Download ARVO 2014 Annual Meeting Abstracts 110 Vitreomacular Interface

ARVO 2014 Annual Meeting Abstracts
110 Vitreomacular Interface and Management
Sunday, May 04, 2014 8:30 AM–10:15 AM
Exhibit/Poster Hall SA Poster Session
Program #/Board # Range: 287–329/B0265–B0307
Organizing Section: Retina
Contributing Section(s): Physiology/Pharmacology, Visual
Psychophysics / Physiological Optics
Program Number: 287 Poster Board Number: B0265
Presentation Time: 8:30 AM–10:15 AM
Drawbridge elevation versus tangential separation of the inner
retina as the mechanism of full thickness macular hole formation
Wai H. Woon1, Denis Greig2, Mike D. Savage3, Mark C. Wilson4,
Colin A. Grant5, Fiona Bishop1, Bataung Mokete1, Chek T. Ngo6,
Liam A. Sullivan1. 1Dept Ophthalmology, St James’ Hospital, Leeds,
United Kingdom; 2Dept Physics, University of Leeds, Leeds,
United Kingdom; 3Dept Applied Mathematics, University of Leeds,
Leeds, United Kingdom; 4Dept Engineering, University of Leeds,
Leeds, United Kingdom; 5Dept Medical Engineering, University
of Bradford, Bradford, United Kingdom; 6Dept Ophthalmology,
University of Sarawak, Sarawak, Malaysia.
Purpose: This study is to test one aspect of a novel bistable
hypothesis of macular hole formation and closure. The inner retina at
the normal fovea has the shape of an inverted shallow dome with a
central hole. The bistable hypothesis postulates that this is a bistable
structure which can be triggered to flip inside out and back again like
an umbrella. Flipping the inner retina inside out causes a macular
hole due to the oblique path of the Muller cells through the retina. An
antero-posterior (A-P) movement of the inner retina would then cause
an A-P and tangential movement of the outer retina. In cross section,
this movement of the inner retina is seen as a drawbridge elevation
of the inner retina and this causes the outer retina to curl up and away
from the central fovea (Fig. 1). In this hypothesis the size of the
macular hole would be related to the degree to which the annulus of
inner retina has been flipped through and there is no requirement for
tangential separation of the inner retina.
Methods: This is a retrospective study of developing full thickness
macular holes that were observed to change morphology prior to
surgery.
For each eye, the following was determined from aligned OCT scans:
dA – average of the change in angle of elevation of the inner retina on
either side of the hole (defined using tangents to the inner retina at a
distance of 700 microns from the axis of the hole)
dI – change in separation of the inner retina (minimum hole diameter
at the level of the inner retina)
dD – change in the base diameter of the macular hole
Results: 17 eyes were identified. One eye progressed through a
sequence of 2 changes in morphology allowing 18 measurements
to be made. In 2 eyes, enlargement of the macular hole with
further elevation of the inner retina was observed despite complete
separation of the parafoveal vitreoretinal attachments at presentation.
Correlation coefficient between dA and dD: 0.63 (p = 0.005)
Correlation coefficient between dI and dD: -0.08 (p = 0.75)
Scatter plots are shown in Fig. 2
Conclusions: This study suggests that the mechanism of macular
hole formation involves the elevation of the inner retina in a
drawbridge manner. These findings are consistent with the bistable
hypothesis of macular hole formation
Schematic of oblique Muller fibres connecting inner and outer retina.
In reality the fibres have a Z-configuration.
©2014, 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 2014 Annual Meeting Abstracts
2013). The purpose of this study was to determine the long term
changes of the parafoveal retinal thickness after MH surgery for up to
4 years
Methods: Twenty-seven eyes of 26 patients (13 women and 13
men) with a MH who underwent PPV at the Matsumoto Dental
University Hospital were studied. The eyes were examined at 1,
3, 6, 12 months (n=27), and 2 (n=16), 3 (n=10), and 4 (n=5) years
after the surgery. The mean retinal thickness was measured in the
images obtained by volume scan mode of the Spectralis HRA+OCT
(Heidelberg Engineering, Germany). The average retinal thickness
of the 4 parafoveal sectors was measured by the built-in software.
The thickness of each retinal layer at 1,000 μm from the fovea as
the representative thickness of each of the 4 parafoveal sectors was
measured in the horizontal and vertical images manually.
Results: The mean parafoveal retinal thickness of the nasal, superior,
inferior, and temporal sectors were 361.9±15.3, 341.2±15.4,
339.9±13.7, 313.3±13.6 mm, respectively at 12 months after
the surgery. All but the nasal sectors at 3, 6 and 12 months were
significantly decreased compared to that at 1 month after the surgery.
There was also a significant decrease in only the temporal sector at
12 months compared to that at 6 months. In contrast, the minimum
decrease was observed at the nasal sector. There was no significant
decrease thereafter in all sectors. A similar tendency of significant
decreases of the thicknesses was observed in the inner nuclear layer
(INL) and outer nuclear layer (ONL) but not in other retinal layers
Conclusions: The postoperative parafoveal retinal thickness
decreased significantly up to 1 year in all but the nasal sectors after
MH surgery with ILM peeling. The reduction of the thickness of INL
and ONL seemed to be associated with this change.
Commercial Relationships: Kouichi Ohta, None; Atsuko Sato,
None; Emi Fukui, None
Scatter plots
Commercial Relationships: Wai H. Woon, None; Denis Greig,
None; Mike D. Savage, None; Mark C. Wilson, None; Colin A.
Grant, None; Fiona Bishop, None; Bataung Mokete, None; Chek
T. Ngo, None; Liam A. Sullivan, None
Program Number: 288 Poster Board Number: B0266
Presentation Time: 8:30 AM–10:15 AM
Residual parafoveal nasal retinal thickening after macular hole
surgery with internal limiting membrane peeling
Kouichi Ohta, Atsuko Sato, Emi Fukui. Ophthalmology, Matsumoto
Dental University, Shiojiri, Japan.
Purpose: We have reported that the parafoveal contour is thicker
at the nasal sector and thinner at the temporal sector in the optical
coherence tomographic (OCT) images recorded 6 months after
successful idiopathic macular hole (MH) closure by pars plana
vitrectomy (PPV) with internal limiting membrane (ILM) peeling
(Ohta K. Br J Ophthalmol 2010, Graefes Arch Clin Exp Ophthalmol
Program Number: 289 Poster Board Number: B0267
Presentation Time: 8:30 AM–10:15 AM
Macular choriovitreal membrane and macular traction
syndrome: comparison with clinical, fluorescein angiographic
and optical coherence tomographic findings
June-Gone Kim1, 2, Yoon Jeon Kim1, 2, Dong Yoon Kim1, 2.
1
Ophthalmology, Univ of Ulsan College, Seoul, Republic of Korea;
2
Ophthalmology, ASAN medical center, SEOUL, Republic of Korea.
Purpose: Macular choriovitreal membrane (MCVM) is an epiretinal
fibrovascular membrane adherent to the posterior vitreous hyaloid
extending from the subfoveal space. We intended to evaluate
preoperative and postoperative clinical features, fluorescein
angiographic and optical coherence tomographic findings of MCVM
by comparing with those of macular traction syndrome (MTS).
Methods: Consecutive nine MCVM patients and 103 MTS patients
underwent successful vitrectomy by one surgeon due to symptomatic
macular traction were identified through a retrospective chart review.
All clinical data were reviewed for underlying ocular and systemic
conditions, visual acuity, optical coherence tomography (OCT), and
fluorescein angiography (FA) findings.
Results: MCVM patients were younger than MTS patients (55.1
years vs. 63.6 years, p=0.040) and showed worse visual acuity
(LogMAR 1.27 vs. 0.66, p=0.001). When compared with MTS
patients, MCVM patients showed higher association with previous
laser history (44.4% vs. 18.4%, p=0.025), ocular comorbidities
(100.0% vs. 41.8%, p=0.001), and diabetes (66.7% vs. 19.4%,
p=0.030). While subfoveal fibrous stalk and photoreceptor disruption
were noted in all of OCT data in patients with MCVM, only 2
patients (1.9%) with MTS showed photoreceptor disruption. In FA,
7 cases of MCVM (71.3%) demonstrated definite hyperfluorescence.
Both MCVM and MTS patients showed significant decrease
©2014, 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 2014 Annual Meeting Abstracts
in central retinal thickness postoperatively owing to successful
removal of macular traction (p=0.001). Although MTS patients
showed marked visual improvement postoperatively (p=0.001),
MCVM patients did not (p=0.355). Rather, MCVM patients showed
improvement of central vision subjectively.
Conclusions: MCVM is the rarely reported disorder caused by
the various pathologic vitreoretinal conditions. It is important
to distinguish MCVM from MTS with thorough preoperative
examination, because of their different surgical approach and
postoperative prognosis.
Fluorescein angiographic(FA) findings of macular choriovitreal
membrane.
Commercial Relationships: June-Gone Kim, None; Yoon Jeon
Kim, None; Dong Yoon Kim, None
Optical coherence tomographic (OCT) findings of macular
choriovitreal membrane and macular traction syndrome(MTS).
Program Number: 290 Poster Board Number: B0268
Presentation Time: 8:30 AM–10:15 AM
Influence of vitreomacular interface on anti-VEGF therapy using
treat and extend treatment protocol for age-related macular
degeneration
Samuel K. Houston1, 2, Nadim Rayess1, 2, Allen C. Ho1, 2, Carl D.
Regillo1, 2. 1Mid-Atlantic Retina, Philadelphia, PA; 2Wills Eye
Hospital, Philadelphia, PA.
Purpose: The purpose of this study is to determine the influence of
the vitreomacular interface (VMI) on treatment outcomes in patients
with neovascular age-related macular degeneration (AMD) who are
treated with anti-VEGF agents using a treat and extend protocol.
Methods: This study is a retrospective, observational, case series
of patients diagnosed with neovascular AMD who were treated at
Mid Atlantic Retina (MAR), the Retina Service of The Wills Eye
Institute, Philadelphia, PA from January 1, 2009 to December 1,
2013. Following IRB approval, patient records were reviewed for
age, gender, visual comorbidities, visual acuity (baseline, year 1),
anti-VEGF treatment history, OCT central retinal thickness (CRT),
and OCT evaluation of vitreomacular interface.
Results: A total of 64 (43 female, 21 male) treatment-naïve patients
with neovascular AMD were reviewed, with a mean age of 80.4
years. 49 patients (77%) did not have evidence of vitreomacular
adhesion or traction (non-VMA), while 15 patients (23%) did have
evidence of VMA or VMT. Baseline mean VA in the non-VMA group
was 20/98 with a mean CRT of 312 microns. Mean VA at year 1 in
the non-VMA group was 20/66 with a mean CRT of 264 microns.
Baseline mean VA in the VMA/VMT group was 20/162 with a mean
CRT of 348 microns. Mean VA at year 1 in the VMA/VMT group
was 20/67 with a mean CRT of 308 microns. Mean total number
of injections at year 1 for the non-VMA group was 7.57 versus 8.7
(P = 0.028) for the VMA/VMT group. The mean interval between
injections in the non-VMA group was 7.5 weeks versus 6.27 weeks
©2014, 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 2014 Annual Meeting Abstracts
(P = 0.022). The mean longest interval between injections in the nonVMA group was 11.4 weeks compared to 9.1 weeks (P = 0.017) in
the VMA/VMT group.
Conclusions: The vitreomacular interface (VMI) appears to have a
significant influence on anti-VEGF treatment intervals and should
be assessed when using a treat-and-extend protocol. VMA/VMT on
OCT may require more intensive treatment with decreased ability to
extend treatment intervals.
Commercial Relationships: Samuel K. Houston, Genentech (F),
Regeneron (F); Nadim Rayess, Genentech (F), Regeneron (F); Allen
C. Ho, Genentech (F), Regeneron (F); Carl D. Regillo, Genentech
(F), Regeneron (F)
Program Number: 291 Poster Board Number: B0269
Presentation Time: 8:30 AM–10:15 AM
Ocriplasmin for Vitreomacular Adhesion (VMA) in the Clinical
Setting: Rates of VMA Release, Development of Macular Holes,
and Visual Outcomes
Andrew Coskey, David M. Brown, Claudia Hooten, Leslie K. Kao,
Charles C. Wykoff, James C. Major, Amy C. Schefler. Research,
Retina Consultants of Houston, Houston, TX.
Purpose: To evaluate the rate of resolution of symptomatic
vitreomacular adhesion (VMA) after a single intravitreal injection of
ocriplasmin.
Methods: This was a retrospective review of all patients treated
with ocriplasimin in a nine-month period immediately after the FDA
approval of the drug (Jan 2013-Sep 2013) at a large, multi-site retina
practice. Clinical data collected and assessed included anatomic
success, pre- and post-injection visual acuity, need for vitrectomy,
and adverse visual effects.
Results: Fifty-two patients underwent treatment. At baseline,
all patients had VMA, two patients (3.8%) had mild epiretinal
membranes and 22 patients (42.3%) had evolving or small macular
holes. Twenty-four patients (46.2%) demonstrated resolution of VMA
by OCT. Mean initial LogMAR scores of patients whose hyaloid
released was 0.469 with a gain of 0.335 post treatment. Eighteen
patients (34.6%) had no anatomic change. Thirteen patients (25%)
had worsening of anatomy and/or vision that required vitrectomy
including five patients (9.6%) who developed a full thickness macular
hole. There was an 18.2% closure rate in the group of patients
that presented with macular holes. This group had initial and final
LogMAR scores of 0.872 and 0.662, respectively. Three patients
whose vision worsened reported an overall decrease/darkening of
their vision, one of whom had a confirmed severe decrease in the
combined response on a full field ERG. Overall, patients’ vision
improved from a LogMAR score of 0.629 pre-treatment to a score of
0.531 post-treatment.
Conclusions: This is the largest series examining the use of
ocriplasmin in a clinical setting since the MIVI-TRUST trial. Despite
the fact that some patients did not meet the strict criteria for entry into
MIVI-TRUST, we still observed a 46% rate of anatomic resolution
of VMA. One quarter of patients still require vitrectomy and severe
ERG changes can occur.
