Download ARVO 2015 Annual Meeting Abstracts 166 Vitreomacular interface

ARVO 2015 Annual Meeting Abstracts
166 Vitreomacular interface disorders
Sunday, May 03, 2015 3:15 PM–5:00 PM
Exhibit Hall Poster Session
Program #/Board # Range: 1198–1237/D0175–D0214
Organizing Section: Retina
Contributing Section(s): Clinical/Epidemiologic Research,
Multidisciplinary Ophthalmic Imaging, Physiology/Pharmacology
Program Number: 1198 Poster Board Number: D0175
Presentation Time: 3:15 PM–5:00 PM
Analysis of the vitreomacular interface in a French populationbased study (The MONTRACHET study: Maculopathy, Optic
Nerve, nuTRition, neurovAsCular and HEarT diseases)
Jacques Bouche-Pillon1, Philippe Koehrer1, Alain M. Bron1,
Catherine P. Garcher1, Christine Binquet1, Christophe tzourio2,
Lionel Bretillon3, Niyazi Acar3. 1CHU dijon, Dijon, France; 2Inserm
U, Bordeaux, France; 3INRA Eye and Nutrition Research Group,
Dijon, France.
Purpose: The aim of this study was to investigate the prevalence and
distribution of vitreomacular adhesion (VMA) in a French population
aged over 75 years and enrolled in the MONTRACHET study.
Methods: An earlier three-city study (3C; 1999) recruited and
studied 9294 subjects aged 65 years or more drawn from three French
cities (Bordeaux, Dijon and Montpellier). After a 10-year follow up,
Dijon’s cohort had a complete ophthalmic examination as part of the
MONTRACHET study. Vitreomacular interface (VMI) was analysed
with a spectral-domain OCT. Vitreomacular adhesion (VMA) in
each patient was classified according to the IVTS (International
Vitreomacular Traction Study) criteria, defining the presence VMA,
vitreomacular traction (VMT) isolated or associated with a foveal
distorsion.
Results: One thousand one hundred and fifty three subjects were
included in the study; the median age was 81 [76-96] years.
Prevalence of vitreomacular adhesion was 12.2%. VMA affected both
eyes in 28.5% of cases (80 patients). The median size of the diameter
of vitreous attachment to the macular surface was 1377 [50-5639]
mm. Attachment was focal (≤1500 m) for 52.3% of cases (147 eyes)
and broad (>1500 m) for 47.7% of cases (134 eyes). Prevalence
of isolated VMT was 0.9% (22 eyes) and was focal (<1500 mm)
in all cases. Prevalence of lamellar holes was 0.6% (13 eyes) and
macular pseudoholes was 0.2% (4 eyes). Prevalence of full-thickness
macular hole was 0.01% (2 eyes). ARMD (Age Related Macular
Degeneration) was associated with VMA in 4 eyes (2.5 %).
Conclusions: The analysis of VMI is interesting due to the
emergence of enzymatic vitreolysis. These results provide new
population data from French subjects aged 75 years and above.
These results from the MONTRACHET study are the first to
analyse and classify VMA using the new classification system of the
International Vitreomacular Traction Study Group in a population
based study.
Commercial Relationships: Jacques Bouche-Pillon, None;
Philippe Koehrer, None; Alain M. Bron, None; Catherine P.
Garcher, None; Christine Binquet, None; Christophe tzourio,
None; Lionel Bretillon, None; Niyazi Acar, None
Program Number: 1199 Poster Board Number: D0176
Presentation Time: 3:15 PM–5:00 PM
Spectral domain optical coherence tomography characteristics
after acute posterior vitreous detachment
Nadim Rayess, Ehsan Rahimy, Jason Hsu. Ophthalmology, Wills Eye
Hospital, Philadelphia, PA.
Purpose: To identify any anatomical retinal changes that develop
after spontaneous acute posterior vitreous detachment (PVD) and
compare it to previously reported findings following ocriplasmin
induced release of vitreomacular traction.
Methods: Prospective single center study of patients with signs and
symptoms (flashers and floaters) of acute PVD less than 2 weeks
duration, and confirmed by funduscopic examination. An enhanced
vitreous imaging spectral-domain optical coherence tomography (SDOCT) protocol was implemented for patients who presented with the
above symptoms. Patients received both a 6-line radial and a 7-line
raster scan pattern using a scan width of 30° centered on the fovea.
This imaging protocol was performed on both the symptomatic eye
and the corresponding fellow eye. SD-OCT scans were then reviewed
to detect any retinal changes, specifically in the external limiting
membrane and ellipsoid zone. The findings were then compared to
the fellow eye.
Results: Forty eyes of 40 patients with a mean age of 59 ± 10 years
were included in this study. The presence of PVD was confirmed by
enhanced vitreous SD-OCT imaging in all cases. The ellipsoid zone
and external limiting membrane were found to be intact in all 40
cases following spontaneous release of the vitreomacular interface.
Similarly, no outer retinal changes were noted in the fellow eye.
Nine of the 40 patients had a retinal tear detected on funduscopic
examination. Seven of these 9 patients demonstrated hyperlucent dots
within the region of detached vitreous.
Conclusions: Spontaneous acute PVD does not seem to cause
ellipsoid zone changes as is noted in patients that undergo release of
vitreomacular traction using intravitreal ocriplasmin injections.This
suggests that the mechanism of ellipsoid zone changes following
ocriplasmin injection may be a result of the pharmacological action
of the drug. Furthermore, the presence of hyperlucent dots in the
region of detached vitreous in patients with acute PVD, may be a
sensitive indicator for the presence of a retinal tear.
Commercial Relationships: Nadim Rayess, None; Ehsan Rahimy,
None; Jason Hsu, None
Program Number: 1200 Poster Board Number: D0177
Presentation Time: 3:15 PM–5:00 PM
Vitreoretinal Interface Enhanced High Density Spectral Domain
Optical Coherence Tomography in Age-Related Macular
Degeneration
Daniela Santos1, 2, Sergio Groman-Lupa1, 2, Yu Cheol Kim1, 2,
Mariana Harasawa1, 2, Guillermo Salcedo3, Miguel Paciuc1, 2, Hugo
Quiroz-Mercado1, 2. 1Opthalmology, Denver Health Medical Center,
Denver, CO; 2Opthalmology, University of Colorado, Denver, CO;
3
Opthalmology, Asociación para Evitar la Ceguera en México,
Mexico City, Mexico.
Purpose: Vitreoretinal interface findings have been reported in
several pathologies using Swept Source OCT (SS OCT). Enhanced
High Density Spectral Domain Optical Coherence Tomography
(EHD- SDOCT) has not been widely studied in eyes affected by
Age-Related Macular Degeneration (AMD). The purpose of this
retrospective, observational study was to report structural findings of
vitreoretinal interface using EHD-SDOCT in eyes with AMD.
Methods: Optovue RTVue XR Avanti (Optovue Inc.) in Enhanced
HD line mode was used in 22 patients (44 eyes) at Denver Health
Medical Center with either dry or wet macular degeneration. The
patients included were subjects with a previous diagnosis of AMD.
The age ranged between 58 and 89 years with a mean age of 73 years.
9% of the patients were male.
Results: The EHD- SDOCT findings included retinal pigment
epithelium disruptions, choroidal neovascularization, retinal thinning,
intraretinal edema, subretinal fluid and drusen in the subjects eyes.
Other non AMD related findings included visualization of the
Cloquet’s canal with or without a vitreous septum connecting to
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
the posterior precortical vitreous pocket and presence of epiretinal
membrane. We found that 22 eyes (50%) had wet AMD while the
other half had dry AMD. Posterior Vitreous Detachment (PVD)
was not observed in any of our patients. Not evaluable premacular
vitreous configuration was present in 10 eyes (22%). Of the evaluable
eyes, Partial PVD was observed in 27 out of 34 eyes (79.41%).
Conclusions: EHD-SDOCT demonstrated to be a useful tool when
observing vitreoretinal interface in AMD patients. Complete PVD
was absent in all of our cases. This is probably linked to the fact that
EHD-SDOCT is associated with wide field imaging and a highquality visualization of vitreoretinal interface.
Commercial Relationships: Daniela Santos, None; Sergio
Groman-Lupa, None; Yu Cheol Kim, None; Mariana Harasawa,
None; Guillermo Salcedo, None; Miguel Paciuc, None; Hugo
Quiroz-Mercado, None
Program Number: 1201 Poster Board Number: D0178
Presentation Time: 3:15 PM–5:00 PM
Post market experience with Ocriplasmin correlating chronic
changes in electrophysiology (ERG) and optical coherence
tomography (OCT)
Maribel La Fontaine, Fadi Shaya, Kent W. Small. Macula and Retina
Institute, Glendale, CA.
Purpose: Intravitreal injections of Ocriplasmin have recently been
used to treat vitreo-macular traction (VMT). Some have reported
associated transient dyschromatopsias and fewer have reported
ERG abnormalities. We reviewed our experience with Ocriplasmin
including ERG and OCT findings before and after the injection.
Methods: A retrospective chart review was conducted of our
first nine consecutive patients who were treated with intravitreal
Ocriplasmin. Pre-injection and post injection data collected were
visual acuity, funduscopy, fundus photographs, OCT and IVFA
findings. Retinal function was evaluated using ISEV standardized
full field ERG testing and when appropriate, visual evoked potential
(VEP). IRB approval was obtained.
Results: Three of the nine patients had successful release of the
vitreo-macular traction but only two of these three patients achieved
closure of the macular hole with visual acuity improvement (20/400
to 20/30; 20/80 to 20/30). Patient 1 had moderate rod and cone
function loss and patient 2 had severe loss of rod function by ERG.
Patient 3 experienced successful release of the vitreo-macular traction
but the macular hole did not close. Patient 3 still experienced a
significant loss in rod and cone function. These three also showed
a disappearance of the ellipsoid layer. Changes in patient 1, 2 and 3
persisted for over 6 months with minimal recovery of cone and rod
function. In patient 1, ERG recordings improved dramatically along
with the reappearance of the ellipsoid layer on OCT but only after 15
months. However, her ERG has not returned to baseline. In patients
2 and 3, the ERG and ellipsoid layer recovered after 6 months. The
six remaining patients experienced no change in visual acuity, ERG
or OCT and all 6 had subsequent successful vitrectomy with hole
closure and improvement in visual acuity.
Conclusions: Ocriplasmin caused vitreo-macular traction release
and significant ERG depression along with loss of ellipsoid layer
in 3 of 9 patients; 2 of the 3 patients had successful macular hole
closure with visual acuity improvement. The OCT ellipsoid layer
loss paralleled the ERG depression. We found no ERG changes in the
patients following vitrectomy and membrane peel with indocyanine
green. This is one of the first reports of chronic ERG changes due to
Ocriplasmin.
Commercial Relationships: Maribel La Fontaine, None; Fadi
Shaya, None; Kent W. Small, None
Program Number: 1202 Poster Board Number: D0179
Presentation Time: 3:15 PM–5:00 PM
Changes in the macular ganglion cell complex thickness
associated to diseases of the vitreomacular interface
Antonio Ferreras1, 2, Patricia Ramiro3, Pilar Calvo1, Blanca
Monsalve4, Beatriz Abadia1, Ana Belen Pajarin5. 1Ophthalmology,
Miguel Servet University Hospital, Zaragoza, Spain; 2University
of Zaragoza, Zaragoza, Spain; 3Hospital Clinico Lozano Blesa,
Zaragoza, Spain; 4Hospital General Universitario Gregorio Marañon,
Madrid, Spain; 5Centro de Salud Seminario, Zaragoza, Spain.
Purpose: To compare the macular retinal ganglion cell plus inner
plexiform layer (RGC) thickness between individuals with normal
vitreomacular interface and subjects with vitreomacular adhesion
(VMA), vitreomacular traction (VMT) and macular holes (MHs).
Methods: The Institutional Review Board approved this retrospective
cohort study. Nine hundred fifteen clinical charts were revised. The
sample was divided into 4 groups according to the International
Vitreomacular Traction Study Group Classification of VMA, VMT,
and MH. The normal group comprised 797 eyes, the VMA group
included 100 eyes, and the VMT and MH groups had 10 and 8 eyes,
respectively. All participants had to have a good quality (≥6/10)
macular spectral-domain optical coherence tomography (OCT) scan
performed with the Cirrus HD OCT (Carl Zeiss Meditec, Dublin,
CA). The Macular Cube 512x128 scans were analyzed with the
Ganglion Cell Analysis protocol. Left eye data were converted to
a right eye format. The RGC thicknesses were compared by oneway analysis of variance (ANOVA; Scheffe post hoc multiple
comparisons test) between groups. The Bonferroni correction for
multiple comparisons was applied, resulting in a significance level of
p≤0.006.
Results: Age did not differ significantly between the groups. The
VMA (p=0.001) and the VMT (p=0.002) groups had a thinner GCL in
the superior sector compared to the normal group. The MH group had
a thinner GCL than the control group in the superior nasal (p=0.002)
and inferior nasal (p=0.001) sectors, while the GCL in the AVM and
MH groups was thinner than the normal group in the inferior sector
(p<0.001 and p=0.002, respectively). The average GCL + inner
plexiform layer thickness was reduced in the AVM and MH groups
while the minimum GCL + inner plexiform layer was thinner in the
AVM and VMT groups.
Conclusions: A reduction of the inner layers was related to diseases
of the vitreomacular interface. In general, the GCL measured by
Cirrus OCT was thinner in the VMA, VMT and the MH groups
compared to the normal group.
Commercial Relationships: Antonio Ferreras, None; Patricia
Ramiro, None; Pilar Calvo, None; Blanca Monsalve, None;
Beatriz Abadia, None; Ana Belen Pajarin, None
Program Number: 1203 Poster Board Number: D0180
Presentation Time: 3:15 PM–5:00 PM
Six-Month Results From the ORBIT Study: Ocriplasmin
Research to Better Inform Treatment of Symptomatic
Vitreomacular Adhesion
Jay S. Duker1, 2, David S. Boyer3, 4, Jeffrey S. Heier5, Peter K.
