Search

Purpose To use optical coherence tomography (OCT) to 3-dimensionally characterize the optic nerve head (ONH) in peripapillary scleral bowing in non-highly myopic healthy eyes. Design Cross-sectional, multicenter study. Methods A total of 362 non-highly myopic (+6 diopters [D] > spherical equivalent > −6D) eyes of 362 healthy subjects from 20-90 years old underwent OCT ONH radial B-scan imaging. Bruch's membrane (BM), BM opening (BMO), anterior scleral canal opening (ASCO), and the peripapillary scleral surface were segmented. BMO and ASCO planes were fit, and their centroids, major axes, ovality, areas and offsets were determined. Peripapillary scleral bowing was characterized by 2 parameters: peripapillary scleral slope (ppSS) of 3 anterior peripapillary scleral segments (0-300, 300-700, and 700-1,000 μm from the ASCO centroid); and ASCO depth relative to a peripapillary scleral reference plane (ASCOD-ppScleral). Peripapillary choroidal thickness (ppCT) was calculated relative to the ASCO as the minimum distance between the anterior scleral surface and BM. Results Both ppSS and ASCOD-ppScleral ranged from slightly inward through profoundly outward in direction. Both parameters increased with age and were independently associated with decreased ppCT. Conclusions In non-highly myopic healthy eyes, outward peripapillary scleral bowing achieved substantial levels, was markedly increased with age, and was independently associated with decreased peripapillary choroidal thickness. These findings provide a normative foundation for characterizing this anatomy in cases of high myopia and glaucoma and in eyes with optic disc tilt, torsion, and peripapillary atrophy.

PurposeTo determine the frequency with which retinal tissues other than the nerve fibre layer, hereafter referred to as protruded retinal layers (PRL), are a component of optical coherence tomography (OCT) neuroretinal rim measurements.MethodsNinety healthy (30 White, Black and Japanese, respectively) subjects were included in the study. A radial scan pattern (24 B-scans centred on Bruch's membrane opening [BMO]) was used. For each of the 48 minimum rim width (MRW) measurement points, we determined whether PRL were present, absent or indeterminate. When present, the proportion of PRL within the MRW was quantified.ResultsProtruded retinal layers were present in 503 (11.6%), absent in 3805 (88.1%) and indeterminate in 12 (0.3%) measurement points. Overall, 69 (76.6%) subjects had ≥1 points with PRL, with White subjects having the highest frequency and Japanese the lowest (29 [97%] and 18 [60%], respectively; p&nbsp

OBJECTIVE: We determined the differential aging effects of the inner six layers of the macula in contrast to the minimum neuroretinal rim width (MRW) and peripapillary retinal nerve fibre layer (RNFL) thickness. DESIGN: Cross-sectional, multi-centre study. PARTICIPANTS: Approximately equal number of White subjects with a normal ocular and visual field examination in each decade group from 20-90 years. METHODS: Optical coherence tomography of the macula, optic nerve head and peripapillary retina. MAIN OUTCOME MEASURES: (i) Sectoral measurements of the inner six layers of the macula; (ii) age-related decline of each of these layers; (iii) strength of the associations with age of the macular parameters, MRW and peripapillary RNFL thickness; (iv) association between ganglion cell layer (GCL) thickness and MRW and peripapillary RNFL thickness. RESULTS: The study sample comprised one eye of 246 subjects with median (range) age of 52.9 (19.8 – 87.3) years. Of the six layers, there was a statistically significant decline with age of only the GCL, inner plexiform layer and inner nuclear layer thickness with rates of −0.11 μm/y, −0.07 μm/y and −0.03 μm/y, respectively. These rates corresponded to 2.92%, 2.15% and 0.88% loss per decade, respectively, and were generally uniform across sectors. The rate of loss of MRW and peripapillary RNFL thickness was −1.22 μm/y and −0.20 μm/y, corresponding to 3.63% and 2.04% loss per decade. However, the association of GCL thickness change with age (R(2) = 0.28) was approximately twice that of MRW and RNFL thickness (R(2) = 0.14 for each). CONCLUSIONS: In concordance with histopathological studies showing age-related loss of retinal ganglion cell axons, we showed a significant decline in GCL thickness, as well as MRW and peripapillary RNFL thickness. The stronger relationship between aging and GCL thickness compared to the rim or peripapillary RNFL may indicate that GCL thickness could be better suited to measure progression of structural glaucomatous loss.

