Changes in oxygen saturation and the retinal nerve fibre layer in patients with optic neuritis

oxygen saturation, retinal nerve fibre layer, optic neuritis

2017 Nov 1. doi: 10.1111/aos.13571. [Epub ahead of print]

Changes in oxygen saturation and the retinal nerve fibre layer in patients with optic neuritis – a pilot study.

Abstract

PURPOSE:

Assessment of retinal oxygen saturation, thickness of a retinal nerve fibre layer (RNFL) and functional changes in the optic nerve during optic neuritis (ON) in patients with multiple sclerosis (MS).

METHODS:

Thirty-two patients with ON due to MS within 3 months of onset of symptoms were enrolled [22 females, 10 males, age 34 ± 9 years, median 32.5 years, 22 patients with the clinically isolated syndrome (CIS), 10 patients with relapsing-remitting from of MS (RRMS)]. All patients were examined using optical coherence tomography (OCT model 4000, Carl Zeiss Meditec, Dublin, CA, USA), automatic optical oximetry (Oxymap ehf, Reykjavik, Iceland) and using visual evoked potentials (VEP) (Metronic Keypoint® , Minneapolis, MN, USA).

RESULTS:

Arterio-venous difference (AVD) was increased in patients ON affected eye compared to patients’ unaffected eye (PUE) [34.2 ± 4.7 versus 31.3 ± 4.6, p = 0.044 (mean ± standard deviation)]. No statistically significant difference was found in vessel oxygen saturation as well as in RNFL thickness in ON affected eyes when compared to unaffected MS eyes and healthy individuals. Significantly lower optic nerve conduction velocity was found in the affected eye when compared to unaffected MS eye and healthy (p < 0.0001 for both comparisons). No correlation between oxygen saturation values and VEP was observed in patients with MS.

CONCLUSION:

The AVD in oxygen saturation is altered in patients with acute ON. In the early stage of ON, AVD could reflect inflammatory and metabolic changes in the affected eye. Therefore, oximetry could be used as another diagnostic method in MS patients in suspicion of ON. This result would be promising for future investigation in this field.

KEYWORDS oxygen saturation, retinal nerve fibre layer, optic neuritis:

multiple sclerosis; optic neuritis; optical coherence tomography; oximetry

DIFFERENCE IN TREATMENT OUTCOMES ACCORDING TO OPTICAL COHERENCE TOMOGRAPHY-BASED STAGES IN TYPE 3 NEOVASCULARIZATION (RETINAL ANGIOMATOUS PROLIFERATION)

Optical Coherence Tomography, Neovascularization , Retinal Angiomatous Proliferation

2017 Oct 10. doi: 10.1097/IAE.0000000000001876. [Epub ahead of print]

DIFFERENCE IN TREATMENT OUTCOMES ACCORDING TO OPTICAL COHERENCE TOMOGRAPHY-BASED STAGES IN TYPE 3 NEOVASCULARIZATION (RETINAL ANGIOMATOUS PROLIFERATION).

Abstract

PURPOSE:

To compare 12-month treatment outcomes of Type 3 neovascularization among its different stages as classified using an optical coherence tomography-based method.

METHODS:

This retrospective observational study included 40 patients (40 eyes) who were newly diagnosed with Type 3 neovascularization. The patients were initially administered 3 monthly anti-vascular endothelial growth factor injections. Repeat treatment was performed when recurrence of fluid was noted. Disease staging was classified using the optical coherence tomography-based method. The best-corrected visual acuity at diagnosis and at 12 months and degree of change in best-corrected visual acuity were compared among the different stages of the disease. In addition, incidence of progression in the disease stages was estimated.

RESULTS:

Among the 40 patients, 14 (35.0%) were classified as Stage 2 and 26 (65.0%) were classified as Stage 3. The best-corrected visual acuity values at diagnosis and at 12 months were 0.61 ± 0.31 (20/81 Snellen equivalents) and 0.46 ± 0.30 (20/57) in the Stage 2 group and 0.67 ± 0.42 (20/93) and 0.70 ± 0.49 (20/100) in the Stage 3 group, respectively. There was a significant difference in best-corrected visual acuity change between the two groups (P = 0.036). During the follow-up period, 3 retinal pigment epithelium tears and 2 submacular hemorrhages had developed in the Stage 3 group. Progression of the disease from Stage 2 to Stage 3 was noted in 2 patients (14.3%).