Kaiser6, 7, Mathew W. MacCumber8, 9, Dante J. Pieramici10, 11.
1
Ophthalmology, New England Eye Center, Boston, MA; 2Tufts
Medical Center, Boston, MA; 3Retina-Vitreous Associates Medical
Group, Los Angeles, CA; 4University of Southern California, Los
Angeles, CA; 5Ophthalmic Consultants of Boston, Boston, MA; 6Cole
Eye Institute, Cleveland, OH; 7Cleveland Clinic, Cleveland, OH;
8
Illinois Retina Associates, Chicago, IL; 9Rush University Medical
Center, Chicago, IL; 10California Retina Consultants, Santa Barbara,
CA; 11California Retina Research Foundation, Santa Barbara, CA.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Purpose: The large Phase IV ORBIT study prospectively and
systematically collects real-world data on clinical outcomes and
safety in patients receiving ocriplasmin according to standard of
care in US retina clinics. This study provides real-world efficacy and
safety data complementary to the Phase III MIVI-TRUST trials and
may further define appropriate patients for ocriplasmin treatment.
Methods: ORBIT is a multicenter, prospective, observational Phase
IV study that plans to enroll 1500 patients from approximately
120 US clinical retina sites. Patients are enrolled at the time of
ocriplasmin injection, and baseline and post-injection data are
collected; patients are followed for up to 12 months. Treatment
decisions, including the frequency and timing of patient visits after
injection, are at the discretion of the treating physician following
standard of care, and are not mandated by the study design. Clinical
effectiveness and safety data are entered in electronic case report
forms, based on investigator assessments. SD-OCT images are
uploaded to a central reading center for independent review.
Results: Here we present preliminary demographic and patient
baseline data obtained from the initial 6 months of the ORBIT study.
Data from both investigator and reading center assessments, as well
as clinical outcome and safety data captured over the first 6 months
of the study are included. As of 11/11/14, 243 patients were enrolled
from 110 clinics. Baseline demographics and ocular characteristics
for these 243 patients are presented in Table 1. Mean age is 79 years
(range=46–92 years); 66% of patients are female. Pre-injection ocular
symptoms (in >3% of patients) included decreased visual acuity,
metamorphopsia, floaters, central visual field defect/central black
spot, difficulty reading at close distance, photopsia, and eye pain/
ocular discomfort. (Table 1)
Conclusions: Data collected from the ORBIT study will assess
the real-world efficacy and safety profile of ocriplasmin, better
characterize post-injection patient experiences, and help identify
patients who may respond best to ocriplasmin therapy.
Commercial Relationships: Jay S. Duker, Alcon/Novartis (C),
ThromboGenics (C); David S. Boyer, Alcon (C), ThromboGenics
(C); Jeffrey S. Heier, Alcon (C), Alcon (F), ThromboGenics (C);
Peter K. Kaiser, Alcon (C), ThromboGenics (C); Mathew W.
MacCumber, Thrombogenics (C), ThromboGenics (F); Dante J.
Pieramici, ThromboGenics (C)
Support: ThromboGenics
Clinical Trial: NCT02079883
Program Number: 1204 Poster Board Number: D0181
Presentation Time: 3:15 PM–5:00 PM
Extended Follow-up of Ocriplasmin for Vitreomacular Traction
Release
David Dyer, William Anderson, Michael P. Ellis, Robert Breeden.
Retina Associates, P.A., Overland Park, KS.
Purpose: To evaluate the parameters that may be predictive in which
ocriplasmin (Jetrea®) may be more likely to lyse vitreomacular
adhesions in patients with vitreomacular traction (VMT). The main
parameter analyzed was size of greatest linear dimension (GLD) and
resolution was followed out to 12 months follow-up.
Methods: A retrospective chart review of consecutive VMT cases
treated with ocriplasmin intravitreal injection and followed for
at least 1 month and no greater than 12 months. Status of VMT
resolution was assessed using Spectral Domain Optical Coherence
Tomography (SD-OCT). Several parameters were assessed including
coexisting ocular conditions to create a more thorough sub-analysis
of the use of ocriplasmin. Information was recorded at intervals of
date pre-injection, date of injection, 1 month, 3 months, 6 months and
12 months post-injection.
Results: 36 eyes were followed retrospectively for an average of 6.7
± 4.3 months in 34 patients, 19 (55.9%) male and 15 (44.1%) female.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Complete resolution of VMT status post ocriplasmin injection was
seen in 13 of 36 eyes (36.1%) at a mean of 39.5 days follow-up. 3
of the 13 eyes (23.1%) that had resolving VMT, resolved after the 1
month follow-up point. The mean GLD of VMT resolution was 367
± 97 microns.
Conclusions: Ocriplasmin intravitreal injection is an effective
alternative to vitrectomy in many patients with VMT. Our results
show a private-practice example that the drug may be used most
effectively in the patients with a GLD of <550 microns.
Commercial Relationships: David Dyer, None; William Anderson,
None; Michael P. Ellis, None; Robert Breeden, None
Program Number: 1205 Poster Board Number: D0182
Presentation Time: 3:15 PM–5:00 PM
New Proposed Classification For Tomographic Posterior Vitreous
Detachment (PVD), And High Prevalence Of Type 3 PVD In
Diabetic Macular Edema Among Diabetic Patients
David Rivera4, 1, liliana Pérez-Peralta4, 1, Aida Jimenez-Corona2,
Sergio Hernández-Jiménez1, Carlos A. Aguilar-Salinas3, Enrique
O. Graue2. 1Centro de atención Integral Del Paciente Con Diabetes,
Instituto Nacional De Ciencias Médicas y Nutrición Salvador
Zubirán, Mexico, Mexico; 2Instituto de oftalmología Fundación
Conde de Valenciana, Mexico, Mexico; 3Instituto Nacional de
Ciencias Médicas y Nutrición Salvador Zubirán, Mexico city,
Mexico; 4Centro de Atención Integral del Paciente con Diabetes,
Institute of Ophthalmology Fundación Conde De Valenciana IAP.,
Mexico city, Mexico.
Purpose:
To describe and propose an new classification of posterior vitreous
detachment measured by optic coherence tomography, and to
describe the correlation between the proposed types of PVD and
diabetic macular edema.
Methods: A prospective study of 122 eyes of 61 consecutive patients
of a diabetes clinic were examined. Patients had the diagnosis of
diabetes and OCT was performed with a spectral-domain OCT.
The imaging of the macula was assessed by a 300 OCT image
crossing the center of the fovea. According the posterior vitreous
status 8 types were described. 0 – Attached; 1 – Mild detachment;
2 – Perifoveal detachment with hyaloidal central adhesión in “U”
shape; 3 - Perifoveal detachment with hyaloidal central adhesión in
“inverted-U” shape; 4 – Perifoveal detachment with central adhesión,
asymetric detachment, higher on one side of the fovea, both in
“U”shape; 5 - Perifoveal detachment with central adhesión, asymetric
detachment, higher on one side of the fovea, one in “U”shape and
one in “inverted-U” shape; 6 - Perifoveal detachment with central
adhesión, asymetric detachment, higher on one side of the fovea, both
in “inverted-U”shape; 7 – Detached; 8 – No classifiable. Macular
edema was classified according to the international classification in
mild, moderate and sever. Statistical analysis was performed using a
Fisher exact test.
Results: Frequencies in the whole population of the different types
of PVD are the following: Type 1: 27%, 2: 17%, 3: 11%, 4: 16%,
5:0%, 6:5%, 7: 20%, 8: 2%. Particularly, type 3 PVD was statistically
associated with eyes presenting moderate and severe macular edema
with an Odds ratio of 4.038 (IC95% 1.34-12.17, P=0.013). Patients
with moderate and severe edema had a frequency of 36.8% of type
3 PVD, while patients without edema had a frequency of 13%. Such
association was not found with mild and none macular edema.
Conclusions: In this novel classification, patients with moderate/
severe macular edema had 4 times more possibilities of having type
3 PVD (Inverted “U” perifoveal) when compared with patients
with mild or no edema. Type 3 PVD is statistially associated with
moderate and severe stages of diabetic macular edema. This provides
another proven factor to the multifactorial pathogenesis of this
diabetic macular edema.
Commercial Relationships: David Rivera, None; liliana PérezPeralta, None; Aida Jimenez-Corona, None; Sergio HernándezJiménez, None; Carlos A. Aguilar-Salinas, None; Enrique O.
Graue, None
Program Number: 1206 Poster Board Number: D0183
Presentation Time: 3:15 PM–5:00 PM
The vitreo macular interface and the response to Anti VEGF
therapy
Kanishka R. Mendis, Helmut Yu, Shadbolt Bruce. ophthalmology, The
Canberra Hospital, Canberra, ACT, Australia.
Purpose: To analyze the vitreo macular interface (VMI) in VEGF
inhibited patients and to investigate if VMI change has an effect on
the treatment response.
Methods: We performed a retrospective, observational, clinical
study. Neo vascular age macular degeneration (NVAMD), exudative
diabetic maculopathy (DME) and retina vein obstruction (RVO) with
macular edema were studied. Three VMI groups were identified,
vitreo macular adhesion (VMA), vitreo macular partial detachment
(VMPD) and vitreo macular detachment (VMD). Patients diagnosed
with fundus fluorescein angiography and serial spectral domain OCT
(SD OCT) scans were included. Patients with a history of vitrectomy
were excluded. Patients with VMA but who later developed VMD
were included. Generalised linear models and repeated measures
ANOVAs were used to evaluate the effect of diagnosis and VMI
types on outcome measures, VA and CMT with adjustments for
confounding and multiple testing (Bonferroni).
Results: 93 eyes of 85 patients treated with anti VEGF therapy
for wet AMD (55 eyes), DME (18) and RVO (20) were identified.
The median age of patients with NVAMD, RVO and CIDME were
70.77, 59.29 and 33 respectively. The distribution of VMA, VMPD,
VMD in wet AMD, RVO, DME were, 3,3,49; 5,2,10 and 6, 2, 7
respectively. Six patients changed from VMA to VMPD. The CMT
was significantly (p=0.05) reduced in the three disease categories
and variable between the VMI types with AMD with VMA having
the most significant (p=0.03) reduction. There was no statistically
significant difference in VA between VMI groups.
Conclusions: VMI may contribute to response to anti VEGF in
AMD.
Commercial Relationships: Kanishka R. Mendis, None; Helmut
Yu, None; Shadbolt Bruce, None
Program Number: 1207 Poster Board Number: D0184
Presentation Time: 3:15 PM–5:00 PM
Ultra-Widefield Spectral Domain Optical Coherence
Tomography Enhanced Vitreous Imaging for Vitreoretinal
Interface Visualization
Matteo G. Cereda, Mariano Cozzi, Marco Pellegrini, Ferdinando
Bottoni, Giovanni Staurenghi. Department of Clinical and
Biomedical Science “Luigi Sacco”, Eye Clinic Sacco Hospital Milan
Italy, Milano, Italy.
Purpose: to evaluate 100 degrees horizontal and vertical vitreoretinal
interface from the macula into periphery using Spectral Domain
Optical Coherence Tomography (SD-OCT) Enhanced Vitreous
Imaging (EVI) montage images of three different 55 degrees B-scan
obtained on the same line.
Methods: Observational case series of 25 eyes. Consecutive patients
from Vitreoretinal Clinic of Luigi Sacco Hospital were scanned using
a new widefield OCT module of Heidelberg Spectralis (Heidelberg
Spectralis, Heidelberg Engineering, Germany software version
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
6.0.9) that allows to extend the field of view of OCT cross-sectional
imaging to 55 degrees (approx. 16.5mm).
Each eye was scanned in 6 different locations, 3 horizontal B-scan
(central, temporal and nasal) and 3 vertical B-scan (central superior
and inferior). In order to match the three different scans we moved
the internal fixation light. A montage technique (Photoshop Elements
version 11; Adobe, San Jose, CA) has been used to generate
horizzontal and vertical SD-OCT images approximately 100 degrees
wide spanning through the fovea.
Retinal layers were positioned inferiorly on the image screen to
achieve adequate imaging resolution of vitreoretinal interface,
furthermore as described in literature as EVI technique we added
circa 2 diopters to the OCT focus and set the ART to 100 frames.
Results: All 50 montage images were created and all had good qualit.
In 3 eyes vitreous was not visible in both horizontal and vertical
montage images (1 full-thickness macular hole and 2 pucker). In
1 eye with posterior vitreous detachment vitreous was well visible
in both montage images but not showing any area of persistent
attachment at the periphery. In the remaining 21 eyes cortical vitreous
was well discernible with adhesion areas at the posterior pole and/
or at the periphery (14 incomplete posterior vitreous detachment, 4
vitreous macular traction, 3 vitreomacular adhesion).
Conclusions: Ultra widefield OCT with EVI technique can clearly
show detailed information of peripheral vitreoretinal interface,
including shape and extension of shallow vitreous detachments.
Moreover vertical EVI ultra widefield OCT apparently gives better
imaging quality of vitreous structure than the horizontal ones. OCT’s
companies should improve their software including an automatic tool
to create montage images.
Commercial Relationships: Matteo G. Cereda, None; Mariano
Cozzi, None; Marco Pellegrini, None; Ferdinando Bottoni,
None; Giovanni Staurenghi, ALCON LABORATORIES, INC (C),
HEIDELBERG ENGINEERING (C), OPTOS, INC (C), OPTOVUE
(S), ZEISS (C), ZEISS (S)
Program Number: 1208 Poster Board Number: D0185
Presentation Time: 3:15 PM–5:00 PM
Visualization of Posterior Vitreous Detachment with SpectralDomain OCT
Manuela Mambretti, Ferdinando Bottoni, Matteo G. Cereda, Anna
Paola Salvetti, Mario V. Cigada, Giovanni Staurenghi. Eye Clinic
- Department of Clinical Science “Luigi Sacco”, Sacco Hospital,
Milan, Italy.