Author(s): Yang, Hongli; Luo, Haomin; Gardiner, Stuart K; Hardin, Christy; Sharpe, Glen P; Caprioli, Joseph; Demirel, Shaban; Girkin, Christopher A; Liebmann, Jeffrey M; Mardin, Christian Y; Quigley, Harry A; Scheuerle, Alexander F; Fortune, Brad; Chauhan, Balwantray C; Burgoyne, Claude F | Abstract: Purpose:To quantify peripapillary choroidal thickness (PCT) and the factors that influence it in healthy participants who represent the racial and ethnic composition of the U.S. population. Methods:A total of 362 healthy participants underwent optical coherence tomography (OCT) enhanced depth imaging of the optic nerve head with a 24 radial B-scan pattern aligned to the fovea to Bruch's membrane opening axis. Bruch's membrane, anterior scleral canal opening (ASCO), and the anterior scleral surface were manually segmented. PCT was measured at 100, 300, 500, 700, 900, and 1100 μm from the ASCO globally and within 12 clock-hour sectors. The effects of age, axial length, intraocular pressure, ethnicity, sex, sector, and ASCO area on PCT were assessed by ANOVA and univariable and multivariable regressions. Results:Globally, PCT was thicker further from the ASCO border and thinner with older age, longer axial length, larger ASCO area, European descent, and female sex. Among these effectors, age and axial length explained the greatest proportion of variance. The rate of age-related decline increased further from the ASCO border. Sectorally, the inferior-temporal sectors were thinnest (10.7%-20.0% thinner than the thickest sector) and demonstrated a higher rate of age-related loss (from 15.6% to 20.7% faster) at each ASCO distance. Conclusions:In healthy eyes, PCT was thinnest in the inferior temporal sectors and thinner PCT was associated with older age, European descent, longer axial length, larger ASCO area, and female sex. Among these associations, age had the strongest influence, and its effect was greatest within the inferior temporal sectors.

PurposeTo assess anterior scleral canal opening (ASCO) offset relative to Bruch's membrane opening (BMO) (ASCO/BMO offset) so as to determine neural canal direction, obliqueness, and minimum cross-sectional area (NCMCA) in 362 healthy eyes.DesignCross-sectional study.MethodsAfter optical coherence tomography optic nerve head and retinal nerve fiber layer thickness (RNFLT) imaging, BMO and ASCO were manually segmented. Planes, centroids, size, and shape were calculated. Neural canal direction was defined by projecting the neural canal axis vector (connecting BMO and ASCO centroids) onto the BMO plane. Neural canal obliqueness was defined by the angle between the neural canal axis and the BMO plane perpendicular vector. NCMCA was defined by projecting BMO and ASCO points onto a neural canal axis perpendicular plane and measuring the area of overlap. The angular distance between superior and inferior peak RNFLT was measured, and correlations between RFNLT, BMO, ASCO, ASCO/BMO offset, and NCMCA were assessed.ResultsMean (SD) NCMCA was significantly smaller than either the BMO or ASCO area (1.33 (0.42), 1.82 (0.38), 2.22 (0.43) mm2, respectively), and most closely correlated to RNFLT (P < .001, R2= 0.158). Neural canal direction was most commonly superior-nasal (55%). Mean neural canal obliqueness was 39.4° (17.3°). The angular distance between superior and inferior peak RNFLT correlated to neural canal direction (P ≤ .008, R2= 0.093).ConclusionsASCO/BMO offset underlies neural canal direction, obliqueness, and NCMCA. RNFLT is more strongly correlated to NCMCA than to BMO or ASCO, and its peripapillary distribution is influenced by neural canal direction.

Background A retrospective observational clinical study to evaluate the safety and effectiveness of the injectable 0.19-mg fluocinolone acetonide intravitreal implant (ILUVIEN) in the treatment of non-infectious uveitic macular edema. Results Data are presented from eight patients (11 eyes) with non-infectious uveitic macular edema who were treated with a 0.19-mg fluocinolone acetonide implant. Nine out of 11 eyes were pseudophakic prior to implantation of fluocinolone acetonide implant, and both phakic eyes required cataract surgery during the follow-up period (the median follow-up was 19 months; range, 8–42 months). Effectiveness and safety were assessed from changes in central retinal thickness (measured using spectral domain optical coherence tomography), corrected distance visual acuity, uveitic activity, and intraocular pressure. The main outcome measures were changes in central retinal thickness, corrected distance visual acuity, uveitic activity, and intraocular pressure. In 11/11 eyes, central retinal thickness improved between months 1 and 3. The mean maximum decrease of central retinal thickness throughout the follow-up period was 168 ± 202 μm (± standard deviation). Nine out of 11 eyes showed an improvement in corrected distance visual acuity (between + 1 and + 8 lines), and 2/11 eyes lost corrected distance visual acuity (− 1 and − 3 lines, respectively). Nine out of 11 eyes presented with inactive inflammation during the follow-up period, and in 1/11 eyes, there was a relapse at month 42. Four out of 11 eyes presented with a relapse of macular edema between months 3 and 8. The mean increase in intraocular pressure was 2.1 ± 4.7 mmHg. Nine eyes were pseudophakic prior to implantation of the injectable fluocinolone acetonide intravitreal implant. Both phakic patients developed a cataract that was treated with cataract surgery in the follow-up period. Conclusions In this small case series with long-term follow-up, treatment of non-infectious uveitic macular edema with the injectable fluocinolone acetonide implant was associated with improved central retinal thickness and corrected distance visual acuity and a manageable safety profile. The advantage of this device is the long-term drug release and the fact that it can be injected into the vitreous as a minor surgical procedure, which is in contrast to other treatment options.

