This report describes a case of angiographically documented foveal avascular zone (FAZ) enlargement after a single intravitreal injection of bevacizumab for macular edema secondary to central retinal vein occlusion (CRVO). A 71-year-old female was treated with an intravitreal bevacizumab injection for macular edema following CRVO. Despite successfully decreased edema one month after injection, the postinjection best-corrected visual acuity immediately decreased from 20/40 to 20/1000 (Snellen equivalent). The FAZ area increased from 0.37 mm² to 3.11 mm² (8.4-fold increase). While intravitreal anti-vascular endothelial growth factor is effective and should be considered as a first-line treatment for macular edema secondary to CRVO, it may aggravate macular ischemia.
Aged ; Bevacizumab* ; Edema ; Endothelial Growth Factors ; Female ; Fluorescein Angiography ; Fovea Centralis ; Humans ; Intravitreal Injections ; Ischemia* ; Macular Edema* ; Retinal Vein* ; Visual Acuity

PURPOSE: To discuss the unique morphology and origin of epiretinal proliferation associated with macular hole (EPMH) occasionally observed in full-thickness macular hole (FT-MH) or lamellar hole (LH) and to introduce the perifoveal crown phenomenon encountered when removing this unusual proliferative tissue. METHODS: Sixteen patients showing EPMH in spectral domain-optical coherence tomography were selected from 212 patients diagnosed with MH, LH, FT-MH, impending MH, macular pseudohole, or epiretinal membrane between January 2013 and December 2014. Of the 212 patients included for clinical analysis, 33, 23, 11, 7, and 190 exhibited LH, FT-MH, impending MH, macular pseudohole, and epiretinal membrane, respectively. We reviewed visual acuity, macular morphology, and clinical course. Surgical specimens were analyzed histologically. RESULTS: EPMH presented as an amorphous proliferation starting from the defective inner/outer segment (IS/OS) junction covering the inner macula surface. Among the 16 patients with EPMH, 11 underwent vitrectomy, and all exhibited the intraoperative perifoveal crown phenomenon. EPMH tissue was sampled in three patients, one of whom had more tissue removed than intended and showed delayed recovery in visual acuity. Despite hole closure, IS/OS junction integrity was not successfully restored in four of 11 patients. Five patients were followed-up without surgical intervention. Visual acuity slightly decreased in three patients and did not change in one patient, while the remaining patient was lost during follow-up. Among the three perifoveal crown tissues obtained, two were successfully analyzed histologically. Neither tissue showed positivity to synaptophysin or S-100 protein, but one showed positivity to cytokeratin protein immunohistochemical staining. CONCLUSIONS: EPMH exhibited a distinct but common configuration in spectral domain-optical coherence tomography. An epithelial proliferation origin is plausible based on its configuration and histological analysis. Perifoveal crown phenomenon was observed when removing EPMH during vitrectomy.
Aged ; Epiretinal Membrane/*diagnosis/etiology/surgery ; Female ; Follow-Up Studies ; Fovea Centralis/*diagnostic imaging ; Humans ; Intraoperative Period ; Male ; Middle Aged ; Retinal Perforations/complications/*diagnosis/surgery ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity ; *Vitrectomy

PURPOSE: Cumulative dissipated energy (CDE) is a phacoemulsification unit parameter designed to monitor the amount of energy delivered during phacoemulsification. Studies have already shown that lower CDE levels have better surgical outcomes, specifically in corneal recovery. However, few literature exists regarding the correlation between CDE and foveal thickness.

METHODS: In this prospective study, subjects with age-related cataract underwent cataract surgery by phacoemulsification. Central subfield thickness (CST), cube volume (CV), and cube average thickness (CAT) of the macula were measured by spectral-domain optical coherence tomography (OCT) at three separate time-points: preoperative, 1 day, and 14 days after cataract surgery. To determine the correlation between parameters, Pearson's correlation coefficients and degree of association, and coefficient of determination (r2 ) were used.