Purpose: To compare different Spectral-Domain Optical Coherence
Tomographers (SD-OCTs) and different scan widths in the evaluation
of posterior vitreous detachment.
Methods: Retrospective analysis of SD-OCT scans acquired the
same day from sixty-nine consecutive patients using: OCT RS-3000
Advance by Nidek (12 millimeters horizontal macula scan); OCT
Avanti RtVue XR by Optovue (12 millimeters horizontal macula
scan) and OCT Spectralis by Heidelberg Engineering (6 and 9
millimeters horizontal scans through the fovea and a “composite”
image, approximately 15 millimeters wide, obtained by composing
horizontal overlapping scans from the macula and the periphery).
Images were randomized and reviewed separately by two vitreoretinal experts, who evaluated the degree of posterior vitreous
detachment (PVD) and whether the Bursa Premacularis (BP) could
be detected. To test the agreement between the two examiners for
PVD grading, Cohen’s kappa was computed; smaller weights were
post-hoc assigned to grades corresponding to no PVD and complete
PVD as they were the primary source of disagreement.
Results: 345 images were evaluated. Interobserver agreement for
PVD was found to be fair to moderate with OCT Spectralis scans,
with the highest agreement obtained with composite scans (κ =
0,569). With 12 millimeters scans, agreement was found to be
substantial with both OCT RS-3000 Advance (κ = 0,654) and OCT
Avanti RtVue XR scans (κ = 0,758). Weighted Cohen’s kappa shows
interobserver agreement to be almost perfect (κ = 0,808 to 0,913)
for all SD-OCT instruments and scans. With OCT Spectralis, the
BP was observed in up to 29,0% of 6 and 9 mm scans and 39,1% of
composite scans (χ2 = 2,5; P = 0,3). The BP was detected in up to
55,1% of OCT Avanti RtVue XR scans and 63,8% of OCT RS-3000
Advance scans (χ2 = 19,6; P = 0,0006).
Conclusions: SD-OCT grading of PVD guarantees high
interobserver reproducibility when applied to the first stages of PVD.
The distinction between no PVD and complete PVD is subject to
higher interobserver variability. In this study, the best results were
obtained using 12 mm scans, which also allow for better visualization
of posterior vitreous structures. Prevalence of the BP (both overall
and corrected by degree of PVD) with 12millimeters scans is
consistent with previously reported data.
Commercial Relationships: Manuela Mambretti, None;
Ferdinando Bottoni, Novartis Pharmaceuticals Corporation (C);
Matteo G. Cereda, None; Anna Paola Salvetti, None; Mario V.
Cigada, None; Giovanni Staurenghi, Alcon Laboratories, Inc.
(C), Allergan Inc. (C), Bayer (C), Boehringer (C), Glaxosmithkline
(C), Heidelberg Engineering (C), Novartis Pharmaceuticals
Corporation (C), Novartis Pharmaceuticals Corporation (S), Ocular
Instruments, Inc. (P), OD - OS (C), Optos, Inc (C), Optovue (S), QLT
Phototerapeutics, Inc. (C), Roche (C), Zeiss (C), Zeiss (S)
Program Number: 1209 Poster Board Number: D0186
Presentation Time: 3:15 PM–5:00 PM
Incidence and clinical characteristics of epiretinal membrane
developing after posterior vitreous detachment
Gavin S. Tan1, 2, Mark S. Blumenkranz2. 1Singapore National
Eye Centre, Mountain View, CA; 2Byers Eye Institute, Stanford
University, Palo Alto, CA.
Purpose: To describe the incidence and clinical characteristics of
epiretinal membrane (ERM) developing after posterior vitreous
detachment (PVD), in a patient population presenting to a tertiary eye
care centre.
Methods: We identified subjects that presented with acute symptoms
of PVD to the ophthalmology clinics at Stanford university. Optical
coherence tomography(OCT) was performed to confirm the presence
of PVD. Subjects with pre-existing ERM and other ocular conditions
which may cause secondary ERM (eg: retinal vein occlusion, uveitis,
diabetic retinopathy, trauma) were excluded. Subjects were followed
up for at least 2 years for the development of ERM on repeat OCT.
Results: 157 subjects were included over a 1 year period. The mean
age of subjects presenting with PVD was 65.2 (+/-11.0) years. 7
eyes (4.5%) developed ERM within the followup period. Epiretinal
membrane was diagnosed on OCT on average 289 days (+/-235)
after PVD. The incidence of retinal tears after PVD was similar in the
group that developed ERM (14%) and the group that did not develop
ERM (12%) (p=0.856). All cases with tears had laser retinopexy
performed. Mean visual acuity was worse in the ERM group (20/38)
compared with the No ERM group (20/26) (p=0.01). 43% of ERM
cases had visual acuity worse than 20/40.
Conclusions: ERM is diagnosed an average of 9 months after PVD
and results in worse VA than those without ERM. Retinal tears
occurring after the PVD was not a risk factor for developing ERM.
Commercial Relationships: Gavin S. Tan, None; Mark S.
Blumenkranz, None
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Program Number: 1210 Poster Board Number: D0187
Presentation Time: 3:15 PM–5:00 PM
Wild-field Spectral-Domain OCT findings of eyes with
symptomatic vitreo-foveal traction treated with intravitreal
Ocriplasmin: a look outside the macula.
Stefano Erba, Sara Bochicchio, Mariano Cozzi, carlo domenico
bianchi, Matteo G. Cereda, Giovanni Staurenghi. Sacco Hospital,
Eye clinic, Department of Clinical Science, Seveso, Italy.
Purpose: To evaluate the baseline features and the changes of vitreopapillary adhesion(VPA) and vitreo-retinal adhesions(VRA) till the
mid periphery of patients that underwent an intravitreal Ocriplasmin
injection (Jetrea, Thrombogenics USA, Alcon/Novartis EU)
Methods: A retrospective case series of patients treated with
Ocriplasmin for sVFT selected on the basis of the MIVI-TRUST trial
results. Images of single SD-OCT B-scans (Heidelberg Spectralis,
Heidelberg Engeneering, Germany) passing through the fovea were
obtained till temporal and nasal mid periphery (horizontal scans), and
till superior and inferior mid periphery (vertical scans). All patients
underwent SD-OCT before intravitreal Ocriplasmin injection, after
one week and one month. We also measured the variations of vitreous
detachment from the traction to the mid periphery in all the quadrants
Results: Seven patients ( 7 eyes), two male and five female, met the
inclusion criteria. 5 eyes presented sVFT and 2 eyes had sVFT with
a full thickness macular hole. At baseline all 7 eyes had VPA; all 7
eyes had visible VRA in the nasal side; 6 eyes had visible VRA in
all the quadrants; in 1 patient VRA was visible only nasally. After
Ocriplasmin injection sVFT resolved in 5 of the 7 patients. VPA
resolved in two eyes where also a resolution of the mid periphery
VRA was noted in all the quadrants. Nasal VRA persisted in the
others 5 patients. Four patients had still a visible VRA in all the
quadrants after the injection. Measures of vitreous detachment
showed, in all the quadrants, only mild increase after injection
Conclusions: Ocriplasmin injection induced a total PVD with the
complete resolution of the sVFT and the VPA in only two eyes of
our series. While VFT resolved in 5 of 7 eyes, in the majority of our
patients no significant changes were noted in the mid periphery VRA.
Our results confirm that Ocriplasmin injection is surely an effective
option for the treatment of the sVFT. On the other hand it is not clear
if ocriplasmin could only resolve the sVFT or accelerate and even
induce a total PVD from the back of the eye. Moreover we still don’t
know if the evaluation of the relationship between the vitreous and
the retina and the head of the optic nerve and the mid periphery could
provide more informations for a careful selection of the patients
eligible for the treatment with Ocriplasmin
Commercial Relationships: Stefano Erba, None; Sara Bochicchio,
None; Mariano Cozzi, Heidelberg Engineering (R); carlo domenico
bianchi, None; Matteo G. Cereda, None; Giovanni Staurenghi,
Alcon Laboratories, Inc (C), Allergan, Inc (C), Bayer (C),
Boehringer (C), Genentech (C), GlaxoSmithKline (C), Heidelberg
Engineering (C), Novartis Pharmaceuticals Corporation (C), Novartis
Pharmaceuticals Corporation (S), Ocular Instruments, Inc (P), Optos,
Inc (C), Optovue (S), Roche (C), Zeiss (C), Zeiss (S)
Purpose: Tissue plasminogen activator (tPA) is a thrombolytic
agent which has the ability to degrade and dissolve fibrin clot.
Although the efficacy of intravitreal tPA injections has been shown
in clinical practice, the ability of intravitreal Injected tPA to diffuse
from the vitreous through the retina and into the subretinal space has
been questioned in an experimental models, as tPA conjugated to
fluorescein, failed to penetrate the retina. We investigate whether an
unconjugated tPA injected into the vitreous could penetrate the neural
retina and enter the subretinal space, in a rat model.
Methods: 24 rats eyes were used in the study.14 right eyes were
injected with intravitreal tPA (0.75 μg/3 μl), 10 right eyes were
injected with intravitreal saline, and served as controls. 3, 24, and
48 hours after tPA injection, animals were euthanized and eyes were
taken for cryosections and immunohfluorescence staining. Goat anti
tPA, followed by alexafluor 568 donkey anti goat (invitrogene) were
used for tPA detection.
Results: TPA staining was detected in deep retinal layers in all eyes
injected with intravitreal tPA. A deeper and more intense staining of
tPA was seen after 3 and 24 hours, compared to a decreased staining
48 hours from injection. No staining of tPA was detected in the retina
in the eyes injected with saline.
Conclusions: We demonstrated that an unconjugated tPA at a dose
of (0.75 μg / 3 μl) injected into the vitreous penetrates the retina
of rats. We speculate that former rabbit model studies that failed to
show penetration of tPA to the retina may be explained by the use of
conjugated tPA that doesn’t penetrate the retina.
Lack of immunohfluorescence staining in the retina of the eye 3
hours after injected with intravitreal Saline. TPA staining seen here is
of vitreous alone. Blue indicate staining of 300 nM 4,6-diamidino-2phenylidole (Sigma).
Program Number: 1211 Poster Board Number: D0188
Presentation Time: 3:15 PM–5:00 PM
Penetration of Intravitreal Injected Tissue Plasminogen Activator
to the Retina - Rats Model Study
Kfir Tal1, 2, Assaf Dotan1, 2, Yael Nisgav3, Mor Dachbash3, Rita
Ehrlich1, 2, Dov Weinberger1, 2, Tami Livnat3, 2. 1Department of
Ophthalmology, Rabin Medical Center,Beilinson Campus Petach
Tikva 49101, Israel, Petach Tikva, Israel; 2Sackler School of
Medicine, Tel Aviv University, Tel Aviv, Israel; 3Laboratory of Eye
Research, Felsenstein Medical Research Center, Petah Tikva, Israel.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
The intraclass correlation coefficient for macula, RNFL was 0.994
and 0.975 respectively in patients with macular hole, while ICC for
GCIPL was measured as at 0.702. The measurement repeatability for
macular, RNFL and GCIPL was high in the normal fellow eye.
Conclusions: The repeatability and the thickness of GCIPL
measurements was lower in patients with macular hole. The impact of
changes in macular shape caused by the macular hole should be taken
into consideration when measuring GCIPL thickness in various eye
diseases such as glaucoma and neuro-ophthalmology.
Commercial Relationships: Jung Yeul Kim, None; Han-min Lee,
None; Il-hwan Shin, None; Chang-Sik Kim, None
Goat anti tPA, followed by alexafluor 568 donkey anti goat
(invitrogene) were used for tPA detection. TPA staining was detected
in deep retinal layers in all eyes injected with 0.75 μg/3 μl intravitreal
tPA. Here 24 hours after injection.
Commercial Relationships: Kfir Tal, None; Assaf Dotan, None;
Yael Nisgav, None; Mor Dachbash, None; Rita Ehrlich, None; Dov
Weinberger, None; Tami Livnat, None
Support: Support Detail (Abstract): This study was supported by a
grant from the Claire and The Amedee Maratier Institute for the study
of blindness and visual disorders, Sackler Faculty of Medicine, TelAviv University.
Program Number: 1212 Poster Board Number: D0189
Presentation Time: 3:15 PM–5:00 PM
Thickness of the Macula, Retinal Nerve Fiber Layer and
Ganglion Cell-Inner Plexiform Layer in the Macular hole
: The Repeatability Study of Spectral Domain Optical Coherence
Tomography
Jung Yeul Kim, Han-min Lee, Il-hwan Shin, Chang-Sik Kim.
Ophthalmology, Chungnam Natl Univ Hosp, Daejeon, Korea (the
Republic of).
Purpose: We measured the thickness of the ganglion cell innerplexiform layer (GCIPL), macula and retinal nerve fiber layer(RNFL)
using spectral domain optical coherence tomography(SD-OCT) in
patients with idiopathic macular hole to analyze repeatability and for
comparison with fellow eye.
Methods: We analyzed 82 patients who visited our retinal clinic.
An experienced examiner obtained two consecutive measurements
from a macular cube 512 × 128 scan using SD-OCT and optic disc
cube 200 X 200 scan. The patients were divided into three groups
according to macular hole size(group A macular hole size < 400
mm, group B 400 mm < macular hole size < 1200 mm, and group
C macular hole size < 1200 mm). Repeatability was determined by
comparing the thickness of GCIPL, macula and RNFL values with
normal fellow eye.
