ARVO 2016 Annual Meeting Abstracts
473 RVO/RAO/myopia/CSR
Wednesday, May 04, 2016 3:45 PM–5:30 PM
Exhibit/Poster Hall Poster Session
Program #/Board # Range: 5330–5362/B0001–B0033
Organizing Section: Retina
Contributing Section(s): Anatomy/Pathology, Low Vision
Program Number: 5330 Poster Board Number: B0001
Presentation Time: 3:45 PM–5:30 PM
Comparison the effectiveness of Ozurdex® and combined therapy
of intravitreal bevacizumab and subtenon triamcinolone injection
in recurred branch retinal vein occlusion with macular edema
Sung Pyo Park1, Won Sup Lee1, Jin Young Kim2, Yong Kyu Kim1. 2Jeju
National University, Jeju, Korea (the Republic of).
Purpose: Intravitreal dexamethasone implant (Ozurdex®) or
combined intravitreal bevacizumab and subtenon triamcinolone
injection were used to subside macular edema(ME) in patients with
branch retinal vein occlusion(BRVO).
We performed a prospective clinical study that we wanted to know
the differences of between Ozurdex® and combined therapy at the
efficacy to subside ME and effect to the IOP in patients with recurred
BRVO.
Methods: The 22 participants visited in Kangdong sacred heart
hospital, from 2013 to 2015 due to BRVO.
Inclusion criteria were BCVA < 0.4, central macular thickness(CMT)
> 300 um in Optical coherence tomography(OCT), previous one
time intravitreal Ozurdex® injection history due to BRVO with ME,
recurred BRVO with ME. Exclusion criteria were retinal disease
except BRVO, steroid responder, IOP > 20mmHg at the baseline.
We performed ophthalmic examinations of visual acuity, BCVA,
IOP (Goldmann applanation tonometer), fundus photography,
autofluorescence photography, OCT (Time domain and spectralis)
at the baseline and 1, 2, 3 months after injections. The relationship
between initial and follow-up examination was analyzed using Paired
t-test SPSS 18.0 (SPSS inc., Chicago, Illinos, USA) and P value of
< 0.05.
Results: Average BCVA was 0.33 at baseline, 0.58 at 3 months after
injection (p-value 0.01) in Ozurdex® group, 0.27 at baseline, 0.47 at 3
months (p-value 0.03) in combined therapy group.
Average IOP was 13.55mmHg at baseline,15.09 at 3 months (p-value
0.1) in Ozurdex® group, 13.45 at baseline, 13.18 at 3 months (p-value
0.75) in combined therapy group.
Average CMT was 578.6 um at baseline, 366.9 um at 3 months
(p-value 0.002) in Ozurdex® group, 575.6 um at baseline, 397.2 um at
3 months (p-value 0.001) in combined therapy group.
Differences between baseline and 3 months after injection were as
followed. (figure)
Conclusions: The central macular thickness and BCVA in both
groups were turned out statistically improved during 3 months after
injection. But the differences of BCVA, IOP, CMT between baseline
and 3 months after injection in both groups were not statistically
significant. Both dexamethasone implant and combined therapy can
be effective options to subside macular edema in recurred branch
retinal vein occlusion.
Differences between baseline and 3 months after injection.
Commercial Relationships: Sung Pyo Park; Won Sup Lee, None;
Jin Young Kim, None; Yong Kyu Kim, None
Program Number: 5331 Poster Board Number: B0002
Presentation Time: 3:45 PM–5:30 PM
Efficacy and Safty of Simultaneous Dexamethasone Intravitreal
Implant and Bevacizumab Compared with Bevacizumab
Monotherapy for Branched Retinal Vein Occlusion
Kui Dong Kang1, Yun Junmyeong1, Hyungbin Hwang1, Su Ah Kim2,
Kyung-A Kim3, Tae-Jin Kim3, Man Jae Kwon3, Sang Hoon Jung3.
