Grosor Coroideo en la degeneración macular asociada a la edad: un estudio trasversal

OBJETIVOS: Investigar posibles diferencias de grosor coroideo entre ojos con degeneración macular asociada a la edad (DMAE) no neovascular (NNV) y neovascular (NV). CENTROS PARTICIPANTES: Hospital universitario Ramon y Cajal (Madrid, España), Hospital universitario San Raffaele (Milán, Italia) e Instituto Oftalmológico Stein (Los Ángeles, Estados Unidos). METODOS: Se diseñó un estudio retrospectivo y observacional incluyendo todos los pacientes diagnosticados con DMAE NNV en un ojo y DMAE NV en el ojo contralateral entre enero 2014 y enero 2015 en los centros participantes. Los Ojos con DMAE NNV fueron divididos en subgrupos según los criterios del grupo Beckman: Cambios normales asociados a la edad (grupo 1), DMAE inicial (grupo 2), DMAE intermedia (grupo 3) y DMAE avanzada (grupo 4). El grosor coroideo y retiniano fue medido manualmente usando tomografía de coherencia óptica de dominio espectral (SD-OCT) en modalidad enhanced depth imaging (EDI) desde 1500 μm nasal hasta 1500 μm temporal a la fóvea. Pruebas estadísticas paramétricas y no paramétricas fueron empleadas para comparar variables cuantitativas, mientras el test χ2 fue empleado en las comparaciones entre variables categóricas. Regresiones logísticas fueron empleadas para evaluar la relación entre el grosor coroideo y otras variables de interés. RESULTADOS: En este estudio se incluyeron 322 ojos de 161 pacientes de los cuales 102 (63.35%) eran mujeres y 59 (36.65%) eran varones. La edad media era 80.80±8.45 años (rango 58-99 años). El tiempo de seguimiento medio fue de 11.2±10.8 meses (rango 1-38 meses). En ojos con DMAE NNV, la coroides era más gruesa en la zona subfoveal y temporalmente temporal a la fóvea, con diferencias estadísticamente significativas si comparadas se comparan con el ojo contralateral con DMAE NV. Las diferencias de grosor coroideo entre DMAE NNV y DMAE NV fueron más marcadas a en estadios más precoces de DMAE NNV. CONCLUSIONES: La coroides subfoveal y temporal era fue significativamente más gruesa en DMAE NNV comparada con la DMAE NV de los ojos contralaterales. El adelgazamiento coroideo fue más significativo en estadios avanzados de la DMAE NNV

Semiautomated optical coherence tomography-guided robotic surgery for porcine lens removal.

PurposeTo evaluate semiautomated surgical lens extraction procedures using the optical coherence tomography (OCT)-integrated Intraocular Robotic Interventional Surgical System.SettingStein Eye Institute and Department of Mechanical and Aerospace Engineering, University of California, Los Angeles, USA.DesignExperimental study.MethodsSemiautomated lens extraction was performed on postmortem pig eyes using a robotic platform integrated with an OCT imaging system. Lens extraction was performed using a series of automated steps including robot-to-eye alignment, irrigation/aspiration (I/A) handpiece insertion, anatomic modeling, surgical path planning, and I/A handpiece navigation. Intraoperative surgical supervision and human intervention were enabled by real-time OCT image feedback to the surgeon via a graphical user interface. Manual preparation of the pig-eye models, including the corneal incision and capsulorhexis, was performed by a trained cataract surgeon before the semiautomated lens extraction procedures. A scoring system was used to assess surgical complications in a postoperative evaluation.ResultsComplete lens extraction was achieved in 25 of 30 eyes. In the remaining 5 eyes, small lens pieces (≤1.0 mm3) were detected near the lens equator, where transpupillary OCT could not image. No posterior capsule rupture or corneal leakage occurred. The mean surgical duration was 277 seconds ± 42 (SD). Based on a 3-point scale (0 = no damage), damage to the iris was 0.33 ± 0.20, damage to the cornea was 1.47 ± 0.20 (due to tissue dehydration), and stress at the incision was 0.97 ± 0.11.ConclusionsNo posterior capsule rupture was reported. Complete lens removal was achieved in 25 trials without significant surgical complications. Refinements to the procedures are required before fully automated lens extraction can be realized

Distinctive Mechanisms and Patterns of Exudative Versus Tractional Intraretinal Cystoid Spaces as Seen With Multimodal Imaging.

