Age-related macular degeneration (AMD) is among the leading causes of severe visual loss in individuals over 60 years old. Retinal changes associated with AMD were previously studied by time-domain optical coherence tomography (OCT). Recently, Fourier-domain OCT (FD-OCT) has been introduced. FD-OCT provides increased scan resolution and scanning speed, and generates three-dimensional (3D) OCT images. The purpose of this study was to demonstrate features of AMD assessed with high-density scanning 3D-FD-OCT (Topcon 3D-OCT1000).
Methods:
The study was designed as a prospective, observational case series. Five patients with typical morphological changes due to AMD were chosen based on funduscopic findings. Eyes with non-exudative- and exudative AMD were included. 3D-FD-OCT images were obtained, and typical morphological changes associated with AMD were presented.
Results:
FD-OCT provided detailed 3D-images of retinal structure. In addition, FD-OCT showed improved retinal coverage and image quality. FD-OCT B-scan imaging identified typical retinal changes associated with AMD. In addition, FD-OCT imaging revealed information about the extent and the 3D shape of retinal lesions.
Conclusion:
3D-FD-OCT imaging is useful for diagnosing and following patients with AMD. In addition, 3D-FD-OCT provided information about the extent and 3D shape of retinal pathologies and showed improved retinal coverage.
Various surgical techniques, including 360° buckling surgery with a retinal cerclage, have been employed to achieve retinal reattachment. Although retinal cerclage is generally effective, long-term complications can arise. Peripheral retinal ischemia and secondary neovascular glaucoma are rare, but serious complications can occur even years after successful retinal reattachment. We report a rare case of a 79-year-old woman who underwent 360° buckling surgery with cerclage for retinal detachment 10 years ago. Although the initial surgery successfully reattached the retina, she later developed a complication characterized by peripheral retinal ischemia and secondary neovascular glaucoma. Early detection and prompt management of such complications are crucial to prevent irreversible visual impairment.
* BACKGROUND AND OBJECTIVE: Age-related macular degeneration (AMD) leads to morphological changes that can interfere with optical coherence tomography retinal thickness measurements. The effects of AMD on two available retinal thickness scan modes were tested. * PATIENTS AND METHODS: Ninety-four scans, equally divided into Radial Line Scans (RLS) and Fast Macula Scans (FMS), of 42 patients with AMD were reviewed. Patients were graded into 4 categories regarding AMD severity. Each scan mode was evaluated for each AMD category. * RESULTS: In dry moderate AMD, 2% of the RLS and 5% of the FMS thickness measurements failed. In dry progressed AMD, the RLS mode performed better (26% failure rate) than the FMS mode (42% failure rate). However, in exudative AMD the FMS mode performed better (6% failure rate) than the RLS mode (28% failure rate). The difference between the RLS and FMS performance in dry progressed AMD compared with exudative AMD was significant (P < .0001). * CONCLUSION: The optical coherence tomography retinal thickness scan modes perform differently, depending on AMD severity. Retinal thickness algorithms with better performance are needed to facilitate measurements in patients with AMD. [Ophthalmic Surg Lasers Imaging 2005;36:310314.1
This work aims to summarize predictive biomarkers to guide treatment choice in DME. Intravitreal anti-VEGF is considered the gold standard treatment for centers involving DME, while intravitreal steroid treatment has been established as a second-line treatment in DME. However, more than 1/3 of the patients do not adequately respond to anti-VEGF treatment despite up to 4-weekly injections. Not surprisingly, insufficient response to anti-VEGF therapy has been linked to low-normal VEGF levels in the serum and aqueous humor. These patients may well benefit from an early switch to intravitreal steroid treatment. In these patients, morphological biomarkers visible in OCT may predict treatment response and guide treatment decisions. Namely, the presence of a large amount of retinal and choroidal hyperreflective foci, disruption of the outer retinal layers and other signs of chronicity such as intraretinal cysts extending into the outer retina and a lower choroidal vascular index are all signs suggestive of a favorable treatment response of steroids compared to anti-VEGF. This paper summarizes predictive biomarkers in DME in order to assist individual treatment decisions in DME. These markers will help to identify DME patients who may benefit from primary dexamethasone treatment or an early switch.
Purpose: Women with a high breast cancer risk dueto a familial predisposition may choose between pre-ventive surgery and regular surveillance. The effective-ness of surveillance in high-risk women and especiallyBRCA1/2 mutation carriers is unknown. We presentfirst results from a single large family cancer clinic.Patients and Methods: Women with breast cancerriskover15%wereexaminedbyphysicalexaminationevery 6 months and mammography every year. Detec-tion rates and screening parameters were calculatedfor the total group and separately for different age andgenetic risk groups.Results: At least one examination was performed in1,198 women: 449 moderate and 621 high-riskwomen and 128 BRCA1/2mutation carriers. Within amedian follow-up of 3 years, 35 breast cancers weredetected (four ductal carcinoma-in-situ; 31 invasive tu-mors); the average detection rate was 9.7 per 1,000.Detection rates (95% confidence interval) for moderateand high-risk women and BRCA1/2carriers were 3.3(1.1 to 8.6), 8.4 (5.4 to 13.2), and 33 (17 to 63) per1,000person-years,respectively.Theratioofobservedcases versus breast cancers expected in an average-risk population of comparable age was 2.7, 7.0 and23.7 respectively. Overall, node negativity was 65%;34% of primary tumors were less than 10 mm; sensi-tivity was 74%. Results with respect to tumor stage andsensitivity were less favorable in BRCA1/2carriers andin women under the age of 40.Conclusion: Itispossibletoidentifyyoungwomenathigh risk for breast cancer. The number of cancersdetected was significantly greater than expected in anage-matched average-risk population and related tothe risk category. Overall, screening parameters werecomparable to population screening data, with lessfavorable results in the youngest age group (< 40) andBRCA1/2carriers.J Clin Oncol 19:924-930.
To assess the functional and morphological outcome of eyes with neovascular AMD treated with intravitreal ranbizumab following an exit strategy treatment regime.
Methods
The Bern treatment regime for neovascular AMD has a fixed injection schedule, even in the non-active stage of the disease. The regimen has been adapted from the PIER study treatment protocol. Eyes with non-active AMD will receive 4 injections in the first year, and 2 injections in the second year of follow-up before treatment stops. Patients that received ranibizumab for treatment and reached the exit criteria were identified, and charts were reviewed to assess functional and morphological outcome.
Results
Only 2.6% of all patients (15 out of 575 patients) reached the exit criteria. Mean change in best corrected ETDRS visual acuity (VA) was 4.5±16.9 letters when comparing baseline VA to 4 weeks after the last injection (p=0.32). OCT mean foveal thickness was significantly thinner after last treatment (247.9±43.0 µm) compared to baseline (332.5±83.1 µm, p=0.002). The mean total number of ranibizumab injections was 15.6±8.0, and the mean total treatment period was 40.9±18.3 months. Twenty percent of eyes had geographic atrophy present at baseline versus 46.6% at the end of treatment.
Conclusions
Even with a fixed treatment regime and a defined treatment exit strategy, only a small percentage of patients reach exit criteria. Retinal thickness has been significantly reduced by repeated intravitreal ranibizumab injections, and geographic atrophy became more frequent.