2
Department of Ophthalmology, SahmYook Medical Center, Seoul,
Korea (the Republic of); 3KIST, Gangneung, Korea (the Republic of).
Purpose: This study was performed to determine whether a
simultaneous injection of dexamethasone intravitreal implant
0.7 mg (dexamethasone delivery system [DDS], OzurdexTM)
and bevacizumab 1.25 mg is more effective than bevacizumab
monotherapy for the treatment of branched retinal vein occlusion
(BRVO).
Methods: Treatment and outcomes data were collected
retrospectively for 51 eyes from 51 patients who underwent
simultaneous DDS and bevacizumab injection or bevacizumab
injection alone. The treatment protocol was to inject DDS
and bevacizumab simultaneously at baseline, and subsequent
bevacizumab (at Months 1 and 2) in the combined treatment group
(n=24), whereas monotherapy eyes (n=27) received bevacizumab
monthly for 3 months (including baseline). Outcome measures
included visual acuity, central retinal thickness (CMT) at 3 and
6 month after initial treatment, and pain questionnaire scores were
calculated at the day of injection.
Results: The mean visual acuity changes from baseline to 6 months
were similar in the 2 groups (combined: +7.4 letters; bevacizumab:
+6.9 letters; P=0.32), however at 3 months, there was a significant
improvement in mean visual acuity (+8.1 lines, P< 0.05) in eyes
with simultaneous DDS and bevacizumab injection compared to
bevacizumab alone. The mean reduction in CMT was greater in
the combination group at both 3 and 6 month (P< 0.05). The pain
questionnaire score was greater in the combined group (P<0.05) and
no adverse effect was observed in both groups.
Conclusions: Simultaneous injection of dexamethasone implant
combined with bevacizumab significantly improves visual acuity in a
relatively short period compared to bevacizumab alone and improves
macular morphology in eyes with BRVO.
Commercial Relationships: Kui Dong Kang, None;
Yun Junmyeong, None; Hyungbin Hwang; Su Ah Kim, None;
Kyung-A Kim, None; Tae-Jin Kim, None; Man Jae Kwon, None;
Sang Hoon Jung, None
Program Number: 5332 Poster Board Number: B0003
Presentation Time: 3:45 PM–5:30 PM
The use of aflibercept in the management of macular edema
secondary to central retinal vein occlusion
Daniel D. Kim, Steven Saraf, Ankit Desai, Uday Desai.
Ophthalmology, Henry Ford Health System, Plymouth, MI.
Purpose: Macular edema (ME) is the leading cause of significant
visual acuity loss in CRVO. The clinical use of aflibercept, a vascular
endothelial growth factor (VEGF) trap-eye, is anecdotally know to
be a more effective and longer lasting treatment. We hypothesize that
aflibercept has a longer duration of action when compared to other
treatments for ME secondary to CRVO.
Methods: A retrospective chart review of 23 eyes from 23 patients
with ME secondary to CRVO was performed. Treatment for the
ME included intravitreal aflibercept, bevacizumab, ranibizumab,
triamcinolone, dexamethasone implant, and focal laser. Data included
mean visual acuity (Va), central subfield thickness (CST), and
intravitreal injection interval. CST data were compared in Stratus to
Spectralis equivalents through four different conversion methods.
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ARVO 2016 Annual Meeting Abstracts
Data was grouped into aflibercept, bevacizumab, and non-aflibercept.
Steroids, ranibizumab, and focal laser were not individually analyzed
due to sparse data. Groups were compared through a Wilcoxon
Signed Rank Test. To test if steroids are a factor in the injection
interval increases of aflibercept, groups were reanalyzed with data
removed after initiation of steroids.