PurposeTo determine clear-cut distinctions between tractional and exudative intraretinal cystoid spaces subtypes.DesignRetrospective, multicenter, observational case series.MethodsA cohort of patients diagnosed with intraretinal cystoid spaces and imaged with optical coherence tomography (OCT), fluorescein angiography (FA), blue fundus autofluorescence (BFAF), en face OCT, and OCT angiography (OCT-A) was included in the study. All images were qualitatively and quantitatively evaluated.ResultsIn this study were included 72 eyes of 69 patients. Exudative intraretinal cystoid spaces (36/72 eyes, 50%) displayed a "petaloid" morphology as seen with en face OCT, FA, and BFAF. Tractional intraretinal cystoid spaces (24/72 eyes, 33.3%), displayed a radial "spoke-wheel" en face OCT pattern. There was no leakage with FA and BFAF did not reveal specific patterns. Eyes with full-thickness macular hole (FTMH, 12/72 eyes, 16.7%) displayed a "sunflower" en face OCT appearance. FTMH showed OCT, OCT-A, and BFAF features of both exudative and tractional cystoid spaces, but without any FA leakage. Inner nuclear layer (INL) thickness was significantly lower in tractional cystoid spaces (P < .001). There were a greater number of INL cystoid spaces in both the exudative and FTMH subgroups (P = .001). The surface area of INL cystoid spaces was significantly lower in the tractional subgroup (P < .001). There was a significant reduction of the microvascular density in eyes with exudative vs tractional (P = .002) and FTMH (P < .001) subgroups.ConclusionsExudative and tractional intraretinal cystoid spaces displayed characteristic multimodal imaging features and they may represent 2 different pathologic conditions with equally different clinical implications

A consensus definition for lamellar macular hole

Background: A consensus on an optical coherence tomography (OCT) definition of lamellar macular hole (LMH) and similar conditions is needed. Methods: The panel reviewed relevant peer-reviewed literature to reach a consensus on LMH definition and to differentiate LMH from other similar conditions. Results: The panel reached a consensus on the definition of 3 clinical entities: LMH, epiretinal membrane (ERM) foveoschisis and macular pseudohole (MPH). LMH definition is based on 3 mandatory criteria and 3 optional anatomical features. The 3 mandatory criteria are the presence of irregular foveal contour, the presence of a foveal cavity with undermined edges, and the apparent loss of foveal tissue. Optional anatomical features include the presence of epiretinal proliferation, the presence of a foveal bump and the disruption of the ellipsoid line. ERM foveoschisis definition is based on 2 mandatory criteria: the presence of ERM and the presence of schisis at the level of Henle’s fiber layer. Three optional anatomical features can also be present: the presence of microcystoid spaces in the inner nuclear layer (INL), an increase of retinal thickness, and the presence of retinal wrinkling. MPH definition is based on 3 mandatory criteria and 2 optional anatomical features. Mandatory criteria include the presence of a foveal sparing ERM, the presence of a steepened foveal profile and an increased central retinal thickness. Optional anatomical features are the presence of microcystoid spaces in the INL and a normal retinal thickness. Conclusions: The use of the proposed definitions may provide uniform language for clinicians and future research

Optical coherence tomography-based consensus definition for lamellar macular hole.