Purpose:To quantify the influence of ocular and demographic factors on central laminar depth (LD) in healthy participants. Methods:A total of 362 normal subjects underwent optical coherence tomography (OCT) enhanced depth imaging of the optic nerve head (ONH) with a 24 radial B-scan pattern aligned to the fovea-to-Bruch's membrane opening (BMO) axis. BMO, anterior lamina, anterior scleral canal opening (ASCO), Bruch's membrane (BM), and the peripapillary scleral surface were manually segmented. The extent of laminar segmentation was quantified within 72 ASCO subsectors. Central LD was quantified relative to four reference planes: BMO, ASCO, BM, and scleral. The effects of age, sex, ethnicity, IOP, BMO area, ASCO area, and axial length on LD were assessed. Results:Laminar visibility was most consistent within the central ASCO (median 89%, range, 69%-95%). LDBMO and LDBM were significantly shallower in eyes with greater age, BMO area, and axial length and in females. LDASCO was shallower in eyes with greater ASCO area and axial length and in European and Hispanic descent compared to African descent eyes. LDSclera behaved similarly, but was not associated with axial length. BMO and ASCO area were not different between African descent and European descent eyes. Conclusions:Central LD was deeper in African descent eyes and influenced least by age, axial length, and sex, but more by ASCO area, when measured relative to the ASCO and sclera. However, the magnitude of these effects for all four reference planes was small, and their clinical importance in the detection of glaucoma and its progression remains to be determined.

Purpose: To retrospectively evaluate the re-injection interval, efficacy and safety of dexamethasone (DEX) intravitreal implant 0.7 mg in the treatment of macular oedema (ME) due to retinal vein occlusion (RVO) in Germany in 2009-2012. Methods: Retrospective, multicentre, anonymised observational study of data collected from the first DEX implant 0.7 mg injection through 3-6 months following the last injection. Data were included if the patient was >18 years old, had a diagnosis of ME secondary to branch or central RVO, and received at least 2 DEX implant 0.7 mg injections during routine practice. Results: Data from 87 patients were analysed. Mean time to re-injection between first and second treatments was 5.03 months in the total RVO population, and 5.46 and 4.52 months for the branch and central RVO subpopulations, respectively. An intraocular pressure increase of >25 mm Hg was recorded in 20% of patients, and 34% of patients began treatment with anti-glaucoma medication, but surgery was not needed for this condition. Conclusions: DEX implant 0.7 mg was found to be well tolerated and effective with repeat treatments in clinical practice.

Im Gegensatz zu Entwicklungslandern tritt die Xerophthalmie in den Industrienationen eher selten auf und ist dort zumeist auf eine Fehlernahrung (z. B. bei geistig behinderten oder psychiatrisch kranken Patienten), chronische Lebererkrankungen (z. B. infolge von Alkoholabusus) oder Darmoperationen zuruckzufuhren. Das Prodromalstadium eines Vitamin-A-Mangels verlauft oftmals subklinisch und ist durch eine Nyktalopie gekennzeichnet. Bei langer andauernden und ausgepragten Vitamin-A-Mangelzustanden kann es zu einer keratinisierenden Metaplasie von Kornea und Konjunktiva, Xerosis, Keratomalazie oder gar Erblindung kommen.

The visual functional diagnostics for patients with advanced glaucomatous optic neuropathy are subject to challenge. Reduced visual acuity, instable fixation and extensive scotomata frequently lead to incorrect results within the central 30° or 24° field. Static automatic perimetry (SAP) in particular is often hampered by extended examination time and fatigue especially in older patients. Focusing of the examination towards the central 10° field using a dense test grid (2° distance between stimulus locations) allows a more exact assessment of the small remaining central island. Tailoring the examination area towards the central 10° field may be useful even in cases with a mean deviation (MD) of 15 dB. In cases of advanced visual field loss kinetic perimetry is superior to static perimetry for various reasons: sharply demarcated visual field defects can be comparatively easily delineated (edge detection); the results are more reliable because fixation can be easily controlled and fatigue is much less pronounced in this interactive examination procedure. However, manual kinetic visual field testing within the central 5° using the conventional Goldmann perimeter is almost impossible due to technical reasons. Semi-automated kinetic perimetry, presenting moving stimuli along interactively defined vectors is a useful tool under these circumstances. The standardized presentation of kinetic stimuli is also feasible within the pericentral region and has particular advantages also with regard to follow-up examinations. On the other hand, detection and delineation of small visual field remnants are comparatively difficult to handle with this kind of vector-based kinetic perimetry.

Die Gesichtsfelduntersuchung mittels statischer automatischer Perimetrie (SAP) ist die Methode der Wahl zur Funktionsbestimmung beim Glaukom. Dennoch lassen sich damit beginnende Skotome oft nicht darstellen, selbst wenn es bereits zu morphologisch erkennbaren Schaden der Nervenfaserschicht gekommen ist. Dies gilt insbesondere fur Nervenfaserbundeldefekte. Die Mikroperimetrie oder Fundusperimetrie erlaubt eine gezielte Untersuchung der Lichtunterschiedsempfindlichkeit uber spezifischen, zugehorigen Netzhautarealen. Beim Glaukomschaden muss im Gegensatz zur primaren Schadigung der Rezeptoren der Verlauf der Nervenfasern und die dadurch hervorgerufene Lokalisation des hervorgerufenen Funktionsausfalls berucksichtigt werden. Dabei ist der Nachweis einer Funktionsschadigung moglicherweise fruhzeitiger als mit der konventionellen statischen Schwellenperimetrie moglich. Der zusatzliche Aufwand an Kosten und Zeit hat die Verbreitung der Fundusperimetrie bisher eingeschrankt. Aktuelle Entwicklungen konnten neue Perspektiven bieten.