Results: Although the Va was not found to different among the
three groups, the aflibercept group had similar CST vs bevacizumab
in 3 or 4 conversion methods, and thinner CST vs non-aflibercept in
3 of 4 conversion methods. The mean injection interval of aflibercept
(10.29 weeks) was found to be longer by 4.00 weeks vs bevacizumab
(6.28 weeks, P<0.001) and by 2.59 weeks vs non-aflibercept
treatments (7.63 weeks, P<0.001). The analysis without steroid data
also showed the mean injection interval of aflibercept (10.41 weeks)
to be longer by 3.94 weeks vs bevacizumab (6.31 weeks, P<0.005)
and by 3.54 weeks vs non-aflibercept treatments (6.52 weeks,
P<0.005).
Conclusions: Our study shows that aflibercept compared to
bevacizumab and non-aflibercept treatments has comparative efficacy
regarding visual acuity and central subfield thickness, but a longer
duration of action. Results were similar in both analysis with and
without steroid data, suggesting that the longer duration of action is
not significantly affected by use of steroids. Should future prospective
studies show similar outcomes, it can have considerable clinical
impact in the management of ME secondary to CRVO.
Commercial Relationships: Daniel D. Kim, None; Steven Saraf,
None; Ankit Desai, None; Uday Desai, None
Program Number: 5333 Poster Board Number: B0004
Presentation Time: 3:45 PM–5:30 PM
The effect of dexamethasone implant (Ozurdex®) on anterior
chamber parameters in patients with retinal vein occlusion
Berna Akova Budak1, Sertac Argun Kivanc1, Sami Yilmaz2,
Berkant Kaderli1, Ozgur Yalcinbayir1, Mehmet Baykara1,
Ahmet A. Yucel1. 1Ophthalmology, Uludag University, Bursa, Turkey;
2
Retina Eye Hospital, Bursa, Turkey.
Purpose: To investigate the effects of dexamethasone implant
(Ozurdex®) on anterior chamber parameters and choroidal thickness
in patients with retinal vein occlusion.
Methods: This retrospective study comprised 65 patients with
central retinal vein (CRVO) or branch retinal vein occlusion (BRVO)
complicated with macular edema who had Ozurdex® injection. The
patients with diabetes, glaucoma and history of any ocular surgery
were excluded. Thirty-six patients (18 females,18 males) with a
mean age of 62±9.1 years and with at least 6 months follow up were
evaluated. All the patients underwent ophthalmologic examination
including visual acuity measurement, biomicroscopy and indirect
funduscopy. In all patients, Pentacam® (Oculus, Germany) was used
as an anterior segment tomographer to assess corneal volume (CV),
central corneal thickness (CCT), anterior chamber volume (ACV)
and anterior chamber depth before dexamethasone injection and at
1st and 3rd months after injection. OCT (Spectralis, Heidelberg) was
performed before dexamethasone injection and at 1st and 3rd months
after injection for retinal nerve fiber layer, central macular (CMT)
and choroidal thickness (CT) measurement.
Results: Eight patients had CRVO and 28 had BRVO. In 61 % of
the patients right eyes were involved and all the eyes were phakic.
Regarding CCT and CV, there was no significant difference between
pre-injection measurement and the others at 1st and 3rd month (CCT
as 547±37 µ, 547±43 and 547±40 respectively and CV as 58±5mm3,
58±5 mm3 and 59±5 mm3 respectively). There was significant
difference between pre-injection and post injection measures of
ACV at 1st and 3rd month (127±24 mm3 ,144±25 mm3, 155±26 mm3,
p<0.001). CMT and CT values at 1st and 3rd months were found to
be significantly lower than pre-injection values (for CMT p<0,001
at 1st month, p=0.03 at 3rd month; for CT p=0.001 at 1st month,
p=0.001 at 3rd month).
Conclusions: Intravitreal Ozurdex injection may also change anterior
segment parameters while significantly decreasing CMT and CT. This
finding should be taken into account during follow up.