Results: The average central macular thickness in patients with
macular hole was 339.9±92.3 which is significantly thicker than the
normal fellow eye which was 251.7±62.2 . The average thickness
of GCIPL in patients with macular hole was significantly thinner at
57.6±22.5, compared to normal fellow eye which was 77.6±12.7 .
There were no significant differences among three groups in terms of
the GCIPL thickness. There were no significant differences in terms
of the average RNFL thickness(p>0.05).
Program Number: 1213 Poster Board Number: D0190
Presentation Time: 3:15 PM–5:00 PM
Characteristics of epiretinal proliferation: A distinguishing
feature of lamellar macular holes
Yuji Itoh, Ashleigh L. Levison, Peter K. Kaiser, Sunil K. Srivastava,
Rishi P. Singh, Justis P. Ehlers. Cole eye institute, Cleveland Clinic,
Beachwood, OH.
Purpose: To characterize the features of hyporeflective epiretinal
proliferations in vitreomacular interface disorders.
Methods: This is a retrospective review of patients with lamellar
macular hole (LMH), epiretinal membrane (ERM), macular
pseudohole (MPH), full-thickness macular hole (FTMH) and
vitreomacular traction syndrome (VMT). Patients from September
2009 to February 2014 were identified through ICD-9 billing codes.
All SDOCT images were obtained using Cirrus HD-OCT. If present,
the hyporeflective proliferation was further characterized. Patients
with history of intravitreal therapy or vitrectomy were excluded.
OCT images were analyzed Cirrus review software as well as a novel
OCT analysis software for area and volumetric analysis of pathology.
Brightness of the epiretinal proliferation and each retinal layer was
evaluated by Image J software.
Results: Epiretinal proliferation was found in 304 of 4144 eyes
(7.3%); 178 of 305 eyes with LMH (58.4%), 31 of 204 eyes with
FTMH (12.9%), 93 of 3365 eyes with ERM (2.8%), 2 of 102 eyes
with MPH (2%) and 0 of 132 eyes with VMT. Of the eyes with
LMH, age with the proliferation (mean; 71.7) was not significantly
differenced with that without the proliferation (71.9). The visual
acuity of these two groups was not significantly changed during
observation period (P = 0.86, 0.33, respectively). The maximum
thickness (35.1 ± 21.6 μm at initial visit, 42.1 ± 23.5 at final visit),
maximum area (0.045 ± 0.046 mm2, 0.056 ± 0.052), volume (0.048
± 0.074 mm3, 0.064 ± 0.096) were significantly increased during
this observation (P < 0.01, for all). The epiretinal proliferation in
LMH were encapsulated by ERM (group A) in 60 of 178 (34%)
eyes as shown in figure 1, and 118 (66%) eyes did not have
encapsulated epiretinal proliferations (group B) also shown in figure
2. The maximum thickness, maximum area and volume were all
significantly larger in the group B than group A (P < 0.01, for all).
The brightness of the epiretinal proliferation (110.1 ± 20.7 a.u.) was
close to that of ganglion cell layer (112.5 ± 20.7) and outer plexiform
layer (117.7 ± 19.6).
Conclusions: The hyporeflective epiretinal proliferation is a distinct
entity that appears to be present in multiple vitreomacular interface
disorders, particularly LMH. Further study is needed to understand its
role in the pathophysiology of LMH and its implications for surgical
and visual outcomes.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
morphologies. (Group 1): Normal foveal contour with operculum in 5
eyes (29.4%); (Group 2): Normal foveal contour without operculum
in 4 eyes (23.5%); (Group 3): Lamellar hole with operculum in 3
eyes (17.6%) and Group 4: Lamellar hole without operculum in 5
eyes (29.4%). Eight eyes (47.1%) had thinning of the umbo with a
discontinuous ILM layer. Two eyes in Group 2 and 1 eye in Group 3
were found to have irregularities/discontinuous areas in the ellipsoid
zone. All study eyes had an intact and continuous ELM.
Conclusions: Aborted macular holes have a variety of OCT findings
that range from apparently normal to marked thinning of the umbo.
Despite these changes, eyes with aborted MH generally retain
good visual acuity. A consistent OCT feature is preservation of a
continuous ELM, which provides insight into the difference in the
pathophysiology of aborted versus full-thickness macular holes.
Commercial Relationships: Yuji Itoh, None; Ashleigh L. Levison,
None; Peter K. Kaiser, Alcon (C), Bausch and Lomb (C), Bausch
and Lomb (C), Carl Zeiss Meditec (C), Topcon (C); Sunil K.
Srivastava, Allergan (R), Bausch and Lomb (C), Bausch and Lomb
(R), Bioptigen (P), Carl Zeiss Meditec (C), Leica (C), Synergetics
(P); Rishi P. Singh, Carl Zeiss Meditec (C); Justis P. Ehlers, Alcon
(C), Bioptigen (C), Bioptigen (F), Bioptigen (P), Carl Zeiss Meditec
(C), Carl Zeiss Meditec (F), Genentech (F), Leica (C), Leica (F),
Synergetics (P), Thrombogenics (C), Thrombogenics (F)
Support: NIH/NEI K23-EY022947-01A1 (JPE); The Robert
Machemer Vitreoretinal Scholarship (YI)
Program Number: 1214 Poster Board Number: D0191
Presentation Time: 3:15 PM–5:00 PM
The Aborted Macular Hole: An Optical Coherence Tomography
Study
Jerome V. Giovinazzo, Steven Agemy, Jessica Lee, Ronald C. Gentile.
Ophthalmology, New York Eye and Ear of Mount Sinai, New York,
NY.
Purpose: To describe the spectral-domain optical coherence
tomography (SD-OCT) findings in aborted macular holes.
Methods: A retrospective chart review of consecutive patients with a
diagnosis of an aborted macular hole (MH) was performed. Criteria
included a stage 1 macular hole that aborted as confirmed by OCT
(Criteria 1) or an eye that had evidence of an aborted MH based on a
combination of history, fundus exam, OCT, and fellow eye findings
(Criteria 2). Data collected included demographics, eye involved,
visual acuity, and fellow eye retinal diagnoses. OCT of the aborted
MH was analyzed for abnormalities in the foveal contour, presence/
absence of pre-foveal opercula, and pre/intra-retinal abnormalities.
Results: Aborted macular holes were identified in 17 eyes of 14
subjects. Mean age was 66.7±8.9SD years. Twelve (85.7%) of the
subjects were women and 2 (14.3%) were men with involvement of
both eyes in 3, right eye in 7, and left eye in 4. Mean best-corrected
visual acuities (LogMAR) were 0.15±0.20 in the study eyes and
0.30±0.34 in the fellow eyes. Diagnosis of an aborted MH was made
using Criteria 1 in 8 eyes (47%) and Criteria 2 in 9 eyes (53%).
There were 10 fellow eyes with fundus visibility of which 3 (27.3%)
were normal, 5 (45.5%) had a MH or a repaired MH, and 1 each
(9.1%) had a lamellar hole and vitreomacular adhesion. OCT of the
aborted MH could be separated into 4 different groups based on OCT
SD-OCT image of an aborted MH showing umbo thinning with a
pre-foveal operculum. There is disruption of the ellipsoid zone and an
intact ELM.
Commercial Relationships: Jerome V. Giovinazzo, None; Steven
Agemy, None; Jessica Lee, None; Ronald C. Gentile, Alcon (C)
Program Number: 1215 Poster Board Number: D0192
Presentation Time: 3:15 PM–5:00 PM
Wider retinal artery trajectories in eyes with macular hole than
in fellow eyes of patients with unilateral idiopathic macular hole
Naoya Yoshihara, Takehiro Yamashita, Toshifumi Yamashita, Keita
Yamakiri, Shozo Sonoda, Taiji Sakamoto. Ophthalmology, Kagoshima
University, Kagoshima, Japan.
Purpose: To determine whether the width of the retinal artery (RA)
trajectory was associated with the formation of macular holes (MHs).
Methods: This is a retrospective, cross sectional, case-control
study comprised 55 patients of MH in a single academic hospital.
Participants are consecutive patients with a unilateral MH and healthy
fellow eyes. The RA trajectory was calculated by a mathematical
model. The coordinates of the best fit curve of the RA trajectory were
determined automatically based upon these plots using the ImageJ
program. The converted coordinates were fit to a second degree
polynomial (ax2/100 + bx + c) equation. The constant ‘a’ is related to
the width and steepness of the curve and was used as a measure of the
RA trajectory. Main outcome measures are the width and steepness
of the RA trajectory, “a”, of the eye with a MH eye was compared to
that of the fellow eye.
Results: The constant ‘a’ was significantly smaller in eyes with a
MH than that of the fellow eyes (0.379 ± 0.094 vs 0.416 ± 0.121, P =
0.001, paired t test), indicating that the RA trajectory was wider in the
MH eyes than in the fellow eyes. There was a significant correlation
between the axial length and RA trajectory in the MH eyes (R =
0.273, P = 0.044) and in the fellow eyes (R = 0.356, P = 0.008;
Spearman’s rank correlation coefficient).
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Conclusions: Because eyes with a MH have a significantly wider and
flatter RA trajectory, there is probably a greater traction on the fovea
which is located between the RA arches with fragile macula. These
may ultimately cause a MH to develop.
Commercial Relationships: Naoya Yoshihara, None; Takehiro
Yamashita, None; Toshifumi Yamashita, None; Keita Yamakiri,
None; Shozo Sonoda, None; Taiji Sakamoto, None
Program Number: 1216 Poster Board Number: D0193
Presentation Time: 3:15 PM–5:00 PM
Baseline Characteristics of Vitreomacular Traction Progressing
to Full-Thickness Macular or Lamellar Holes in the Phase III
Trials of Enzymatic Vitreolysis
Eric W. Schneider1, 2, Cynthia A. Toth2, Glenn J. Jaffe2. 1Tennessee
Retina, Nashville, TN; 2Duke University Eye Center, Durham, NC.
Purpose: To identify characteristics associated with progression
from vitreomacular traction (VMT) to a full-thickness macular
hole (FTMH) or lamellar hole (LH) following a single intravitreal
injection of saline or ocriplasmin.
Methods: A post-hoc analysis was performed on 445 eyes with
baseline VMT included in a phase III trial evaluating ocriplasmin for
symptomatic vitreomacular adhesion (MIVI-TRUST). Exact logistic
regression analyses were used to identify baseline characteristics
significantly associated with progression from VMT to FTMH or LH
over the 6-month study period. Kaplan-Meier survival analysis was
performed to compare time to FTMH or LH development between
treatment groups. OCT images were graded independently by two
certified readers at the Duke OCT Reading Center.
Results: Twenty eyes (4.5%) developed a FTMH and 38 (9.7%)
developed a LH during the study period. The rate of progression to
FTMH or LH did not differ significantly between ocriplasmin- and
saline-treated eyes (p=0.125 for FTMH, p=0.348 for LH). Mean time
to FTMH and LH development was similar in ocriplasmin- (176.0
days [d] for FTMH, 168.8d for LH) and saline-treated (172.4d for
FTMH, 164.7d for LH) (p=0.090 for FTMH, p=0.369 for LH). On
univariate analysis, the presence of subretinal fluid (SRF) (adjusted
odds ratio [AOR] 5.64, 95% confidence interval [CI] 2.02-17.17, p
< 0.001) and mean SRF thickness (AOR 1.10, 95% CI 1.04-1.16,
p=0.003) were associated with FTMH development. Both remained
significantly associated with FTMH development on multivariate
testing. On univariate analysis, the presence of macular schisis
(AOR 2.26, 95% CI 1.39-3.82, p=0.004) and mean retinal thickness
(AOR 1.06, 95% CI 1.01-1.10, p=0.010) were associated with LH
development. There was a trend towards increased progression
to LH with baseline intraretinal cysts (AOR 2.62, 95% CI 0.9248.747, p=0.076) that did not reach significance. Schisis remained a
significant predictor of LH formation on multivariate testing.
Conclusions: VMT, when associated with SRF, is more likely to
progress to FTMH while, when associated with intraretinal changes
(such as schisis), appears more likely to progress to a LH. These
findings suggest a disparate natural history for VMT based on the
level of retinal dehiscence (intra- versus subretinal) and argues for
continued use of the stage 1 FTMH classification.
Commercial Relationships: Eric W. Schneider, None; Cynthia A.
Toth, Alcon (P), Bioptigen (F), Genentech (F); Glenn J. Jaffe, Alcon
(C), Heidelberg Engineering (C), Neurotech (C)
Program Number: 1217 Poster Board Number: D0194
Presentation Time: 3:15 PM–5:00 PM
Effect of Vitreomacular Adhesion on Treatment Outcomes in the
Ranibizumab for Edema of the mAcula in Diabetes-3 (READ-3)
Study
Mohammad A. Sadiq1, Mohamed K. Soliman1, 2, Mostafa S. Hanout1,
Salman Sarwar1, Aniruddha Agarwal1, Robin High1, Diana V. Do1,
Quan Dong Nguyen1, Yasir J. Sepah1. 1University of nebraska
medical center, Stanley M. Truhlsen Eye Institute, Omaha, NE;
2
Ophthalmology, Assiut University, Assiut, Egypt.
Purpose: The role of vitreomacular adhesion (VMA) in visual and
anatomic outcomes has not been explored previously in patients with
diabetic macular edema (DME). In this retrospective study, data from
patients enrolled in the READ-3 study was analyzed to evaluate the
association of VMA with best corrected visual acuity (BCVA) and
central retinal thickness (CRT).
Methods: In the READ-3 study, patients with DME received
monthly IVT injections of either 0.5 or 2.0mg ranibizumab (RBZ).
Spectral domain optical coherence tomography (SD-OCT) images
(Heidelberg Spectralis®) from patients that completed the M6
primary end point of the study were analyzed at baseline visit (BL) to
identify the presence (VMA+) or absence (VMA-) of VMA. Patients
with any degree of vitreomacular traction, as defined in published
literature, were excluded from analysis. All images were graded by
two independent graders. VMA was classified by size of adhesion
into either focal (<1500mm) or broad (≥1500mm). Main outcome
measures were mean change in BCVA and CRT at M6. Student t-test
was performed; statistical significance was set at p<0.05.