To evaluate prognostic factors of response to intravitreal bevacizumab therapy of macular edema (ME) due to central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO). Patients with ME due to CRVO (32 patients) or BRVO (38 patients) received intravitreal bevacizumab (2.5 mg/0.1 ml) at baseline, and every 6 to 8 weeks if OCT showed persistent or recurrent ME. Visual acuity (EDTRS), ophthalmic examination and OCT were performed at baseline and at all follow-up visits. Six to 8 weeks after first injection, baseline factors (visual acuity, central retinal thickness, age and gender) were analyzed retrospectively between patients with resolved ME (group 1) and persisting ME (group 2). At last visit, baseline factors of patients with resolved ME since first injection (group A), with recurrent ME since baseline (group B) and with persistent ME since baseline (group C) were compared. In CRVO patients, central retinal thickness (CRT) and patients’ age are prognostic predictors in bevacizumab therapy. Age of CRVO patients differed significantly between groups 1 and 2 after first injection, while CRT only showed a strong trend to thinner CRT. At last visit, age and CRT differed statistically significantly between groups A, B and C. In BRVO patients, none of the investigated factors revealed any prognostic value. In CRVO and BRVO patients, final CRT is correlated with the CRT after first injection. CRT and age of patients have prognostic value in bevacizumab therapy of ME due to CRVO. CRVO patients who benefit from therapy are significantly younger and have a lower CRT at baseline than patients with persisting ME. In BRVO patients, no predictive factors for effectiveness of bevacizumab therapy could be observed.

Bei einer 76-jahrigen Patientin mit extrafoveal okkulter choroidaler Neovaskularisation (CNV) bei altersbedingter Makuladegeneration (AMD) entwickelten sich 1 Tag nach der 7. Bevacizumab-Injektion Symptome ahnlich einer Endophthalmitis. Die Diagnose ergab eine Immunreaktion mit Pseudohypopyon nach mehrfachen Bevacizumab-Injektionen. Der Befund bildete sich innerhalb von 5 Tagen unter alleiniger Kortikosteroid-Behandlung komplett zuruck. Daraufhin erfolgte die Weiterbehandlung mit Pegaptanib, und es trat kein intraokularer Reizzustand mehr auf.

Untersucht wird ein OCT-abhangiges individuelles Reinjektionsprozedere mit intravitrealem Bevacizumab bei neovaskularer AMD. 32 Patienten mit aktiver subfovealer okkulter CNV bei AMD wurden einmalig mit 1,25 mg Bevacizumab intravitreal behandelt und nur reinjiziert bei im OCT persistierender bzw. erneut auftretender sub- bzw. intraretinaler Flussigkeit. Kontrolluntersuchungen erfolgten in 6–8-wochigen Abstanden. Nach einmaliger Injektion war bei 74% der Patienten die sub- und intraretinale Flussigkeit komplett resorbiert. 44% dieser Patienten blieben wahrend eines Follow-up von 30±13 Wochen trocken, 56% benotigten nach durchschnittlich 19±8 Wochen eine 2. Injektion, wonach bei 82% der Befund erneut abtrocknete und sich der initiale Visusgewinn wieder einstellte. 32% dieser Patienten blieben daraufhin stabil trocken (Follow-up 32±12 Wochen). Von den Patienten, die nach der 1. Injektion nicht abtrockneten (26%), zeigte sich bei 44% nach der 2. Injektion ein trockener Befund. Bei allen Patienten konnte uber die Behandlungsdauer eine Visusstabilisierung erzielt werden, bei 30% ein signifikanter Visusanstieg ≥3 Linien. Bevacizumab-Reinjektionen in Abhangigkeit vom OCT-Befund fuhren bei exudativer AMD neben einer Reduktion der Injektionsanzahl zu einer anatomischen und funktionellen Befundstabilisierung.

Hintergrund Das Makulaodem (MO) infolge venoser retinaler Verschlusse lasst sich durch intravitreales Bevacizumab gut beeinflussen. Unklar ist, wann und nach welchen Kriterien Reinjektionen erfolgen sollten.

Background Paroxysmal nocturnal hemoglobinuria (PNH) is characterized by the classic triad of haemolytic anaemia, thrombophilia and cytopenia with the majority of cases occurring in adulthood. PNH constitutes a nonmalignant clonal disease of hematopoietic stem cells harboring somatic mutations in the X-linked phosphatidyl inositol glycan complementation group-A (PIG-A) gene. Methods We report for the first time retinal venous vascular occlusion as the primary manifestation of PNH. A patient of untypical age for retinal vascular occlusions presented with a history of 4 weeks of progressive reduction in visual acuity. Results The screening tests for thrombophilia were not successful. However, elevated LDH was detected, leading to the diagnosis of PNH. Conclusions To date, no report shows retinal vascular occlusion as the primary symptom leading to the diagnosis PNH. This article describes, for the first time, that this rare disease needs to be considered in the differential diagnosis of retinal vascular occlusions.

