111 research outputs found
Management of unresolved optic disc pit maculopathy with human amniotic membrane patch implant: A case report
No full textBackground/Purpose Inverted Inner Limiting Membrane (ILM)-flap approach can fail in the treatment of Optic disc pit maculopathy (ODPM). We report a surgical technique involving human amniotic membrane (hAM) patch implant to treat unresolved ODPM after inverted (ILM)-flap technique. Case Report One patient with decreased visual acuity (1 LogMar) after unsuccessful inverted ILM-flap technique to treat ODPM, underwent hAM patch implant and was evaluated. A surgical approach including a 2 mm size graft patch of hAM implantation over the optic disc pit followed by fluid-air exchange was performed. A gas endotamponade was finally used. The patient was instructed to maintain face-down position for the first three days after surgery. The hAM patch remained detectable over the pit for the entire 6-months follow-up. The ODPM gradually resolved and visual acuity partially recovered to 0.17 LogMar during follow-up. No postoperative complications or recurrence were reported. Conclusion hAM patch implant may be effective to manage ODPM after unsuccessful inverted ILM-flap
Pachychoroid disease spectrum: how multimodal imaging and OCT angiography have improved our knowledge
No full textPachychoroid spectrum disorders (PSDs) represent a group of chorioretinal disorders characterized by abnormal choroidal thickening and various pathological changes in the choroid, retinal pigment epithelium, and retina. This review provides a comprehensive analysis of current multimodal imaging techniques in the diagnosis and management of PSDs. We examine the role of various imaging modalities including optical coherence tomography (OCT), OCT angiography (OCTA), en face OCT, fluorescein angiography (FA), indocyanine green angiography (ICGA), infrared imaging (IR), and fundus autofluorescence (FAF) in evaluating PSDs. Each imaging modality provides unique insights: OCT reveals characteristic choroidal thickening and structural changes; OCTA demonstrates alterations in choroidal flow and neovascularization; en face OCT allows detailed visualization of choroidal vasculature and intervortex anastomoses; FA shows patterns of leakage; ICGA reveals choroidal hyperpermeability and pachyvessels; IR imaging assists in RPE evaluation; and FAF highlights RPE dysfunction. The integration of these imaging techniques has enhanced our understanding of the pathophysiology of PSDs and improved our ability to diagnose, monitor, and treat these conditions. This review particularly emphasizes how OCTA has advanced our knowledge of choroidal circulation and neovascularization in PSDs. We also discuss future directions in imaging technology and their potential impact on personalized therapeutic approaches, including optimized photodynamic therapy based on imaging biomarkers. The synergistic use of multimodal imaging represents a cornerstone in the management of PSDs, enabling more precise diagnosis and tailored treatment strategies
How Reliable Is Pyramidal Wavefront-Based Sensor Aberrometry in Measuring the In Vivo Optical Behaviour of Multifocal IOLs?
No full textCataract or refractive lens surgery, along with the implantation of multifocal intraocular lenses (MF-IOL), enables a complete range of functional far, near and intermediate vision. Refractive, diffractive and extended depth of focus (EDoF) or combination of these principles represent the technology used to obtain this multifocality. Aberrometry makes it possible to study the aberrations induced by MF-IOLs. Among the different optical principles available to measure ocular aberrations, pyramidal wavefront-based sensor (PWS) aberrometry shows the highest resolution with MF-IOLs. Retinal image quality measured by a PWS aberrometer differed significantly according to the technology of the implanted lens. Monofocal and diffractive lenses showed the highest values of far-distance retinal image quality, followed by refractive and EDoF lenses; however, retinal image quality analysed in diffractive lenses appears to be more dependent on residual refractive error. Considering this limitation, PWS-aberrometry could be used to compare diffractive lenses. Nevertheless, further studies are needed to provide additional information about the clinical retinal image quality of MF-IOLs and to help surgeons in the important preoperative selection of IOLs
SEVERE VISUAL LOSS DURING ANTI-VEGF INTRAVITREAL INJECTIONS IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: TIMING, PROGNOSIS, AND OPTICAL COHERENCE TOMOGRAPHY FINDINGS