Commercial Relationships: Andrew Coskey, None; David M.
Brown, None; Claudia Hooten, None; Leslie K. Kao, None;
Charles C. Wykoff, None; James C. Major, None; Amy C.
Schefler, None
Program Number: 292 Poster Board Number: B0270
Presentation Time: 8:30 AM–10:15 AM
Full Thickness Macular Hole secondary to High Power,
Handheld, Blue Laser: Natural History and Management
Outcomes
Nicola G. Ghazi1, 2, Sulaiman Alsulaiman1. 1Vitreo/Retinal
(KKESH), King Khaled Eye Specialist Hosp, Riyadh, Saudi Arabia;
2
Ophthalmology, University of Virginia, Charlottesville, VA.
Purpose: To report the natural history and management outcomes
of macular hole caused by momentary exposure to a high-power,
handheld, blue laser devise
Methods: This is a consecutive case series of 15 eyes of 15 patients
who presented with macular hole caused by exposure to a blue laser
device (450 nm and a power range from 150 mW to 1200 mW) to a
single institution. Evaluation included a full ophthalmic examination,
fundus photography, macular spectral-domain optical coherence
tomography and fundus fluorescein angiography. The main outcome
measures included the visual and anatomical outcomes
Results: All patients were young males. There were 11 eyes with
full-thickness macular hole (FTMH) and 4 eyes with stage 1 holes
compromising 2 with outer retinal disruption in the fovea and 2 with
foveal schisis-like cavity. Best corrected Snellen visual acuity at
presentation ranged from 20/30 to 20/400 (mean 20/165). All eyes
were observed for at least 3 months prior to any intervention. Six
eyes with FTMH underwent pars plana vitrectomy, internal limiting
membrane peeling along with gas or silicone oil tamponade. Five
of the six operated eyes had complete closure of the macular hole
with marked visual recovery. One eye had a persistently open hole
following surgery attributed to lack of positioning. The remaining
five eyes with FTMH did not undergo surgery for various reasons
and none of them closed spontaneously. The 4 eyes with outer retinal
disruption and foveal schisis-like changes healed spontaneously with
complete visual and anatomical recovery. The final mean BCVA for
all eyes was 20/53 (range: 20/30 to 20/125).
Conclusions: FTMH can result from momentary exposure to highpower handheld laser devices, which can permanently reduce central
vision. While spontaneous closure may be anticipated in some cases,
most cases require surgical intervention. Vitrectomy is successful in
closing the macular hole along with visual acuity improvement in
most of the cases.
Commercial Relationships: Nicola G. Ghazi, None; Sulaiman
Alsulaiman, None
Program Number: 293 Poster Board Number: B0271
Presentation Time: 8:30 AM–10:15 AM
Clinical and Anatomic Outcomes of Patients Undergoing Surgery
for Vitreofoveal Traction
Christine Bokman1, Marco A. Gonzalez2, Harry W. Flynn2, William
Smiddy2. 1University of Miami Miller School of Medicine, Miami,
FL; 2Bascom Palmer Eye Institute, Miami, FL.
Purpose: To evaluate the clinical characteristics and optical
coherence tomography (OCT) outcomes for patients with vitreofoveal
traction (VFT) undergoing pars plana vitrectomy (PPV).
Methods: This is a non-comparative interventional consecutive
case series from January 2007 through November 2013. Patients
undergoing PPV for symptomatic VFT were identified. Patients with
concomitant macular holes were excluded from this series. Clinical
characteristics and OCT features were compared preoperatively and
postoperatively.
Results: A total of 68 eyes in 68 patients underwent PPV. The
mean age at time of surgery was 60.5 years (range of 46 to 77).
Preoperatively, visual acuity ranged from 20/25 to 20/400 and
improved at least 1 line or more in 44% of eyes. Postoperatively, a
©2014, 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 2014 Annual Meeting Abstracts
macular hole developed in 4 eyes (5.9%). The appearance of traction
on OCT resolved in all eyes. Central subfoveal thickness improved
from 405.4 microns to 286.6 microns post-operatively. Preoperative
optical coherence tomography features did not correlate with visual
acuity.
Conclusions: Patients with vitreofoveal traction usually achieve
favorable visual and OCT outcomes after PPV.
Commercial Relationships: Christine Bokman, None; Marco A.
Gonzalez, None; Harry W. Flynn, None; William Smiddy, None
Program Number: 294 Poster Board Number: B0272
Presentation Time: 8:30 AM–10:15 AM
Resolution of Vitreomacular Traction Using Jetrea and its
Potential Role in Diabetic Macular Edema
Bradley ONeill1, Amar Shah2, Joseph M. Coney3. 1St. Elizabeth
Health Center, Youngstown, OH; 2Northeast Ohio Medical
University, Rootstown, OH; 3Retina Associates of Cleveland,
Beachwood, OH.
Purpose: To evaluate the safety and efficacy of intravitreal injection
of Jetrea in patients diagnosed with symptomatic vitreomacular
traction (VMT) and its potential role in treatment of diabetic macular
edema (DME).
Methods: An 8-month retrospective chart analysis was conducted
on 24 patients with symptomatic VMT who received intravitreal
injection of Jetrea 125μg using standard sterile pars plana injection
technique. Each patient underwent OCT imaging before treatment.
Visual acuity was measured and dilated fundus exam was performed
1 week and 1 month after injection. The primary endpoint was
resolution of VMT at 1 month. Secondary end points included
need for surgical intervention, continued presence of macular hole,
decrease in macular hole size, and change in VMT thickness.
Results: Overall, 12 of 24 eyes in patients aged 53-94 years old
(mean 71.90 years old) treated with Jetrea had complete resolution of
VMT within 1 month after injection. Fifty percent of patients showed
an improvement of best-corrected visual acuity. Nine eyes had
macular holes, pre-injection sizes ranged from 90μm - 326μm (mean
171.78 μm); 7 holes closed after Jetrea injection. Five patients had an
epiretinal membrane before injection; of those, only 1 eye resolved
with treatment. Of the nine diabetic eyes treated, 4 experienced VMT
resolution. Three eyes were noted to have concomitant DME; 1 of
which had marked improvement of DME in addition to complete
resolution of VMT.
Conclusions: Intravitreal injection of Jetrea successfully resolved
vitreomacular traction in half of those treated. Use of Jetrea in
treatment of concurrent diabetic macular edema may be a potential
area of interest for future studies.
Figure 1: Results following injection with Jetrea are shown above.
Vitreomacular Traction (VMT). Epiretinal Membrane (ERM). Visual
Acuity (VA).
Figure 2: OCT images of a patient with VMT and DME in the
same eye are shown both before (above) and 1 week after (below)
injection with Jetrea. Before Jetrea injection, patient’s DME had been
unsuccessfully treated with numerous injections of Lucentis.
Commercial Relationships: Bradley ONeill, None; Amar Shah,
None; Joseph M. Coney, Thrombogenics (C), Thrombogenics (F)
©2014, 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 2014 Annual Meeting Abstracts
Program Number: 295 Poster Board Number: B0273
Presentation Time: 8:30 AM–10:15 AM
Internal limiting membrane peeling’s influence on rates of cystoid
macular edema following cataract surgery
Tanuj Banker, James M. Osher, Kristen Midgley, Michael Lai.
Georgetown Univ/Retina Grp of Washington, Washington, DC.
Purpose: To analyze the outcomes and complications following
cataract extraction (CE) in eyes which had previously undergone
small gauge (23/25g) pars plana vitrectomy (PPV) with epiretinal
membrane (ERM) peeling. Risk factors potentially associated with
increased rates of cystoid macular edema (CME) were also identified.
Methods: A consecutive interventional case series from 2010 to
2012 (n=81) by one group of retinal surgeons who performed PPV
with ERM peeling using small gauge instrumentation in phakic
eyes. Exclusion criteria included pre-existing macular disease,
postoperative retinal detachment, previous PPV, documented followup of less than three months, combined MP/CE/PCIOL, and eyes that
remained phakic during the postoperative period. Postoperative CME
was confirmed with Spectral Domain Optical Coherence Tomography
(SD-OCT) and fluorescein angiography (FA). Primary outcome
measure was the rate of CME after CE. Secondary outcome measures
included visual acuity (VA) assessment.
Results: Eighty-one eyes with a mean age of 65.16 +/- 11.7 years
were followed for a mean time of 579 days. The mean preoperative
VA was 20/70 (logMAR 0.52), improving to 20/50 (logMAR 0.44)
post-MP prior to CE. (p < 0.05). The mean VA prior to CE/PCIOL
placement was 20/200 (logMAR 1.0), improving to 20/50 (logMAR
0.37) post-operatively (p < 0.01). Post CE/PCIOL placement, 22.2%
of eyes (n=18) had CME with a mean central macular thickness
(CMT) of 426.23 microm ± 79.5 vs. 335.04 microm ± 68.7 for eyes
without CME (p<.01). 61.7% (n=50) of MP procedures included
intraoperative ILM peeling. Eyes with ILM peeling had a CMT of
356.31 microm ± 91.32 vs. 362.94 microm ± 95.85 for eyes without
ILM peeling (p>.81).
Conclusions: MP with PPV is an effective treatment for visually
significant ERM and results in improved visual acuity. CME develops
frequently after CE/PCIOL in eyes that have undergone previous MP.
Peeling the ILM does not appear to alter the risk of CME. SD-OCT is
an effective tool in monitoring postoperative CME. Eyes undergoing
CE/PCIOL placement after MP require careful monitoring with OCT
to evaluate for postoperative CME.
Commercial Relationships: Tanuj Banker, None; James M.
Osher, None; Kristen Midgley, None; Michael Lai, None
Program Number: 296 Poster Board Number: B0274
Presentation Time: 8:30 AM–10:15 AM
Outer Band Reflectivity Changes on SD-OCT Following
Intravitreal Ocriplasmin for Vitreomacular Traction (VMT) and
macular holes (MH)
Nathan C. Steinle, Carlos Quezada, Ma Nasir, Dante J. Pieramici,
Alessandro Castellarin, Robert F. See, Stephen Couvillion,
Dilsher Dhoot, Melvin Rabena, Robert L. Avery. California Retina
Consultants, Santa Barbara, CA.
Purpose: To report initial experience with intravitreal ocriplasmin
(IVO) and to describe outer retinal band reflectivity changes observed
on spectral domain OCT (SDOCT) following IVO injection in
patients with VMT with or without MH.
Methods: A consecutive retrospective review of patients with
VMT and MH who were treated with IVO was performed. Patients
underwent complete ophthalmic evaluation, including nonstandardized Snellen visual acuity testing, and SD-OCT at baseline
and follow-up visits.
Results: Twenty-four eyes of 24 consecutive patients received IVO
for symptomatic VMT. Patients ages ranged from 53 to 93 years with
a mean of 73 years. The mean follow-up was 168 days (range 20-291
days), and there were 15 phakic and 9 pseudophakic eyes.
VMT release at day 30 after IVO was achieved in 12 out of 24 (50%)
patients, at an average of 14 days (1-30 days) after treatment. Eight
patients had pre-ocriplasmin MH associated with VMT. Closure of
the MH post ocriplasmin was achieved in 2 patients and 6 patients
underwent PPV for MH repair. Ten of 24 (42%) patients presented
with changes in the outer bands (external limiting membrane and/
or IS/OS lines) on SD-OCT after ocriplasmin injection. In 7 of 10
(70%) of these patients, VMT release was noted on OCT by day 30
post-injection compared to 4 of 12 (33%) patients without outer band
changes post-IVO. Normalization of the outer band reflectivity was
achieved in all cases by the end of follow-up. Mean visual acuity
(VA) improved from 0.50 logMar at baseline to 0.37 logMar at the
last-follow-up visit. In patients with decreased outer band reflectivity,
mean VA improved from 0.45 logMar to 0.23 logMar at the last
follow-up.
No complications were observed during the injection procedure.
Common referred symptoms post IVO were floaters in 12/24 patients,
distortion (6/24) and flashes in 5/24. Dyschromatopsia was reported
by 2 patients at day 1 post IVO, symptoms improved within 3 weeks.
No retinal tears, detachment or endophthalmitis were found after
IVO.
Conclusions: In this case series of VMT/MH patients treated with
ocriplasmin, changes in the SD-OCT outer retina reflectivity was
relatively common. Within weeks the outer retinal reflectivity
improved, as did the visual acuity. Further studies to investigate the
association between outer band reflectivity changes with the use of
IVO and long-term visual acuity are warranted.
Commercial Relationships: Nathan C. Steinle, None; Carlos
Quezada, None; Ma Nasir, None; Dante J. Pieramici, None;
Alessandro Castellarin, None; Robert F. See, None; Stephen
Couvillion, None; Dilsher Dhoot, None; Melvin Rabena, None;
Robert L. Avery, None
Program Number: 297 Poster Board Number: B0275
Presentation Time: 8:30 AM–10:15 AM
Photoreceptor outer segment length and outer foveal thickness as
predictive factors associated with visual outcome after vitrectomy
for vitreomacular traction syndrome
Yusuke Ichiyama, Hajime Kawamura, Masato Fujikawa, Osamu
Sawada, Yoshitsugu Saishin, Masahito Ohji. ophthalmology, Shiga
University of Medical Science, Otsu, Japan.
Purpose: To investigate the predictive factors for postoperative
BCVA in patients with vitreomacular traction (VMT) syndrome
treated with vitrectomy.
Methods: Twelve eyes of 12 patients that underwent vitrectomy
for VMT syndrome and followed for at least 12 months were
retrospectively reviewed. A standard three-port 23 or 25 gauge pars
plana vitrectomy with the internal limiting membrane (ILM) peeling
was performed. Phacoemulsification and aspiration with intraocular
lens implantation was performed simultaneously in phakic eyes.
We assessed the associations among postoperative best-corrected
visual acuity (BCVA) at 12 months after the surgery and preoperative
parameters including BCVA, age, central foveal thickness (CFT : the
distance between ILM and retinal pigment epithelium [RPE] at the
foveal center), outer foveal thickness (OFT : the distance between
external limiting membrane [ELM] and RPE at the foveal center),
photoreceptor outer segment length (PROS length : the distance
between IS/OS junction and RPE at the foveal center).