CONCLUSION:

The visual outcome was worse in Stage 3 than in Stage 2, and adverse events that may lead to abrupt visual deterioration developed only in Stage 3. Further studies are needed to reveal whether anti-vascular endothelial growth factor therapy can suppress the progression of the disease stages.

Optical Coherence Tomography, Neovascularization , Retinal Angiomatous Proliferation

PMID:
29019795
DOI:
10.1097/IAE.0000000000001876

LONG-TERM OUTCOMES OF RANIBIZUMAB TREATMENT OF MYOPIC CHOROIDAL NEOVASCULARIZATION IN EAST-ASIAN PATIENTS FROM THE RADIANCE STUDY

OUTCOMES,RANIBIZUMAB,MYOPIC,CHOROIDAL NEOVASCULARIZATION, ASIAN,RADIANCE STUDY

2017 Sep 27. doi: 10.1097/IAE.0000000000001858. [Epub ahead of print]

LONG-TERM OUTCOMES OF RANIBIZUMAB TREATMENT OF MYOPIC CHOROIDAL NEOVASCULARIZATION IN EAST-ASIAN PATIENTS FROM THE RADIANCE STUDY.

Abstract

PURPOSE:

To evaluate long-term efficacy and safety of ranibizumab for treatment of myopic choroidal neovascularization (mCNV) in clinical practice.

METHODS:

Noninterventional, retrospective cohort study of East-Asian patients previously treated with ranibizumab during the RADIANCE trial. Forty-one patients who completed the RADIANCE trial were followed-up for up to 48 months (post-RADIANCE observation period). Outcome measures were best-corrected visual acuity changes from baseline (assessed at RADIANCE trial initiation), mCNV recurrences, and ocular adverse events.

RESULTS:

Mean visual gain from baseline best-corrected visual acuity (56.5 ± 12.1 letters) (20/80) was significant at 12 months (+14.3 ± 11.4 letters, n = 40, P < 0.0001), 24 months (+10.4 ± 22.3 letters, n = 31, P = 0.0143), 30 months (+11.0 ± 22.4 letters, n = 29, P = 0.0134), 42 months (+12.9 ± 20.9 letters, n = 25, P = 0.0051), and 48 months (+16.3 ± 18.7, n = 16, P = 0.0034). Of the 16 patients who completed 48 months of follow-up, 63% gained ≥10 letters and 13% lost ≥10 letters. Over the post-RADIANCE observation period, 83% of patients required no further treatment for mCNV, 10% experienced mCNV recurrences, and 12% experienced a nonserious ocular adverse event. Patients who required additional treatment for mCNV received a mean of 5.0 (SD 5.9, range 1.0-18.0) ranibizumab injections.

CONCLUSION:

Best-corrected visual acuity gained at the end of the RADIANCE trial was sustained over additional 36 months of follow-up. Few patients required further treatment and no new safety concerns were observed.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

OUTCOMES,RANIBIZUMAB,MYOPIC,CHOROIDAL NEOVASCULARIZATION, ASIAN,RADIANCE STUDY
PMID:
28961671
DOI:
10.1097/IAE.0000000000001858
OUTCOMES,RANIBIZUMAB,MYOPIC,CHOROIDAL NEOVASCULARIZATION, ASIAN,RADIANCE STUDY

Drugs Avastin and Lucentis.

Quantitative Assessment of Microstructural Changes of the Retina in Infants With Congenital Zika Syndrome

Microstructural Changes, Retina, Infants, Congenital Zika Syndrome

2017 Sep 7. doi: 10.1001/jamaophthalmol.2017.3292. [Epub ahead of print]

Quantitative Assessment of Microstructural Changes of the Retina in Infants With Congenital Zika Syndrome.

Abstract

IMPORTANCE:

A better pathophysiologic understanding of the neurodevelopmental abnormalities observed in neonates exposed in utero to Zika virus (ZIKV) is needed to develop treatments. The retina as an extension of the diencephalon accessible to in vivo microcopy with spectral-domain optical coherence tomography (SD-OCT) can provide an insight into the pathophysiology of congenital Zika syndrome (CZS).