RESULTS: One hundred eyes from 93 subjects were analysed. Preoperatively, mean CST was 247.71 ± 21.44 µm, CV was 9.38 ± 0.82 mm3 , and CAT was 262.94 ± 22.15 µm. At 12.42 + 11.05 of mean CDE exposure, the fovea increased in thickness in all measured parameters. The relationship between CDE and the change in foveal thickness values from baseline to postoperative Day 1 and Day 14 were examined. The correlation coefficients obtained for CST, CV, and CAT had low association to CDE. Furthermore, only the correlation coefficients of the difference between baseline and Day 1 of CST, and the difference between baseline and Day 14 observations of CV were significant (0.279 and -0.206, p=0.005 and p=0.040, respectively) but still with a low degree of association.

CONCLUSION: There is a low, significant, direct association of the difference of CST on Day 1 from baseline with CDE, and a low, significant, indirect association of the difference of CV on Day 14 from baseline with CDE after routine phacoemulsification.

Human ; Phacoemulsification ; Tomography, Optical Coherence ; Fovea Centralis ; Macula Lutea ; Cataract Extraction ; Cataract

PURPOSE: To evaluate the 12-month outcome of anti-vascular endothelial growth factor (VEGF) treatment for extrafoveal polypoidal choroidal vasculopathy (PCV). METHODS: This retrospective observational study included 32 eyes of 32 patients newly diagnosed with extrafoveal PCV (polyps located more than 500 microm from the center of the fovea). Patients were treated with intravitreal ranibizumab, bevacizumab, or both. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) at diagnosis and at 12 months were compared. Eyes were divided into two groups according to the presence of submacular hemorrhage. The BCVA in each group was compared at baseline and at 12 months. RESULTS: During the 12-month study period, patients received an average of 4.0 +/- 1.1 anti-VEGF injections. The BCVA at baseline, three-month post-diagnosis, and 12-month post-diagnosis was 0.59 +/- 0.40, 0.34 +/- 0.38, and 0.38 +/- 0.38, respectively. The BCVA at 12 months was significantly better than the baseline value (p = 0.002). The CFT at baseline, three-month, and 12-month post-diagnosis was 477.1 +/- 194.2 microm, 214.5 +/- 108.8 microm, and 229.8 +/- 106.1 microm, respectively. The CFT at 12 months was significantly lower than the baseline value (p < 0.001). A significant improvement in BCVA was noted in eyes with and without submacular hemorrhage (n = 13, p = 0.032 and n = 19, p = 0.007, respectively). CONCLUSIONS: Anti-VEGF therapy was beneficial in extrafoveal PCV, regardless of the presence of submacular hemorrhage.
Aged ; Angiogenesis Inhibitors/*therapeutic use ; Bevacizumab/therapeutic use ; Choroidal Neovascularization/diagnosis/*drug therapy/physiopathology ; Female ; Fluorescein Angiography ; Fovea Centralis/pathology ; Humans ; Intravitreal Injections ; Male ; Microscopy, Confocal ; Middle Aged ; Polyps/diagnosis/*drug therapy ; Ranibizumab/therapeutic use ; Retrospective Studies ; Tomography, Optical Coherence ; Treatment Outcome ; Vascular Endothelial Growth Factor A/*antagonists & inhibitors ; Visual Acuity/drug effects/physiology

We report two cases of surgical removal of a retained subfoveal perfluorocarbon liquid (PFCL) bubble through a therapeutic macular hole combined with intravitreal PFCL injection and gas tamponade. Two patients underwent pars plana vitrectomy with PFCL injection for rhegmatogenous retinal detachment. In both cases, a retained subfoveal PFCL bubble was noticed postoperatively by funduscopy and optical coherence tomography. Both patients underwent surgical removal of the subfoveal PFCL through a therapeutic macular hole and gas tamponade. The therapeutic macular holes were completely closed by gas tamponade and the procedure yielded a good visual outcome (best-corrected visual acuity of 20 / 40 in both cases). In one case, additional intravitreal PFCL injection onto the macula reduced the size of the therapeutic macular hole and preserved the retinal structures in the macula. Surgical removal of a retained subfoveal PFCL bubble through a therapeutic macular hole combined with intravitreal PFCL injection and gas tamponade provides an effective treatment option.
Aged ; Female ; Fluorocarbons/*administration & dosage ; Follow-Up Studies ; Fovea Centralis ; Humans ; Intravitreal Injections ; Retinal Perforations/diagnosis/physiopathology/*surgery ; Suction/*methods ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy/*methods