©2014, 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 2014 Annual Meeting Abstracts
Results: Seven eyes (58%) were phakic and 5 (42%) were
pseudophakic preoperatively, with males accounting for 3 cases. The
mean patient age at the vitrectomy was 68.6 ± 9.8 years. The mean
logarithm of minimum angle of resolution (logMAR) BCVA was
0.42 ± 0.34 at baseline and statistically significantly improved to 0.19
± 0.24 at 12 months after surgery (P=0.023). Preoperative BCVA,
OFT and PROS length were significantly correlated with BCVA at
12 months after the surgery (BCVA: P = 0.032, r = 0.619, OFT: P =
0.001, r = -0.840, PROS: P = 0.002, r = -0.790, respectively). Age,
axial length and CFT were not significantly correlated with VA after
the surgery (Age: P = 0.331, r = -0.307, axial length: P = 0.091, r =
0.533, CFT: P = 0.545, r = -0.194).
Conclusions: Preoperative BCVA, OFT and PROS length could be
good predictive factors of postoperative BCVA in patients with VMT
syndrome.
Commercial Relationships: Yusuke Ichiyama, None; Hajime
Kawamura, None; Masato Fujikawa, None; Osamu Sawada,
None; Yoshitsugu Saishin, None; Masahito Ohji, None
Program Number: 298 Poster Board Number: B0276
Presentation Time: 8:30 AM–10:15 AM
Predictors of Success with Intravitreal Ocriplasmin in the
Treatment of Symptomatic Vitreomacular Adhesion
Daniel B. Roth, Henry L. Feng, Kunjal K. Modi, Howard F. Fine,
Harold M. Wheatley. Ophthalmology, Robert Wood Johnson Med
School, New Brunswick, NJ.
Purpose: Ocriplasmin is a proteolytic enzyme that is approved for
the treatment of symptomatic vitreomacular adhesion (VMA). Our
study investigates the characteristics of our initial series of eyes
treated with intravitreal ocriplasmin in order to determine predictors
of success with this pharmacologic agent.
Methods: Retrospective review of 62 eyes with symptomatic VMA
associated with vision loss and anatomic distortion of the macula.
Each eye was treated with a single pars plana injection of ocriplasmin
(125mcg in 0.1cc) then assessed at 1 week and 1 month with OCT.
Associated conditions included macular hole (MH), cystoid macular
edema (CME), myopic schisis, epiretinal membrane (ERM), dry
AMD, and diabetic macular edema (DME).
Results: Ocriplasmin induced VMA resolution in 41% of all cases.
26% experienced VMA release if other macular disease was also
present vs. 59% if no other disease present (p=0.01), and successful
in only 20% of eyes with ERM, 12.5% with dry AMD, and 20% with
DME. Patients ≤age 75 were 3.2 times more likely to achieve VMA
release (p=0.004). 51% released if VMA diameter was <750μm vs.
14% if diameter ≥750μm (p=0.002), and for every additional 100μm
there was a 20% increased likelihood of VMA not releasing. VMA
release occurred in 23% of pseudophakic eyes vs. 51% in phakic
eyes (p=0.02). VMA release occurred in 69% of eyes with MH vs.
16% of non-MH eyes (p<0.001). However, 40% of MH eyes required
surgical closure despite VMA release. Nonsurgical MH closure
was associated with better pre-injection VA (p=0.014). Mean VMA
diameter was smaller in MH eyes that closed pharmacologically
(341μm vs. 723μm). Closure was not associated with MH diameter,
but most eyes in this cohort had smaller MHs. Factors that did not
predict VMA release included photopsia, dyschromatopsia, subjective
visual loss, pre-treatment VA, decreased VA at one week, presence of
DM, presence of CME, and prior treatments.
Conclusions: Ocriplasmin may effectively accomplish vitreomacular
separation in eyes that have pathology associated with vitreomacular
traction. Features that may predict success include younger age,
smaller VMA diameter, phakia, and absence of other macular
pathology. In addition, better pre-injection VA and smaller VMA
diameter may predict nonsurgical MH closure. Proper case
selection is imperative for optimizing success in the pharmacologic
management of symptomatic VMA with ocriplasmin.
Commercial Relationships: Daniel B. Roth, Bayer (C), Forsight
Labs (C), Ohr (C), Regeneron (C), Thrombogenics (C); Henry L.
Feng, None; Kunjal K. Modi, None; Howard F. Fine, Allergan (C),
Auris Surgical Robotics (C), Genentech (C), Regeneron (C); Harold
M. Wheatley, None
Support: Thrombogenics Unrestricted Educational Grant
Program Number: 299 Poster Board Number: B0277
Presentation Time: 8:30 AM–10:15 AM
Jetrea (ocriplasmin) as a treatment option for symptomatic
vitreomacular traction with or without macular hole (<400 mm) first clinical experience
Mathias M. Maier, Sophia Bonse, Christiane Frank, Nikolaus
Feucht, Chris Lohmann. Ophthalmology, Klinikum Rechts der Isar,
Augenklinik, TUM, Munich, Germany.
Purpose: To evaluate the resolution rate after therapy with
intravitreal Jetrea (ocriplasmin) in patients with symptomatic
vitreomacular traction (<1500 mm) with or without macular hole
(<400 mm) in a clinical setting.
Methods: Until now we prospectively examined 14 eyes of 14
patients with symptomatic vitreomacular traction with or without
macular hole who underwent intravitreal injection of 0,1ml Jetrea.
Visual acuity and SD-OCT ultrastructural parameters were measured
before injection. Resolution of the vitreomacular traction, visual
acuity and SD-OCT ultrastructural parameters were evaluated again
one month after treatment in preliminary 8 of 14 treated eyes as a
temporary outcome in the ongoing assessment.
Results: Vitreomacular traction resolved in 6 of the 8 injected
and yet evaluated eyes. 2 of them showed full-thickness macular
hole afterwards. 2 eyes initially presented macular holes which
both closed. Best corrected visual acuity was 0.46±0.28 Log MAR
at baseline, improving to 0.36±0.21 Log MAR at 1 month after
injection. Foveal thickness was 354,87±59,9 mm at baseline, reducing
to 294±66,6 mm at 1 month.
Conclusions: In the ongoing study, there was yet a large percentage
of resolution of vitreomacular traction and closure of macular
holes after injection of Jetrea. This was further associated by an
improvement of visual acuity and reduction of foveal thickness.
Commercial Relationships: Mathias M. Maier, None; Sophia
Bonse, None; Christiane Frank, None; Nikolaus Feucht, None;
Chris Lohmann, None
Program Number: 300 Poster Board Number: B0278
Presentation Time: 8:30 AM–10:15 AM
Pneumatic Maculopexy: A Novel Approach for Treatment of
Symptomatic Vitreomacular Traction
Calvin E. Mein1, 2, Clement K. Chan3, 4. 1Ophthalmology, Retinal
Consultants of San Antonio, San Antonio, TX; 2Ophthalmology,
University of Texas Health Science Center, San Antonio, TX;
3
Ophthalmology, Southern California Desert Retina Consultants,
Palm Desert, CA; 4Ophthalmology, Loma Linda University, Loma
Linda, CA.
Purpose: To demonstrate the efficacy of intraocular gas injection
and limited face-down positioning for treatment of symptomatic
vitreomacular traction(VMT)
Methods: A retrospective case review was conducted on 9 eyes with
vitreomacular traction syndrome treated with intraocular gas injection
and limited face down positioning. All eyes were treated with inoffice injection of 0.3 to 0.4ml of C3F8 gas and instructed to position
face down part time for at least one or two days.
©2014, 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 2014 Annual Meeting Abstracts
Results: Nine cases were reviewed. All eyes had VMT. One eye had
a Stage 2 macular hole.
Five eyes with vitreomacular traction alone and no macular hole had
complete release of the VMT within one month after intraocular gas
injection alone.
One eye with a Stage 2 macular hole was treated with 0.3 ml of C8F8
and limited face down position. Complete closure of the macular hole
was achieved by week four.
One eye with broad VMT was treated with ocriplasmin with
incomplete release of the VMT. Intraocular gas injection of 0.3ml of
C3F8 resulted in release of the central VMT.
One eye with VMT initially treated with ocriplasmin developed a
full thickness macular hole within 24 hours. Injection of 0.3 ml of
C8F8 gas and face down positioning resulted in complete closure of
the macular hole within four days.
One eye with VMT was initially treated with Ocriplasmin but the
VMT did not resolve. An intraocular gas injection was performed.
The patient developed a retinal detachment that was successfully
repaired with vitrectomy and gas tamponade.
Conclusions: Intraocular gas injection alone in the office setting
followed by limited face-down positioning appears to be a viable
novel alternative for treatment of symptomatic VMT.
Commercial Relationships: Calvin E. Mein, Acucela (F), National
Eye Institute (F), Quark (F), Regeneron (I), Roche Genentec (R),
Thrombogenics (F); Clement K. Chan, Acucela (F), Allergan (R),
National Eye Institute (F), Regeneron (F), Roche-Genentec (F),
Thrombogenics (R), Valeant (R)
Program Number: 301 Poster Board Number: B0279
Presentation Time: 8:30 AM–10:15 AM
Ocriplasmin for Vitreomacular Adhesion: Aftermarket
Experience and Findings
Eric Nudleman, Alan J. Ruby, Jeremy Wolfe. Ophthalmology &
Visual Sciences, William Beaumont Hospital, Royal Oak, MI.
Purpose: We aimed to identify morphologic criteria to help select
appropriate patients for treatment with Ocriplasmin and describe the
morphologic changes after VMA release.
Methods: This is a retrospective review of patients treated with
Ocriplasmin for symptomatic VMA at a single center between
February 2013 and September 2013. The primary end point was
release of VMA at one month post-injection. Additional endpoints
included VMA release by adhesion size, presence of subretinal fluid
(SRF) after release of adhesion, size of SRF at 1 week and 1 month,
outer retinal structural change, visual acuity, and closure of macular
hole.
Results: Thirty seven patients met inclusion criteria. Twenty seven
eyes had symptomatic VMA and 10 eyes had stage 2-3 macular holes.
Sixteen eyes (43%) had complete separation at 1 month. Ten eyes
had macular holes at presentation, of which 9 eyes (90%) separated
and seven eyes (70%) had closure at 1 month. Epiretinal membrane
was present in 2 of 16 eyes (12.5%) that separated, and 10 of 21 eyes
(48%) that failed to separate. Average adhesion size was 277 μm (55
μm – 668 μm) in eyes with separation and 657 μm (288 μm - 2994
μm) in eyes that failed. An average vision improvement of -0.19
logMAR was seen in patients that separated, whereas an average
vision change of +0.016 logMAR was seen in patients that did not
separate. SRF was present following separation in 11 eyes (69%), and
persisted through 1 month in 9 eyes (56%). Between 1 week and 1
month follow-up, the average SRF height decreased by 54% and the
average SRF basal diameter decreased by 56%. Changes in the IS/OS
junction were present in 20 eyes (54%) at 1 week, 15 eyes (40%) at 1
month, and 6 eyes (16%) at last follow-up. The IS/OS changes were
equal in eyes that separated and did not separate.
Conclusions: Separation of VMA following treatment with
Ocriplasmin occurred in 43% of treated eyes. The rate of separation
was increased in patients with smaller adhesions without an epiretinal
membrane. SRF was present in the majority of patients following
separation, but it was reduced by half at 1 month follow-up. Changes
in IS/OS junction following treatment were seen in roughly half of
patients, but these changes resolved in most patients at final followup.
Commercial Relationships: Eric Nudleman, Thrombogenics (F);
Alan J. Ruby, Thrombogenics (F); Jeremy Wolfe, Thrombogenics
(F)
Support: Thrombogenics Grant Support
Program Number: 302 Poster Board Number: B0280
Presentation Time: 8:30 AM–10:15 AM
Analysis of Anatomic and Visual Acuity Outcomes Following
Ocriplasmin Therapy in Symptomatic Vitreomacular Adhesion
(VMA) Patients
Robert Park. Carolina Ophthalmology PA, Asheville, NC.
Purpose: In the combined phase 3 clinical trials to assess safety and
efficacy of ocriplasmin intravitreal injection (TG-MV-006 and TGMV-007), 26.5% of ocriplasmin-treated patients achieved the study’s
primary end point, which was pharmacologic resolution of VMA.
Some post-marketing case series have reported higher efficacy rates,
highlighting the importance of proper patient selection. This study
tracked overall rates of VMA resolution and associated anatomic and
visual acuity outcomes in patients treated with ocriplasmin.
Methods: This was a retrospective efficacy and safety study in which
patients with OCT-confirmed VMA and associated symptomatology
were administered a single intravitreal injection of ocriplasmin.
Baseline patient and ocular characteristics were recorded for future
post-hoc analysis and included age, sex, lens status, visual acuity
(VA), symptoms, presence of epiretinal membrane, size of adhesion,
presence and size of macular hole (MH), and central retinal thickness.
In patients without baseline MH, we evaluated the rate of VMA
resolution up to the last day of follow-up. In patients with baseline
MH, VMA resolution and FTMH closure were evaluated.
Results: Twenty patients were treated: the rate of VMA resolution
in patients without baseline MH was 42% (5/12), and the MH
closure rate was 38% (3/8). Average age for patients with VMA
resolution was 80.2 years, average greatest linear dimension (GLD)
was 145 mm, average duration of symptoms was 4.5 months, and
average improvement in VA was 2 lines. For patients without VMA
resolution, averages were 77.8 years, GLD was 218 mm, duration of
symptoms 3.3 months, and VA improvement was 0.33. For patients
with MH at baseline and with hole closure, average age was 71.7
years, average linear dimension of base of hole was 93 mm, average
duration of symptoms was 0.92 months, and average improvement
in VA was 2.3-lines. Averages for patients without hole closure were
70.1 years, linear dimension of base of hole was 153 mm, symptoms
for 2.7 months, and decrease in VA of 0.25. Additional analysis is
ongoing and will be presented.
