Diagnostic Ability of Macular Nerve Fiber Layer Thickness Using New Segmentation Software in Glaucoma Suspects

Purpose. To assess the capacity of internal retinal layer thickness measurements made at the macula using new spectral-domain optical coherence tomography (OCT) software to distinguish between healthy subjects and those with suspected glaucoma. The diagnostic performance of such measurements also was compared with that of conventional peripapillary retinal nerve fiber layer (RNFL) thickness measurements. Methods. The study included 38 subjects with suspected glaucoma and 38 age-matched healthy subjects. In one randomly selected eye of each participant, thickness measurements at the level of the macula were made of the nerve fiber layer (mRNFL), the ganglion cell layer (GCL), and the ganglion cell complex (GCC; GCL + internal plexiform layer) through automated OCT segmentation. Peripapillary RNFL thickness (pRNFL) also was determined using the conventional scan. Results. As the only variable showing intergroup variation, mRNFL in the glaucoma suspects was significantly thinner in the quadrants inner inferior (P = 0.003), inner temporal (P = 0.010), and outer inferior (P = 0.017). The variable best able to discriminate between the two groups was inner inferior mRNFL thickness, as indicated by an area below the receiver operating characteristic (ROC) curve of 0.742. Conclusions. Macular RNFL thickness measurements showed an improved diagnostic capacity over the other variables examined to distinguish between healthy subjects and glaucoma suspects

Normative database for separate inner retinal layers thickness using spectral domain optical coherence tomography in Caucasian population

Purpose: Develop the first normative database of the thickness of every inner retinal layer in the macular area in a healthy, Caucasian population between 18 to 87 years old, using Spectralis Optical Coherence Tomography (OCT). Methods: On this transversal, observational study, 300 patients between 18 to 87 years old and without an ophthalmological condition were recruited. Macular OCT scans were performed on all patients (Spectralis OCT, Heidelberg Engineering). An axial length measurement, and keratometry were performed using an optical biometer. The volume and thickness of the different macular sectors of the inner retinal layers (retinal nerve fiber layer (RNFL), ganglion cells layer (CGL) and inner plexiform layer (IPL)) were analyzed with the Spectralis OCT segmentation software. An eye was randomly selected for each patient. Results: 297 patients (179 females and 118 males) were included in the study. The mean age was 56.07 years (range: 40.50-72). The multivariate analysis showed a positive correlation between the RNFL thickness and the axial length (p < 0.001). The mean central retinal thickness was 278.2 Mm (range: 266-291), the mean central RNFL thickness was 12.61 Mm (range: 11-14), the mean central CGL thickness was 17.63 Mm (range: 14-21) and the mean central IPL thickness was 22.02 Mm (range: 20-25). The multivariate analysis showed a negative correlation between age and CGL thickness and inner IPL thickness (p< 0.001). Conclusion: This study provides a normative database of the volume of each of the inner retinal layers on a Caucasian population

Efficacy of Ologen matrix implant in Ahmed Glaucoma Valve Implantation

To determine the efficacy and safety of the Ologen collagen matrix adjunctive to Ahmed valve surgery. A randomized prospective multicentre clinical trial involving 58 patients that were followed for one year. Conventional surgery with Ahmed valve was performed in 31 eyes (Control group/CG) and in 27 Ologen (Ologen group/OG) was placed over the valve’s plate. Baseline data: age, corneal thickness, intraocular pressure(IOP) and antiglaucoma medications.Postoperative data (days 1, 7 and months 1, 3, 6 and 12): IOP, antiglaucoma medications, visual acuity and complications were recorded. Frequency of hypertensive phase, complete and qualified success and survival rate were studied. No differences were found between CG and OG in the baseline data. The only difference between groups was a significantly lower IOP at day 1. No other differences were found in the follow-up between groups. Hypertensive phase (56%CG and 55%OG, p = 0,947), complete success 28,6%CG and 30,4%OG (p = 0,88) and qualified success 96,4% and 95,9%(p = 0,794). Survival rates at 1 year were 76,7%(CG) and 69,2%(OG)(p = 0,531). 38,7% of patients in the CG suffered some complication during follow-up and 61,5% in OG(p = 0,086). Ologen does not increase safety or efficacy in Ahmed valve surgery at one-year follow-up. This is the first study that shows no benefit of Ologen adjunctive to this surgery

Eficacia de la matriz de colágeno Ologen en la cirugía de glaucoma con implante de válvula de Ahmed