Untersucht wurde der Effekt von intravitreal appliziertem Bevacizumab als Off-Label-Therapie bei verschiedenen angiographischen Subtypen der neovaskularen altersabhangigen Makuladegeneration (AMD). 75 Patienten mit neovaskularer AMD und „recent disease progression“ wurden angiographischen Subtypen zugeordnet und mit intravitrealem Bevacizumab (1,25 mg/0,05 ml) in 6-wochigen Abstanden therapiert. Bei subfovealer klassischer choroidaler Neovaskularisation (CNV) erfolgte zusatzlich eine photodynamische Therapie. ETDRS-Visus, ophthalmologische Untersuchungen und optische Koharenztomographien (OCT) wurden vor Therapie, nach einer Woche und in 6-wochigen Intervallen durchgefuhrt. Weiterhin erfolgen Fluoreszenzangiographien und internistische Kontrolluntersuchungen. Bei allen angiographischen Subtypen fuhrte die Bevacizumab-Therapie wahrend einer Nachbeobachtungszeit von 37±13 Wochen im Mittel zu einer Visusstabilisierung (Verlust von weniger als 15 Buchstaben). Patienten mit okkulter extrafovealer CNV (n=6) erzielten den hochsten Visusanstieg (2±2 Linien). Die Bevacizumab-Therapie wurde von allen Patienten ohne systemische oder intraokulare Nebenwirkungen sehr gut vertragen. In einem Fall kam es zum Riss des retinalen Pigmentepithels. Intravitreale Bevacizumab-Injektionen wirken bei allen angiographischen CNV-Subtypen im Sinne einer Makulaodemreduktion und fuhren zu einer Visusstabilisierung bzw. -besserung.

Venose retinale Gefasverschlusse konnen durch eine erhohte intravitreale VEGF-Konzentration zur Ausbildung eines Makulaodems fuhren. Wir berichten uber anatomische und funktionelle Ergebnisse nach intravitrealer Bevacizumab-Injektion bei venosen retinalen Verschlussen. 18 Patienten mit Zentralvenen- und 22 Patienten mit Venenastverschluss und persistierendem Makulaodem (>300 μm) wurden in einer prospektiven Studie mit 2,5 mg Bevacizumab intravitreal behandelt. EDTRS-Visus, ophthalmologische Untersuchung und OCT erfolgen vor Therapiebeginn, 1 Woche nach Injektion und in monatlichen Intervallen. Reinjektionen wurden bei persistierendem bzw. erneutem Makulaodem in 6-wochigen Abstanden durchgefuhrt. Bei keinem der 40 Patienten kam es zu einer subjektiven oder objektiven Befundverschlechterung. Die Injektionen (im Mittel 2,6±1,4 Injektionen) wurden bei einem mittleren Follow-up von 23±13 Wochen ausnahmslos sehr gut vertragen. Bei 73,3% der Patienten mit Zentralvenen- und bei 76,5% der Patienten mit Venenastverschluss kam es bei letzter Vorstellung zu einem signifikanten Visusanstieg (Visusgewinn um mindestes 3 Zeilen). Gleichzeitig hat sich die mittlere Netzhautdicke bei Patienten mit Zentralvenenverschluss von 921±264 μm auf 239±66,2 μm, und bei Patienten mit Venenastverschluss von 678±221 auf zuletzt 236±78 μm reduziert. In dieser Studie konnten nach intravitrealen Bevacizumab-Injektionen in einer Konzentration von 2,5 mg bislang keine intraokularen oder systemischen Nebenwirkungen beobachtet werden. Die bisherigen Ergebnisse zeigen, dass die intravitreale Anti-VEGF-Therapie eine viel versprechende Option bei Makulaodem infolge venoser retinaler Verschlusse ist.

Conventional optic disc margin-based neuroretinal rim measurements lack a solid anatomic and geometrical basis. An optical coherence tomography (OCT) index, Bruch's membrane opening minimum rim width (BMO-MRW), addresses these deficiencies and has higher diagnostic accuracy for glaucoma. We characterized BMO-MRW and peripapillary retinal nerve fiber layer thickness (RNFLT) in a normal population.Multicenter cross-sectional study.Normal white subjects.An approximately equal number of subjects in each decade group (20-90 years of age) was enrolled in 5 centers. Subjects had normal ocular and visual field examination results. We obtained OCT images of the optic nerve head (24 radial scans) and peripapillary retina (1 circular scan). The angle between the fovea and BMO center (FoBMO angle), relative to the horizontal axis of the image frame, was first determined and all scans were acquired and analyzed relative to this eye-specific FoBMO axis. Variation in BMO-MRW and RNFLT was analyzed with respect to age, sector, and BMO shape.Age-related decline and between-subject variability in BMO-MRW and RNFLT.There were 246 eyes of 246 subjects with a median age of 52.9 years (range, 19.8-87.3 years). The median FoBMO angle was -6.7° (range, 2.5° to -17.5°). The BMO was predominantly vertically oval with a median area of 1.74 mm(2) (range, 1.05-3.40 mm(2)). Neither FoBMO angle nor BMO area was associated with age or axial length. Both global mean BMO-MRW and RNFLT declined with age at a rate of -1.34 μm/year and -0.21 μm/year, equivalent to 4.0% and 2.1% loss per decade of life, respectively. Sectorially, the most rapid decrease occurred inferiorly and the least temporally; however, the age association was always stronger with BMO-MRW than with RNFLT. There was a modest relationship between mean global BMO-MRW and RNFLT (r = 0.35), whereas sectorially the relationship ranged from moderate (r = 0.45, inferotemporal) to nonexistent (r = 0.01, temporal).There was significant age-related loss of BMO-MRW in healthy subjects and notable differences between BMO-MRW and RNFLT in their relationship with age and between each other. Adjusting BMO-MRW and RNFLT for age and sector is important in ensuring optimal diagnostics for glaucoma.