Results: 152 eyes (152 patients) were randomized in the READ-3
study. 124 eyes (124 patients) were found to be eligible for the study.
At BL, 26 patients were classified as VMA(+) and 98 patients were
classified as VMA(-). BL characteristics are shown in Table. The
distribution of the two doses of RBZ (0.5mg and 2.0mg) between
the two groups was equal. At M 6, the VMA(+) group showed a
mean improvement of 11.31±6.67 letters, whereas the VMA(-) group
showed a mean improvement of 6.86±7.58 letters. The difference
between the two groups was statistically significant (p=0.007). Mean
improvement in CRT was 173.81±132.31mm and 161.84±131.34 mm
in the VMA(+) and VMA(-) groups respectively (p=0.681).
At M6, among the 26 VMA(+) eyes (at BL), 12 eyes showed either
complete (9) or partial (3) resolution; 12 eyes showed no change in
VMA status; 2 eyes were not gradable and were excluded. Changes
in VMA status in the VMA(+) group did not lead to statistically
significant differences in VA and CRT at M6.
Conclusions: Patients with DME and VMA(+) may achieve higher
visual gain with anti-VEGF therapy than those who are VMA(-). The
analyses also suggest that VMA status should not be a determining
factor in considering anti-VEGF therapy for eyes with DME.
Table - Baseline Characteristics
Commercial Relationships: Mohammad A. Sadiq, None;
Mohamed K. Soliman, None; Mostafa S. Hanout, None; Salman
Sarwar, None; Aniruddha Agarwal, None; Robin High, None;
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Diana V. Do, Allergan (C), Genentech (C), Genentech (S), Regeneron
(C), Regeneron (S), Santen (C); Quan Dong Nguyen, Genentech
(F), Genentech (S), L-path (F), MacuSight (F), Ophthotech (F),
Regeneron (F), Regeneron (S), Santen (F); Yasir J. Sepah, None
Program Number: 1218 Poster Board Number: D0195
Presentation Time: 3:15 PM–5:00 PM
Outcomes of Vitrectomy for Vitreomacular Traction after an
Initial Observation Period
Jonathan Tzu, Harry W. Flynn, william smiddy. Bascom Palmer Eye
Institute, Miami, FL.
Purpose: The purpose of this study is to investigate the clinical
course and surgical outcomes of patients with vitreomacular traction
(VMT) and managed initially by observation, but eventually
underwent surgical intervention for development of a macular hole or
worsening symptoms
Methods: The current study is a non-comparative, multicenter
case series of patients with a diagnosis of VMT based on clinical
symptoms and findings on spectral domain optical coherence
tomography (SD-OCT) between the years of 2006 and 2013. All
patients were initially observed but subsequently a small number of
patients had surgery because of the development of full thickness
macular hole or worsening symptoms. Follow-up including visual
acuity, changes in SD-OCT findings, and time to surgery were
recorded.
Results: VMT by SD-OCT from 5 retina clinics was identified in 230
eyes of 185 patients. These patients were all managed by observation
initially. Pars plana vitrectomy (PPV) was eventually performed in 10
of 230 eyes (4.1%). Six of the 10 eyes developed a macular hole, and
4 of the 10 eyes had worsening symptoms from VMT. The mean time
of observation before PPV was 23.8 months (range 3 - 76 months).
At last follow up, all of 6 the patients who developed a macular
hole had successful surgical closure of the hole. The four patients
with worsening VMT also had anatomic success- relief of the VMT
postoperatively resulting in resolution of subretinal and intraretinal
fluid. Postoperative best corrected visual acuities were ≥ 20/40 in 8 of
10 eyes.
Conclusions: After a period of initial observation, VMT patients
undergoing surgical intervention achieved improved anatomic and
visual outcomes.
Program Number: 1219 Poster Board Number: D0196
Presentation Time: 3:15 PM–5:00 PM
OZONE: Ocriplasmin Ellipsoid Zone Retrospective Data Collection
Study
K Bailey Freund. 1Ophthalmology, Vitreous Retina Macula
Consultants of New York, New York, NY; 2Ophthalmology, New
York University School of Medicine, New York, NY.
Purpose: Safety and efficacy of ocriplasmin to treat symptomatic
vitreomacular adhesion (VMA), was established in phase 3 clinical
trials using time-domain optical coherence tomography (TD-OCT)
to assess retinal anatomy. Using spectral domain optical coherence
tomography (SD-OCT) allows observation and measurement of
subtle retinal changes and enables more accurate monitoring of
disease progression and response to therapy. A Phase 4 study was
designed to retrospectively review and further characterize anatomic
and symptomatic changes, using SD-OCT, following treatment of
VMA with JETREA® (ocriplasmin).
Methods: The Phase 4 OZONE study will include 200 patients from
~30 US sites. Anatomic and symptomatic changes over 6-months in
patients treated with ocriplasmin for VMA and imaged with SDOCT. Images will be masked and uploaded to a Central Reading
Center (CRC) for review and analysis. The primary endpoint is the
proportion of patients with ellipsoid zone disruption by Day 21 postocriplasmin injection, which was not present at baseline. Secondary
endpoints include: incidence, time to onset and/or resolution of
ellipsoid zone disruption, subretinal fluid development, VMA status,
macular hole changes, vitrectomy, visual acuity changes from
baseline and adverse drug reactions (Table 1).
Results: As of 11/12/14, preliminary data from 52 patients at 11
clinics were available. Preliminary data on baseline characteristics
include: mean age: 71 years; gender: 61.5% female; baseline
lens status in study eye: phakic= 67%, pseudophakic= 33%, and
aphakic=0%; baseline visual acuity in study eye (Snellen) 20/40 or
better=29%, 20/50-20/80=52%, and 20/100 or worse= 17%, 10/200=
2%; injection position: supine=83%, sitting=2%, sitting at 45°=12%.
Conclusions: The OZONE study utilizing SD-OCT in postocriplasmin patients will further characterize anatomic and
symptomatic changes post-ocriplasmin. Data from the full population
and image analysis will be available.
Commercial Relationships: Jonathan Tzu, None; Harry W. Flynn,
None; william smiddy, None
Support: Research to Prevent Blindness and NEI Core grant P30EY14801
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
mm) and broad (>1500 mm), and isolated vs concurrent. Multivariate
test of means and t-test were used to compare studied variables.
Results: There were 54 eyes of 42 patients (15 females) in the study.
There were 18 and 36 eyes with broad and focal VMT, respectively,
and 10 and 44 eyes with isolated and concurrent VMT, respectively.
There was no difference in the CFT between broad and focal VMT
groups (p=0.31). The eyes in the broad VMT group had significantly
higher nasal choroidal thickness (p=0.004), subfoveal choroidal
thickness (p=0.004), and temporal choroidal thickness (p=0.002)
compared to the focal VMT group. The VMT angle was more open
in eyes with focal VMT compared to broad VMT (p=0.002). No
significant difference was seen between the concurrent and isolated
VMT groups in the vitreofoveal angle (p= 0.24). VMT angle
correlated positively with the CFT (r= 0.42, p<0.001), whereas no
correlation was seen between the VMT angle and the subfoveal
choroidal thickness (p=0.38), nasal choroidal thickness (p=0.67) and
temporal choroidal thickness (p=0.87).
Conclusions: The eyes with broad VMT have thicker choroid and the
eyes with focal VMT have more open vitreofoveal angle. Both seem
to result from the tractional forces of the vitreous on the macular area.
Angle of VMT influences central foveal thickness.
Commercial Relationships: Igor Kozak, None; Giulio Barteselli,
None; Yasir J. Sepah, None; Mohammad A. Sadiq, None; Robin
High, None; Diana V. Do, None; Quan Nguyen, None
Commercial Relationships: K Bailey Freund, Bayer HealthCare
(C), Genentech (C), Heidelberg Engineering (C), Regeneron (C),
ThromboGenics (C)
Support: ThromboGenics, The Macula Foundation, Inc.
Clinical Trial: NCT02193945
Program Number: 1220 Poster Board Number: D0197
Presentation Time: 3:15 PM–5:00 PM
Correlation of vitreomacular traction with foveal thickness,
subfoveal choroidal thickness and vitreomacular angle
Igor Kozak1, Giulio Barteselli2, Yasir J. Sepah3, Mohammad A.
Sadiq3, Robin High3, Diana V. Do3, Quan Nguyen3. 1King Khaled
Eye Specialist Hospital, Riyadh, Saudi Arabia; 2University of Milan,
Milan, Italy; 3University of Nebraska, Omaha, NE.
Purpose: To investigate structural characteristics of vitreomacular
traction (VMT), especially if there is a correlation between 1)
the VMT grade, central foveal thickness (CFT) and the choroidal
thickness, 2) the VMT grade and the vitreofoveal angle and 3) the
vitreofoveal angle, vitreomacular adhesion (VMA) and choroidal
thickness.
Methods: Images of patients with VMT were retrospectively studied
at the King Khaled Eye Specialist Hospital (Riyadh, Saudi Arabia),
the University of Milan (Milan, Italy), and the Truhlsen Eye Institute
at the University of Nebraska Medical Center (Omaha, Nebraska,
USA). Raster scans of the macula taken with a spectral-domain
optical coherence tomography (SD-OCT) device were reviewed.
Conventional scans of the vitreoretinal interface were analyzed to
measure CFT and degree of vitreofoveal angle. Enhanced depth
imaging (EDI) scans were analyzed to measure choroidal thickness
in the macula. The VMT was classified based on the International
Vitreomacular Traction Study Group Classification into focal (<1500
Program Number: 1221 Poster Board Number: D0198
Presentation Time: 3:15 PM–5:00 PM
Size and vitreomacular attachment of Full Thickness Macular
Hole
Elise Philippakis1, 2, Franck Amouyal1, 2, Aude Couturier1, 2, Elise
Boulanger-Semama1, 2, Pascale G. Massin1, 2, Alain Gaudric1, 2, Ramin
Tadayoni1, 2. 1Ophthalmology, Lariboisière Hospital, Paris, France;
2
Université Paris 7 Diderot, Paris, France.
Purpose: To study the correlation between the vitreomacular
attachment and the size of primary full-thickness macular holes.
Methods: Retrospective observational case series. The records of
100 consecutive patients operated for primary full thickness macular
hole (FTMH) between 2012 and 2013 were reviewed. Collected
data included the best corrected visual acuity (BCVA), fundus
examination and preoperative spectral domain-optical coherence
tomography (SD-OCT). Patients were sorted according to the
International Vitreomacular Traction Study Group classification, by
the presence of a vitreomacular traction (VMT), and according to
their size, as small (less than 250mm), medium (250mm-400mm) and
large (more than 400mm), measured on SD-OCT horizontal scans.
Results: Baseline characteristics were: men/women ratio of 29/71,
mean age of 71,1 ± 7 years (52-89). A vitreomacular traction was
present in 22% of eyes. The mean preoperative diameter of holes was
not significantly different according to the presence of a VMT: 339
± 134mm in eyes with VMT and 423 ± 191mm in eyes without VMT
(p=0,057).The distribution of FTMH according to size and presence
of a VMT was not significantly different (p=0,69): respectively 19%,
32% and 49% of small, medium and large FTMH in the group with
VMT and 27%, 32% and 41% in the group without VMT. In our
series, 6% of patients presented with small FTMH and VMT and 13%
of patient with FTMH less than 400mm and VMT.
Conclusions: In our series of 100 FTMH, there was no significant
relation between the size of hole and the presence of a vitreomacular
traction, despite the supposed role of the vitreous traction in FTMH
pathogenesis. Only 13% of FTMH had a VMT and a diameter less
than 400mm, for which vitreolysis has been proposed as possible
treatment.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Commercial Relationships: Elise Philippakis, None; Franck
Amouyal, None; Aude Couturier, None; Elise BoulangerSemama, None; Pascale G. Massin, None; Alain Gaudric, None;
Ramin Tadayoni, None
Program Number: 1222 Poster Board Number: D0199
Presentation Time: 3:15 PM–5:00 PM
Assessment of Anatomical and Functional Outcomes in the
Ocriplasmin for Vitreomacular Traction Intravitreal Injection
Decisions (OVIID 1) Trial
Ramin Tadayoni1, Danyel Carr2, Zhenming Zhao2, Aaron Osborne2.
1
Ophthalmology, Hopital Lariboisiere-Ophthalmologie, Paris, France;
2
Alcon Research Ltd., Fort Worth, TX.
Purpose: Analysis of pooled data from 2 studies assessing the
safety and clinical efficacy of ocriplasmin (clinicaltrials.gov ID
NCT00781859 and NCT00798317, respectively) showed that
the effect of ocriplasmin in inducing resolution of vitreomacular
adhesion (VMA) is greatest in patients without epiretinal membrane
(ERM) and in patients with a VMA diameter of <1500 μm. The
OVIID 1 study (NCT02035748) has been designed to observe the
anatomical and functional outcomes in VMT/sVMA patients treated
with ocriplasmin.
Methods: Phase IV, multi-center, prospective, single-arm study
in which patients diagnosed with VMT/sVMA are treated with
ocriplasmin 125 μg by intravitreal injection.
The study population includes adult subjects diagnosed with VMT/
sVMA, with evidence of focal VMT visible on spectral domainoptical coherence tomography (SD-OCT). Key exclusion criteria
include presence of ERM over the macula at baseline, broad VMT/
VMA (>1500 μm) at baseline, or macular hole (MH) >400 mm
in diameter in study eye. The study includes a total of 6 planned
visits (including screening visit): During visit 1, subjects receive
a single intravitreal injection of ocriplasmin, as per the country’s
product label. Subsequent visits occur on Days 7, 28, 90, and 180.