Conclusions: Treatment with a single intravitreal injection of
ocriplasmin was effective in symptomatic VMA patients with or
without FTMH at baseline, and results from this study will help
inform physicians and patients on what to expect after treatment with
ocriplasmin.
Commercial Relationships: Robert Park, ThromboGenics, Inc. (C)
©2014, 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 2014 Annual Meeting Abstracts
Program Number: 303 Poster Board Number: B0281
Presentation Time: 8:30 AM–10:15 AM
Does macular hole size affect visual outcome?
Linda H. Kemp1, Paul Flavahan1, David Yorston1, 2. 1Ophthalmology,
Gartnavel General Hospital, Glasgow, United Kingdom;
2
Ophthalmology, Tennent Institute, Glasgow, United Kingdom.
Purpose: Studies of prognostic factors in macular hole surgery
showed smaller hole size, better pre-operative vision, shorter
duration, younger age, and earlier stage macular holes are all
associated with better anatomical and visual outcomes. A recent study
of 50 eyes found base diameter is the best predictor of anatomical
and visual outcome. However, many studies are confounded by
different anatomical outcomes. We performed this study to determine
if these factors were useful predictors of final vision in eyes that have
successful hole closure.
Methods: All eyes were examined with the Heidelberg Spectralis
OCT. Minimum hole diameter, basal hole diameter and hole height
were measured in accordance with published definitions. All patients
who were not already pseudophakic had combined cataract surgery
and vitrectomy. Following vitrectomy, the ILM was peeled, and
the eye filled with C3F8 or C2F6 gas. Patients postured face down
overnight following surgery, but no further posturing was required.
Visual success was defined as a corrected vision of 6/12 or better.
133 eyes were included. 130 (97.7%) holes were closed with one
operation. Only the 130 anatomical successes were included in
analysis of visual outcomes. 65 (50%) eyes achieved a vision of 6/12
or better.
Results: Patient age, pre-operative visual acuity, minimum hole
diameter, basal hole diameter, and hole height were all entered into
a logistic regression model. Only pre-operative vision (p<0.0001)
and basal diameter (p=0.045) were associated with visual outcome.
The pre-op vision and basal diameter were used to rank eyes by
probability of visual success, and a receiver operating characteristics
curve was plotted. The area under the curve was 0.75, indicating
good agreement.
Conclusions: Previous studies have shown that anatomical closure is
linked to hole diameter. As hole closure is linked to final vision, it can
be a confounding factor. Since anatomical success rates of macular
hole surgery are approaching 100%, it is useful to identify which
factors will predict final visual acuity assuming anatomical closure.
We found that pre-operative visual acuity was the most important
predictor of final vision, and that hole size was less helpful. This may
be explained if hole size is primarily a predictor of hole closure, and
of secondary importance in predicting final vision.
Receiver operating characteristics curve for vision 6/12 or better.
Area under curve=0.75
Commercial Relationships: Linda H. Kemp, None; Paul
Flavahan, None; David Yorston, None
Program Number: 304 Poster Board Number: B0282
Presentation Time: 8:30 AM–10:15 AM
Post-operative restoration of macular microstructure: visual &
anatomic outcomes of macular hole surgery at the New York Eye
and Ear Infirmary
Julia Mathew Padiyedathu, Anna Gabrielian. Ophthalmology, New
York Eye and Ear Infirmary, New York, NY.
Purpose: The evaluation of anatomic and visual outcomes in macular
hole cases treated surgically at the New York Eye and Ear Infirmary
from 2006 to 2012.
Methods: 33 eyes of 30 patients with the diagnosis of non-traumatic
macular hole that underwent pars plana vitrectomy (PPV), membrane
peel, gas/silicone oil tamponade, with at least 6 months of followup were included in this retrospective study. Pre- and postoperative
macular assessment was conducted with spectral-domain optical
coherence tomography (OCT). Sub-group analysis was performed on
post-operative microstructural anatomy and its association with postoperative visual outcomes.
Results: The mean age was 62.7 years and 25 patients (83%) were
female. All patients underwent PPV with internal limiting membrane
peel, 31 eyes (96%) had intraocular gas tamponade, and 2 eyes (6%)
underwent silicone oil tamponade. Vision improved in 23 eyes (70%),
stayed the same in 6 eyes (18%), and became worse in 4 eyes (12%).
The mean improvement in BCVA was 0.4 logMAR units. There
was successful closure of macular holes in 27 eyes (82%). In 6 eyes
(18%) the macular holes remained open. Fifty percent of the holes
that remained open were in eyes undergoing reoperation. For the
microstructural outcome sub-analysis, 9 of 33 eyes were excluded
due to lack of data or lack of MH closure. Of the remaining 24 eyes,
17 eyes (71%) had successful restoration of the IS/OS junction, with
a mean post-op BCVA of 0.4 logMAR units (mean improvement in
BCVA of 0.3 logMAR units). In 7 eyes (29%), the IS/OS junction
was absent, abnormal, or defective, with a mean post-op BCVA of 0.6
logMAR units (mean improvement of BCVA of 0.8 logMAR units).
Conclusions: Surgical repair of macular holes leads to an
improvement of vision in the majority of cases. Closure of macular
holes is achieved after vitrectomy. Prior unsuccessful surgical repair
©2014, 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 2014 Annual Meeting Abstracts
of macular hole is associated with failure to achieve macular hole
closure. Successful restoration of microstructural retinal architecture
is associated with improved visual acuity.
Commercial Relationships: Julia Mathew Padiyedathu, None;
Anna Gabrielian, None
Program Number: 305 Poster Board Number: B0283
Presentation Time: 8:30 AM–10:15 AM
Long-term Clinical Outcomes with Ocriplasmin: The OASIS
Study – Baseline Demographics and Ocular Characteristics
Michael Tolentino. 1Reseach, CRMD, Winter Haven, FL;
2
Ophthalmology, University of Central Florida, Orlando, FL.
Purpose: To present the demographics and baseline ocular
characteristics of subjects enrolled in the OASIS study.
Methods: The OASIS study is an ongoing study evaluating the
long-term efficacy and safety of a single intravitreal injection of
ocriplasmin 0.125mg compared to sham treatment in subjects with
symptomatic vitreomacular adhesion/vitreomacular traction (VMT)
including macular hole with no epiretinal membranes (ERM) at
baseline. This Phase 3b, 24-months study is randomized, doublemasked and multicenter with optional cross-over treatment. Selected
sites participated in full-field ERG (ffERG) and microperimetry
(MP1) sub-studies.
Results: Overall two hundred and twenty subjects were enrolled at
25 retina centers in the United States between November 2011 and
November 2012: 131 subjects in the main study, 62 in the ffERG
sub-study and 27 in the MP-1 sub-study. The mean age of subjects
was 69.1 years (SD: 10.29). The majority of the subjects were female
(67.3%), White (89.5%) and non-Hispanic (92.7%). Masked data
at Baseline showed, the mean BCVA was 63.2 (SD: 9.65) ETDRS
letters(20/63 Snellen). Metamorphopsia was present in 171 subjects
(77.7%) (95% CI: 72.2; 83.2) on Amsler grid. Macular hole was
diagnosed in 76 subjects (34.5%). All 220 subjects had VMA and
partial PVD on SD-OCT.
Conclusions: The present report describes the baseline demographics
and ocular characteristics of subjects enrolled in the OASIS study,
which is designed to provide long-term efficacy and safety data in
subjects with symptomatic vitreomacular adhesion/VMT including
macular hole and excluding ERM.
Commercial Relationships: Michael Tolentino, Thrombogenics
(C), Thrombogenics (F), Thrombogenics (R)
Support: Thrombogenics Research Grant
Clinical Trial: NCT01429441
Program Number: 306 Poster Board Number: B0284
Presentation Time: 8:30 AM–10:15 AM
Spectral-Domain Optical Coherence Tomography Features and
Prediposing to Macular Hole Developement
Rodrigo Abreu1, Lorena Sole1, Marta Marmol2, Jeroni Nadal2.
1
Ophthalmology, University Hospital of La Candelaria, Santa Cruz
de Tenerife, Spain; 2Ophthalmology, Barraquer Institute, Barcelona,
Spain.
Purpose: To investigate the clinical and spectral-domain optical
coherence tomographic features of patients with macular hole
(MH) compared to normal eyes (NE) subjects and the possible
optical coherence tomography predisposing factors for the MH
developement.
Methods: Retrospective electronic health record based study.
Clinical and tomographic features of patients with MH and
NE patients were collected. All patients underwent complete
ophthalmologic examination including best-corrected visual acuity,
slit-lamp biomicroscopy, fundus photography, and spectral domain
optical coherence tomography. The features of the retina and the
vitreomacular interface were graded based on spectral domain optical
coherence tomography thickness. In both groups a tomographic study
was performed using 512 x 128 Macular Cube protocol Cirrus-HD
OCT (Carl Zeiss Meditec, Dublin, CA).
Results: A total of 202 eyes from 202 patients (100 NE and 102 MH)
were analyzed. There were no statistically significant differences in
the mean age of both groups (60.86 ± 14.01 Healthy / 62.29 ± 13.62
AM), or gender distribution . MH stage III (30.4%) and MH stage IV
(52.9 %) had a higher representation in the sample (79.4 %). Time
of MH diagnosis was over a month in 74.5% of the patients. Mean
foveal thickness and inner ring perifoveal thickness were significantly
higher in men compared to women (p < 0.05 ) in the NE group,
however these differences were not statistically significant in the
MH group ( p > 0.05). Volume, average thickness of the cube, nasal
sectors and upper inner sector of the OCT study decreased with age,
statistically significant only in women ( p < 0.05) in the NE group.
Women had lower retinal thickness in all sectors of the outer ring in
the OCT in the MH group compared to the NE group.
Conclusions: These findings suggest that the retina thinning is
being produced with age in healthy women and this retina thinning
is maintained in women who develop MH. As women have more
thinned retinas, they have lower resistance to vitreomacular traction
compared to men who have thicker retinas. These data could stablish
a new hypothesis to explain the higher incidence of MH in women
compared to men.
Commercial Relationships: Rodrigo Abreu, None; Lorena Sole,
None; Marta Marmol, None; Jeroni Nadal, None
Program Number: 307 Poster Board Number: B0285
Presentation Time: 8:30 AM–10:15 AM
Three-Dimensional Enhanced Imaging of the Vitreoretinal
Interface in Eyes with Diabetic Retinopathy Using Swept-Source
Optical Coherence Tomography
Mehreen Adhi1, Jonathan J. Liu2, Martin F. Kraus3, Ireneusz
Grulkowski2, Andre J. Witkin1, Caroline R. Baumal1, Joachim
Hornegger3, James G. Fujimoto2, Jay S. Duker1, Nadia K. Waheed1.
1
Ophthalmology, New England Eye Center, Tufts University School
of Medicine, Boston, MA; 2Research Laboratory of Electronics,
Massachusetts Institute of Technology, Cambridge, MA; 3Pattern
Recognition Lab and Graduate School in Advanced Optical
Technologies, University of Erlangen-Nuremburg, Erlangen,
Germany.
Purpose: To demonstrate in-vivo three-dimensional enhanced
imaging of the posterior vitreous and the vitreoretinal interface in
eyes with diabetic retinopathy using a long-wavelength swept-source
optical coherence tomography (SS-OCT) prototype.
Methods: Thirteen patients with diabetes (21 eyes) with or without
clinical evidence of diabetic retinopathy as determined by a complete
ophthalmic examination performed by a retina specialist, were
prospectively recruited for imaging on a prototype long-wavelength
(1050nm) SS-OCT system with 6mm resolution and 3.6mm imaging
range. Up to eight orthogonally scanned three-dimensional SS-OCT
volumes consisting of 500x500 axial scans were acquired for each
eye over a 12x12mm region (~40 degrees) of the retina. A registration
algorithm was applied to remove motion artifacts and merge multiple
volumes to improve signal. Visualization of the posterior vitreous and
the vitreoretinal interface was enhanced using a high dynamic range
(HDR) method.
Results: Of the 21 eyes, 15 eyes had clinical features suggestive of
diabetic retinopathy, while 6 eyes had no clinical evidence of diabetic
retinopathy. Of the 15 eyes that had diabetic retinopathy, 6 eyes
had non-proliferative diabetic retinopathy, 5 eyes had proliferative
diabetic retinopathy and 4 eyes had diabetic macular edema.
©2014, 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 2014 Annual Meeting Abstracts
Enhancement of the posterior vitreous and the vitreoretinal interface
using the HDR method showed hyaloid detachment near the optic
disk in 19 of 21 eyes (90%) and hyaloid detachment elsewhere in 18
of 21 eyes (86%). Of the 15 eyes with clinical evidence of diabetic
retinopathy, the detached hyaloid appeared thickened in 6 of 15
eyes (40%) when compared to eyes without diabetic retinopathy.
Vitreoschisis was observed in 8 of 15 eyes (53%), fibrovascular
adhesions between the detached hyaloid and retina were seen in 7 of
15 eyes (47%) and vitreous aggregations/clumps were visible in 9 of
15 eyes (60%) with diabetic retinopathy.
Conclusions: SS-OCT with registration followed by application of
the HDR method provides wide-field three-dimentional information
of the posterior vitreous and the vitreoretinal interface in eyes with
diabetic retinopathy. A detailed observation of these features may be
useful in assessing the progression of diabetic retinopathy, planning
diabetic vitreous surgery and predicting treatment outcomes.
Commercial Relationships: Mehreen Adhi, None; Jonathan
J. Liu, None; Martin F. Kraus, Optovue Inc (F); Ireneusz
Grulkowski, None; Andre J. Witkin, None; Caroline R. Baumal,
None; Joachim Hornegger, Optovue Inc (F); James G. Fujimoto,
Carl Zeiss Meditech, Inc (F), Optovue, Inc (F); Jay S. Duker, Carl
Zeiss Meditech, Inc (F), Optovue, Inc (F); Nadia K. Waheed, None
Support: This work was supported in part by a Research to
Prevent Blindness Unrestricted grant to the New England Eye
Center/Department of Ophthalmology, Tufts University School of
Medicine, NIH contracts R01-EY11289-27, R01-EY13178-12, R01EY013516-09, R01-EY018184-05, Air Force Office of Scientific
Research FA9550-10-1-0551, FA9550-10-1-0063 and FA9550-12-10499 and the Massachusetts Lions Club.