Commercial Relationships: Berna Akova Budak, None; Sertac
Argun Kivanc, None; Sami Yilmaz, None; Berkant Kaderli, None;
Ozgur Yalcinbayir; Mehmet Baykara, None; Ahmet A. Yucel,
None
Program Number: 5334 Poster Board Number: B0005
Presentation Time: 3:45 PM–5:30 PM
Comparing of Bevacizumab and Combination Low-Dose
Bevacizumab-Triamcinolone in Central Retinal Vein Occlusion
Seong-Jae Kim1, Inyoung Chung1, Hyun Woong Kim2,
Seongwook Seo1, Jong Moon Park1. 1Gyeongsang National University
Hospital, Jinju, Korea (the Republic of); 2Busan Paik Hospital,
Busan, Korea (the Republic of).
Purpose: To report the effects and intraocular pressure results of
intravitreal bevacizumab alone injection compared with intravitreal
low-dose bevacizumab combined with low-dose triamcinolone
injection in patients with central retinal vein occlusion.
Methods: In total, 40 eyes of 40 patients diagnosed with central
retinal vein occlusion were evaluated. Of these, 20 eyes of 20 patients
were injected with intravitreal bevacizumab (1.25 mg/0.05 mL) and
20 eyes of 20 patients were injected with low-dose bevacizumab
(0.625 mg/0.025 mL) combined with low-dose triamcinolone (1
mg/0.025 mL). The best corrected visual acuity (BCVA), central
macular thickness, and intraocular pressure of treated eyes were
measured before injection and at 1 month, 2 months, and 3 months
after injection.
Results: In both the intravitreal bevacizumab and the low-dose
bevacizumab combined with low-dose triamcinolone groups, central
macular thickness decreased significantly at 1 month, 2 months, and 3
months after injection (p < 0.05). In addition, in both groups, neither
intraocular pressure (IOP) nor BCVA decreased significantly at 1
month, 2 months, or 3 months after injection (p > 0.05). The BCVA,
IOP, and central macular thickness (CMT) at 1 month, 2 months, and
3 months after injection showed no significant differences between
the intravitreal bevacizumab group and the low-dose bevacizumab
combined with low-dose triamcinolone group (p > 0.05).
Conclusions: The the CMT of both groups decreased significantly,
and BCVA of both groups increased significantly in patients with
central retinal vein occlusion. The injection of low-dose intravitreal
bevacizumab combined with low-dose intravitreal triamcinolone
may be useful for the treatment of central retinal vein occlusion.
injection (p > 0.05). The BCVA, IOP, and central macular thickness
(CMT) at 1 month, 2 months, and 3 months after injection showed
no significant differences between the intravitreal bevacizumab
group and the low-dose bevacizumab combined with low-dose
triamcinolone group (p > 0.05).
Commercial Relationships: Seong-Jae Kim, None;
Inyoung Chung, None; Hyun Woong Kim, None; Seongwook Seo,
None; Jong Moon Park, None
These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/
to access the versions of record.
ARVO 2016 Annual Meeting Abstracts
Program Number: 5335 Poster Board Number: B0006
Presentation Time: 3:45 PM–5:30 PM
Metamorphopsia Associated with Branch Retinal Vein Occlusion
Koichiro Manabe1, Rie Osaka1, Yuki Nakano1, Tomoyoshi Fujita1,
Chieko Shiragami1, Kazuyuki Hirooka1, Yuki Muraoka2, Akihito Uji2,
Akitaka Tsujikawa1. 1Department of Ophtalmology, Kagawa
university Faculty of Medicine, Miki-cho, Japan; 2Department of
Ophthalmology and Visual Sciences, Kyoto University, Kyoto, Japan.
Purpose: To apply M-CHARTS for quantitative measurements of
metamorphopsia in eyes with acute branch retinal vein occlusion
(BRVO) and to elucidate the pathomorphology that causes
metamorphopsia.