Safety is assessed through the use of reported adverse events and
ophthalmologic examinations.
Results: The study is planned to enroll 400 patients from about
90 centers in 11 countries across Europe and Canada. The primary
efficacy endpoint is the proportion of patients with nonsurgical
resolution of focal VMT/sVMA at Day 28, as determined by
central reading center evaluation of SD-OCT data. Secondary and
exploratory endpoints include changes in best-corrected visual
acuity, proportion of subjects with closure of macular hole, changes
in metamorphopsia, and visual function assessment (Table 1). Side
effects are also monitored based on clinical information and high
resolution SD-OCT of the macula and optic nerve head.
Conclusions: The systematic and standardized collection and
evaluation of data on the use of ocriplasmin in different countries
will contribute to the characterization of appropriate patients for
ocriplasmin treatment, and provide additional insights into its safety
profile.
Table 1 Secondary and Exploratory Endpoints
Commercial Relationships: Ramin Tadayoni, None; Danyel Carr,
Alcon Research Ltd. (E); Zhenming Zhao, Alcon Research Ltd. (E);
Aaron Osborne, Alcon Research Ltd. (E)
Clinical Trial: NCT00781859
Program Number: 1223 Poster Board Number: D0200
Presentation Time: 3:15 PM–5:00 PM
Ocular Coherence Tomographic Findings in Patients with
Vitreomacular Traction Treated with Pneumatic Vitreolysis,
Intravitreal Ocriplasmin, or Vitrectomy with Membrane Peeling
Gina Yu1, Jorge G. Arroyo1, Kyle V. Marra2. 1Surgery Ophthalmology, Beth Israel Deaconess Medical Center, Boston, MA;
2
University of California, San Diego School of Medicine, San Diego,
CA.
Purpose: To evaluate the resolution rate of vitreomacular traction
(VMT) after receiving one of the following treatments, as compared
to intravitreal placebo (control): (1) in-office intraocular C3F8 gas
injection (pneumatic vitreolysis (PV)), (2) intravitreal ocriplasmin
(IVO), or (3) pars plana vitrectomy with membrane peeling (PPV)
Methods: This review retrospectively analyzed 33 medical records
(n=35 eyes) from VMT patients who underwent PV, IVO, PPV, or
a control injection. All treatments were administered by a single
surgeon at Beth Israel Deaconess Medical Center (BIDMC). PV
patients received an injection of 0.3 mL of C3F8 gas and instructed
to face down 15 minutes per hour while awake for 48 hours. IVO
patients had an injection of Jetrea 125 ug per the package insert
guidelines. PPV patients had vitrectomy with epiretinal and internal
limiting membrane (ERM & ILM) peeling. Control patients received
injections of anti-VEGF for age-related macular degeneration. The
primary outcome measure was VMT resolution as established by
optical coherence tomography (OCT) at day 28. The visual acuity
(VA) at month 6, the OCT-measured central foveal thickness (CFT:
distance between ILM and retinal pigment epithelium at fovea) at
days 0 and 28, and resulting complications were recorded.
Results: Zero out of 10 control (0%), 3 out of 7 IVO (42.9%;
p=0.10), 7 out of 8 PV (87.5%; p<0.01) and 10 out of 10 PPV
patients (100%; p<0.01) experienced VMT resolution at day 28. A
third of IVO (33.3%) and PPV (33.3%) patients and a majority of
PV patients (80%) had VA improvement. Difference in CFT before
and after treatment was not significant in any treatment group (PV:
p=0.10, IVO: p=0.07, and PPV p=0.50). No PV, 1 IVO (33.3%), and
3 PPV (33.3%) patients developed worse VA. No patients developed
retinal tears or detachment. One PV (12.5%) and no IVO and PPV
patients developed a macular hole.
Conclusions: PV effectively provided VMT release compared to
control and had a higher rate of release compared to IVO. PV also
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
had the highest rate of VA improvement. Both PV and PPV had
statistically significantly higher rates of VMT resolution than control
but IVO did not. This study suggests PV could provide a readily
accessible and minimally invasive alternative to PPV and IVO,
but future randomized, controlled studies to compare efficacies is
necessary.
Commercial Relationships: Gina Yu, None; Jorge G. Arroyo,
None; Kyle V. Marra, None
Program Number: 1224 Poster Board Number: D0201
Presentation Time: 3:15 PM–5:00 PM
Clinical Results of Ocriplasmin For Symptomatic Vitreomacular
Traction Syndrome
Anuj Chawla, Jorge Fortun. Ophthalmology, Bascom Palmer Eye
Institute, West Palm Beach, FL.
Purpose: To evaluate the clinical response of ocriplasmin for
treatment of vitreomacular traction syndrome and determine
anatomic and patient characteristics to stratify potential response to
treatment. The MIVI-TRUST trials trials were two, parallel, phase
III randomized control trials comparing the effectiveness of an
ocriplasmin injection to a placebo saline injection in the treatment
of symptomatic vitreomacular adhesion. The trials also determined
certain positive predictive factors. These include age less than 65
years of age, absence of epiretinal membrane (ERM), phakic lens
status, and adhesion <1500 um. The purpose of this study was to
evaluate the effectiveness of ocriplasmin in the clinical setting, and
evaluate anatomic changes that occur post injection using spectral
domain OCT.
Methods: This is a retrospective case series of 35 consecutive
patients who received ocriplasmin for symptomatic vitreomacular
traction syndrome. OCT was used to determine if the vitreomacular
traction was released within 30 days of injection. Pre and post
injection best corrected Snellen visual acuity was measured and
converted to logmar values. The age of the patient, presence of ERM,
lens status, and size of the adhesion were documented. Anatomic
changes seen on OCT were also recorded.
Results: 35 patients received ocriplasmin for symptomatic
vitreomacular traction. 15 of these patients had release of
the vitreomacular traction by day 28. Of the 15 patients that
demonstrated release of the vitreomacular traction, 12 had 3 or more
positive predictive factors (age <65, absence of ERM, phakia, and
adhesion less than 1500 um). The average change in visual acuity
when converted to logmar is 0.0367.
Conclusions: Patient treated with ocriplasmin for symptomatic
vitreomacular traction experienced release in 15 out of 35 injections
(42.8%). Of the 15 patients that had a postive response 12 (80%)
had 3 or more positive predictive factors. Overall there was an
improvement in visual acuity, with a logmar value of 0.0367.
Anatomic changes seen after injection include cystoid macular
edema, persistent sub-retinal fluid, and inner segment - outer segment
junction changes. These results support the use of ocriplasmin for
sVMA and show an improved response rate compared to the MIVITRUST trials.
Commercial Relationships: Anuj Chawla, None; Jorge Fortun,
None
Program Number: 1225 Poster Board Number: D0202
Presentation Time: 3:15 PM–5:00 PM
Comparison of surgery, intravitreal ocriplasmin and observation
in symtomatic vitreomacular traction syndrome
Saba A. Alreshaid. vitro retina division, king khaled eye especialist
hospita, Riyadh, Saudi Arabia.
Purpose: To compares the effects of pars plana vitrectomy and
intravitreal injection of ocriplasmin with observation in symtpmatic
VMT
Methods: retrospective study of patients who had symtomatic
VMT . VMT was diagnosed by spectral domain optical coherence
tomography . Main outcome measures included best-corrected visual
acuity and VMT status (released vs not released) at baseline and the
last follow-up.
Results: Total of 51 eyes of 50 patients. 11 eyes in surgical group,
8 eyes in ocriplasmin group and 32 eyes in observation group. The
mean ± SD follow up in surgical, ocriplasmin and observation groups
were 10.27 ± 4.63 months, 3.87 ± 2.66 months and 6.27 ± 2.29
months, respectively. Baseline visual acuity (logMAR) in surgical,
ocriplasmin and observation groups was 0.81 ± 0.24 (Snellen
equivalent 20/125), 0.53 ± 0.29 (20/70) and 0.58 ± 0.25 (20/70),
respectively. Visual acuity (logMAR) at the last visit in surgical,
ocriplasmin and observation groups was 0.64 ± 0.26 (20/80), 0.52
± 0.29 (20/70) and 0.57 ± 0.28 (20/70), respectively. The change in
visual acuity between baseline and the last visit was significant in the
surgical group (p=0.041) and was non-significant in the ocriplasmin
(p=0.40) and observation (p=0.62) groups. At the last visit, VMT
was released in all eyes (100%) in the surgical group, in 5 of 8 eyes
(62.5%) in the ocriplasmin group and in 10 of 32 eyes (31.2%)
in the observation group and was statistically significant in VMT
release between surgery vs observation (P=0.00008) and surgery
vs ocriplasmin (p=0.027) however was not sginificant between
ocriplasmin and observation (p=0.1031). one case had lamellar hole
after surgery, worsening of BCVA in one case after ocriplasmin
injection and two in the observation group.
Conclusions: Surgical intervention results in complete release
of VMT with improvement in visual acuity. Intravitreal
pharmacotherapy and observation have similar rates of VMT release
with little change in visual acuity
Commercial Relationships: Saba A. Alreshaid, None
Program Number: 1226 Poster Board Number: D0203
Presentation Time: 3:15 PM–5:00 PM
The Prevalence of Vitreomacular Adhesion in Patients 40 Years
and Older- VAST Study
Julie Rodman1, Diana Shechtman1, Jay Haynie2, Larry Alexander3,
Leo Semes4, William Jones6, Steven Ferrucci5, Ava K. Bittner1,
Murray Ocular Oncology and Retina7, Schaeffer Eye Center8.
1
Optometry, Nova Southeastern University, Fort Lauderdale, FL;
2
Retina and Macula Specialists, Tacoma, WA; 3Not Applicable,
McKinney, TX; 4Optometry, UAB School of Optometry,
Birmingham, AL; 5Sepulveda VAMC, Sepulveda, CA; 6Jones Eye
Care, Albuquerque, NM; 7Murray Ocular Oncology, Miami, FL;
8
Schaeffer Eye Center, Birmingham, AL.
Purpose: A prospective, cross-sectional study was performed to
determine the prevalence of vitreomacular adhesion (VMA) in a
diverse group of subjects over 40 years of age. Secondary analysis
included correlation between VMA and gender, ethnicity, and
refractive error.
Methods: Preliminary findings for this study include data from a
subset of 1475 eyes of 760 subjects (60.3% females) with a mean
age of 57 years (range 40-91; SD 9.4). The refractive status indicated
that 6.98% were emmetropes, 32% were myopes, and 61% were
hyperopes. For subjects reporting ethnicity, 45.7% were white, 35.6%
were black, 12.5% were Hispanic, 6.2% were Asian and/or mixed
decent. Subjects were classified into groups by 10-year age categories
(e.g., 40-49 years). A comprehensive eye examination, including
medical history, amsler grid testing, ophthalmoscopy and Spectral
Domain Optical Coherence Tomography (SD-OCT) was performed
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
on each subject. The status of the posterior vitreoretinal interface was
evaluated by a team of independent, masked readers, who determined
the presence or absence of VMA on SD-OCT. Classification was
done according to the rubric established by “The International
Vitreomacular Traction Study (IVTS) Group.”
Results: Vitreomacular adhesion was present in 40.6% of eyes. When
comparing age categories, VMA was most prevalent in the 50-59
year old age group (35.56%). With advancing age, the percentage
of patients with VMA decreases (3.34% in patients 80-95 years of
age). Prevalence of VMA was associated with ethnicity, as patients
of Afro-American descent were less likely to have VMA than
Caucasians (p=0.0094). Neither myopic or hyperopic (p=0.2819)
refractive error nor gender (p=0.145) seemed to play a significant
role in the prevalence of VMA. Data collection is ongoing to increase
the sample size, especially in eyes with various maculopathies; those
findings will also be analyzed and presented.
Conclusions: Vitreomacular adhesion was present in more than a
third of eyes that represented a wide range of demographic and ocular
characteristics. Patients who were of older age and/or Afro-American
descent were significantly less likely to have VMA.
Commercial Relationships: Julie Rodman, Carl Zeiss (F), Optovue
(F), Thrombogenics (F); Diana Shechtman, Carl Zeiss (F), Nova
Southeastern University (F), Optovue (F), Thrombogenics (F);
Jay Haynie, None; Larry Alexander, None; Leo Semes, None;
William Jones, None; Steven Ferrucci, None; Ava K. Bittner,
None; Murray Ocular Oncology and Retina, None; Schaeffer Eye
Center, None
Support: Nova Southeastern University Health Professions Research
Grant, Nova Southeastern University Presidential Grant
Clinical Trial: NCT02160340
Program Number: 1227 Poster Board Number: D0204
Presentation Time: 3:15 PM–5:00 PM
Effect of intravitreal Ranibizumab injections on Vitreomacular
interface in patients with Age Related Wet Macular
Degeneration(AMD)
Harbhajan Kaur Arora, Seena Nambiar, Manju Chandran, Geeta
Menon. Ophthalmology, Frimley Park Hospital, Surrey,United
Kindom, Camberley, United Kingdom.
Purpose: To study the effect of intravitreal Ranibizumab injections
on Vitreomacular interface in patients with Age Related Wet Macular
Degeneration(AMD)
Methods: We retrospectively analysed medical records and Optical
coherent tomography (OCT ) scans of 27 consecutive patients (27
eyes) diagnosed with exudative AMD and receiving intravitreal
Ranibizumab. The treatment consisted of 3 consecutive injections of
Ranibizumab 0.5mg/0.05ml and then treated if necessary, depending
on the retreatment criterion. Best corrected visual acuity (BCVA)
(ETDRS),Central macular thickness (CMT), size of Vitreomacular
adhesion/ traction (VMA/VMT), number of injections given were
recorded and analysed at 0,3,6 and 12 months.