No full textPurpose: Intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) is the standard of care for neovascular age-related macular degeneration (nAMD). However, a small subgroup of patients still experience severe visual impairment, which may be related to the number of IVI administered. Methods: This retrospective observational study analyzed data from patients with sudden severe visual decline (≥15 Early Treatment Diabetic Retinopathy Study [ETDRS] letters loss between two consecutive IVIs) during anti-VEGF treatment for nAMD. Best correct visual acuity examination, optical coherence tomography (OCT) and OCT angiography (OCTA) were performed before every IVI and central macular thickness (CMT) and drug injected were collected. Results: 1019 eyes received anti-VEGF IVI for nAMD from December 2017 to March 2021. Severe VA loss occurred in 15.1% after a median of 6 (range 1-38) IVI. Ranibizumab was injected in 52.8%, and aflibercept in 31.9% of cases. Functional recovery after 3 months was significant, without further improvement at 6 months. Visual prognosis relative to the percentage of CMT change showed better visual outcome in eyes with no substantial change in CMT compared to an increase of >20% or a decrease of >5%. Conclusion: In this first real-life study exploring severe VA loss during anti-VEGF treatment in patients with nAMD, we found that it was not unusual for a ≥15 ETDRS letters loss to occur between two consecutive IVIs, often within 9 months of diagnosis and 2 months after the last IVI. Close follow-up and a proactive regimen should be preferred, at least in the first year
Intraoperative OCT-Guided Selective Epiretinal Membrane (ERM) Peeling Versus ERM and Internal Limiting Membrane Peeling for Tractional Macular Edema in Diabetic Eyes
No full textBackground and Aim: Despite the abundant literature, internal limiting membrane (ILM) peeling remains a controversial topic, especially in diabetic eyes. We compared the safety and effectiveness of intraoperative optical coherence tomography (iOCT)-assisted selective epiretinal membrane (ERM) peeling with dye-assisted ERM and ILM peeling, for the treatment of tractional diabetic macular edema (tDME). Material and Methods: In this single-center retrospective study, we evaluated consecutive patients with tDME who underwent iOCT-assisted selective ERM peeling (Group A) or “dual blue” dye-assisted ERM and ILM peeling (Group B). Best corrected visual acuity (BCVA) and central macular thickness (CMT) were compared over a 12-month follow-up. A linear mixed model analysis was performed. Results: At baseline, the two groups were comparable in terms of their demographic and clinical outcomes. No significant difference between BCVA and CMT was observed among the groups. Both groups showed significant improvement in outcomes at the last follow-up (p < 0.001), although only iOCT-assisted ERM peeling ensured significant visual gain and macular thinning (p < 0.001) one month after surgery. A significant effect of time on both outcomes (p < 0.001) and of time–treatment interaction on visual change (p = 0.02) were observed. In eight patients, macular edema recurred (Group A: two patients; Group B: six patients) and was managed with an intravitreal dexamethasone implant. In Group A, one patient developed a recurrence of ERM without the need for reoperation. Conclusions: iOCT-assisted ERM removal may be as effective as dye-assisted ERM and ILM peeling to treat tDME. Additionally, it ensures a quicker recovery of visual function and macular thickness. The observed ERM recurrence within the 1-year follow-up was mild and did not necessitate additional surgery
Evaluation of the Efficacy of Ozonated Oil in Liposomes as an Adjuvant in Intravitreal Injection Prophylaxis: OPERA Study
No full textBackground/Purpose:
The prevention of endophthalmitis continues to pose a significant challenge for intravitreal injections (IVIs) due to the increasing prevalence of these procedures. In response, we conducted a prospective, interventional, single-center clinical study to evaluate the collective efficacy of ozonated oil in liposomes, administered via eye drops (Ozodrop IVTTM), and eyelid foam (BlefoxTM) in combination with povidone iodine (PI) 5% as prophylaxis.
Methods:
Both eyes of each patient were included and categorized into two groups. Group 1 received prophylaxis with Ozodrop IVTTM and BlefoxTM for three days, followed by PI 5% before intravitreal (IV) injection. Group 2, comprising contralateral eyes, underwent standard prophylaxis with PI 5% only. Conjunctival and eyelid edge swabs were collected from both eyes at T0 (four days before IV) and T1 (10 minutes before injection, after 30-second treatment with PI 5% and washing with balance salt solution). Swabs were plated on chocolate agar for aerobic bacteria and blood agar for anaerobic bacteria. The primary endpoint assessed the difference in bacterial colonies reduction between the two groups at specified time points. The study employed a paired-eye design. Secondary endpoints included conjunctival hyperemia evaluation and subject satisfaction grade.