A recently developed digital tonometer for transpalpebral intraocular pressure (IOP) measurement, distributed by Corneal, Inc., allows the noninvasive measurement of IOP for screening purposes. We measured the IOP of 218 eyes in 109 patients of the Interdisciplinary Uveitis Center of the University of Heidelberg with intact corneal epithelium. IOPs were measured first with the TGDc-01 tonometer, and then by means of Goldmann tonometry. IOPs were recorded by two independent examiners. The mean of three measurements obtained with the TGDc-01 was taken, whereas only one measurement was performed with the Goldmann tonometer. The mean difference between the TGDc-01 and Goldmann measurements was 3.7 mmHg. The standard deviation of the differences was ±4.06 mmHg. Thus measurements acquired with the TGDc-01 may range 4.4 mmHg above or 11.8 mmHg below the values given by Goldmann tonometry. The IOP values obtained with the TGDc-01 were in poor agreement with Goldmann tonometry. We found a higher variation as well as a bias towards lower IOP values with the TGDc-01. It is a question of clinical judgement as to how far these deviating measurements can be accepted for screening purposes. Because the IOPs obtained with the TGDc-01 are generally lower and less accurate than those obtained with the Goldmann tonometer we believe that the TGDc-01 is not a reliable tool for IOP measurement in clinical routine.

Purpose To evaluate the long-term prognosis of visual function in patients with orbital cavernomas after conservative and surgical treatment. Design Interventional case series. Methods The authors describe the outcome of 20 patients with cavernous hemangiomas of the orbit treated in their departments between 1988 and 2003. This prospective study included five cases followed by clinical and radiologic observation and 15 cases of symptomatic tumors that were completely removed by means of a frontotemporal or by means of a transconjunctival approach. The clinical characteristics of orbital cavernomas were analyzed together with their appropriate treatment. Furthermore, the authors present the unusual case of a patient suffering from progressive visual deterioration from a cerebral cavernoma compressing the optic nerve. Results The follow-up period was between 3 and 10 years. All orbital cavernomas in the group of conservatively managed patients remained stable. The transconjunctival excision of a medially located lesion was uncomplicated. The frontotemporal approach was chosen for large tumors situated in the proximity of the orbital apex and was associated with a higher number of complications. A good overall outcome of visual function and patient satisfaction was achieved in 11 of 14 cases operated on by craniotomy. Conclusion The combination of clinical signs and magnetic resonance imaging (MRI) is highly sensitive and specific for the diagnosis of orbital cavernomas. In the presence of visual deterioration clearly attributable to the tumor we recommend immediate surgery, while lesions producing solely exophthalmos can safely be followed by observation. The transcranial approach offers excellent exposure and a rewarding cosmetic result and may be considered for large lesions superior and medial to the optic nerve, especially if they involve the orbital apex. © 2004 Elsevier Inc. All rights reserved.

Die Moglichkeit einer exakten 3-dimensionalen Biomorphometrie der Papille ist durch die Ende der 80er-Jahre entwickelte Laser-Scanning-Tomographie erreicht worden. Diese Untersuchungsmethode erlaubt eine 3-dimensionale Vermessung der Papillentopographie mit hoher Genauigkeit und Reproduzierbarkeit. Mit dem Heidelberg Retina Tomograph steht ein Untersuchungsgerat zur Verfugung, das dank ausgefeilter und bedienungsfreundlicher Software eine Untersuchung in kurzer Zeit ermoglicht und bereits einen festen Platz unter den augenarztlichen Untersuchungsmethoden gefundenhat.Anhand vergleichender Verlaufsbeobachtungen hat sich gezeigt, dass sich mit dieser Untersuchungstechnik eine glaukomatose Schadigung der Papillentopographie haufig bereits vor dem Nachweis einer Zunahme der Gesichtsfeldausfalle nachweisen lasst.Daher darf die Laser-Scanning-Tomographie inzwischen bei der Verlaufsbeobachtung der Glaukompatienten nicht mehr fehlen.

Purpose This retrospective study was designed to investigate the re-injection interval, efficacy and safety of OZURDEX® in routine clinical practice. Methods This analysis contains data from 87 patients from 10 sites in Germany who had received at least 2 OZURDEX® injections. Data was collected from the time of the patients’ first injection until 3 – 6 months following their latest OZURDEX® injection. Results The mean time to OZURDEX® re-injection between 1st and 2nd treatments was 141 days (5.03 months) in the overall population. Mean time intervals for the BRVO and CRVO sub-populations were 153 days (5.46 months) and 127 days (4.52 months) respectively. In the overall population, a mean LogMAR BCVA improvement from 0.68 to 0.51 was recorded following the last OZURDEX® injection (mean time of 11.0 weeks post-injection). For BRVO, mean improvement was from 0.54 to 0.43 (mean time of 10.5 weeks post injection) and for CRVO, 0.83 to 0.58 (mean time of 11.5 weeks post injection). Reductions in central retinal thickness were also observed. Intraocular pressure measurements over 25mmHg were reported in 19.5% of patients. No glaucoma surgeries were reported. 5 patients underwent cataract surgery during the course of the study (4 had known lens opacity at baseline and opacity status data from the 5th was missing). Conclusion In this real life study, OZURDEX® was found to be safe and effective with repeat treatments. The mean re-injection interval for RVO patients was 5.0 months.