El glaucoma se define como una neuropatía óptica crónica y progresiva. El factor de riesgo más importante para el desarrollo de glaucoma, así como para su progresión, es una presión intraocular (PIO) elevada. La cirugía suele reservarse para los casos donde el tratamiento con medicación hipotensora tópica no consigue detener la progresión de la enfermedad, cuando existe intolerancia al tratamiento o en casos de glaucomas refractarios a tratamiento médico. Los dispositivos de drenaje (DDD) cada vez son mas utilizados, sobre todo tras el estudio TVT (Tube versus Trabeculectomy) que demostraba mayor tasa de éxito y menor número de re-intervenciones con los dispositivos de drenaje comparado con la trabeculectomía con MMC (mitomicina C) a 5 años de seguimiento. Dentro de los dispositivos valvulados, la válvula de Ahmed (AGV; New World Medical, Inc., Rancho Cucamonga, CA) es la más utilizado en nuestro medio. Una de las limitaciones de este dispositivo comparado con otros es la alta incidencia de fase hipertensiva. Esto ocurre en el 40-80% de los pacientes y ha demostrado que ser un signo de mal pronóstico a medio y largo plazo. Otra complicación de los DDD es la encapsulación de la ampolla. Para tratar de evitar estas complicaciones se han utilizado antimetabolitos intraoperatorios como la mitomicina C (MMC) con resultados controvertidos. Ologen® (Aeon Astron Corporation, Taipei, Taiwán) es una matriz porosa de colágeno biodegradable que se desarrolló con el objetivo de reemplazar a la MMC en cirugía de trabeculectomía (TBCT). Es un modulador de la cicatrización que se coloca bajo de la conjunctiva/tenon, no solo actúa como un reservorio sino que también ayuda a separar mecánicamente la conjuntiva del cuerpo valvular y evita las adherencias entre ellos. Esta matriz, actuando sobre la migración de los fibroblastos, dirige la cicatrización hacia la regeneración del tejido y lejos de la formación de fibrosis. El objetivo de esta tesis fue comparar la eficacia clínica y la seguridad de la matriz de colágeno Ologen en la cirugía de válvula de Ahmed. Este es el primer ensayo clínico prospectivo multicéntrico aleatorizado que evalua la eficacia de la asociación del Ologen a la implantación de válvula de Ahmed en comparación con la cirugía convencional, con el mayor tiempo de seguimiento y en población caucásica..

Risk of renal damage associated with intravitreal anti-VEGF therapy for diabetic macular edema in routine clinical practice

Purpose: Vascular endothelial growth factor inhibitors (anti-VEGF) have been shown to be effective in the treatment of diabetic macular edema. However, there is little information about the systemic effects of intraocular administration of anti-VEGF drugs in patients with coexistent diabetic nephropathy because it can produce adverse renal effects. Methods: This retrospective cohort study analyzed the effect of intravitreal anti-VEGF drugs (bevacizumab, ranibizumab, or aflibercept) on eFGR and microalbuminuria (MicA) in patients with diabetic macular edema and nonproliferative retinopathy without chronic kidney disease (CKD). Results: Sixty-six patients were included, 54.5% male and 45.5% female, with a mean age of 66.70 ± 11.6 years. The mean follow-up of patients with antiangiogenic treatment was 42.5 ± 28.07 months, and the mean number of injections was 10.91 ± 7.54. In 12.1% of the cases, there was a worsening of the glomerular filtration rate (eFGR) and a 19.7% worsening of the microalbuminuria (MicA). The number of injections was not related to the worsening of the eFGR (P = 0.74) or the MicA (P = 0.239). No relationship was found between the type of drug and the deterioration of the GFR (P = 0.689) or the MicA (P = 0.53). Conclusions: Based on the results, there is a small proportion of patients with increase in MicA and the decrease in eFGR after anti-VEGF therapy, and these was no associated with the number of injection or the drug type. Ophthalmologists should be aware of renal damage in order to do a close monitoring of renal function and proteinuria after intravitreal administration of anti-VEGF mainly in hypertensive patients

Utility of Bruch membrane opening-based optic nerve head parameters in myopic subjects

Purpose: To evaluate whether the new rim analysis software with spectral-domain optical coherence tomography (SD-OCT) shows advantages over the retinal nerve fiber layer (RNFL) thickness in patients with moderate myopia. Methods: In this prospective cross-sectional study, we studied 65 healthy subjects, 37 with spherical refractive errors in the range of -3 to -6 D (moderate, G1) and 28 with less than -3 D (low/non-myopic, G0). All patients were examined with Heidelberg Spectralis SD-OCT, including Glaucoma Premium Module Edition (GPME) software. With GPME, we analyzed the neuroretinal rim (Bruch membrane opening-minimum rim width [BMO-MRW]) and RNFL. Results: The average age of subjects was 30.2 ± 9.3 years for G0 and 29.9 ± 7.1 years for G1 (p = 0.903). Mean sphere was −0.5 ± 0.3 D (-1.25 to 0 D) G0 and -3.9 ± 0.3 D (-6.00 to -3 D) G1 (p<0.001). The RNFL thickness comparison between G0 and G1 showed a significantly lower thickness in G1 (p = 0.018). The BMO-MRW measurements were similar in both groups (p = 0.331). With the BMO-MRW examination, the number of sectors classified as pathologic per subject in G1 were significantly lower compared to RNFL analysis (p = 0.023). Conclusions: Ring analysis based on BMO-MRW measurements shows a lower rate of false-positives compared to RNFL thickness when studying healthy moderate myopic eyes and it would be advisable to take this into consideration when analyzing these patients

The mean nasal outer RNFL thickness in healthy Caucasian subjects as a function of axial length.

<p>AL = axial length.</p

Distribution of macular IPL values using Spectralis-SD-OCT in normal subjects.

<p>Distribution of macular IPL values using Spectralis-SD-OCT in normal subjects.</p

Distribution of macular RNFL values using Spectralis-SD-OCT in normal subjects.

<p>Distribution of macular RNFL values using Spectralis-SD-OCT in normal subjects.</p