RETINA

LONGITUDINAL ASSESSMENT OF CHOROIDAL STRUCTURE IN PATIENTS WITH MACULAR NEOVASCULARIZATION

imagePurpose:

To investigate morphologic changes of choroidal structure through chronologic aspect in progression of macular neovascularization (MNV) with pachychoroid features.

Methods:

One hundred seventy-one MNV participants above 50 years old with or without pachychoroid features were included in the analysis. Age-matched 132 normal patients were analyzed as control group. The total choroidal area and ratio of Sattler’s layer area to total choroidal area, derived by summing 25 horizontal raster scans of the 30° × 20° scan area on enhanced depth imaging optical coherence tomography, were calculated to compare the difference among the normal eyes and the MNV eyes with/without pachychoroid features.

Results:

The mean ratio of Sattler’s layer area to total choroidal area is maintained at around 40% in normal eyes and MNV eyes without pachychoroid features. In MNV with pachychoroid features, the ratio of Sattler’s layer area to total choroidal area changes according to the disease activity. Ratio of Sattler’s layer area to total choroidal area is 34.1 ± 4.4% at the time of onset, 37.2 ± 4.8% at the time of remission, and decreases during recurrence from 36.8 ± 3.8% to 33.4 ± 3.8% (all P

By Lee, Kanghoon; Chin, Hee Seung, ago

FLUIDIC PERFORMANCE OF A DUAL-ACTION VITRECTOMY PROBE COMPARED WITH A SINGLE-ACTION PROBE

imagePurpose:

To assess flow rates, nearfield effects, and traction of a dual-cutting 20,000 cpm vitrectomy probe (HYPERVIT, Alcon) versus a single-cutting 10,000 cpm probe (Advanced ULTRAVIT, Alcon).

Methods:

Flow rates were evaluated for 25+ and 27+ gauge probes using balanced salt solution or porcine cadaver vitreous (biased open, 50/50, and biased closed duty cycles). Probes were suspended in an open beaker, and flow rates were calculated using a precision balance. Nearfield effects and flow pulsatility were assessed using a validated simulation model based on experimental microparticle image velocimetry. Traction was assessed by attaching vitreous to a cantilever beam and measuring the deflection of the beam.

Results:

For HYPERVIT probes, aqueous flow rates were similar across all cutting rates. Vitreous flow rates increased with increasing cutting rates. At maximum cutting rates, aqueous flow was 62%–67% greater (25+) and 63% greater (27+) with HYPERVIT versus Advanced ULTRAVIT (P

By Steel, David H.; Charles, Martin; Zhu, Ying; Tambat, Sonalee; Irannejad, A. Mani; Charles, Steve, ago

Surgical Technique, Indications, and Outcomes of BIOM-Assisted Transvitreal Biopsy for Uveal Melanoma

imagePurpose:

Controversy exists regarding the best method for biopsy of uveal melanoma. We describe our transvitreal technique and evaluate the safety of this technique as well as the efficacy for obtaining sample for prognostic genetic profiling.

Methods:

Description of surgical technique and retrospective case series. Medical records for uveal melanoma patients who underwent transvitreal biopsy using our described technique were analyzed for tumor size, location, primary treatment, method of biopsy, and any complications thereof. Characteristics of tumors that underwent transvitreal biopsy were noted including tumor size, location, or presence of subretinal fluid, to see whether these affected surgeon preference for biopsy modality. A cohort of contemporaneous uveal melanoma patients who underwent biopsy through a transscleral technique served as a comparator group for these patient, tumor, and complication factors.

Results:

A total of 27 patients aged 27.2 to 88.6 years (mean 64.8) underwent transvitreal biopsy using our described technique between 2013 and 2016. There were 15 small, 10 medium, and 2 large tumors at diagnosis with the majority (n = 17) posterior to the equator. Intraoperative complications included a clot or small trickle of blood at the biopsy site in 20 (74.1%) of patients, small localized subretinal hemorrhage in 8 (29.6%), small vitreous hemorrhage in 4 (14.8%), and small transient choroidal detachments in 1 patient (3.6%). When subretinal hemorrhage occurred, it was almost always into a pre-existing pocket of subretinal fluid (P = 0.0093). However, the presence of subretinal fluid was not associated with the decision to proceed with any biopsy (P = 0.36) or transvitreal biopsy specifically (P = 1.00). By 3 months, subretinal and/or vitreous hemorrhage resolved in essentially all cases. There were no cases of iatrogenic retinal detachment or extraocular tumor spread over a mean follow-up of 41.7 (range: 20–62.1) months. Adequate tissue for gene expression profiling was obtained from each biopsy. The comparator group of patients undergoing transscleral biopsy including 21 uveal melanomas in 20 patients (one eye had two melanomas). Transvitreal biopsies were more common in patients with small (n = 15; P

By Snyder, Laura L.; Daniels, Anthony B., ago

PREDICTORS AND IMPORTANCE OF COMPLETE POLYPOIDAL LESION REGRESSION IN THE EVEREST II STUDY: Predictors of Polyp Regression in Polypoidal Choroidal Vasculopathy

imagePurpose:

To evaluate the predictors of complete polypoidal lesion regression (CPREG) in polypoidal choroidal vasculopathy.

Methods:

Post hoc analysis of EVEREST II—a 24-month, multicenter, randomized, controlled clinical trial of 322 patients with polypoidal choroidal vasculopathy, randomized to receive ranibizumab with or without photodynamic therapy. Images of indocyanine green angiography (ICGA) were graded by a central reading center. Multiple logistic regression analysis with significant baseline predictors then was conducted to assess adjusted odds ratios for CPREG at month (M) 12.

Results:

Baseline ICGA characteristics were comparable between the treatment groups. Patients treated with combination therapy had higher odds of achieving CPREG at M12 (adjusted odds ratio = 4.64; 95% confidence interval, 2.85–7.55; P

By , ago