Results:
A total of 390 eyes from 195 patients (mean age: 69.6 ± 10.4 years, 48% female) were enrolled. Chocolate agar demonstrated a significant reduction in bacterial load, with decreases of 72.3% in group 1 and 50.3% in group 2 (p<0.001). Testing on blood agar also exhibited reductions, with percentages of 66.7% in group 1 and 49.7% in group 2 (p<0.001). Five (2.66%) patients reported traces, while mild was reported by only one (0.53%) patient regarding conjunctival hyperemia. No other adverse events were reported. A total of 159 (84.57%) patients reported no ocular discomfort, while mild discomfort occurred in 28 (14.89%) patients.
Conclusions:
The combination of ozonated oil in liposomes with PI in IV prophylaxis effectively reduced microbial load, surpassing the efficacy of standard prophylaxis with PI alone. This finding suggests a potential enhancement in intravitreal injection safety through the incorporation of ozonated oil in liposomes as an adjuvant therapy
Long-term Eplerenone treatment in chronic central serous chorioretinopathy: effects on affected and fellow eye
No full textPurpose: Purpose of this study is to assess long-term morpho-functional retinal and choroidal changes both in affected and in fellow eyes with chronic central serous chorioretinopathy (cCSC) in response to continuous oral EPL treatment by means of structural OCT and OCTA.
Methods: This study was conducted on patients with monolateral subretinal fluid (SRF) secondary to cCSC. We enrolled a total of 34 eyes, 17 eyes with SRF and 17 fellow eyes with pachychoroid disease spectrum. Baseline best-corrected visual acuity (BCVA) and anatomical (OCT and OCTA) parameters of both eyes were collected at eplerenone initiation, and at 6,12, and 48 months. The imaging assessment was performed with a swept-source-OCTA (SS-OCTA) (DRI OCT, Triton, Topcon Corp., Tokyo, Japan). All patients received 50 mg daily of eplerenone after approval by the patient’s primary care provider. Potassium levels were monitored throughout the study period. Choriocapillaris en face OCTA images were exported and analyzed with Fiji ImageJ.
Results: All the patients completed the 48-month continuous therapy with EPL. (i) cCSC affected eyes; Compared with baseline (0.34 ± 0.13 LogMAR), the BCVA significantly improved at follow-up visits (6 months logMAR 0.28 ± 0.13, p=0.039; 12 months logMAR 0.22± 0.11, p=0.025; 48 months logMAR 0.21± 0.08, p=0.028). Moreover, there was a significant reduction from baseline at 6,12 and 48-months follow-up in all structural OCT parameters (SRF and SFCT; p<0.05). (ii) cCSC fellow eyes; SFCT showed a significant reduction from baseline (594 ± 234.4 μm) at follow-up visits (6 months 533 ± 203.2 μm, p=0.001; 12 months 506 ± 184.2 μm, p=0.011; 48 months 491.3 ± 179.5 μm, p=0.001). Choriocapillaris flow deficit percentage (FD%) analysis showed a statistically significant reduction after continuous EPL treatment. Compared with the baseline, the SS-OCTA analysis showed a significant FD% decrease from 28.9 ± 1.96 % at baseline to 26.8 ± 1.61 at 6 months (p= 0.022), to 26.6 ± 1.42 at 12 months (p=0.001) and, to 26.4 ± 1.44 at 48 months (p<0.001). However, we did not find statistical significance at follow-up visits to regard BCVA (p>0.05).