Program Number: 308 Poster Board Number: B0286
Presentation Time: 8:30 AM–10:15 AM
Complications of Intravitreal Ocriplasmin in the Treatment of
Symptomatic Vitreomacular Adhesion
Henry L. Feng, Daniel B. Roth, Kunjal K. Modi, Howard F. Fine,
Harold M. Wheatley. Robert Wood Johnson Medical School,
Piscataway, NJ.
Purpose: Ocriplasmin is a proteolytic enzyme approved for treatment
of symptomatic vitreomacular adhesion (VMA). Our study evaluates
the features of our initial series of eyes treated with intravitreal
ocriplasmin in order to determine potential complications with this
agent.
Methods: Retrospective review of 62 eyes with symptomatic VMA
associated with vision loss and anatomic macular distortion. Each
eye was treated with a pars plana injection of ocriplasmin (125mcg in
0.1cc) and assessed at 1 week and 1 month post-injection using OCT,
with added follow-up in complicated cases. Associated conditions
included macular hole (MH), cystoid macular edema, diabetic
macular edema, myopic schisis, epiretinal membrane, and dry AMD.
Results: Initial enlargement in MH width after injection occurred
in 54% of MH eyes. 100% of eyes with MH enlargement required
surgical MH closure vs. 27% in those without MH enlargement
(p=0.001). In MH-enlarged eyes, best visual acuity (VA) attained
within 8 months post-surgery was significantly lower than that
attained by non-MH-enlarged eyes within 8 months post-injection
(p=0.001, mean VA 20/112 vs. 20/34). MH enlargement was not
associated with differences in age, pre-injection VA, VMA width,
or MH width (p=0.82, 0.43, 0.21, 0.69). Subretinal fluid (SRF)
developed after injection in 37% of eyes without initial SRF. In this
subset, SRF resolved surgically in 35% and spontaneously in 35%,
but 30% remained unresolved over a mean follow-up of 5 months.
Eyes with spontaneous SRF resolution resolved over a range of
1 to 4 months with a mean of 2 months. However, there was no
difference between SRF eyes and non-SRF eyes in VA at 1 week
(p=0.11) or best VA over 8 months follow-up (p=0.24). No eyes in
our series experienced new ellipsoid layer disruption. Subjective
visual worsening was reported during the initial 2 days after injection
in 43% of eyes, with objective VA decline in 20% and 33% at 1
week and 6 weeks, respectively. Photopsia and dyschromatopsia was
reported in 48% and 15% of eyes, respectively.
Conclusions: Ocriplasmin may effectively achieve vitreomacular
separation in eyes with symptomatic VMA. However, MH
enlargement and SRF development may increase the likelihood
of requiring surgical intervention and negatively impact VA. An
understanding of potential complications and appropriate patient
expectations are vital in the management of symptomatic VMA with
ocriplasmin.
Commercial Relationships: Henry L. Feng, None; Daniel B.
Roth, Bayer (C), Forsight Labs (C), Ohr (C), Regeneron (C),
Thrombogenics (C); Kunjal K. Modi, None; Howard F. Fine,
Allergan (C), Auris Surgical Robotics (C), Genentech (C), Regeneron
(C); Harold M. Wheatley, None
Support: Thrombogenics Unrestricted Educational Grant
Program Number: 309 Poster Board Number: B0287
Presentation Time: 8:30 AM–10:15 AM
A RETROSPECTIVE COHORT STUDY IN PATIENTS WITH
DISEASES OF THE VITREOMACULAR INTERFACE
(ReCoViT)
Peter Stalmans1, Benedicte Lescrauwaet2, Koenraad Blot2.
1
Department of Ophthalmology, Universitaire Ziekenhuizen Leuven,
Leuven, Belgium; 2Xintera Ltd., London, United Kingdom.
Purpose: Data on vitreomacular (VM) pathology are scarce. The
purpose of this study was to characterize OCT-based ocular features
present in patients diagnosed with diseases of the VM interface:
vitreomacular adhesion (VMA), vitreomacular traction (VMT) and
macular hole (MH), associated symptomatology, and rates over time
of interventions and of spontaneous resolution.
Methods: Retrospective, single-center, observational study. The
cohort included patients from a large tertiary care ophthalmology
center in Flanders, who had at least 1 outpatient visit between
July 2009 and August 2013, when only watchful waiting and
vitrectomy were available as treatment options, before the era of
pharmacological vitreolysis. Patients were enrolled with OCT
findings related to disorders of the VM interface, with or without
visual symptoms. Patients diagnosed with concurrent retinal disorders
influencing visual acuity and patients with isolated epiretinal
membrane were excluded. Survival curves were performed for timeto-event analysis. Results focus on eyes with baseline VM interface
pathology and with at least one follow-up visit.
Results: The total cohort included 687 eyes from 500 patients, of
which 557 eyes from 401 patients had at least one follow-up visit
(analysis population). The majority of eyes presented with MH
without VMT (236/557, 42.4%), or VMT alone (223/557, 40.0%). Of
the patients with at least one follow-up, 23.9% of VMT eyes had a
vitrectomy performed within 1 year of diagnosis, and the chances of
spontaneous resolution within 1 year were 21.5%. In eyes followed
for MH with VMT at baseline, progression to MH without VMT
occurred in 17.4% within 1 year. Metamorphopsia was the reason for
referral in 22.3% of patients with VMT, and in 60.9% of patients with
MH with VMT. A high proportion of the 401 patients (38.9%) also
had VM pathology in the fellow eye.
Conclusions: Metamorphopsia was a hallmark symptom of
vitreomacular pathology, and the prevalence of metamorphopsia in
eyes with diseases of the VM interface may be highly underestimated.
Frequently disease of the VM interface is found bilaterally. In eyes
©2014, 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 2014 Annual Meeting Abstracts
with VMT and VMT+MH, rates of spontaneous resolution within
1 year were small, and a significant number required vitrectomy.
A watchful waiting approach in these eyes may delay treatment
intervention and increase the risk of disease progression.
Commercial Relationships: Peter Stalmans, Alcon, Inc. (C),
Bausch & Lomb, Inc. (F), DORC International B.V./Dutch
Ophthalmic USA (R), ThromboGenics NV (F); Benedicte
Lescrauwaet, ThromboGenics NV (C); Koenraad Blot,
ThromboGenics NV (C)
Support: Scientific Sponsorship Agreement from ThromboGenics
NV
Program Number: 310 Poster Board Number: B0288
Presentation Time: 8:30 AM–10:15 AM
Foveal Detachment after Idiopathic Macular Hole Surgery
Ramin Tadayoni, Elise Boulanger-Scemama, Aude Couturier, Rabih
Hage, Pascale Massin, Alain Gaudric. Ophthalmology, Lariboisiere
University Hospital, Paris, France.
Purpose: To determine the incidence and dimensions of foveal
detachment (FD) following idiopathic macular hole (MH) surgery
and to identify its clinical and anatomical risk factors.
Methods: A retrospective analysis was performed on 100 eyes
from 100 consecutive patients who had undergone vitrectomy and
gas tamponade for idiopathic macular hole. We specifically studied
postoperative FD, taking care to distinguish it from outer foveal
defect in photoreceptors lines without actual detachment. The
anatomical features of FD were analyzed on postoperative spectraldomain optical coherence tomography (SD-OCT) and correlated with
morphological and clinical data at baseline, 1 month and 3 months
postoperatively. The size of defect was measured and compared with
preoperative MH base diameter.
Results: A FD was found on postoperative SD-OCT of 18% (12/65)
of eyes at 1 month and only 4% (3/70) of eyes at 3 months after
surgery. The base diameter of the defect at 1 month (371±92 μm)
and 3 months (341±104 μm) postoperatively were always smaller
than the preoperative MH base diameter (766±203 μm). The only
factor significantly associated with persistence of a FD was a higher
preoperative central macular height (P=0.012). Results showed no
statistical difference in postoperative visual acuity between eyes with
and without FD and all cases reattached spontaneously.
Conclusions: This is the first SD-OCT study of post-operative FD
after MH surgery. These FD were rare, especially at 3 months, and
reattached spontaneously. The base diameter of FD was always
smaller than the preoperative MH base diameter, and its presence
was correlated to the macular height, suggesting that these FD are
remnant of the preoperative macular elevation.
Commercial Relationships: Ramin Tadayoni, Alcon (C), Alimera
(C), Allergan (C), Bausch & Lomb (C), Bayer (C), FCI-Zeiss (C),
Novartis (C), Thrombogenics (C); Elise Boulanger-Scemama, None;
Aude Couturier, None; Rabih Hage, None; Pascale Massin, None;
Alain Gaudric, None
Program Number: 311 Poster Board Number: B0289
Presentation Time: 8:30 AM–10:15 AM
MICROSTRUCTURAL MACULAR CHANGES AFTER
INTERNAL LIMITING MEMBRANE PEELING OBSERVED
IN SPECTRAL DOMIAN OPTICAL COHERENCE
TOMOGRAPHY
Mariana Flores, Carla Perez. Hospital Nuestra Señora de la Luz,
Distrito Federal, Mexico.
Purpose: Describe using spectral domain-optical coherence
tomography (SD-OCT), the microstructural changes after internal
limiting membrane (MLI) peeling in the treatment of macular hole.
Methods: Complete ophthalmic examination and SD-OCT
preoperatively and also at 1 month and 3 months postoperatively.
Vitrectomy and gas tamponade were performed with MLI peeling
after staining with brilliant peel.
DESIGN: Prospective, longitudinal, descriptive, case series.
MAIN OUTCOME MEASURES: The integrity of the photoreceptor
inner segment/outer segment (IS/OS) junction, the external limiting
membrane (ELM) on SD-OCT images and the BCVA.
Results: 9 patients with macular hole closed up. In the first month
postoperative BCVA was 0.2 logMAR . Microstructural changes were
found in 100 % of patients. ELM complete restoration in 88.8%, IS/
OS juntion 22.2 % and interdigitation zone in 11.1 % . At 3 months
postoperative BCVA was 0.14. ELM intact in 100%, IS/OS juntion
44.4%, interdigitation zone 33.3 %.
Conclusions: The complete restoration of the ELM and IS/OS
juntion predict potential better visual outcomes in the pacientes of
macular hole closed up.
Commercial Relationships: Mariana Flores, None; Carla Perez,
None
Program Number: 312 Poster Board Number: B0290
Presentation Time: 8:30 AM–10:15 AM
Persistent Macular Holes after Vitrectomy Combined With
Routine Peeling of the Internal Limiting Membrane (ILM)
Lochan Bellamkonda1, Kamal Kishore1, 2. 1Illinois Retina Institute,
Peoria, IL; 2Surgery, University of Illinois College of Medicine
Peoria Campus, Peoria, IL.
Purpose: To investigate predictive factors for persistent macular
holes following vitrectomy, gas and peeling of ILM, and report on the
outcomes following repeat vitrectomy procedure for such eyes.
Methods: A retrospective chart review of 152 eyes of 143
consecutive patients undergoing surgery for idiopathic full-thickness
macular holes between April, 2003 and June, 2013 by a single
surgeon was conducted. Six eyes failed to close after initial surgery.
Patients’ age, hole size, duration of symptoms, lens status, gas
tamponade, preop visual acuity (VA) were analyzed to investigate
predictive factors for persistence. Data were collected on anatomical
and visual outcomes following repeat surgery for these holes. Size
was measured with OCT (81 eyes) or on fundus photos (remaining
eyes). Face-down (FD), or eye-down (ED) positioning for one (SF6)
to two (C3F8) wks was utilized during initial surgery. Repeat surgery,
after a mean of 6 (range 3-10) wks, consisted of ILM peeling over a
wide area, almost to the arcade, and 18% C3F8 tamponade followed
by 2 wks of FD or ED positioning. For ED positioning, patients
were advised to read or perform fine visual task such as watching a
movie gazing at a book or electronic device placed horizontally at or
below their chest level. They were also advised to take 10 minutes
break every hr. Diluted (1:10) triamcinolone acetonide was used to
help visualize ILM during repeat surgery, and most cases of primary
surgery. Two-sample t-test and Fisher Exact test were used for
statistical analysis.
Results: No statistically significant difference was observed between
“Successful” and “Persistent” groups in the parameters studied
(Table). All six persistent holes closed after repeat surgery. After 5-17
(mean 9+/-5) follow up, 3 eyes gained >0.2 logMAR, one eye was
stable, and two eyes suffered decline in >0.2 logMAR (one due to
cataract and other due to dry AMD). Mean gain in VA, and final VA
after repeat surgery were 0.25 and 0.78 (Snellen 20/120) logMAR,
compared to 0.3 and 0.46 (Snellen 20/60) logMAR for “successful”
group, P=0.83, and 0.07.
Conclusions: Success rate for initial surgery was 96%, and
remaining holes closed with repeat surgery. Patients with hole closure
after initial surgery showed a tendency towards better final VA. We
©2014, 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 2014 Annual Meeting Abstracts
were unable to find statistically significant preoperative parameters
between the two groups.
Commercial Relationships: Lochan Bellamkonda, None; Kamal
Kishore, None
Program Number: 313 Poster Board Number: B0291
Presentation Time: 8:30 AM–10:15 AM
Macular Pucker Lowers Contrast Sensitivity which Improves
After Surgery
Justin Nguyen1, Kenneth M. Yee1, 2, Christianne A. Wa1, 2, Alfredo A.
Sadun2, J Sebag1, 2. 1VMR Institute, Huntington Beach, CA; 2Doheny
Eye Institute, Los Angeles, CA.
Purpose: Macular pucker may reduce contrast sensitivity by altering
inner retinal function. Interference with incident light by the detached
posterior vitreous cortex as a result of posterior vitreous detachment
(PVD) and the premacular membrane may further reduce contrast
sensitivity. It is thus hypothesized that patients with macular pucker
will have lower contrast sensitivity compared to controls and that this
will improve following vitrectomy with membrane peeling.