PURPOSE: To compare the foveal thickness (FT) parameters measured by Stratus optical coherence tomography (OCT) and Spectralis OCT in various retinal diseases and to construct conversion formulas between the two types of OCT devices. METHODS: We examined 366 consecutive patients (475 eyes) with retinal diseases and 13 normal controls (13 eyes). The patients were categorized into eight retinal disease groups. The mean amount and distribution of foveal thickness differences (FTD) measured by Stratus and Spectralis OCT were determined, and conversion formulas were constructed for Stratus OCT FT from Spectralis OCT FT for each retinal disease group. RESULTS: Among retinal diseases, the mean FTD was significantly larger in exudative age-related macular degeneration (AMD) patients (mean +/- SD, 94.0 +/- 55.0 microm) compared to normal subjects (66.2 +/- 11.7 microm; p < 0.0001). The proportion of eyes with a mean FTD outside 1.96 standard deviations of normal subject FTD was greatest in the exudative AMD (50.0%) group and smallest in the macular hole (18.2%) group. The predicted FTs obtained through the conversion formulas showed lower variance than the actual FTD values, especially in the exudative AMD group. The prediction line for exudative AMD deviated most from that of normal subjects. CONCLUSIONS: FTD shows diverse values and variances among various retinal diseases, especially in exudative AMD, which indicates that Stratus OCT FT cannot be predicted from Spectralis OCT FT by FTD value alone. We constructed statistically significant conversion formulas, which provided more reliable methods to predict Stratus OCT-measured FT from Spectralis OCT measurements for different retinal disease groups.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Female ; Fovea Centralis/*pathology ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Retinal Diseases/*pathology ; Retrospective Studies ; *Tomography, Optical Coherence ; Young Adult

PURPOSE: To investigate correlations between preoperative and postoperative foveal microstructures in patients with macula-off rhegmatogenous retinal detachment (RRD). METHODS: We reviewed the records of 31 eyes from 31 patients with macula-off RRD who had undergone successful re-attachment surgery. We analyzed data obtained from complete ophthalmologic examinations and optical coherence tomography (OCT) before and 9 to 12 months after surgery. All postoperative OCT measurements were taken with spectral-domain OCT, but a subset of preoperative OCT measurements were taken with time-domain OCT. RESULTS: The mean duration of macular detachment was 15.5 +/- 15.2 days, and mean preoperative best-corrected visual acuity (BCVA, logarithm of the minimum angle of resolution) was 1.03 +/- 0.68. Preoperative visual acuity was correlated with retinal detachment height (p < 0.001) and the existence of intraretinal separation (IRS) along with outer layer undulation (OLU) (p = 0.022), but not with macula-off duration. The final BCVA was significantly correlated with integrity of the junction between the photoreceptor inner and outer segments (IS/OS) combined with the continuity of external limiting membrane (ELM) (p = 0.025). The presence of IRS and OLU on a detached macula were highly correlated with the final postoperative integrity of the IS/OS junction and the ELM (p = 0.017). CONCLUSIONS: Eyes preoperatively exhibiting IRS and OLU showed a higher incidence of disruption to the photoreceptor IS/OS junction and the ELM at final follow-up. Such a close correlation between preoperative and postoperative structural changes may explain why ultimate visual recovery in such eyes is poor.
Adolescent ; Adult ; Female ; Fovea Centralis/*pathology/*surgery ; Humans ; Macula Lutea/pathology/surgery ; Male ; Middle Aged ; *Recovery of Function ; Retinal Detachment/*pathology/*surgery ; Retrospective Studies ; *Tomography, Optical Coherence ; Young Adult

