A qualitative and quantitative analysis of filtering blebs with optical coherence tomography in patients after primary trabeculectomy

Purpose: To provide a qualitative and quantitative analysis of filtering blebs with optical coherence tomography (OCT) in patients after primary trabeculectomy. Methods: We retrospectively studied 27 eyes of 25 patients who had a fornix-based flap in primary trabeculectomy: 21 with mitomycin C (MMC) and 6 without MMC. Successful blebs were defined by intraocular pressure (IOP) ≤ 18 mmHg without medication or additional surgery. Filtering blebs were examined using two types of OCTs working at a wavelength of 840 nm and 1310 nm. In this study, we analyzed the OCT morphological-pattern and quantified the reflectivity of blebs. The period between trabeculectomy and OCT examination ranged from 1 week to 2 years. Results: Blebs were classified on the basis of OCT morphological-pattern into three different categories: cystoid type, diffuse type and layer type. The MMC was associated with successful blebs (100%). A significant association was found between bleb good functionality and cystoid-pattern with both devices: 840-nm OCT (p=0.01) and 1310-nm OCT (p=0.03). The reflectivity of filtering blebs correlated very well to the postoperative IOP (R2= 0.90; p<0.001) and to the reduction of IOP (R2= 0.38; p= 0.001). A significant difference (p= 0.02) in characteristics of bleb morphology was found using 840-nm OCT and 1310-nm OCT. Conclusions: A highly significant association of bleb reflectivity to the degree of functionality could be shown. Although 840-nm OCT was not developed to assess the anterior segment, it may be considered a useful tool to evaluate the functionality of blebs in the post-operative period

Photodynamic therapy of corneal neovascularization with verteporfin

Purpose. To describe the effect of photodynamic therapy (PDT) using verteporfin (Visudyne((R))) on corneal neovascularization (CNV) in two patients. Methods. Two patients with corneal neovascularization were treated with a nonthermal laser light at 689 nm delivered 15 min after an intravenous infusion of verteporfin. Postoperative outcome of neovascularization was followed clinically (inflammation, intraocular pressure, and visual acuity) and photographically [color photographs and corneal fluorescein and indocyanine green (ICG) angiography] for a minimum of 6 months. Results. Successful photothrombosis of corneal neovascularization was obtained immediately after treatment in the two patients, and regression was verified by corneal fluorescein and ICG angiography. In one case, partial vessel recanalization was observed after 1 month, and treatment was repeated, with complete regression of new vessels. No relevant side effects were observed in our cases. Conclusions. PDT with verteporfin is an effective and safe procedure indicated for patients with corneal neovascularization; however, multiple sessions may be required

Unfavorable effect of photodynamic therapy for late subretinal neovascularization with chorioretinal anastomoses associated with idiopathic multiple serous detachments of the retinal pigment epithelium

Abstract PURPOSE: To describe a case of a 46-year-old woman with an asymptomatic history of unilateral multiple serous detachments of the retinal pigment epithelium (PED) in the right eye, treated with photodynamic therapy (PDT) with verteporfin for recent onset of subfoveal choroidal neovascularization (CNV) with chorioretinal anastomoses (CRA). METHODS: Case report. RESULTS: Fluorescein and indocyanine green (ICG) angiography, performed with a Heidelberg scanning laser ophthalmoscope (SLO), demonstrated a predominantly classic foveal choroidal neovascular membrane associated with a PED and 1 one retinal and 2 two venous chorioretinal anastomoses. The left fundus was normal. PDT therapy was performed according to standard techniques. Three PDT treatments were performed at an interval of 3 months. Three months after the second PDT, visual acuity dropped to 20/200, with an enlargement of the neovascular network. One month after the third treatment, visual acuity deteriorated further and the CRA appeared enlarged, associated with a dense fibrotic reaction in the centere of the lesion. CONCLUSIONS: This clinical observation demonstrates that idiopathic serous detachments of the retinal pigment epithelium may represent predisposing changes to CNV development, and in the case CNV is associated with CRA, PDT may be unsuccessful

Humphrey visual field 10-2 and macular retinal thickness correlations in glaucomatous patients.

Purpose:To provide a quantitative comparison between the macular retina thickness (MRT) and the Humphrey visual field (HVF) 10-2 SITA-standard strategy parameters in glaucomatous patients. Methods:Retrospective statistical analysis of spectral domain optical coherence tomography macular cube scans 512x128 (Cirrus HD-OCT 4000, Carl Zeiss Meditec, Inc. , Dublin, CA) compared with HVF mean deviation (MD) and pattern standard deviation (PSD) in sixty eyes of thirty-six glaucomatous subjects. Abnormal MRT on OCT was defined as an average macular thickness value of any one of four quadrants to be less than 5% of normative database. Results:Eighteen (30% ) glaucomatous eyes showed an abnormal MRT. In patients with reduced MRT the mean was 236,8 μm, whereas in patients with normal MRT the mean was 264,3 μm. In eleven eyes with MRT reduction the average MD was -10,56 dB, and PSD was greater than 2,5 dB in seven of these eleven eyes. In 61% of glaucomatous patients there was a correlation between MRT and MD. Conclusions:In glaucomatous patients, OCT macular retinal thickness analysis may help in detecting the existence of a visual field defec

The role of axial length (AxL) in planning strabismus surgery

Purpose: To discuss the importance of axial length (AxL) in strabismus surgery and the utility of its association to preoperative deviation data, in calculating the amount of recession to perform in patients affected by convergent strabismus. Methods: Case files of 28 patients, affected by non accommodative esotropia, who underwent recession of one or both medial rectus, in our department between 2009 and 2011, were analyzed. Subject age, data regarding pre and post-intervention angle of deviation for near (ND) and far distance (FD), and axial length (IOL Master, Carl Zeiss, Jena, Germany) were all evaluated. Post operation angle of deviation was evaluated after 3 months from intervention. Results: The patients have been divided in two groups in relation to mean AxL (21.78 mm): the former group had less than 21.78 mm, the second a longer AxL. Results have been evaluated as percent reduction of deviation, between pre- and post-operation. Percent reduction in shorter AxL was 66.37% (ND)and 68.22% (FD); reduction in longer AxL was 81.78 % (ND) and 87.09% (FD) Conclusion: Our results show that the recession of an extraocular muscle is more effective in a larger eye than in a small one. Axial length seems to be an import factor in predicting results of strabismus surgery and should be routinely obtained before any operation, in order to increase the amount of recession in shorter eyes. A large number of dose-response curves have been proposed over time as well the mechanisms that underlie a satisfactory outcome. According to different investigators, preoperative deviation appears to be the most important parameter that must be take into account before strabismus surgery. Importance, besides, has been given to globe size considering both axial length and external surface, but in many reports, conclusions do not agree with our clinical experience