Results: The mean age at presentation was 80yrs. At the end of
one year mean number of injections given were 6.8. Mean BCVA
(ETDRS) letters at baseline was 57.88 and showed a statistically
significant improvement at 12 months by 7.12 letters (p=0.044828).
Visual acuity was improved or stabilized in 22 out of 27 eyes (81%) .
Baseline CMT was 334.08 micron and showed a significant reduction
by 60.99 micron (p=0.018003). Mean size of VMA/VMT at baseline
was 1229 micron and 1062 micron after one year. Change in size
of VMA/VMT was not statistically significant (p=0.54746).During
the study period out of 27 eye only 3 had spontaneous resolution 1 (
David A et al ) of VMA/VMT.
Conclusions: Although few cases of spontaneous resolution of
VMT after Ranibizumab injection have been reported in literature2,3
(Rouvas A et al 2008, 2013), our results with small number
of patients concluded that there was no significant change in
vitreomacular interface before or after getting Ranibizumab.
Further prospective studies with larger group of patients receiving
different kinds of anti-vascular endothelial growth factor (antiVEGF) injections are needed to fully evaluate the effect of different
kind of anti-VEGFs on Vitreomacular interface.
Commercial Relationships: Harbhajan Kaur Arora, None; Seena
Nambiar, None; Manju Chandran, None; Geeta Menon, Alcon
(F), Allergan (F), Beyer (F), Novartis (F), Research Grant (F), Travel
Grant (F)
Program Number: 1228 Poster Board Number: D0205
Presentation Time: 3:15 PM–5:00 PM
Optical coherence tomography findings of the vitreoretinal
interface in fellow eyes of patients with vitreomacular traction or
full thickness macular holes
Julian E. Klaas, Sophie Burzer, Sophia Abraham, Nikolaus Feucht,
Chris Lohmann, Mathias M. Maier. Ophthalmology, Rechts der Isar,
TUM, Munich, Germany.
Purpose: We performed a retrospective, observational clinical study
to evaluate the vitreoretinal interface (VRI) in fellow eyes of patients
with vitreomacular traction (VMT) or full thickness macular hole
(FTMH) based on spectral domain optical coherence tomography
(SD-OCT) examination.
Methods: The VRI in fellow eyes of 46 patients with VMT, 12 of
which had concomitant FTMH, and the VRI of 34 patients with
FTMH with complete resolution of VMT was reviewed by spectral
domain optical coherence tomography (Spectralis HRA+OCT,
Heidelberg Engineering, Germany) for the presence of vitreomacular
adhesion (VMA), VMT, and the formation of a FTMH, lamellar
macular hole (LMH) or epiretinal membrane (ERM). Patients
underwent complete ophthalmic evaluation, including SD-OCT at
baseline and follow-up visits and were included into the VMT-group
or the FTMH-group. To classify the morphology of the VRI, we used
the International Vitreomacular Traction Study Classification System
by Duker et al. (Ophthalmology, 2013), evaluating the baseline SDOCT data for significant classification parameters, including size of
vitreomacular adhesion, macular thickness and volume and structural
changes of retinal layers.
Results: Of 46 eyes with VMT, 16 (34,78 %) fellow eyes also
showed evidence of VMT. One of the 16 had FTMH with persisting
VMT. 10 (21,74%) showed formation of an ERM, of which 2
(4,26 %) demonstrated a LMH. With 8 patients (17,39 %) showing
evidence of VMA, and 13 patients (28,26 %) with an unremarkable
VRI, 21 fellow eyes (45,65 %) showed no pathological morphology.
With regards to the 34 patients who had FTMH with complete
resolution of VMT, 7 VMAs taken together with 18 unremarkable
OCTs resulted in 73,53 % of fellow eyes showing a physiological
VRI. 2 fellow eyes (5,88 %) demonstrated FTMHs without VMT, and
3 (8,82 %) in turn demonstrated VMT. 5 eyes (14,71 %) revealed an
ERM, 2 of them concurrent with a LMH.
Conclusions: Our SD-OCT-based retrospective review showed that
fellow eyes of patients with VMT or FTMH were at increased risk of
demonstrating pathological changes in the morphology of the VRI.
Commercial Relationships: Julian E. Klaas, None; Sophie Burzer,
None; Sophia Abraham, None; Nikolaus Feucht, None; Chris
Lohmann, None; Mathias M. Maier, None
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Program Number: 1229 Poster Board Number: D0206
Presentation Time: 3:15 PM–5:00 PM
Jetrea® (Ocriplasmin) as a treatment option for symptomatic
vitreomacular traction with or without macular hole (≤400 mm)
in comparison to transconjunctival vitrectomy
Mathias M. Maier, Sophia Abraham, Christiane Frank, Nikolaus
Feucht, Chris P Lohmann. Augenklinik, Klinikum rechts der Isar,
Technische Universität München, Munich, Germany.
Purpose: To evaluate the resolution rate of vitreomacular traction
(<1500 mm) and the closure rate of macular holes (≤400mm)
after therapy with intravitreal Jetrea® (Ocriplasmin) compared
to transconjunctival vitrectomy in patients with symptomatic
vitreomacular traction with or without macular hole (≤400 mm) in a
clinical setting.
Methods: We prospectively examined 21 eyes of 21 patients with
symptomatic vitreomacular traction (VMT) with or without full
thickness macular hole (FTMH), who underwent intravitreal injection
of 0,1ml Jetrea®. And we retrospectively reviewed 18 eyes of 18
patients with vitreomacular traction with or without FTMH who
underwent 23-gauge vitrectomy. In both groups visual acuity and
SD-OCT ultrastructural parameters were measured before injection/
vitrectomy. Resolution of VMT, closure of macular holes, visual
acuity and SD-OCT ultrastructural parameters were evaluated again
in both groups 1, 3 and 6 months after treatment.
Results: VMT resolved in 17 of 21 eyes treated with Ocriplasmin
after 6 month (80.95%) as compared to 100% of eyes who underwent
vitrectomy. In the Ocriplasmin group 5 eyes initially presented
FTMH with VMT (23.80%), 2 of them were closed 1 month after
Ocriplasmin treatment. The remaining 3 had vitrectomy with ILMpeeling and gas tamponade and closed thereafter. All FTMH were
closed after 6 month. Best corrected visual acuity was 0.38±0.23
Log MAR at baseline, improving to 0.34±0.24 Log MAR at 6
months after ocriplasmin treatment. Best corrected visual acuity in
the vitrectomy group improved from 0.55±0.29 Log MAR before
operation to 0.53±0.51 Log MAR at 6 months postoperative.
Foveal thickness was 355.95±114.53 mm at baseline, reducing to
277.77±40.26 mm at 6 months after ocriplasmin treatment. Foveal
thickness of eyes who underwent vitrectomy was 494.61±126.02 mm
at baseline, reducing to 330.2±88.85 mm at 6 months postoperative.
Conclusions: In the ongoing study, a large percentage of resolution
of vitreomacular traction after intravitreal injection of Ocriplasmin
was observed, and 2 out of 5 macular holes closed. This was further
associated by an improvement of visual acuity and reduction of
foveal thickness.
Commercial Relationships: Mathias M. Maier, None; Sophia
Abraham, None; Christiane Frank, None; Nikolaus Feucht, None;
Chris P Lohmann, None
Program Number: 1230 Poster Board Number: D0207
Presentation Time: 3:15 PM–5:00 PM
1 year outcomes of intravitreal octriplasmin for symptomatic
vitreomacular traction
Yue Zhao1, 2, Yuji Itoh2, Justis P. Ehlers2, Sunil K. Srivastava2, Rishi
P. Singh2, Peter K. Kaiser2. 1Cleveland Clinic Lerner College of
Medicine, Cleveland, OH; 2Cole Eye Institute, Cleveland Clinic
Foundation, Cleveland, OH.
Purpose: Intravitreal ocriplasmin for symptomatic vitreomacular
adhesion (sVMA) permits early intervention and avoids surgical risk.
Initial reports describe visual and anatomic changes in the first month
after injection. We aim to follow these changes for at least one year
after treatment.
Methods: We assessed effect of ocriplasmin 0.125ug in a
retrospective case series of Cole Eye Institute patients with sVMA.
Eyes were categorized into two groups: eyes treated with ocriplasmin
alone, and eyes requiring further vitrectomy (V). Ocriplasmin alone
eyes were further subdivided into responders (R), defined by sVMA
resolution, and non-responders (NR), defined by lack of resolution.
Primary outcome was incidence of sVMA resolution. Secondary
outcomes included changes in visual acuity (VA), changes in optical
coherence tomography (OCT) measurements, and incidence of
vitrectomy in eyes followed for at least one year. Comparisons were
analyzed using Wilcoxan tests and presented as count/percentage or
median/interquartile range.
Results: Of 19 ocriplasmin treated eyes, 9 (47%) demonstrated OCT
confirmed sVMA release. Median time to resolution was 7 days.
sVMA did not resolve in 10 eyes, of which 6 (32%) eyes required
further vitrectomy. 14/19 (74%) eyes were followed for a minimum
of one year: 8 ocriplasmin alone (5 R, 3 NR) and 6 vitrectomy
(V) eyes. Baseline VA was significantly lower in eyes treated with
ocriplasmin alone (logmar 0.29, 0.18-0.42) compared to vitrectomy
eyes (0.40, 0.32-0.54, p=0.03). Final VA was 0.20 in ocriplasmin
alone and 0.24 in vitrectomy eyes (p=0.84). In ocriplasmin alone
eyes, VA improved by -0.14 in both responder and non-responder
eyes. Time to best VA was 142 days in responders and 129 days
in non-responders (p = 0.55). OCT central subfield thickness was
thinner in the ocriplasmin-alone eyes than in the vitrectomy eyes
at baseline (267um vs. 390um, p=0.05) and follow-up (227um vs.
309.5um, p=0.03). Transient subretinal fluid was noted in 7/14 (50%)
eyes. 6 eyes (43%) had macular holes at baseline, 3 resolved with
ocriplasmin and 3 required vitrectomy.
Conclusions: This study ocriplasmin outcomes after one year follow
up. Visual acuity improved over several months in both ocriplasmin
responders and non-responders, and final visual acuity was similar
across groups. OCT measurements differed at baseline and at final
follow-up in ocriplasmin eyes when compared to those requiring
vitrectomy.
Commercial Relationships: Yue Zhao, None; Yuji Itoh, None;
Justis P. Ehlers, Leica (C), Thrombogenics (C), Thrombogenics (F),
Zeiss (C); Sunil K. Srivastava, Allergan (C), Bausch and Lomb (C),
Leica (C); Rishi P. Singh, Alcon (C), Alcon (C), Thrombogenics
(C), Thrombogenics (C); Peter K. Kaiser, Alcon (C), Allegro (C),
Novartis (C), Thrombogenics (C)
Program Number: 1231 Poster Board Number: D0208
Presentation Time: 3:15 PM–5:00 PM
THE INCIDENCE OF PREVIOUS POSTERIOR VITREOUS
DETACHEMENT IN PATIENTS UNDERGOING PARS PLANA
VITRECTOMY FOR RESOLUTION OF SYMPTOMATIC
VITREOUS FLOATERS
Ian Kirchner, David Ellenberg, Philip H. Scharper. Ophthalmology,
Krieger Eye Institute, Baltimore, MD.
Purpose: To evaluate if the presence or absence of a posterior
vitreous detachment (PVD) is significant with regards to the
symptoms of vitreous floaters and patients decision to undergo pars
plana vitrectomy (PPV) for removal of vitreous floaters.
Methods: A retrospective review of all patients who underwent PPV
from 2013 through October 2014 was initially performed. All patients
with current or history of retina or vitreous pathology including
vitreous hemorrhage, macular hole, history of uveitis, history of
retinal detachment, previous retina surgery or other concurrent retinal
pathology were excluded from the study. All patients undergoing
PPV strictly for symptomatic floaters were included. Standard 23G
PPV (Constellation, Alcon, TX) was performed on all patients. The
posterior hyaloid was visualized intraoperativly with intravitreal
triamcinolone. All operative reports were reviewed to evaluate
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
whether there was a previous PVD preoperatively or if the PVD was
created surgically.
Results: 157 eyes of 140 patients were initially identified. 18 eyes
were excluded for vitreous hemorrhage, 18 eyes for to previous
retina surgery, 7 eyes for previous uveitis, 5 eyes for macular
hole, 38 eyes for retained lens material or a dislocated IOL, 5 eyes
for endophthalmitis, 1 eye for asteroid hyalosis, and 1 eye for
hemorrhagic choroidal detachment. 64 eyes met the inclusion criteria
and underwent PPV strictly for resolution of symptomatic floaters.
An additional 6 eyes were then excluded because there was not
mention of the presence or absence of a PVD in the operative report.
27/58 eyes (47%) already had a PVD prior to surgery confirmed
intraoperatively with triamcinolone. 31/58 eyes (53%) did not have a
previous PVD and a surgical PVD was created.
Conclusions: While it is often thought that a PVD is responsible
for symptomatic vitreous floaters, our study shows that the presence
of a PVD is not necessarily related to the severity of symptoms or
patients’ decision to undergo surgical removal of floaters. In our
study, more than half of the patients who choose to undergo PPV for
symptomatic floaters did not have PVD pre-operatively. It is likely
that location of the vitreous opacities and density of the vitreous
syneresis has a greater significance than the presence or absence of a
PVD.
Commercial Relationships: Ian Kirchner, None; David Ellenberg,
None; Philip H. Scharper, None
Program Number: 1232 Poster Board Number: D0209
Presentation Time: 3:15 PM–5:00 PM
Enhanced High-density Line Spectral-domain Optical Coherence
Tomography Imaging of Vitreoretinal Interface. Description of
Selected Cases
Yu Cheol Kim1, 2, Mariana Harasawa2, Guillermo S. Villanueva2, 2,
Frank S. Siringo2, 2, Miguel Paciuc-Beja2, 2, Jeffrey Olson2, Naresh
Mandava2, Hugo Quiroz-Mercado2, 2. 1Department of Ophthalmology,
Keimyung Univ/Dongsan Medical Ctr, Daegu, Korea (the Republic
of); 2Ophthalmology, University of Colorado, School of Medicine,
Denver, CO.