Conclusions: Our results showed long-term morpho-functional improvement in response to continuous oral EPL therapy in both eyes of patients with cCSC. We demonstrated that the beneficial effect of EPL for cCSC occurs within the first 6 months, with continuous improvement over one year and with a maintenance at 48 months
Effects of diabetic retinopathy on longitudinal morphological changes in AMD-associated type 1 macular neovascularization
No full textAbstract The purpose of this study was to investigate the effect of diabetic retinopathy (DR) on longitudinal morphological changes in AMD-associated type 1 macular neovascularization using optical coherence tomography angiography (OCTA). We enrolled fifty treatment-naïve eyes with a diagnosis of exudative AMD and type 1 MNV. Twenty of 50 eyes were affected by mild DR. En face OCT angiography were examined for the MNV lesion area (mm2), the MNV flow area (mm2), the central macular thickness (CMT) and the BCVA. The OCTA acquisition was performed at the following visits: (i) before the loading phase (LP) of intravitreal injection of aflibercept (T1), and (ii) 1 month after the last intravitreal injection of loading phase comprising 3 monthly injections (T2). All morpho-functional parameters showed a significantly change at T2 compared to T1 values in both groups. Furthermore, we found a greater MNV area reduction after LP in eyes without DR (P = 0.023). With regard to the remaining parameters, no significant changes were found between two groups (P > 0.05). Our analysis revealed a less MNV area reduction after loading dose of anti-VEGF therapy in eyes affected by diabetic retinopathy
Choroidal remodeling following different anti-VEGF therapies in neovascular AMD
No full textAbstract The purpose of this study was to investigate choroidal morphology remodeling in AMD-associated type 1 macular neovascularization using two different anti-VEGF drugs. We registered 73 treatment-naïve eyes with a diagnosis of exudative AMD and type 1 MNV. Patients received 3 monthly intravitreal aflibercept (n = 36, aflibercept group [AG]) or brolucizumab (n = 37, brolucizumab group [BG]). Baseline best-corrected visual acuity (BCVA) and anatomical (structural optical coherence tomography) parameters were collected at “T1 control”, before the loading phase (LP) of intravitreal injection, and at “T2 control”, 1 month after the last injection. The main outcomes measured were choroidal vascularity index (CVI), sub-foveal choroidal thickness (SFCT), and central macular thickness (CMT). Our results displayed significant SFCT reduction in both groups between T1 and T2 (p 0.05) after the loading aflibercept injections. Moreover, only the BG displayed a significant choroidal remodeling (stromal choroidal area [SCA], total choroidal area [TCA] and CVI) at T2 (p < 0.05). In particular, a relevant stromal and total choroidal volume reduction was noted, accompanied by an increase in CVI. To conclude, the latter modifications of the choroidal morphology were found significant between two groups (p < 0.05). Our analysis showed a significant impact of brolucizumab on choroidal morphology in eyes affected by type 1 nAMD. This effect was found relevant when compared with aflibercept
Short-term peripapillary structural and vascular changes following anti-VEGF vs. Dexamethasone intravitreal therapy in patients with DME
No full textPurpose To evaluate short-term peripapillary structural and vascular changes in DME after treatment with dexamethasone implant (DEX-I) and anti-VEGFs using OCT-A. Methods Sixty-five patients with naive center-involving DME were enrolled. 33 of sixty five patients (group 1) underwent with single DEX-I 0.7 mg (Ozurdex, Allergan, Inc., USA), 32 of sixty-five (group 2) underwent with intravitreal injection of aflibercept 0.5 mg (Eylea, Bayer, Genentech, San Francisco, USA). The OCT acquisition was completed at the following visits: (i) "T1 visit" corresponding to the intravitreal injection of DEX-I or aflibercept in patients with naive center-involving DME (ii) "T2 visit" corresponding to the examination performed 2 weeks after intravitreal injection of aflibercept and 1 month after DEX-I. The parameters analyzed were: (i) RPC vasculature density (VD); (ii) peripapillary retinal nerve fiber layer (pRNFL) thickness, and (iii) intraocular pressure (IOP). Results The RPC analysis showed a VD increase at T2 in both groups, although values did not reach statistical significance (48.12 +/- 4.17 and 49.04 +/- 4.23; P = 0.081 in Group 1 and 46.93 +/- 3.16 and 47.17 +/- 3.70; P = 0.087 in Group 2). Likewise, the pRNFL thickness and IOP fluctuations did not show statistically significant changes in in both groups among the different study visits. Conclusions After intravitreal injection (anti-VEGF or DEX-I), no significant short-term changes were found in peripapillary microvasculature, IOP and pRNFL thickness in diabetic eyes treated with anti-VEGF or DEX-I
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