Methods: A total of 23 eyes were studied. B-scan ultrasonography
(Aviso, Quantel, France) was performed in 16 eyes of 8 patients (5
females, 3 males; 71 ± 12 years) with unilateral macular pucker.
Contrast sensitivity was measured prospectively in the 8 eyes of
these 8 patients with clinically significant macular pucker. Findings
were compared to the fellow eyes as well as to 7 eyes of 7 agematched controls (4 females, 3 males; 66 ± 4 years) using Freiburg
acuity contrast testing [Weber index: %W = (Maximum Luminance
– Minimum Luminance) / Maximum Luminance] performed at a
spatial frequency of 5 cpd. The lower the Weber index, the better the
contrast sensitivity. Sutureless 25 Gauge vitrectomy with membrane
peeling was performed without chromodissection in the macular
pucker eyes by one surgeon (JS).
Results: All (8/8; 100%) macular pucker eyes had PVD with a
detached posterior vitreous cortex detected by ultrasound. Average
pre-operative contrast sensitivity in patients with macular pucker was
6.41 ± 2.11 %W, which was significantly worse than age-matched
controls (2.96 ± 1.82 %W; P<0.012), and the fellow eyes (3.55 ±
2.14 %W; P<0.03). Contrast sensitivity improved at 1 week (4.03 ±
1.99 %W; P=0.05) and 1 month (3.63 ± 1.76 %W; P<0.04) postoperatively to levels essentially the same as the normal fellow eyes.
Conclusions: Following PVD, macular pucker and the presence of a
detached posterior vitreous cortex as well as a premacular membrane
are associated with decreased contrast sensitivity when compared
to the fellow eye and age-matched controls. Contrast sensitivity
improves after vitrectomy with membrane peeling, suggesting that
contrast sensitivity may be a useful index of disease severity and the
response to surgical therapy for macular pucker.
Commercial Relationships: Justin Nguyen, None; Kenneth M.
Yee, None; Christianne A. Wa, None; Alfredo A. Sadun, None; J
Sebag, None
Program Number: 314 Poster Board Number: B0292
Presentation Time: 8:30 AM–10:15 AM
An international multi-center investigation of macular holes: the
European Vitreo-Retinal Society Macular Hole Study
Ron A. Adelman1, Barbara Parolini3, Zofia Michalewska2, Didier
Ducournau2. 1Ophthal & Visual Science, Yale Univ Sch of Medicine,
New Haven, CT; 2EVRS, Nanes, France; 3Istituto Clinico S.Anna,
Verona, Italy.
Purpose: To investigate factors associated with outcome of macular
hole repair.
Methods: An international collaborative multi-center nonrandomized clinical study spanning 4 continents. Symptoms, signs,
techniques, dyes, tamponades, post-operative positioning, success
rate and complications were evaluated.
Results: 4207cases of idiopathic macular hole were enrolled by
140 retina specialists from 28 countries. 85.7% of holes closed
following vitrectomy and 59% gained at least 3 lines of visual acuity.
After multivariate regression, predictors for hole closure include
earlier stage, shorter duration of hole and staining (p<0.001). There
was no statistically significant difference among dyes including
ICG, trypan blue, brilliant blue and other dyes. Staining improved
anatomical outcome, but it did not affect visual outcome. There
was no statistically significant difference in success rate among a
variety of tamponades. Factors associated with better visual outcome
include: hole closure, better baseline visual acuity, earlier stage and
shorter duration of hole (p<0.001). 6% of cases had Inverted ILM
flap technique that was associated with good anatomical and visual
outcome. Retinal tear was noted in 3.2% of cases.
Conclusions: Early repair of macular hole was associated with a
better visual outcome. Staining improved anatomical success but not
visual success. There was no statistically significant difference among
©2014, 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 2014 Annual Meeting Abstracts
dyes. Inverted ILM flap technique may be a promising technique for
large macular holes.
Commercial Relationships: Ron A. Adelman, None; Barbara
Parolini, None; Zofia Michalewska, None; Didier Ducournau,
None
Program Number: 315 Poster Board Number: B0293
Presentation Time: 8:30 AM–10:15 AM
The influence of cataract surgery on central choroidea and
vitreomacular interaction
Sandra Rezar, Stefan Sacu, Katharina Eibenberger, Michael
Georgopoulos, Wolf Bühl, Christian Simader, Ursula SchmidtErfurth. Department of Ophthalmology and Optometry, Medical
University of Vienna, Vienna, Austria.
Purpose: To evaluate the influence of cataract surgery on the central
choroidea and vitreomacular interaction using two different OCT
devices.
Methods: We evaluated 33 eyes of 33 patients, 23 patients showing
normal retinal architecture and 10 patients with diagnosis of agerelated macular degeneration (AMD). All patients were scheduled for
cataract surgery. The patients underwent spectral-domain (SpectralisSD-OCT) and swept-source (SS-Topcon DRI) OCT measurements.
6x6mm (20°x20°) volume and 8.9mm line scans with SD-OCT using
the enhanced depth imaging (EDI) mode for the visualization of the
choroid. 6x6mm (512x64) and 12mm scans were performed using
SS-OCT. Measurements were done before cataract surgery, one day,
one week and one month thereafter.
Results: We included 23 patients with normal fundus and mean
age of 66±8.4 years and 10 patients with AMD and mean age
of 76±11.5. Preoperative central choroidal volume (CCV) in
patients with normal fundus was 0.21±0.06/0.20±0.06mm3
(SD/SS-OCT), 0.19±0.05/0.19±0.05mm3 one day after
surgery, 0.19±0.05/0.19±0.05mm3 after one week and
0.20±0.06/0.21±0.07mm3 after one month, respectively (p>0.05). No
significant changes were found regarding CCV after cataract surgery
at each time point (p>0.05). AMD group showed a mean CCV of
0.16±0.05/0.16±0.07mm3 preoperative, 0.16±0.05/0.16±0.07mm3
one day after surgery, 0.16±0.05/0.15±0.05mm3 one week and
0.15±0.05/0.16±0.05mm3 after one months. The CCV was significant
thinner in the patients with AMD (p=0.03), however, no significant
different changes were observed after cataract surgery in this group
and between the two devices (p>0.05). Preoperative, vitreomacular
adhesion (VMA) was observed in 38%, vitreomacular traction
(VMT) in 6%, macular vitreous detachment (MVD) in 13% and
posterior vitreous detachment (PVD) in 41%. After one month VMA
was seen in 33%, VMT in 4%, MVD in 22% and PVD in 41% with
both SS and SD-OCT evaluations being identical.
Conclusions: Successful cataract surgery does not seem to
have an influence on CCV. Spectralis and Topcon devices show
comparable outcomes concerning evaluation of central choroidea and
vitreomacular interaction.
Commercial Relationships: Sandra Rezar, None; Stefan Sacu,
None; Katharina Eibenberger, None; Michael Georgopoulos,
None; Wolf Bühl, None; Christian Simader, None; Ursula
Schmidt-Erfurth, None
Clinical Trial: 1876/2913
Program Number: 316 Poster Board Number: B0294
Presentation Time: 8:30 AM–10:15 AM
Predisposing factors and prognosis of postoperative foveal
detachment following successful macular hole (MH) surgery
Athanasios Vachtsevanos1, 2, Vaggelis Lokovitis1, Solon Asteriades1,
Athanasios Vakalis1, Dimitrios Koreas1, Stavrenia Koukoula1, Tranos
Paris1. 1OPHTHALMICA Eye Clinic, Thessaloniki, Greece; 2Eye
Clinic “O Agios Dimitrios” General Hospital, Thessaloniki, Greece.
Purpose: To identify pre- and intraoperative risk factors that
predispose to outer retinal fluid development following successful
macular hole surgery. The natural course of the foveal detachment
was also investigated.
Methods: Thirty four eyes of 33 patients that underwent pars plana
vitrectomy for idiopathic MH were studied. Best corrected visual
acuity (BCVA), and Spectralis SD-OCT images were examined
preoperatively and at 1, 3, 6 months postoperatively. Patients’
demographic characteristics, stage of macular hole and differentiation
between surgeons regarding surgical technique were also recorded.
Correlation between postoperative foveal detachment and the above
possible explanatory variables were evaluated.
Results: Postoperative presence of outer retinal fluid was observed
in 13/34 (38%) eyes. In 9/13 of those eyes foveal detachment
disappeared by 6 months but one patient developed lamellar hole
leading to full thickness MH 26 months following initial surgery.
Preoperative BCVA was 0.55 ± 0.23 improving to 0.33±0.2 in the
final follow up. Postoperative VA was better in eyes that did not
developed postoperative foveal detachment (0.40 ±0.23 vs 0.32±0.20)
but did not reach statistical significance (p=0.30). Development of
postoperative foveal detachment was associated with preoperative
foveal vitreomacular traction (p=0.048), stage II MH (p=0.017) and
smaller size of the closest distance between the MH edges (p=0.046).
Conclusions: Postoperative foveal detachment is a common
finding following successful MH surgery. Meticulous evaluation
of preoperative clinical and OCT findings may disclose risk factors
associated with this condition.
Commercial Relationships: Athanasios Vachtsevanos, None;
Vaggelis Lokovitis, None; Solon Asteriades, None; Athanasios
Vakalis, None; Dimitrios Koreas, None; Stavrenia Koukoula,
None; Tranos Paris, None
Program Number: 317 Poster Board Number: B0295
Presentation Time: 8:30 AM–10:15 AM
Long-Term Follow-Up Study on the Natural Progression of
Lamellar Macular Holes
Jessica Lee1, Rahul Mandiga1, 3, Lawrence J. Singerman2, Llewelyn
Rao2. 1Ophthalmology, Case Western Reserve University, Cleveland,
OH; 2Retina Associates of Cleveland, Cleveland, OH; 3North
Carolina Retina Associates, Raleigh, NC.
Purpose: To determine the natural progression of lamellar macular
holes (LMH) and their visual prognosis in a large retrospective cohort
of patients.
Methods: The charts of 87 eyes of 78 patients with a diagnosis of
macular hole by ICD coding (362.54) were identified from 20082013. The patient charts were retrospectively reviewed and only those
patients with a diagnosis of a lamellar macular hole as confirmed by
an Ocular Coherence Tomography (OCT) scans were included in
the study. None of the patients had undergone surgery for lamellar
macular hole repair. Baseline visual acuity (VA) and endpoint VA
were recorded. Main outcome measures were best-corrected visual
acuity (BCVA), influence of an epiretinal membrane (ERM) on the
LMH, posterior vitreous detachment (PVD), and history of diabetes
or hypertension.
©2014, 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 2014 Annual Meeting Abstracts
Results: The patients included 52 females and 26 males with a
mean age of 71 years. The mean follow-up time was 3 years (range
1.83 months to 16 years). At the time of diagnosis, the mean visual
acuity was 20/50. At the end of follow-up, the mean visual acuity
was 20/60. More than 55% were found to have a PVD and 64% were
found to have an ERM. Only 11% of LMH were associated with a
concomitant diagnosis of diabetes mellitus and 52% of LMH were
associated with hypertension.
Conclusions: This long term study of a large cohort of patients
revealed that the majority of LMH occurs in elderly women and
is commonly associated with an ERM. LMH patients appear to
have relatively good visual acuity that tends to remain stable with
observation alone without requiring immediate surgical intervention.
Commercial Relationships: Jessica Lee, None; Rahul Mandiga,
None; Lawrence J. Singerman, None; Llewelyn Rao, None
Program Number: 318 Poster Board Number: B0296
Presentation Time: 8:30 AM–10:15 AM
Wide-field OCT and vitreo-retinal adherence
Matteo G. Cereda, Ferdinando Bottoni, Sara Bochicchio, Claudia
Orini, Giovanni Staurenghi. Dpt. of Clinical and Biomedical Science
“Luigi Sacco”, Eye Clinic Sacco Hospital Milan Italy, Milano, Italy.
Purpose: to show the ability of wide-field OCT (montage images of
OCT B-scans obtained on the same line) to visualize the relationship
between the vitreous and the retina at the posterior pole, optic nerve
and the retina till the mid-periphery
Methods: Consecutive, observational case series. 38 eyes of 36
consecutive patients with macular pucker (3 eyes), macular hole
(5), lamellar macular hole (7), vitreo-macular traction (9) and
normal (14) were included. Montage images of at least 3 OCT
B-scans (Heidelberg Spectralis, Heidelberg Engeneering, Germany)
(horizontal and vertical through the fovea) were obtained in each
case; montage images were composed using picture editing software
(Photoshop Elements version 11; Adobe, San Jose, CA)
Results: All 76 montage images were created and all had good
quality.
In 6 eyes vitreous was not visible in both horizontal and vertical
montage images (5 lamellar macular hole and 1 pucker). In other
6 eyes vitreous was visible as full adherent to the retina in both
horizontal and vertical montage images (5 normal and 1 traumatic
macular hole). In the remaining 26 eyes (9 normal, 2 lamellar
macular hole, 2 macular pucker, 9 vitreo-macular traction and 4
macular hole) shallows vitreous detachments were visible in different
position and with different size showing an incredibly high variability
between the same ocular conditions
Conclusions: Wide-field OCT can clearly show a complete posterior
vitreous detachment (when vitreous is not visible), a complete
vitreo-retina adhesion (when vitreous is full adherent) and detailed
information (including shape and extension) of shallow vitreous
detachments. In the era of new therapeutic approach to vitreo-retinal
interface diseases, including drugs and small invasive tools for
surgery, an in deep knowledge of the vitreo-retinal relation could help
ophthalmologists to properly manage patients. Wide-field OCT can
show this information. OCT’s manufactures should improve their
software including an automatic tool to create montage images
Macular pucker with a complete posterior vitreous detachment.
Vitreous is not visible in the montage image.
Lamellar macular hole: vitreous is full adherent at the nasal side and
optic nerve head, there is a shallow vitreous detachment in the fovea
area and a small area of attachment in the temporal side.