OBJECTIVE:

To quantify the microstructural changes of the retina in CZS and compare these changes with those of cobalamin C (cblC) deficiency, a disease with potential retinal maldevelopment.

DESIGN, SETTING, AND PARTICIPANTS:

This case series included 8 infants with CZS and 8 individuals with cblC deficiency. All patients underwent ophthalmologic evaluation at 2 university teaching hospitals and SD-OCT imaging in at least 1 eye. Patients with cblC deficiency were homozygous or compound heterozygotes for mutations in the methylmalonic aciduria and homocystinuria type C (MMACHC) gene. Data were collected from January 1 to March 17, 2016, for patients with CZS and from May 4, 2015, to April 23, 2016, for patients with cblC deficiency.

MAIN OUTCOMES AND MEASURES:

The SD-OCT cross-sections were segmented using automatic segmentation algorithms embedded in the SD-OCT systems. Each retinal layer thickness was measured at critical eccentricities using the position of the signal peaks and troughs on longitudinal reflectivity profiles.

RESULTS:

Eight infants with CZS (5 girls and 3 boys; age range, 3-5 months) and 8 patients with cblC deficiency (3 girls and 5 boys; age range, 4 months to 15 years) were included in the analysis. All 8 patients with CZS had foveal abnormalities in the analyzed eyes (8 eyes), including discontinuities of the ellipsoid zone, thinning of the central retina with increased backscatter, and severe structural disorganization, with 3 eyes showing macular pseudocolobomas. Pericentral retina with normal lamination showed a thinned (<30% of normal thickness) ganglion cell layer (GCL) that colocalized in 7 of 8 eyes with a normal photoreceptor layer. The inner nuclear layer was normal or had borderline thinning. The central retinal degeneration was similar to that of cblC deficiency.

CONCLUSIONS AND RELEVANCE:

Congenital Zika syndrome showed a central retinal degeneration with severe GCL loss, borderline inner nuclear layer thinning, and less prominent photoreceptor loss. The findings provide the first, to date, in vivo evidence in humans for possible retinal maldevelopment with a predilection for retinal GCL loss in CZS, consistent with a murine model of the disease and suggestive of in utero depletion of this neuronal population as a consequence of Zika virus infection.

Microstructural Changes, Retina, Infants, Congenital Zika Syndrome

 

PMID:

Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration

Optical Coherence Tomography, Progression, Non-Neovascular, Atrophic, Age-Related Macular Degeneration

2017 Aug 25. pii: S0161-6420(16)32460-5. doi: 10.1016/j.ophtha.2017.06.032. [Epub ahead of print]

Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration.

Abstract

PURPOSE:

Appearance of geographic atrophy (GA) on color photography (CP) is preceded by specific features on spectral-domain optical coherence tomography (SD OCT). We aimed to build SD OCT-based risk assessment models for 5-year new onset of GA and central GA on CP.

DESIGN:

Prospective, longitudinal study.

PARTICIPANTS:

Age-Related Eye Disease Study 2 Ancillary SD OCT study participants with age-related macular degeneration (AMD) with bilateral large drusen or noncentral GA and at least 1 eye without advanced disease (n = 317).

METHODS:

For 1 eye per participant, qualitative and quantitative SD OCT variables were derived from standardized grading and semiautomated segmentation, respectively, at baseline. Up to 7 years later, annual outcomes were extracted and analyzed to fit multivariate logistic regression models and build a risk calculator.

MAIN OUTCOME MEASURES:

New onset of CP-visible GA and central GA.

RESULTS:

Over a follow-up median of 4.0 years and among 292 AMD eyes (without advanced disease at baseline) with complete outcome data, 46 (15.8%) developed central GA. Among 265 eyes without any GA on baseline CP, 70 (26.4%) developed CP-visible GA. Final multivariate models were adjusted for age. In the model for GA, the independent predicting SD OCT factors (P < 0.001-0.03) were: hyperreflective foci and retinal pigment epithelium (RPE) layer atrophy or absence, followed by choroid thickness in absence of subretinal drusenoid deposits, photoreceptor outer segment loss, RPE drusen complex volume, and RPE drusen complex abnormal thinning volume. For central GA, the factors (P < 0.001) were RPE drusen complex abnormal thinning volume, intraretinal fluid or cystoid spaces, hyperreflective foci, and RPE layer atrophy or absence. The models yielded a calculator that computes the probabilities of CP-visible, new-onset GA and central GA after 1 to 5 years.