Purpose Accurate measurement of central corneal thickness (CCT) is essential in refractive surgery and advanced glaucoma diagnostics. The gold standard for pachymetry is full-contact ultrasound-based pachymetry. As this method is associated with potential sources of error, noncontact methods have been introduced. The aim of this study was to compare CCT results measured using 4 different techniques. Methods In this analysis of 20 patients (40 eyes) at the University Eye Hospital Heidelberg, Germany, we compared a slit-lamp-mounted optical coherence tomography (OCT) system (SL-OCT, Heidelberg Engineering, Heidelberg, Germany), conventional ultrasound pachymetry (IOPac, Heidelberg Engineering), optical low coherence reflectometry (OLCR, Haag-Streit, Germany), and scanning-slit pachymetry (Orbscan). Results Comparison among the 4 groups did not show significant differences, except the comparison of OLCR to Orbscan; the mean was significantly different (p=0.0247) and the Orbscan detected slightly thicker values than the other methods. Conclusions Orbscan, SL-OCT, and OLCR provide non-touch technology, without the need for local anesthesia, and limiting the risk of infection or artifacts. Extreme care must be used interpreting the results obtained from Orbscan, as this technique may overestimate the CCT significantly.

Purpose To evaluate the short-term safety and efficacy of intravitreal bevacizumab for the treatment of intraretinal or subretinal fluid accumulation secondary to chronic central serous chorioretinopathy (CSC). Methods Twelve patients were treated with intravitreal injections of 2.5 mg bevacizumab at 6-to 8-week intervals until intraretinal or subretinal fluid resolved. Observation procedures were Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA), ophthalmic examination, and optical coherence tomography (OCT), performed at 6- to 8-week intervals. Fluorescein angiography was performed at baseline visit and thereafter depending on clinical and OCT findings. Multivariate analysis of variance with repeated measures was used to calculate a statistical significance of change in BCVA and mean central retinal thickness, which were the main outcome measures. SAS statistical software was used for analyses. Results Patients received 2±1 intravitreal injections of bevacizumab on average during a follow-up of 24±14 weeks. Mean BCVA increased by 2±2 lines; the change in BCVA (log-MAR) was significant (pConclusions Anatomic and functional improvement following intravitreal bevacizumab injections suggest that vascular endothelial growth factor (VEGF) may be involved in fluid leakage in patients with chronic CSC. The results suggest a possible role for anti-VEGF agents in the treatment of chronic CSC. Further evaluation of intravitreal bevacizumab for chronic CSC in controlled randomized studies is warranted.

To evaluate the long-term outcome of an OCT-guided reinjection scheme for bevacizumab treatment of macular edema (ME) due to retinal vein occlusion.Patients with persistent ME (250 microm) due to central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) received intravitreal bevacizumab 2.5 mg/0.1 ml. Visual acuity (ETDRS), ophthalmic examination and OCT were performed at baseline and at 6- to 8-week intervals. Reinjections were only performed if OCT showed persistent or recurrent ME.Sixty-one patients with a minimum follow-up of 25 weeks were included in this analysis. Mean follow-up was 60 +/- 29 wks. In CRVO patients, central retinal thickness (CRT) decreased from 748 +/- 265 microm to 372 +/- 224 microm (p0.001) and visual acuity (VA) improved by 1.9 +/- 3.2 lines. In BRVO patients, mean CRT decreased from 601 +/- 206 microm to 386 +/- 178 microm (p0.001) and VA improved by 1.8 +/- 2.6 lines. Thirty-three percent of CRVO and 15% of BRVO patients did not show a ME recurrence foror =25 wks at last visit. Thirty-seven percent of CRVO and 50% of BRVO patients suffered recurrences of ME within the last 25 wks, whereas 30% of CRVO and 35% of BRVO patients did not achieve a complete resolution of ME at any follow-up visit after receiving a minimum of three injections. CRVO patients with dry interval ofor =25 weeks at last visit were significantly younger, had a thinner CRT at baseline and more often had a complete resolution of ME after the first injection. In CRVO and BRVO, final VA was correlated significantly with initial VA, patients' age and final CRT. Change of VA was correlated with change of CRT in BRVO.Patients with retinal vein occlusion benefit from treatment with bevacizumab. Favourable long-term results without necessity of further injections were achieved in 33% and 15% of CRVO and BRVO patients respectively. The remaining patients needed repeated injections to treat ME recurrences. However, one third of the CRVO/BRVO patients did not improve in VA, and further injections might be discontinued in these patients.

PURPOSETo report a case of advanced glaucomatous optic atrophy years after bilateral radial keratotomy. METHODSMultiple intraocular pressure (IOP) measurements of both eyes in a 40-year-old woman who underwent previous bilateral radial keratotomy were obtained using Goldmann applanation tonometry as well as air-puff and Schiotz tonometry. In addition to regular eye examinations, corneal thickness, surface, and shape were examined using Orbscan and C-Scan. RESULTSThe cornea of both eyes did not show signs of corneal thinning, but flattening of the corneal surface was observed. The decreased corneal curvatures precipitated a misjudgment of IOP readings measured by central applanantion tonometry (12 to 18 mmHg), whereas impression and non-contact tonometry revealed elevated IOP values (21 to 27 mmHg). CONCLUSIONSChanges of the corneal shape without corneal thinning can lead to falsely low IOP values. Therefore, in eyes that have undergone corneal refractive surgery, non-Goldmann measurement of IOP and continued examination of the optic nerve and possibly visual fields are recommended. [J Refract Surg. 2008;24:51-54.] ABOUT THE AUTHORS From the Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. The authors have no proprietary interest in the materials presented herein. Correspondence: Alexander Friedrich Scheuerle, MD, Dept of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany. Tel: 49 6221 566625; Fax: 49 6221 56; E-mail: Alexander_Scheuerle@med.uni-heidelberg.de Received: October 1, 2006 Accepted: May 16, 2007 Posted online: September 28, 2007