BackgroundA consensus on an optical coherence tomography definition of lamellar macular hole (LMH) and similar conditions is needed.MethodsThe panel reviewed relevant peer-reviewed literature to reach an accord on LMH definition and to differentiate LMH from other similar conditions.ResultsThe panel reached a consensus on the definition of three clinical entities: LMH, epiretinal membrane (ERM) foveoschisis and macular pseudohole (MPH). LMH definition is based on three mandatory criteria and three optional anatomical features. The three mandatory criteria are the presence of irregular foveal contour, the presence of a foveal cavity with undermined edges and the apparent loss of foveal tissue. Optional anatomical features include the presence of epiretinal proliferation, the presence of a central foveal bump and the disruption of the ellipsoid zone. ERM foveoschisis definition is based on two mandatory criteria: the presence of ERM and the presence of schisis at the level of Henle's fibre layer. Three optional anatomical features can also be present: the presence of microcystoid spaces in the inner nuclear layer (INL), an increase of retinal thickness and the presence of retinal wrinkling. MPH definition is based on three mandatory criteria and two optional anatomical features. Mandatory criteria include the presence of a foveal sparing ERM, the presence of a steepened foveal profile and an increased central retinal thickness. Optional anatomical features are the presence of microcystoid spaces in the INL and a normal retinal thickness.ConclusionsThe use of the proposed definitions may provide uniform language for clinicians and future research

Reshaping ophthalmology training after COVID-19 pandemic

Background The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on practical activities and didactic teaching of residents and fellows. This survey aimed to propose long-term changes for ophthalmology training based on the changes experienced by trainees and their perception of new training opportunities. Methods An online survey was distributed to ophthalmology trainees in multiple countries. Descriptive statistics were used to analyse the data. Results A total of 504 analyzable responses were collected from 32 different countries. The current impact of COVID-19 pandemic was described as "severe" by most trainees (55.2%); however, the future perspective was more optimistic as demonstrated by the greater number of responses reporting a presumed "moderate" (37.3%), "mild" (14.1%) or "slight" (4.2%) long-term impact. The vast majority of trainees reported a decrease >= 50% of clinical activity (76.4%) and >75% of surgical activity (74.6%). Although an initial gap in didactic teaching has been experienced by many (55.4%), regular web-based teaching was reportedly attended by 67.7% of the respondents. A strong agreement was found regarding the worthwhile role of web-based case-presentations in clinical training (91.7%), web-based discussion of edited surgical videos (85.7%) and simulation-based practice (86.9%) in surgical training. Conclusions This survey, focusing on trainees' perspective, strongly reinforces the need to promptly include new technology-based training tools, such as web-based teaching, virtual surgical simulators, and telementoring, in long-term reorganisation of ophthalmology training to ensure its continuity and effectiveness, which would remain available even in the face of another unpredictable crisis within the health system

Reshaping ophthalmology training after COVID-19 pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on practical activities and didactic teaching of residents and fellows. This survey aimed to propose long-term changes for ophthalmology training based on the changes experienced by trainees and their perception of new training opportunities. Methods: An online survey was distributed to ophthalmology trainees in multiple countries. Descriptive statistics were used to analyse the data. Results: A total of 504 analyzable responses were collected from 32 different countries. The current impact of COVID-19 pandemic was described as “severe” by most trainees (55.2%); however, the future perspective was more optimistic as demonstrated by the greater number of responses reporting a presumed “moderate” (37.3%), “mild” (14.1%) or “slight” (4.2%) long-term impact. The vast majority of trainees reported a decrease ≥50% of clinical activity (76.4%) and >75% of surgical activity (74.6%). Although an initial gap in didactic teaching has been experienced by many (55.4%), regular web-based teaching was reportedly attended by 67.7% of the respondents. A strong agreement was found regarding the worthwhile role of web-based case-presentations in clinical training (91.7%), web-based discussion of edited surgical videos (85.7%) and simulation-based practice (86.9%) in surgical training. Conclusions: This survey, focusing on trainees’ perspective, strongly reinforces the need to promptly include new technology-based training tools, such as web-based teaching, virtual surgical simulators, and telementoring, in long-term reorganisation of ophthalmology training to ensure its continuity and effectiveness, which would remain available even in the face of another unpredictable crisis within the health systempublishersversionPeer reviewe