CONCLUSIONS:

For AMD eyes with large drusen and no advanced disease, we built a novel risk assessment model-based on age and SD OCT segmentation, drusen characteristics, and retinal pathology-for progression to CP-visible GA over up to 5 years. This calculator may simplify SD OCT grading and with future validation has a promising role as a clinical prognostic tool.

PMID:
28847641
DOI:
10.1016/j.ophtha.2017.06.032

Diabetic macular edema with and without subfoveal neuroretinal detachment

Diabetic, macular edema,subfovea neuroretinal detachment

2017 Jul 4. pii: S0002-9394(17)30280-5. doi: 10.1016/j.ajo.2017.06.026. [Epub ahead of print]

Diabetic macular edema with and without subfoveal neuroretinal detachment: two different morphological and functional entities.

Abstract

PURPOSE:

To assess specific morphologic and functional characteristics in eyes with diabetic macular edema (DME) with subfoveal neuroretinal detachment (SND+) vs DME without SND (SND-).

DESIGN:

Cross-sectional, prospective, comparative case series.

METHODS:

Seventy two patients (72 eyes: 22 eyes SND+ and 50 eyes SND-) with treatment-naïve, center-involving DME were evaluated. Data gathering included fundus color photographs, fluorescein angiography, spectral-domain optical coherence tomography (SD-OCT), best corrected visual acuity (BCVA), and microperimetry. The following parameters were evaluated with SD-OCT: central macular thickness (CMT, including SND); central retinal thickness (CRT, excluding SND); choroidal thickness (CT); nasal and temporal retinal thickness (RT) at 500 μm and 1500 μm from the fovea; the number of hyper-reflective retinal spots (HRS) in the central 3000 μm; and the presence of SND and integrity of the external limiting membrane (ELM). Retinal sensitivity (RS) was evaluated within 4° and 12° of the fovea. Correlation among CT, RS, and HRS in patients with and without SND was determined.

RESULTS:

CMT (P=0.032), temporal RT at 1500 μm (P=0.03), mean CT (P=0.009) and mean number of HRS (P=0.0001) were all higher in SND+ vs SND- eyes. CRT, BCVA, HbA1c, and prevalence of systemic arterial hypertension were not different between the two groups. RS within 4° (P=0.002) and 12° (P=0.015) was lower in SND+ vs SND- eyes. SND correlated significantly with disruption of the ELM (54.55% vs 24%, P=0.01) and lower RS. A direct correlation was found between the number of HRS, presence of SND, CT, and RS within 12° in SND- eyes, and an inverse correlation was found between CT and RS within 12° in SND+ eyes.

CONCLUSIONS:

This data may improve characterization of DME in eyes with SND. DME with SND correlates with greater CT, more HRS, disruption of the ELM and significant macular functional impairment (RS decrease) vs SND-.

KEYWORDS:

OCT; choroidal thickness; diabetic macular edema; external limiting membrane; fixation; hyperreflective spots; microperimetry; neuroretinal detachment; retinal sensitivity

Evaluating structural progression of retinitis pigmentosa after cataract surgery

cataract surgery, ellipsoid zone, optical coherence tomography, phacoemulsification, posterior subcapsular cataract, retinitis pigmentosa, visual acuity

2017 Jun 7. pii: S0002-9394(17)30238-6. doi: 10.1016/j.ajo.2017.05.026. [Epub ahead of print]

Evaluating structural progression of retinitis pigmentosa after cataract surgery.

Abstract

PURPOSE:

To determine whether cataract surgery accelerates disease progression in retinitis pigmentosa (RP).

DESIGN:

Retrospective cohort study.