Commercial Relationships: Matteo G. Cereda, None; Ferdinando
Bottoni, None; Sara Bochicchio, None; Claudia Orini, None;
Giovanni Staurenghi, Allergan, Inc. (C), Canon (S), Glaxo Smith
Kline (C), Heidelberg Engineering (C), Ocular Instruments, Inc. (P),
OD-OS (C), Optovue (S), Pfizer Ophthalmics (C), Zeiss (S)
Program Number: 319 Poster Board Number: B0297
Presentation Time: 8:30 AM–10:15 AM
Intravitreal Ocriplasmin for Symptomatic Vitreomacular
Adhesion
David Warrow1, 3, Auvni Patel2, 3, Joseph Raevis2, Michael Lai1, 3.
1
Retina Group of Washington, Greenbelt, MD; 2Ophthalmology,
Georgetown University School of Medicine, Washington, DC;
3
Ophthalmology, Medstar Washington Hospital Center, Washington,
DC.
Purpose: To determine the efficacy of a single intravitreal
ocriplasmin injection to relieve symptomatic vitreomacular adhesion
(VMA).
Methods: This is a retrospective case review of 35 patients with
symptomatic VMA who received intravitreal ocriplasmin injection
at the Retina Group of Washington between February 2013 and
November 2013. Extracted data included patient demographics, lens
status, medical and ocular comorbidities, VMA size and duration,
presence of epiretinal membrane (ERM), FTMH, cystoid macular
edema (CME), posterior vitreous detachment (PVD), and optical
coherence tomography (OCT) ellipsoid zone changes, FTMH
size, best corrected visual acuity (BCVA), follow up, surgery, and
complications.
Primary endpoints included release of VMA and closure of
FTMH. Secondary endpoints included rate of PVD induction and
ellipsoid zone changes, change in BCVA, time to VMA release, and
complications.
Results: The mean subject age was 69.4 years, and 23 (66%) patients
were female. 25 (71%) subjects were phakic, and 10 (29%) were
pseudophakic. Nine subjects (26%) had retinal comorbidities. Mean
VMA diameter was 571 micrometers, with average duration of 7.9
months prior to injection; 25 (71%) had associated CME, 9 (26%)
had ERM, and 6 (17%) had FTMH, of mean size 186 microns. Mean
pre-injection BCVA was 20/57 (0.46 LogMAR) and final BCVA was
20/43 (0.33 LogMAR).
©2014, 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 2014 Annual Meeting Abstracts
VMA release occurred in 15 (43%) subjects after a mean 10.2 days
after injection, with complete PVD noted in 12. Mean VMA diameter
(p = 0.005) and duration (p = 0.03), absence of retinal comorbidities
(p = 0.02), and mean age (p = 0.04) were predictive of VMA release.
FTMH closure occurred in 1 of 6 cases (17%).
Ellipsoid zone changes were seen in 10 (29%) patients. Eight (23%)
subjects underwent surgery. Two (6%) patients had complications
- one retinal detachment and one intraocular pressure spike. Mean
follow up was 96 days.
Conclusions: Intravitreal ocriplasmin may be a reasonable treatment
option for patients with symptomatic VMA, and may be particularly
useful in VMA of limited size and duration.
Spectral domain optical coherence tomography (OCT) image prior
to ocriplasmin injection of a 51 year old woman with a 261 micron
vitreomacular adhesion (VMA) and impending full thickness macular
hole.
One week post-injection OCT of the same 51 year old woman,
showing complete resolution of her VMA, with persistent subretinal
fluid.
Commercial Relationships: David Warrow, None; Auvni Patel,
None; Joseph Raevis, None; Michael Lai, None
Support: Lions Club of VIrginia
Purpose: We report outcomes of management in 2 eyes with
recurrent macular hole presenting with cystoid macular edema
(CME). One eye was managed with repeat pars plana vitrectomy
(PPV), internal limiting membrane (ILM) peel and C3F8 tamponade,
the other was managed with periocular triamcinolone acetonide
injections alone.
Methods: Two patients, a 65 year old woman (Patient A) and a 71
year old man (Patient B), each with a history of a surgically managed
and previously closed full thickness macular hole were found to
have a recurrent macular hole with CME in their previously treated
eye. Patient A presented with best corrected visual acuity (BCVA)
of 20/50 in the affected eye, and underwent repeat surgical repair
(PPV, ILM peel, C3F8 tamponade and periocular triamcinolone
acetonide injection). Patient B presented with BCVA of 20/70 in the
affected eye and non-operative management with serial periocular
triamcinolone acetonide injections was undertaken.
Results: Patient A: 3 months after repeat surgical repair, BCVA of
the treated eye remained 20/50 with closure of the macular hole
confirmed by optical coherence tomography (OCT). Foveal contour
was restored despite mild remaining CME. Patient B received
monthly periocular triamcinolone acetonide injections over a 3 month
period. BCVA of the treated eye improved to 20/25 with closure of
the macular hole confirmed by OCT. Foveal contour was restored and
there was no evidence of continued CME.
Conclusions: While treatment of the recurrent macular hole is
classically surgical in nature, regardless of associated CME, nonoperative management is not well studied. Medical management,
including periocular triamcinolone acetonide injections, might be
considered in the treatment of the recurrent macular hole with CME.
The best management technique for the recurrent macular hole with
CME warrants further exploration.
Top Left: Recurrent macular hole of Patient A prior to surgical repair.
Top Right: Closed macular hole of Patient A at 3 month follow up
visit showing mild CME. Bottom Left: Recurrent macular hole of
Patient B prior to serial periocular triamcinolone acetonide injections.
Bottom Right: Closed macular hole of Patient B after serial
periocular triamcinolone acetonide injections.
Commercial Relationships: Ross B. Chod, None; Levent
Akduman, None
Program Number: 320 Poster Board Number: B0298
Presentation Time: 8:30 AM–10:15 AM
Surgical versus Medical Management of the Recurrent Macular
Hole with Cystoid Macular Edema
Ross B. Chod, Levent Akduman. Ophthalmology, St. Louis University
Eye Institute, Clayton, MO.
©2014, 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 2014 Annual Meeting Abstracts
Program Number: 321 Poster Board Number: B0299
Presentation Time: 8:30 AM–10:15 AM
Long Term Outcomes of 20G versus 23G Pars Plana Vitrectomy
in the Treatment of Traumatic Macular Hole
Khalid Al Rubaie1, Nicola G. Ghazi1, 2, Fernando J. Arevalo1, 3.
1
Ophthalmology, KKESH, Riadh, Saudi Arabia; 2Ophthalmology,
University of Virginia, Charlottesville, VA; 3Ophthalmology, Wilmer
Eye Institute, Baltimore, MD.
Purpose: To compare the long-term results of 23- and 20-gauge pars
plana vitrectomy (PPV) for traumatic macular hole (TMH)
Methods: A retrospective, comparative case series of 29 consecutive
eyes of 29 patients with TMH that underwent either 23- or 20-gauge
PPV was conducted. The main outcome measure was the anatomical
closure rate following surgery.
Results: Among 29 patients, 6 (20.8%) were younger than 16
years. Twenty-five patients (86.2%) were males. Twenty gauge
PPV was performed in 16 eyes (55.2%) and 23-gauge PPV was
performed in the remaining 13 eyes (44.8%). Dye-assisted internal
limiting membrane peeling was performed in all but 3 (10.3%) eyes.
Anatomical failure was seen in a total of 11 eyes (37.9%). Among
those, 6 eyes (54.4%) were in the 23-gauge PPV group and 5 (45.6%)
in the 20-gauge PPV group. The success rate was not statistically
significantly different between the two groups. None of the eyes
developed retinal breaks or detachment.
Conclusions: Twenty three-gauge PPV has a similar success rate to
twenty-gauge PPV in TMH.
Commercial Relationships: Khalid Al Rubaie, None; Nicola G.
Ghazi, None; Fernando J. Arevalo, None
Program Number: 322 Poster Board Number: B0300
Presentation Time: 8:30 AM–10:15 AM
Visual and Anatomic Outcome in Eyes with Idiopathic
Juxtafoveal Macular Telangiectasia (MacTel) and Full Thickness
Macular Holes Undergoing Surgical Repair
Poorav Patel1, Christina J. Flaxel1, 2. 1Oregon Health and Science
University, Portland, OR; 2Casey Eye Institute, Oregon Health and
Science University, Portland, OR.
Purpose: To report visual and anatomic outcomes in eyes with
idiopathic juxtafoveal macular telangiectasia (MacTel) undergoing
small gauge vitrectomy surgery with gas tamponade for full thickness
macular holes (FTMH)
Methods: Medical records of all adult patients with the diagnoses
of both MacTel and FTMH who were diagnosed and had surgery
between 2003-2013 at Casey Eye Institute were reviewed.
Preoperative and postoperative data were obtained including visual
acuity and OCT imaging to evaluate the overall visual acuity changes
and the macular hole closure rates. These cases were then compared
with historical controls that also underwent surgical repair as well as
those undergoing observation only.
Results: Over a 10- year period, 2 cases that met the search criteria
were identified (Patient A and B). Hole closure was obtained in 1 of
2 cases, with both cases requiring multiple procedures. Patient A is a
58 year-old woman with a VA OS of 20/400 and an OCT illustrating
a macular hole greater than 500 microns, who underwent 3 surgical
repairs including ILM peel without hole closure. Patient B is a 62
year-old gentlemen who presented with VA OD 20/200 and a macular
hole of 320 microns, and underwent 5 surgical interventions with
eventual hole closure. Overall, final visual acuity was unchanged in
these cases.
Six prior cases undergoing surgical repair have been reported in
the literature. In 3 of these cases, the holes closed while in 3 cases
the hole remained open. In addition, 3 cases had improved vision
while 2 had no vision changes and the 3rd had reduced vision post-
operatively. In those cases undergoing observation only, visual acuity
tends to remain stable over time.
Conclusions: Surgical intervention for MacTel and FTMH may
not provide visual acuity benefit. Eyes with mactel tend to have
stable visual acuity even with the development of a FTMH as the
mechanism of hole formation is probably degenerative in nature
rather than tractional with lateral separation of the photoreceptors and
loss of Mueller cell structural support. Unless visual acuity decreases
dramatically or definite vitreo-macular traction is noted, surgical
intervention may not be beneficial.
Commercial Relationships: Poorav Patel, None; Christina J.
Flaxel, None
Program Number: 323 Poster Board Number: B0301
Presentation Time: 8:30 AM–10:15 AM
Vitreomacular Adhesion: Clinical Course and Outcomes
Managed by Initial Observation
Jonathan Tzu1, Vishak J. John1, Harry W. Flynn1, William Smiddy1,
Adam Carver2, Robert Leonard2, Homayoun Tabandeh3, David S.
Boyer3, Maria H. Berrocal4. 1Bascom Palmer Eye Institute, Miami,
FL; 2Ophthalmology, Dean McGee Eye Institute, Oklahoma City,
OK; 3Ophthalmology, Retina Vitreous Associates Medical Group, Los
Angeles, CA; 4Ophthalmology, University of Puerto Rico, San Juan.
Purpose: The purpose of this study is to investigate the clinical
course and outcomes of patients with vitreomacular adhesion (VMA)
and managed initially by observation
Methods: The current study is a case series of patients with a
diagnosis of vitreomacular adhesion based on clinical symptoms and
findings on spectral domain optical coherence tomography (SD-OCT)
between the years of 2005 and 2013. VMA was graded based on
the degree of distortion of the foveal contour. Grade 1 is incomplete
cortical vitreous separation with attachment at the fovea and visible
distortion, Grade 2 is Grade 1 with any intraretinal cysts or clefts, and
Grade 3 is Grade 2 findings with subretinal fluid beneath the fovea.
Follow-up including visual acuity, changes in SD-OCT findings, and
timing of the release of VMA as seen on SD-OCT were recorded.
Results: VMA by SD-OCT from 4 retina clinics was identified in
139 eyes of 112 patients. Mean age was 73 years and mean time of
follow up was 30 months. Baseline VMA grading was the following:
Grade 1 - 52 eyes (37%), Grade 2 - 73 eyes (53%), and Grade
3 - 14 eyes (10%). By the last follow-up, spontaneous release of
VMA occurred in 44 (32%) of eyes. Spontaneous release of VMA
occurred at a mean of 16.8 months from initial visit and median of
9.8 months. At baseline, mean logMAR best corrected visual acuity
(BCVA) was 0.26 (20/36) [range 20/20 to 20/200], and at last follow
up was 0.28 (20/38) [range 20/20 to 20/400]. Pars plana vitrectomy
was performed in 7 eyes (5.0%) [6 for macular hole, 1 for increased
VMA] and BCVA outcomes were ≥ 20/40 in 6 of 7 eyes.
Conclusions: In the current study, patients generally had a favorable
clinical course when managed by initial observation. Spontaneous
release of VMA occurred in 32% of patients, and pars plana
vitrectomy was performed in 5% of patients by last follow-up.
Commercial Relationships: Jonathan Tzu, None; Vishak J. John,
None; Harry W. Flynn, None; William Smiddy, None; Adam
Carver, None; Robert Leonard, None; Homayoun Tabandeh,
None; David S. Boyer, None; Maria H. Berrocal, None
Support: Supported by NIH Center Core Grant P30EY014801,
Research to Prevent Blindness Unrestricted Grant, Department of
Defense (DOD- Grant#W81XWH-09-1-0675).
©2014, 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 2014 Annual Meeting Abstracts
Program Number: 324 Poster Board Number: B0302
Presentation Time: 8:30 AM–10:15 AM
Preclinical Identification of Eyes at risk of Developing Idiopathic
Macular Hole — An Update
Ana S. C. Silva1, João Figueira3, 4, Sílvia Simão4, Nuno Gomes5,
Carlos Neves6, Angelina M. Silva7, Natália Ferreira7, Rui Bernardes2,
1 1
. IBILI, Faculty of Medicine at University of Coimbra, Coimbra,
Portugal; 2Centre for New Technologies in Medicine, AIBILI,
Coimbra, Portugal; 3Ophtalmology Service, Coimbra University
Hospital, Coimbra, Portugal; 4AIBILI, Coimbra, Portugal; 5Braga
Hospital, Braga, Portugal; 6North Lisbon Hospital Center, Lisbon,
Portugal; 7St António Hospital, Porto Hospital Center, Porto,
Portugal.