PURPOSE To determine intraocular pharmacokinetics of aflibercept and VEGF-A in patients with neovascular age-related macular degeneration (nAMD) during a treatment period of 6 months. METHODS Seven nonvitrectomized patients diagnosed with macular edema secondary to nAMD undergoing intravitreal injections (IVI) of aflibercept. Patients were treatment naive at least for the last 2 months and received intravitreal injection of 2 mg aflibercept for the first time. Aqueous humor samples were obtained prior to each injection procedure during a 6-month period: three times monthly, then bimonthly. Over all 35 samples were analyzed with ELISA for unbound VEGF-A and a self-developed assay for unbound aflibercept. RESULTS In all cases, wet AMD was inactive after IVI. Unbound aflibercept could be detected in all samples. Initial mean concentration of aflibercept was 305.4 ± 43.8 μg/mL and remained stable after the first injection with 0.8 ± 0.5 μg/mL. Initial mean level of unbound VEGF-A was 190.7 ± 26.9 pg/mL. A significant decrease of the concentration to 92.6 ± 10.2 pg/mL (P < 0.05, Wilcoxon rank sum test) after the first injection was observed. This level remained stable during further treatment. CONCLUSIONS Levels of unbound aflibercept and unbound VEGF-A remained stable after every month and every second month of IVI. The findings of these small case series support suggestions that treatment intervals with bimonthly IVI of aflibercept are sufficient due to a detectable remaining biologic active concentration of aflibercept.

1 Introduction.- 1.1 Why Is Laser Scanning Ophthalmoscopy Needed?.- 1.2 Technical Background.- 1.3 Stereometric Parameters of the HRT.- 2 Healthy Optic Discs.- 2.1 Natural Variety of Optic Discs.- 2.2 Regular Shapes.- 2.3 Micropapillas.- 2.4 Megalopapillas.- 2.5 Tilted Discs.- 3 Glaucomas.- 3.1 Automated Classification Procedures.- 3.2 Moderate Glaucomas.- 3.3 Nerve Fiber Bundle Defects.- 3.4 Advanced Glaucomas.- 3.5 Micropapillary Glaucomas.- 3.6 Megalopapillary Glaucomas.- 3.7 Normal Tension Glaucomas.- 3.8 Classification Errors.- 4 Follow-up Examinations.- 4.1 Strategies for Longitudinal Analysis.- 4.2 Progression of Glaucoma.- 5 Prominent Optic Discs.- 5.1 Scanning of Prominent Discs.- 5.2 Drusen of the Optic Nerve.- 5.3 Optic Nerve Swelling.- 5.4 Papilledemas.- 6 Macular Scans.- 6.1 The Macular Edema Software Module.- 6.2 Cystoid Macular Edema.- 6.3 Branch Vein Occlusion.- 6.4 Central Serous Retinopathy.- 6.5 Macular Puckers.- 6.6 Macular Holes.- 7 Miscellaneous.- 7.1 Optimizing Imaging.- 7.2 Astigmatism.- 7.3 Retinal Irregularities.- 7.4 Floaters.- 8 Confocal Corneal Imaging.- 8.1 The Rostock Cornea Modu.- References.

Background: The opacification of hydrophilic intraocular lenses (IOLs) is a very rare complication in terms of absolute numbers. We report on the analyses of opacified Euromaxx ALI313Y and ALI313 IOLs (Argonoptics, Germany) using light and scanning electron microscopy, X-ray spectroscopy and optical bench analysis. Methods: Opacified Euromaxx ALI313Y and ALI313 IOLs were explanted after patients presented with a decrease in visual acuity. The explants were sent to our laboratory and examined using light and scanning electron microscopy. The composition of the deposits was analysed using X-ray spectroscopy. The optical quality of the intraocular lens (IOL) was assessed using the OptiSpheric IOL PRO optical bench (Trioptics GmbH Wedel, Germany). Modulation transfer function (MTF) was measured at all spatial frequencies and United States Air Force (USAF) 1951 resolution target pictures were documented. Results: Macroscopically, the entire optic was opacified in all IOLs. Light and scanning electron microscopy revealed numerous fine, granular, crystalline-like deposits, which were always distributed in a line parallel to the anterior and posterior surfaces of the IOLs. X-ray spectroscopy could prove the deposits consisted of Calcium and Phosphate. Measurements in the optical bench showed deterioration of MTF values at all spatial frequencies and the USAF target pictures demonstrated a significant reduction of brightness as well as resolution with the opacified IOLs. Conclusions: The calcification of hydrophilic IOLs only occurs rarely. The exact chemical composition of the deposits can be assessed by means of X-ray spectroscopy. Optical quality analysis of the explanted Euromaxx ALI313Y and ALI313 IOLs showed significant reduction of MTF values, which was confirmed by USAF target pictures.