METHODS:

Seventy eyes of 40 patients with RP were categorized as having had phacoemulsification with intraocular lens implantation versus no cataract surgery at a single tertiary-level institution. Spectral domain optical coherence tomography (SD-OCT) was used to measure the ellipsoid zone (EZ) width, which has been demonstrated to be a reliable marker of RP severity, at baseline and throughout follow-up (median 768 days). RP progression was calculated as the loss of EZ width over time for all patients. Additional post-operative data was collected for the cataract surgery group, including pre- and post-operative best-corrected visual acuity, incidence of macular edema, posterior capsular opacification, epiretinal membrane, and intraocular lens subluxation.

RESULTS:

Multivariable analysis including age, baseline EZ width, mode of inheritance, and cataract surgery status showed that there was no significant difference in RP progression between the cataract surgery and control groups (P=0.23). Mode of inheritance was associated with RP progression, with autosomal recessive RP progressing at 148 microns/year and autosomal dominant RP progressing at 91 microns/year (P=0.003). Visual acuity improved in almost all eyes that underwent surgery (17/19, 89%), and remained stable in remaining eyes (2/19, 11%). There was a high incidence of post-surgical posterior capsular opacification (18/19, 95%). There were no serious complications such as lens subluxation or endophthalmitis.

CONCLUSIONS:

Our findings suggest that cataract surgery is a safe and effective means of improving visual acuity in RP patients and that it does not seem to be associated with faster disease progression as measured using SD-OCT.

KEYWORDS:

IS/OS; cataract surgery; ellipsoid zone; optical coherence tomography; phacoemulsification; posterior subcapsular cataract; retinitis pigmentosa; visual acuity

PMID:
28601586
DOI:
10.1016/j.ajo.2017.05.026
cataract surgery, ellipsoid zone, optical coherence tomography, phacoemulsification, posterior subcapsular cataract, retinitis pigmentosa, visual acuity

Retinitis pigmentosa example not from article

outcome of intravitreal ziv-aflibercept therapy for non-responsive neovascular age-related macular degeneration

AMD, Aflibercept, Anti-VEGF, Bevacizumab, Choroidal neovascularization, Ranibizumab, Ziv-aflibercept

2017 Jun 8. pii: bjophthalmol-2017-310318. doi: 10.1136/bjophthalmol-2017-310318. [Epub ahead of print]

One-year outcome of intravitreal ziv-aflibercept therapy for non-responsive neovascular age-related macular degeneration.

Abstract

AIM:

To evaluate 12-month outcome of intravitreal ziv-aflibercept (IVZ) therapy in eyes with neovascular age-related macular degeneration (nAMD) that are non-responsive to bevacizumab and ranibizumab.

METHODS:

This retrospective study included 16 eyes (14 patients) with nAMD who were on prior treatment with bevacizumab and ranibizumab and were treated with as-needed IVZ (1.25 mg/0.05 mL) for 12 months. The primary outcome measure was the mean change in best corrected visual acuity (BCVA) and secondary outcome measures included mean change in central macular thickness (CMT), retinal pigment epithelial detachment (RPED) heights, longest treatment free interval, presence of subretinal fluid (SRF) and intraretinal fluid (IRF) and adverse events.

RESULTS:

There was no change in the mean logarithm of minimum angle of resolution (logMAR) BCVA at baseline and following treatment with IVZ therapy (p=0.978). The mean number of IVZ injections during 12 months was 5.9±3.3, and the mean number of antivascular endothelial growth factors (VEGFs) injections prior to switching to IVZ was 8.4±4.7. The mean treatment free interval was longer during IVZ therapy (114.4±67.1 days) compared with 76.3±54.6 days before IVZ therapy (p=0.03). Five (31.25%) eyes had visual gains of at least 0.1 logMAR, 3 (18.75%) eyes had stable BCVA (within 0.1 logMAR) and 8 (50%) eyes had BCVA decline of at least 0.1 logMAR. There was no significant difference in the mean CMT, RPED heights and presence of IRF and SRF at 12 months compared with baseline. No adverse events were noted.

CONCLUSION:

IVZ increased the treatment free interval in non-responders but no significant change in visual and anatomic outcomes.

