithelial detachment in age-related macular degeneration.
- Author
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Baumal CR, Reichel E, Duker JS, Wong J, and Puliafito CA
- Subjects
- Aged, Aged, 80 and over, Female, Fluorescein Angiography methods, Follow-Up Studies, Fundus Oculi, Humans, Laser Coagulation, Macular Degeneration pathology, Male, Middle Aged, Retinal Detachment etiology, Retinal Detachment surgery, Retrospective Studies, Treatment Outcome, Visual Acuity, Coloring Agents, Indocyanine Green, Macular Degeneration complications, Pigment Epithelium of Eye pathology, Retinal Detachment diagnosis
- Abstract
Purpose: Indocyanine green (ICG) angiography may improve visualization of choroidal neovascularization (CNV) associated with serous retinal pigment epithelial detachment (RPED) in age-related macular degeneration (AMD). The features of ICG hyperfluorescence associated with serous RPED and therapeutic effect of ICG-directed laser photocoagulation in eyes with serous RPED is evaluated., Design: Retrospective review of all simultaneous fluorescein/ICG angiograms (n = 918) performed over an 18-month period to identify 44 eyes in 39 patients with serous RPED secondary to AMD on fluorescein angiography., Participants: Thirty-nine patients with AMD, aged 53 to 89 years, participated., Intervention: Eyes were nonrandomly treated with ICG-directed laser photocoagulation or observation., Main Outcome Measures: Characteristics of ICG hyperfluorescence associated with a serous RPED are reviewed. Final visual acuity and anatomic appearance of the serous RPED are given., Results: Twenty-three (52%) of the 44 eyes had an isolated serous RPED without obvious CNV, and 21 (48%) of the 44 eyes had a serous RPED associated with occult CNV on fluorescein angiography. Indocyanine green angiography demonstrated underlying CNV in 19 eyes (83%) with an isolated serous RPED and in all 21 eyes (100%) with serous RPED and occult CNV. The pattern of ICG hyperfluorescence revealed focal CNV in 15 eyes and plaque CNV in 4 eyes with an isolated serous RPED. In eyes with serous RPED and occult CNV, focal CNV and plaque CNV were noted with ICG in 8 and 13 eyes, respectively. No follow-up was available for two eyes. Twenty eyes were treated with ICG-directed laser photocoagulation. In these eyes, the visual acuity remained stable in 6 eyes (30%) and decreased in 14 eyes (70%). Twenty-two eyes were observed, and the visual acuity remained stable in 8 (36%), improved in 2 (9%), and decreased in 12 eyes (55%)., Conclusions: Although ICG angiography may enhance visualization of CNV associated with serous RPED in AMD, ICG-directed laser treatment did not appear to improve visual acuity when compared with observed eyes in this series.
- Published
- 1997
- Full Text
- View/download PDF
16. Characterization of epiretinal membranes using optical coherence tomography.
- Author
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Wilkins JR, Puliafito CA, Hee MR, Duker JS, Reichel E, Coker JG, Schuman JS, Swanson EA, and Fujimoto JG
- Subjects
- Aged, Edema pathology, Female, Fluorescein Angiography, Fundus Oculi, Humans, Macula Lutea pathology, Male, Membranes pathology, Middle Aged, Visual Acuity, Retinal Diseases diagnosis, Tomography methods
- Abstract
Objective: To evaluate optical coherence tomography (OCT), a novel noncontact and noninvasive imaging technique, for the diagnosis and quantitative characterization of epiretinal membranes., Methods: Optical coherence tomography is similar to an ultrasound B-scan, except that light rather than sound is used, which enables higher resolution. Over a 2-year period, OCT was used to examine 186 eyes of 160 patients who had a diagnosis of an epiretinal membrane. Optical coherence tomograms were correlated with visual acuity, slit-lamp biomicroscopy, fluorescein angiography, and funds photography., Results: Based on OCT, the epiretinal membrane was clearly separated from the retina with focal points of attachment in 49 eyes and globally adherent (no observed separation) in 125 eyes. Globally adherent membranes were associated with the following features: macular pseudohole (32 eyes), a difference in optical reflectivity between the membrane and retina (65 eyes), and/or a visible membrane tuft or edge (92 eyes). The membrane was undetectable on OCT in 12 eyes. The membrane thickness (mean +/- standard deviation) was 61 +/- 28 microns in the 169 eyes in which the thickness could be measured with OCT. Mean central macular thickness measured with OCT correlated with visual acuity (R2 = 0.73)., Conclusion: Optical coherence tomography was able to provide a structural assessment of the macula that was useful in the preoperative and postoperative evaluation of epiretinal membrane surgery. Quantitative measurements and the assessment of membrane adherence with OCT may be useful in characterizing the surgical prognosis of eyes with an epiretinal membrane.
- Published
- 1996
- Full Text
- View/download PDF
17. Ganciclovir intraocular implant.
- Author
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Morley MG, Duker JS, and Reichel E
- Subjects
- Antiviral Agents therapeutic use, Drug Implants, Ganciclovir therapeutic use, Humans, AIDS-Related Opportunistic Infections drug therapy, Antiviral Agents administration & dosage, Cytomegalovirus Retinitis drug therapy, Drug Delivery Systems, Ganciclovir administration & dosage
- Published
- 1996
- Full Text
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18. Optical coherence tomography of age-related macular degeneration and choroidal neovascularization.