A 24 year-old Malay lady presented with high grade fever, myalgia, generalized rashes, severe headache and was positive for dengue serology test. Her lowest platelet count was 45 × 10(9) cells/L. She complained of sudden onset of painlessness, profound loss of vision bilaterally 7 days after the onset of fever. On examination, her right eye best corrected vision was 6/30 and left eye was 6/120. Her anterior segment examination was unremarkable. Funduscopy revealed there were multiple retinal haemorrhages found at posterior pole of both fundi and elevation at fovea area with subretinal fluid. Systemic examination revealed normal findings except for residual petechial rashes. She was managed conservatively. Her vision improved tremendously after 2 months. The retinal hemorrhages and foveal elevation showed sign of resolving. Ocular manifestations following dengue fever is rare. However, bilateral visual loss can occur if both fovea are involved.
Dengue ; complications ; diagnosis ; Female ; Fovea Centralis ; pathology ; Humans ; Macula Lutea ; pathology ; Retinitis ; diagnosis ; etiology ; Vision Tests ; Young Adult

PURPOSE: To compare the effectiveness of intravitreal injections of bevacizumab and ranibizumab in patients with treatment-naive polypoidal choroidal vasculopathy (PCV). METHODS: Records from 106 consecutive patients who received intraviteral bevacizumab (n = 58, 1.25 mg) or ranibizumab (n = 52, 0.5 mg) for treatment of PCV were retrospectively reviewed. After three initial monthly loading injections, injection was performed as needed. The main outcome measures included best-corrected visual acuity (BCVA), foveal central thickness (FCT) as assessed by spectral domain optical coherence tomography, and the changes in polypoidal lesions based on an indocyanine green angiography. RESULTS: The average number of injections was 3.31 +/- 1.25 in the bevacizumab group and 3.44 +/- 0.92 in the ranibizumab group. Mean logarithm of the minimum angle of resolution of BCVA from baseline to 6 months after injection improved by 0.17 in the bevacizumab group (p = 0.03) and by 0.19 in the ranibizumab group (p = 0.01). Average FCT decreased from 322 +/- 62.48 microm to 274 +/- 40.77 microm in the bevacizumab group (p = 0.02) and from 338 +/- 50.79 microm to 286 +/- 36.93 microm in the ranibizumab group (p = 0.02). Polyp regression rate was 20.7% (12 of 58 eyes) in the bevacizumab group and 21.2% (11 of 52 eyes) in the ranibizumab group. There was no statistically significant difference between groups in BCVA improvement achieved, FCT improvement achieved, and polyp regression rate between groups. CONCLUSIONS: Intravitreal injections of bevacizumab and ranibizumab have similar effects in stabilizing of visual acuity, macular edema, and regression of polypoidal complex in PCV eyes over the short term.
Angiogenesis Inhibitors/administration & dosage ; Antibodies, Monoclonal, Humanized/*administration & dosage ; Choroid/*blood supply ; Choroid Diseases/diagnosis/*drug therapy/physiopathology ; Dose-Response Relationship, Drug ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fovea Centralis/pathology ; Fundus Oculi ; Humans ; Intravitreal Injections ; Male ; Middle Aged ; Peripheral Vascular Diseases/diagnosis/*drug therapy/physiopathology ; Retrospective Studies ; Time Factors ; Tomography, Optical Coherence ; Treatment Outcome ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Visual Acuity

OBJECTIVEDesign a convenient and stable eye refractometer based on the theory of blur circle.

METHODSAnalyze the retinal blur circle in both Emsly reduced eye model and Liou & Brennan 1997 eye model by ZEMAX. Design the coefficients including PD (pupil diameter) and NO' (length between node point and fovea) with the purpose of improving the accuracy. At last, compare the clinical optometry data from this refractor with the data obtained from optometry hospital in Wenzhou.

RESULTSThe blur circle diameters are nearly the same in both reduced eye model and the Liou & Brennan 1997 eye model. With the PD = 4 mm and NO' = 20 mm, the refractor shows a fine accuracy in optometry. The paired t test shows that the myopia group and the astigmatism axial direction group have no statistical difference between the data from the blur circle refractor and the hospital (P > 0.05), while the astigmatism degree group has the result of P = 0.41 which may be caused by the poor cooperation of pediatric patients. 80% of the astigmatism degree data differ from the data from the hospital in less than 0.75D.

CONCLUSIONThe blur circle refractor, with the features of convenience and fine accuracy, is promised to be a new style of refractometer in the future.

Astigmatism ; Equipment Design ; Fovea Centralis ; Humans ; Models, Statistical ; Myopia ; Ophthalmoscopes ; Ophthalmoscopy ; Refraction, Ocular ; Visual Acuity