KEYWORDS:

AMD; Aflibercept; Anti-VEGF; Bevacizumab; Choroidal neovascularization; Ranibizumab; Ziv-aflibercept

Early postnatal hyperglycaemia is a risk factor for treatment-demanding retinopathy of prematurity

postnatal, hyperglycaemia, risk factor, treatment,retinopathy prematurity

Send to

Br J Ophthalmol. 2017 Jun 2. pii: bjophthalmol-2016-309187. doi: 10.1136/bjophthalmol-2016-309187. [Epub ahead of print]

Early postnatal hyperglycaemia is a risk factor for treatment-demanding retinopathy of prematurity.

Abstract

BACKGROUND:

To investigate whether neonatal hyperglycaemia in the first postnatal week is associated with treatment-demanding retinopathy of prematurity (ROP).

METHODS:

This is a Danish national, retrospective, case-control study of premature infants (birth period 2003-2006). Three national registers were searched, and data were linked through a unique civil registration number. The study sample consisted of 106 cases each matched with two comparison infants. Matching criteria were gestational age (GA) at birth, ROP not registered and born at the same neonatal intensive care unit. Potential ‘new’ risk factors were analysed in a multivariate logistic regression model, while adjusted for previously recognised risk factors (ie, GA at birth, small for gestational age, multiple birth and male sex).

RESULTS:

Hospital records of 310 preterm infants (106 treated; 204 comparison infants) were available. Nutrition in terms of energy (kcal/kg/week) and protein (g/kg/week) given to the preterm infants during the first postnatal week were statistically insignificant between the study groups (Mann-Whitney U test; p=0.165/p=0.163). Early postnatal weight gain between the two study groups was borderline significant (t-test; p=0.047). Hyperglycaemic events (indexed value) were statistically significantly different between the two study groups (Mann-Whitney U test; p<0.001). Hyperglycaemia was a statistically independent risk factor (OR: 1.022; 95% CI 1.002 to 1.042; p=0.031).

CONCLUSION:

An independent association was found between the occurrence of hyperglycaemic events during the first postnatal week and later development of treatment-demanding ROP, when adjusted for known risk factors.

KEYWORDS:

Hyperglycemia.; Preterm birth, Retinopathy of Prematurity; Risk factors

Fundamental principles of an anti-VEGF treatment regimen: optimal application of intravitreal anti-vascular endothelial growth factor therapy of macular diseases.

anti-VEGF, treatment regimen,anti-vascular endothelial growth factor, therapy,macula

Graefes Arch Clin Exp Ophthalmol. 2017 May 19. doi: 10.1007/s00417-017-3647-4. [Epub ahead of print]

Fundamental principles of an anti-VEGF treatment regimen: optimal application of intravitreal anti-vascular endothelial growth factor therapy of macular diseases.

Abstract

BACKGROUND:

Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is now considered the gold standard for the treatment of various retinal disorders. As therapy has evolved, so too have the treatment regimens employed by physicians in clinical practice; however, visual outcomes observed in the real world have typically not reflected those reported in clinical trials. Possible reasons for this include a lack of consensus on treatment regimens and a lack of clarity about what the aims of treatment should be.

METHODS:

The Vision Academy Steering Committee met to discuss the principles of an ideal treatment regimen, using evidence from the literature to substantiate each point. Literature searches were performed using the MEDLINE/PubMed database (cut-off date: March 2016) and restricted to English-language publications. Studies with fewer than ten patients were excluded from this review.

RESULTS:

The Steering Committee identified the following four key principles for the ideal treatment regimen for anti-VEGF management of retinal diseases: 1. Maximize and maintain visual acuity (VA) benefits for all patients 2. Decide when to treat next, rather than whether to treat now 3. Titrate the treatment intervals to match patients’ needs 4. Treat at each monitoring visit.

CONCLUSIONS:

It is proposed that the adoption of a proactive and more personalized approach in the clinic such as a treat-and-extend regimen will lead to benefits for both the patient and the physician, through a reduction in the associated treatment burden and better utilization of clinic resources. Implementation of the four principles should also lead to better VA outcomes for each patient, with a minimized risk of vision loss.

KEYWORDS:

Aflibercept; Anti–vascular endothelial growth factor; Retinal disease; Treat-and-extend; Treatment regimens; Visual acuity