- Author
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Hee MR, Baumal CR, Puliafito CA, Duker JS, Reichel E, Wilkins JR, Coker JG, Schuman JS, Swanson EA, and Fujimoto JG
- Subjects
- Adult, Aged, Aged, 80 and over, Choroid pathology, Choroid surgery, Exudates and Transudates, Female, Fluorescein Angiography, Fundus Oculi, Humans, Laser Coagulation, Macular Degeneration complications, Macular Degeneration surgery, Male, Middle Aged, Neovascularization, Pathologic complications, Neovascularization, Pathologic surgery, Pigment Epithelium of Eye pathology, Retina surgery, Retinal Detachment pathology, Retinal Drusen pathology, Choroid blood supply, Macular Degeneration pathology, Neovascularization, Pathologic pathology, Retina pathology, Tomography methods
- Abstract
Objective: The authors used optical coherence tomography (OCT), a new technique for cross-sectional imaging of the retina, to morphologically study eyes with nonexudative and exudative age-related macular degeneration (AMD). In patients with untreated exudative AMD, OCT was compared with fluorescein angiography in the identification and classification of choroidal neovascularization (CNV)., Methods: Optical coherence tomography imaging is analogous to ultrasound, except that the use of light rather than sound enables higher longitudinal resolution with a noncontact and noninvasive measurement. Optical coherence tomography was performed on 391 patients with the clinical diagnosis of AMD and was compared with conventional clinical examination to establish the cross-sectional morphology of different lesions and to develop a classification scheme for CNV. Optical coherence tomograms and fluorescein angiograms then were reviewed and correlated independently in 90 eyes of 86 patients who had exudative AMD without previous laser treatment., Results: Pigmentary changes, soft drusen, and detachments of the neurosensory retina and retinal pigment epithelium all had distinct presentations on OCT. Subretinal and intraretinal fluid caused changes in retinal thickness or elevation that could be quantified directly from the images. Choroidal neovascularization was evident in the tomograms as a thickening and fragmentation of a reflective layer, which corresponded to the retinal pigment epithelium and choriocapillaris. Changes in the reflection from this layer were observed during the progression of neovascularization, and after laser photocoagulation treatment. Classic CNV consistently presented with well-defined boundaries on OCT, whereas occult CNV had a variable cross-sectional appearance., Conclusions: Optical coherence tomography was useful in quantitatively evaluating subretinal and intraretinal fluid, assessing possible subfoveal involvement of neovascularization, and in monitoring CNV before and after laser photocoagulation. Optical coherence tomography was unable to detect CNV beneath serous pigment epithelial detachments. Optical coherence tomography may have potential in accurately defining the boundaries in a subset of angiographically occult CNV.
- Published
- 1996
- Full Text
- View/download PDF
19. Indocyanine green angiography and choroidal neovascularization obscured by hemorrhage.
- Author
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Reichel E, Duker JS, and Puliafito CA
- Subjects
- Fundus Oculi, Humans, Macular Degeneration complications, Middle Aged, Neovascularization, Pathologic etiology, Choroid blood supply, Coloring Agents, Fluorescein Angiography, Indocyanine Green, Neovascularization, Pathologic diagnosis, Retinal Hemorrhage complications
- Abstract
Background and Objective: To determine the use of indocyanine green (ICG) angiography in detecting choroidal neovascularization obscured by hemorrhage. STUDY/DESIGN: Indocyanine green angiography was performed on 20 consecutive patients who were suspected to have choroidal neovascular membranes (CNVs) that were obscured by subretinal or intraretinal hemorrhage on fluorescein angiography. The etiology of choroidal neovascularization was age-related macular degeneration., Results: In all patients, ICG angiography was able to detect some choroidal neovascularization. The entire extent of the CNV was identified in 12 (60%) of these patients after ICG angiography was performed. In the remaining eight eyes (40%), the CNV still was obscured partially by a thick layer of hemorrhage. Difficulty in detection was due to thick subretinal hemorrhage, lipid exudate, and pigment., Conclusion: The authors conclude that ICG angiography is superior to fluorescein angiography in showing the presence and extent of CNVs associated with age-related macular degeneration that are almost entirely obscured by hemorrhage.