Purpose: We introduce a new method to observe the morphologic
feature of the vitreous with spectral-domain optical coherence
tomography (SD-OCT) by evaluating and describing the posterior
vitreous structure of various selected cases using Enhanced highdensity (HD) line mode.
Methods: This is a descriptive case series of SD-OCT images with
Enhanced HD line at Denver Health Medical Center, University of
Colorado School of Medicine in 2014. The medical records with
ocular images for these patients were analyzed.
Results: Enhanced HD line in vitreoretinal mode with SD-OCT
offered wide images with well-visible vitreoretinal interface.
Posterior precortical vitreous pocket (PPVP) that was often mistaken
as posterior vitreous detachment on regular cross line mode was
easily identified. Vitreomacular adhesion and traction, absence or
presence of connecting channels between PPVP and Cloquet’s canal,
liquefied vitreous lacuna, and emulsified oil droplet-layer could be
observed.
Conclusions: SD-OCT using enhanced HD line in vitreoretinal mode
enables clear visualization of the posterior vitreous structure.
Commercial Relationships: Yu Cheol Kim, None; Mariana
Harasawa, None; Guillermo S. Villanueva, None; Frank S.
Siringo, None; Miguel Paciuc-Beja, None; Jeffrey Olson, None;
Naresh Mandava, None; Hugo Quiroz-Mercado, None
Program Number: 1233 Poster Board Number: D0210
Presentation Time: 3:15 PM–5:00 PM
The processes of postoperative macular hole closure after
inverted internal limiting membrane flap technique.The
processes of postoperative macular hole closure after inverted
internal limiting membrane flap technique
Hirano Masayuki1, Yuki Morizane1, Tetsuhiro Kawata1, Shuhei
Kimura1, Mio Hosokawa1, Yusuke Shiode1, Shinichiro Doi1, Mika
Hosogi1, Atsushi Fujiwara2, Fumio Shiraga1. 1Ophthalmology,
Okayama university, Okayama city, Japan; 2Okayama Rosai Hospital,
Okayama city, Japan.
Purpose: To investigate the closure process of refractory macular
holes (MHs) after the inverted internal limiting membrane (ILM) flap
technique by comparing that of idiopathic MHs after vitrectomy with
ILM removal.
Methods: Eight eyes of 8 refractory MH patients (2 men and 6
women, mean age 73.7 ± 5.1 years) who underwent the inverted ILM
flap technique and 11 eyes of 11 idiopathic MH patients (5 men and 6
women, mean age 67.5 ± 6.7 years) who were treated with vitrectomy
and ILM peeling were studied. The inverted ILM flap technique was
basically performed according to the report of Michalewska et al
(Ophthalmology 2010). In all patients, at the end of the operation,
the eyes were replaced with 20% sulfur hexafluoride gas and
patients were asked to remain face down for 3 days. The closure
processes of MH were imaged using swept source optical coherence
tomography (DRI OCT-1, Topcon, Japan) starting from 6 hours after
the operation, followed by everyday examination till MH closure was
confirmed.
Results: The final closure rates of MHs after the initial surgery were
75.0% (6 eyes) in refractory MHs and 100.0% (11 eyes) in idiopathic
MHs. The durations required for the closure of refractory MHs were
6 hours for 2 eyes (33.3%), 3 days for 2 eyes (33.3%), and 10 days
for 2 eyes (33.3%). On the other hand, the durations required for the
closure of idiopathic MHs were 6 hours for 5 eyes (45.4%), 1 day for
3 eyes (27.2%), and 3 days for 3 eyes (27.2%). The mean duration
until the closure of refractory MHs was significantly longer than
that of idiopathic MHs (106 ± 107.9 hours and 28.9 ± 28.7 hours
respectively, p < 0.05, unpaired t-test). In refractory MHs that closed
after the initial surgery, the type of MH closure was U-type in all eyes
(6 eyes), although the restoration of the ellipsoid zone was observed
in 3 eyes (50%).
Conclusions: The inverted ILM flap technique is effective to close
refractory MHs and aiding the recovery of the macular conformation.
The postoperative period of refractory MHs to close was longer
than that of idiopathic MHs, possibly due to the differences in the
mechanism of MH closure between these MHs.
Commercial Relationships: Hirano Masayuki, None; Yuki
Morizane, None; Tetsuhiro Kawata, None; Shuhei Kimura,
None; Mio Hosokawa, None; Yusuke Shiode, None; Shinichiro
Doi, None; Mika Hosogi, None; Atsushi Fujiwara, None; Fumio
Shiraga, Alcon Japan (C), Alcon Japan (F), AMO Japan (F), Byer
(C), Chuo Sangio Co. (F), Novartis„ÄÄPharma (F), Novertis Pharma
(C), Pfizer (F), Santen Pharmaceutical (C), Santen Pharmaceutical
(F), Senju Pharmaceutical (F), Topcon Co. (F)
Program Number: 1234 Poster Board Number: D0211
Presentation Time: 3:15 PM–5:00 PM
Intravitreal gas injection for the treatment of vitreomacular
traction syndrome
Shelley Day, Jose A. Martinez, Peter A. Nixon, Mark Levitan, Clio A.
Harper. Austin Retina Associates, Austin, TX.
Purpose: Vitreomacular traction syndrome can cause symptomatic
metamorphopsia and decrease in visual acuity. While it is typically
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
treated with vitrectomy surgery or intravitreal ocriplasmin injection,
these procedures can be invasive and costly. The purpose of this
retrospective, consecutive case series is to evaluate the efficacy of
intravitreal gas injection for treatment of symptomatic vitreomacular
traction syndrome.
Methods: Ten eyes of 10 patients with symptomatic vitreomacular
traction on spectral-domain optical coherence tomography (sdOCT)
received an intravitreal injection of 0.3 mL of 100% sulfur
hexafluoride (SF6) or perfluoropropane (C3F8). The primary outcome
was the number of eyes with release of vitreomacular traction on
sdOCT at one month after treatment. Secondary outcomes included
change in visual acuity and central subfield thickness 1 month after
treatment.
Results: Six patients (60%) had resolution of vitreomacular traction
on sdOCT by one month after injection. Of these, 2 (20%) developed
full thickness macular holes. Mean visual acuity at one month
improved slightly after injection by 0.09 logMAR units, although this
change was not statistically significant (p = 0.20). Central subfield
thickness on sdOCT decreased by an average of 46.5 microns after
injection (p = 0.002). All eyes with release of vitreomacular traction
had pre-treatment vitreomacular adhesion of less than 521 microns.
No post-injection complications were noted.
Conclusions: Intravitreal injection of expansile SF6 or C3F8 gas
is a low-cost and minimally invasive alternative for the treatment
of symptomatic vitreomacular traction syndrome. Further study is
warranted.
Commercial Relationships: Shelley Day, None; Jose A. Martinez,
None; Peter A. Nixon, None; Mark Levitan, None; Clio A. Harper,
None
Program Number: 1235 Poster Board Number: D0212
Presentation Time: 3:15 PM–5:00 PM
Spectral domain optical coherence tomography guided facedown
posturing versus 1 week facedown posturing after idiopathic full
thickness macular hole surgery
Kunyong Xu, Eduardo Navajas. Ophthalmology, Queen’s University,
Kingston, ON, Canada.
Purpose: To compare idiopathic full thickness macular hole (FTMH)
closure rates between spectral domain optical coherence tomography
(SD-OCT) guided facedown posturing and conventional 1 week
facedown posturing.
Methods: Consecutive patients who underwent pars plana
vitrectomy, membrane peeling with indocyanine green dye, and
C3F8 gas tamponade for idiopathic FTMH between July 2013 and
September 2014 were included. For the SD-OCT guided group, SDOCT was performed first day after surgery. If the FTMH was closed,
the patient could assume any position but lying supine for 1 week.
If the FTMH was not closed on the first postoperative day, SD-OCT
was performed daily until the FTMH closed or for up to 1 week.
If the hole closed or 1 week elapsed, the patient was asked to stop
positioning. The control group positioned for 1 week after surgery
and had SD-OCT at 1 month to confirm closure.
Results: Twenty nine eyes of 28 patients were included, 7 eyes in
the SD-OCT guided group and 22 eyes in the control group. The
mean follow up for the SD-OCT guided and control group was 118.9
days and 193.5 days, respectively. FTMH closure rate for both the
SD-OCT guided and control group was 100%. Mean time for FTMH
closure in the SD-OCT group was 1.3 days. There was no statistical
difference in postoperative VA at the last visit between the SD-OCT
guided group (0.47± 0.25 LogMAR) and control group (0.52 ± 0.40
LogMAR) (p=0.7764). No statistically significant correlation was
found between FTMH basal diameter and the VA at the last visit
(r=0.36, p=0.0519, Spearman correlation coefficient).
Conclusions: This study showed no difference in FTMH closure
rates and postoperative VA between SD-OCT guided facedown
posturing and conventional 1 week facedown posturing.
Commercial Relationships: Kunyong Xu, None; Eduardo
Navajas, None
Program Number: 1236 Poster Board Number: D0213
Presentation Time: 3:15 PM–5:00 PM
Clinical Characteristics and Management of Full Thickness
Macular Holes Following Vitrectomy for Vitreomacular Traction
Marco Gonzalez, Harry W. Flynn, william smiddy, Christine Bokman.
Bascom Palmer Eye Institute, Miami, FL.
Purpose: To describe the clinical characteristics and optical
coherence tomography (OCT) outcomes for patients undergoing pars
plana vitrectomy (PPV) for full thickness macular holes (FTMH)
that developed after surgery for symptomatic vitreomacular traction
(VMT).
Methods: This is a non-comparative, interventional, consecutive
case series from January 2007 through February 2014. Patients
with comorbid ocular conditions (macular holes, diabetic macular
edema, advanced glaucoma, etc) were excluded. Preoperative
and postoperative clinical characteristics and OCT features were
compared.
Results: A total of 4 eyes that developed full thickness macular
holes following PPV for VMT were included. The mean age at time
of surgery was 70.5 years (range of 56 to 82). Mean best corrected
visual acuity prior to vitrectomy was 20/55 (range of 20/30 to
20/200). During initial vitrectomy, internal limiting membrane was
peeled in 3 (75%) eyes. No intraoperative macular hole was noted.
The average time between initial surgery and identification of the full
thickness macular hole was 144 days (range of 44-236 days). After
PPV for FTMH, 3 of 4 eyes (75%) achieved macular hole closure.
The fourth patient declined further surgery and best corrected visual
acuity remained at 20/400. Mean final best corrected visual acuity
after successful macular hole repair in 3 eyes was 20/59 (range of
20/25 to 20/400).
Conclusions: Postoperative macular hole formation after PPV for
VMT is uncommon. FTMHs after PPV for VMT can be successfully
repaired with further surgery but visual acuity outcomes are variable.
Commercial Relationships: Marco Gonzalez, None; Harry W.
Flynn, Almeira (C), Pfizer (C), Santen (C); william smiddy, Alimera
(C), Allergan (C); Christine Bokman, None
Support: Supported in part by Research to Prevent Blindness New
York, NY.
Program Number: 1237 Poster Board Number: D0214
Presentation Time: 3:15 PM–5:00 PM
Interim Results From INJECT: INvestigation of JETREA in
Patients With Confirmed Vitreomacular Traction
Peter Stalmans1, Franklin Masin2, Claudio Spera2, Severine Durier2,
Lawrence Rasouliyan3. 1Dept Ophthalmology UZLeuven, UZLeuven,
Leuven, Belgium; 2Alcon Laboratories Inc., Fort Worth, TX; 3ICON
Clinical Research, Barcelona, Spain.
Purpose: The safety and clinical efficacy of JETREA (ocriplasmin)
have been established in two phase 3 vehicle-controlled clinical
studies. However, the long-term effects of ocriplasmin in a realworld setting have not been widely documented in large populations
across different countries. The purpose of this study is to characterize
baseline characteristics, safety profile, and clinical effectiveness of
ocriplasmin in real-world settings across different countries.
Methods: Non-interventional, multicenter, prospective study in
vitreomacular traction (VMT) patients treated with ocriplasmin.
Enrolled patients are followed for 12 months. Frequency and timing
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
of post-injection visits are at the discretion of the treating physician.
Patient baseline characteristics collected include age, race, gender,
presence and size of macular hole (MH), presence of ERM, and
size of vitreomacular adhesion. Safety assessments include ocular
symptoms and adverse events.
Results: The interim analysis included 105 patients with available
baseline OCT data and at least 28 days of follow-up. The majority
of patients were female (62%), white (97%), with a mean age of
72 years (range 46 – 89 years). Most patients presented with VMT
without macular hole: 64/105 (61%) with VMT only, and 41/105
(39%) with VMT plus MH. The most frequently reported adverse
events were: drug ineffective (n=8), vitreous floaters (n=7), photopsia
(n=7), and visual acuity reduced (n=5).
Conclusions: Results from this study provide insights into presenting
characteristics of patients with VMT and VMT with MH, who receive
ocriplasmin in a real world setting, and will contribute to the further
characterization of ocriplasmin efficacy, safety profile, and global
treatment patterns.
Table 1. Demographics and Baseline Characteristics of Study
Population.
Commercial Relationships: Peter Stalmans, Alcon Laboratories
Inc. (C), Alcon Labratories Inc. (C); Franklin Masin, Alcon
Laboratories Inc. (E); Claudio Spera, Alon Laboratories Inc.
(E); Severine Durier, Alcon Laboratories, Inc. (E); Lawrence
Rasouliyan, ICON Clinical Research (C)
Clinical Trial: ENCEPP/SDPP/4554
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].