Purpose: To discriminate healthy eyes from eyes with increased risk
of developing idiopathic macular holes (IMH).
Methods: Although causes for IMH aren’t fully understood, it is well
known that patients with unilateral IMH have increased probability
of developing IMH in their other eye (a risk increased by 10-20%).
In this work, we present further evidence to the hypothesis presented
in 2012 (Invest Ophthalmol Vis Sci 2012;53: E-Abstract 5219): that it
is possible to detect this increased risk of developing IMH based on
information present in an optical coherence tomography.
Using Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA, USA), we
imaged the macular region of eyes at risk of developing IMH and
eyes from a control group. In neither group were included eyes with
glaucoma, myopia (> 3D) or other retinal pathology. To obtain a map
of the retinal surface, the shape of the inner limiting membrane was
depth-wise corrected by the retinal pigment epithelium.
The surface shape is described by a set of parameters obtained by
fitting a set of well-known 2D mathematical functions to the retinal
maps. In addition, features from a set of bidimensional profiles are
added, to improve discrimination, namely the curvature, angle at
the fovea, and the volume of the foveal depression. A total of 27
parameters are thus computed per eye.
Twenty-four eyes from 24 patients with unilateral IMH (18 women,
age 67.2±6.8 years), and 32 eyes from 19 patients (13 women, age
59.3±7.3 years) were imaged and processed. We resort to support
vector machines (SVM), a supervised learning model, to classify eyes
into the group of healthy and at risk. To improve the performance
of the classification, backward elimination and forward selection
routines were ran to identify an optimal set of features. We used
an N-fold cross-validation process (N=10) to determine the system
performance.
Results: For a reduced set of features we were able to achieve an
accuracy of 83.6%, sensitivity of 66.7% and specificity of 96.8%.
These results represent a step forward as compared to the ones
previously presented by our group.
Conclusions: The results here achieved not only reinforce the
previously demonstrated possibility to identify eyes at risk of
developing IMH using noninvasive imaging techniques, but also
show that the improvements made over the last years are yielding
positive results, demonstrating an increase in the reliability of our
test.
Commercial Relationships: Ana S. C. Silva, None; João Figueira,
None; Sílvia Simão, None; Nuno Gomes, None; Carlos Neves,
None; Angelina M. Silva, None; Natália Ferreira, None; Rui
Bernardes, None
Support: FCT project PTDC/BBB-BMD/2739/2012; COMPETE
program FCOMP-01-0124-FEDER-028110; FCT project PEST-C/
SAU/UI3282/2013 and COMPETE program FCOMP-01-0124FEDER-037299
Clinical Trial: NCT01220804
Program Number: 325 Poster Board Number: B0303
Presentation Time: 8:30 AM–10:15 AM
Morphology and Microstructure by en face OCT of Cystoid
Cavities in Full Thickness Macular Holes
Bruno Lumbroso1, Cristina Savastano2, 1, Marco Rispoli1. 1Centro
Oftalmologico Mediterraneo, Rome, Italy; 2Ophthalmology, Catholic
University, Rome, Italy.
Purpose: Purpose: To compare Optical Coherence Tomography
(OCT) transverse images at different retina levels in Full Thickness
Macular Holes (FTMH) to understand the macular microstructure
by en face OCT scans. In this presentation, we describe the different
patterns of cystoid cavities of each retinal layers in macular holes,
using transverse OCT. The aim of the study is to investigate the
details of OCT en face images at different layer levels to understand
the correlations between macular microstructure and edema cavities
morphology.
Methods: Methods: 24 eyes of 24 patients affected by cystoid
cavities secondary to FTMH were evaluated by en face scans at
different depths in the retina following exactly inner nuclear layer,
outer plexiform layer and Henle layer and outer nuclear layer in
eyes. We used transverse scans from Heidelberg Spectralis and from
Optovue RTVue to generate tridimensional shape. The scan that
better fitted to the interested layer was chosen to observe each layer
isolated from the others.
Results: Results: All eyes assessed with enface OCT showed
morphological details corresponding to the analyzed layers. At Inner
nuclear layer (INL) and Inner Plexiform Layer (IPL) the cavities
are small and rounded related to the vertical part of Muller cells
and Henle fiber. In the Outer Plexiform Layer (OPL) and Outer
Nuclear Layer (ONL), cavities were larger. The shape and dimension
of edema cavities in these layers were consistent with horizontal
enlarged Muller cells bodies and the cavity separations were slanted.
Conclusions: Conclusions: Enface OCT images provide a new layers
analysis possibility in cystoid cavities related to FTMH. Macula
microstructure visualization allows a better understanding and
interpretation of Muller cells and Henle’s fibers structure in macular
disorders.
Commercial Relationships: Bruno Lumbroso, None; Cristina
Savastano, None; Marco Rispoli, None
Program Number: 326 Poster Board Number: B0304
Presentation Time: 8:30 AM–10:15 AM
Aniseikonia and Foveal Microstructure Following Vitrectomy for
Epiretinal Membrane
Kuniharu Tasaki, Fumiki Okamoto, Yoshimi Sugiura, Yoshifumi
Okamoto, Tetsuro Oshika. Ophthalmology, Tsukuba University,
Ibaraki, Tsukuba, Japan.
Purpose: To quantify the degree of aniseikonia in patients
undergoing vitrectomy for epiretinal membrane (ERM), and
to investigate the relationship between aniseikonia and foveal
microstructures with spectral-domain optical coherence tomography
(SD-OCT).
Methods: This study included 44 eyes of 44 patients with idiopathic
ERM. We examined visual acuity and aniseikonia with the New
Aniseikonia Test and SD-OCT before and 3and 6 months after
surgery. Based on the obtained OCT images, we quantified the
following parameters using an image-processing program: central
foveal thickness (CFT), mean thickness of the ganglion cell layer
(GCL), inner nuclear layer (INL) and outer retinal layer (ONL+OPL:
outer nuclear layer and outer plexiform layer). The status of the
photoreceptor inner and outer segment junction (IS/OS), external
limiting membrane (ELM), and cone outer segment tips (COST) were
also evaluated.
©2014, 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 2014 Annual Meeting Abstracts
Results: Thirty-nine of 44 patients (89%) had macropsia, 1 patient
(2%) had micropsia, and 4 patients (9%) had no aniseikonia
preoperatively. Mean preoperative aniseikonia score was 6.1 ±
4.7%. Vitrectomy significantly improved visual acuity in patients
with ERM, but did not change the severity of aniseikonia.
Multiple regression analysis revealed that preoperative aniseikonia
was significantly related to preoperative INL thickness, while
postoperative aniseikonia was associated with postoperative INL
thickness. Preoperative INL thickness was found to be a significant
prognostic factor for postoperative aniseikonia at 6 months.
Conclusions: Most of the ERM patients had macropsia, which did
not improve by surgery. The severity of aniseikonia was associated
with preoperative INL thickness.
Commercial Relationships: Kuniharu Tasaki, None; Fumiki
Okamoto, None; Yoshimi Sugiura, None; Yoshifumi Okamoto,
None; Tetsuro Oshika, None
Program Number: 327 Poster Board Number: B0305
Presentation Time: 8:30 AM–10:15 AM
Predictive factors for the spontaneous resolution of vitreomacular
traction
David Almeida1, Eric K. Chin1, James C. Folk1, Karim Rahim2,
Stephen R. Russell1. 1Ophthalmology, Division of Retina, University
of Iowa Hospitals & Clinics, Iowa City, IA; 2Queen, Kingston, ON,
Canada.
Purpose: To examine variables that are predictive for the
spontaneous resolution of vitreomacular traction syndromes (VMT).
It is currently unknown what factors, if any, are predictive for the
spontaneous release of VMT.
Methods: Retrospective case-control study of 61 patients with
VMT and a minimum of three months of follow-up time. Optical
coherence tomography (OCT) anatomic variables were characterized
according to broad (>400 microns) versus focal (<400 microns)
adhesions and by degree of inner versus outer retinal involvement.
Treatment variables were investigated according to previous
intravitreal injections of vascular endothelial growth factor (VEGF)
inhibitors. Spontaneous release of VMT (VMT-SR) was defined as
patients that experienced resolution of VMT with observation alone
or following injection with anti-VEGF agents but without surgical
intervention or ocriplasmin. A binary logistic regression model was
created to ascertain significant prognostic variables predictive for the
spontaneous release of VMT. Main outcome measures were defined
as anatomic (OCT) and treatment (intravitreal injections) variables
prognostic for the spontaneous release of VMT.
Results: Of the 61 patients identified, 21 (35%) experienced
spontaneous resolution of their VMT and 40 (65%) did not. Patients
in the VMT-SR group were significantly associated with having
only inner retinal distortion, but not outer retinal involvement, on
OCT imaging (p=0.0129) and previous treatment with intravitreal
injections of anti-VEGF (p=0.0181). Binary logistic regression
modeling revealed anatomic (OCT inner retinal anatomy
involvement, p=0.001597) and treatment (previous intravitreal
injections, p=0.01127) factors as prognostic variables predictive of
spontaneous release of VMT. Odds ratio (OR) for the anti-VEGF
injections was 7.39 (sensitivity 0.52, specificity 0.88) and for the
OCT anatomic variable was 10.45 (sensitivity 0.95, specificity 0.35).
The combination of the injection and OCT variables resulted in an
OR of 16.28 (p=0.0001662).
Conclusions: Eyes with VMT causing only inner retinal distortion on
OCT and or having previous or ongoing intravitreal injections of antiVEGF are more likely to develop spontaneous VMT release without
the need for surgical intervention or ocriplasmin. These are novel
findings that may help clinicians with management decisions when
seeing patients with VTM.
Commercial Relationships: David Almeida, None; Eric K. Chin,
None; James C. Folk, None; Karim Rahim, None; Stephen R.
Russell, None
Program Number: 328 Poster Board Number: B0306
Presentation Time: 8:30 AM–10:15 AM
Comparison of the Red Reflex from Three Surgical Microscopes
Carl Chancy, Jim Schwiegerling, Justin Knight. College of Optical
Sciences, University of Arizona, Tucson, AZ.
Purpose: To evaluate the sensitivity of the red reflex to tilt for
different surgical microscopes.
Methods: We analyzed the optical performance of three surgical
microscopes: the LuxOR Ophthalmic Microscope (Alcon Surgical),
OPMI Lumera T (Carl Zeiss Meditec), and the Leica M-501 (Leica
Microsystems). We assessed the red reflex and its sensitivity to eye
rotation. A 1-inch diameter PMMA sphere was machined into an eye
model. An aspheric cornea designed to focus incident light onto the
back-side of the sphere. In addition, an 8 mm diameter Coddington
pupil were machined into the solid sphere with single point diamond
turning. The area around the pupil was painted black to form an
opaque mask of the pupil, while the back side of the sphere was
painted red to provide a reflex similar to the eye. The eye model was
mounted under each microscope on a tilt stage. Photographs of the
red reflex for tilt angles ranging from 0 to 20 degrees were captured.
Camera settings and lighting conditions were identical across the
three devices. The captured images were analyzed in a photo-editing
program. A square patch of pixels within the pupil was analyzed
and the average of the pixel values within the square was used as a
measure of the red reflex intensity.
Results: For the red reflex, the LuxOR had the brightest reflex
compared to the other two microscopes. Furthermore, the red reflex
was nearly invariant with eye rotation for the LuxOR, whereas the
red reflex from the Lumera and the Leica microscopes demonstrated
a falloff in intensity, as well as crescent-shaped artifacts with
increased rotation.
Conclusions: We demonstrated a system for evaluating the optical
properties of surgical microscopes. The LuxOR microscope also
provided a red reflex that was highly insensitive to eye rotation when
compared to the other two microscopes.
Commercial Relationships: Carl Chancy, Alcon Laboratories, Inc.
(F); Jim Schwiegerling, Alcon Laboratories, Inc. (F); Justin Knight,
None
Support: Financial Support from Alcon Laboratories, Inc
Program Number: 329 Poster Board Number: B0307
Presentation Time: 8:30 AM–10:15 AM
Multimodal imaging of epimacular membranes
Aurelie Brolly, Hassiba Bouakkaz, Sarah Ayello-Scheer, Céline
Devisme, Alexandre Leseigneur, Jose A. Sahel, Michel Paques.
CHNO des quinze-vingts, Paris, France.
Purpose: To document the earliest stages of epiretinal membranes
(ERMs) and the effect of the surgery using adaptive optics (AO)
Methods: Prospective study of 23 patients with ERMs at various
stages examined by AO flood imaging (ImagineEye, Orsay, France).
Thirteen were observed over up to 18 months; while 10 underwent
surgery and were followed one year.
Results: AO allowed identifying ERMs at a very early stage (i.e.
measuring less than 250mm); they were often plurifocal and located
preferentially around vessels. Because ERMs were in all case highly
anisotropic, multi-incidence analysis allows a better delimitation.
The surface of ERMs presented a combination of diffuse blurring
©2014, 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 2014 Annual Meeting Abstracts
surrounding a myriad of highly reflective, dots 10- 20 mm in diameter.
In some cases, a noncontractile progression front surrounded the
retractile center. Retinal folds molded retinal vessels. ERMS could be
distinguished from the foldings of the inner limiting membrane. After
surgery, retinal unfolding was noted, as well as residual ERM and
early recurrences.
Conclusions: AO is highly sensitive for the diagnosis of ERMs, and
the delimitation of their extent. AO should also help understanding
the pathogenesis of the membranes and their progression. AO may
be of interest for the follow up of patients at risk for developing
vitroretinal proliferation, for instance following retinal detachment
surgery.
Commercial Relationships: Aurelie Brolly, None; Hassiba
Bouakkaz, None; Sarah Ayello-Scheer, None; Céline Devisme,
None; Alexandre Leseigneur, None; Jose A. Sahel, None; Michel
Paques, Imagineye (C)
Support: ANR_09_TECS_009_01_IPHOT
Clinical Trial: C10-03
©2014, 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].