- Published
- 1995
- Full Text
- View/download PDF
20. Optical coherence tomography of macular holes.
- Author
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Hee MR, Puliafito CA, Wong C, Duker JS, Reichel E, Schuman JS, Swanson EA, and Fujimoto JG
- Subjects
- Adult, Aged, Female, Fluorescein Angiography, Fundus Oculi, Humans, Macula Lutea physiopathology, Male, Middle Aged, Photography, Retina physiopathology, Retinal Perforations physiopathology, Tomography instrumentation, Macula Lutea pathology, Retina pathology, Retinal Perforations diagnosis, Tomography methods
- Abstract
Purpose: To assess the potential of a new diagnostic technique called optical coherence tomography (OCT) for diagnosing and monitoring macular holes. This technique is a novel noninvasive, noncontact imaging modality that produces high longitudinal resolution (10-micron) cross-sectional tomographs of ocular tissue., Methods: Optical coherence tomography is analogous to ultrasound except that optical rather than acoustic reflectivity is measured. Cross-sectional tomographs of the retina profiling optical reflectivity in a thin, optical slice of tissue are obtained with a longitudinal resolution of 10 microns. Optical coherence tomography was used to examine 49 patients with the clinical diagnosis of idiopathic full-thickness macular hole, impending macular hole, epimacular membrane with macular pseudohole, or partial-thickness hole. The resulting OCTs were correlated with contact lens and slit-lamp biomicroscopy, fundus photography, and fluorescein angiography., Results: The cross-sectional view produced by OCT was effective in distinguishing full-thickness macular holes from partial-thickness holes, macular pseudoholes, and cysts. Optical coherence tomography was successful in staging macular holes and provided a quantitative measure of hole diameter and the amount of surrounding macular edema. Optical coherence tomography also was used to evaluate the vitreoretinal interface in patients' fellow eyes and was able to detect small separations of the posterior hyaloid from the retina., Conclusion: Optical coherence tomography appears potentially useful as a new, noninvasive, diagnostic technique for visualizing and quantitatively characterizing macular holes and assessing fellow eyes of patients with a macular hole. The tomographic information provided by OCT eventually may lead to a better understanding of the pathogenesis of macular hole formation.
- Published
- 1995
- Full Text
- View/download PDF
21. The digital indocyanine green videoangiography characteristics of well-defined choroidal neovascularization.
- Author
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Avvad FK, Duker JS, Reichel E, Margolis TI, and Puliafito CA
- Subjects
- Aged, Aged, 80 and over, Choroid pathology, Female, Fluorescein Angiography methods, Fundus Oculi, Humans, Male, Middle Aged, Retrospective Studies, Video Recording, Choroid blood supply, Indocyanine Green, Neovascularization, Pathologic pathology
- Abstract
Purpose: To evaluate the digital indocyanine green (ICG) videoangiography characteristics of well-defined choroidal neovascularization (CNV)., Methods: The authors retrospectively reviewed all ICG angiograms performed at the New England Eye Center over a 2-year period. Included in this study were all patients with the clinical and fluorescein angiographic diagnosis of well-defined CNV according to the Macular Photocoagulation Study Group criteria., Results: Of the 25 eligible patients, 18 (72%) had a well-demarcated area of ICG hyperfluorescence that was observed either both early and late (6 patients = 24%) or only late (12 patients = 48%) on the ICG angiogram. Five patients (20%) showed only poorly demarcated late hyperfluorescence on ICG angiography. Two patients (8%) had type II occult CNV associated with classic CNV as per the Macular Photocoagulation Study Group criteria. Both patients showed a late, well-demarcated area of ICG hyperfluorescence greater than the area imaged with fluorescein angiography., Conclusions: Choroidal neovascularization which is well-defined on fluorescein angiography has variable ICG appearances. When there is late leakage associated with a well-defined CNV on fluorescein angiography (type II occult CNV), ICG angiography may more completely delineate the extent of the lesion.
- Published
- 1995
- Full Text
- View/download PDF
22. Imaging of macular diseases with optical coherence tomography.
- Author
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Puliafito CA, Hee MR, Lin CP, Reichel E, Schuman JS, Duker JS, Izatt JA, Swanson EA, and Fujimoto JG
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Fluorescein Angiography, Fundus Oculi, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, Tomography instrumentation, Retina pathology, Retinal Diseases diagnosis, Tomography methods
- Abstract
Background/purpose: To assess the potential of a new diagnostic technique called optical coherence tomography for imaging macular disease. Optical coherence tomography is a novel noninvasive, noncontact imaging modality which produces high depth resolution (10 microns) cross-sectional tomographs of ocular tissue. It is analogous to ultrasound, except that optical rather than acoustic reflectivity is measured., Methods: Optical coherence tomography images of the macula were obtained in 51 eyes of 44 patients with selected macular diseases. Imaging is performed in a manner compatible with slit-lamp indirect biomicroscopy so that high-resolution optical tomography may be accomplished simultaneously with normal ophthalmic examination. The time-of-flight delay of light backscattered from different layers in the retina is determined using low-coherence interferometry. Cross-sectional tomographs of the retina profiling optical reflectivity versus distance into the tissue are obtained in 2.5 seconds and with a longitudinal resolution of 10 microns., Results: Correlation of fundus examination and fluorescein angiography with optical coherence tomography tomographs was demonstrated in 12 eyes with the following pathologies: full- and partial-thickness macular hole, epiretinal membrane, macular edema, intraretinal exudate, idiopathic central serous chorioretinopathy, and detachments of the pigment epithelium and neurosensory retina., Conclusion: Optical coherence tomography is potentially a powerful tool for detecting and monitoring a variety of macular diseases, including macular edema, macular holes, and detachments of the neurosensory retina and pigment epithelium.
- Published
- 1995
- Full Text
- View/download PDF
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