Methods: This prospective study consisted of 42 consecutive patients
(42 eyes) with acute BRVO. Both at baseline and one month after
the treatment with ranibizumab, metamorphopsia was measured with
M-CHARTS, and the retinal morphological changes were examined
with optical coherence tomography.
Results: At baseline, metamorphopsia was detected in the vertical
and/or horizontal directions in 29 (69.0%) eyes; the mean vertical
and horizontal scores were 0.59 ± 0.57 and 0.52 ± 0.67, respectively.
The maximum inner retinal thickness showed no association with the
M-CHARTS score, but the M-CHARTS score was correlated with
the total foveal thickness (r = 0.43, P = .004), the height of serous
retinal detachment (r = 0.31, P = .047), and the maximum outer
retinal thickness (r = 0.36, P = .020). One month after treatment, both
the inner and outer retinal thickness substantially decreased in all
eyes. However, metamorphopsia persisted in 26 (89.7%) of 29 eyes.
The posttreatment M-CHARTS score was not correlated with any
posttreatment morphological parameters. However, the posttreatment
M-CHARTS score was weakly correlated with the baseline total
foveal thickness (r = 0.35. P = .024) and closely correlated with the
baseline M-CHARTS score (r = 0.78, P < .001).
Conclusions: Metamorphopsia associated with acute BRVO was
quantified using M-CHARTS.
Commercial Relationships: Koichiro Manabe, None; Rie Osaka;
Yuki Nakano, None; Tomoyoshi Fujita, None; Chieko Shiragami,
None; Kazuyuki Hirooka, None; Yuki Muraoka, None;
Akihito Uji, None; Akitaka Tsujikawa, None
Program Number: 5336 Poster Board Number: B0007
Presentation Time: 3:45 PM–5:30 PM
Laser treatment of central serous chorioretinopathy with 532 nm
Nd-YAG laser
Alexandros Topalidis, Christian Enders, Max Loidl, Gerhard K. Lang,
Gabriele E. Lang. Department for Ophtalmology, University of Ulm,
Ulm, Germany.
Purpose: Central serous chorioretinopathy (CSC) is characterized by
serous detachment of the retina caused by focal leakage through the
retinal pigment epithelium (RPE). Because recurrent CSC often leads
to retinal atrophy and permanent visual loss we studied the effect
of focal laser treatment of the leakage site in patients with acute
recurrence of CSC.
Methods: In a retrospective study a total of 42 eyes were analyzed,
that were treated between 2011 and 2015. 84% were male, 16%
female. The mean age was 47 years (range 31 to 70 years). We
included symtomatic patients suffering from visual deterioration
due to recurring CSC with subretinal fluid involving the center of
the fovea. Before treatment, each patient underwent a complete
ophtalmological examination including the assessment of best
corrected visual acuity (BCVA), fundus autofluorescence (FAF),
fundus fluorescein angiography (FFA) and optical coherence
tomography (OCT). All examinations except FFA were repeated
4-12 weeks after laser treatment. Each patient received direct laser
treatment of the leakage site as identified on FFA with mild laser
burns. A pulse length of 100ms, a spot size of 100μm and energy of
50-100mW was used with a frequency-doubled neodymium-doped
yttrium aluminium garnet (Nd-YAG) laser with 532nm wavelength.
Statistical analysis was performed with the paired t-test.
Results: Mean BCVA improved significantly (p<0.001) from 20/32
(range 20/400 to 20/20) to 20/25 (range 20/32 to 20/16) 8 weeks
after treatment. Eight weeks after laser treatment 71% of the patients
had an improvement of BCVA and 48% of them showed a BCVA of
20/20. The mean central retinal thickness (CRT) before treatment was
476 μm (SD172 μm) and eight weeks after treatment 238 μm (SD 33
μm), showing a mean reduction of 238 μm (p<0.001). No patient had
a deterioration of macular edema or BCVA. Complete resolution of
macular edema after treatment was found in 46% after 4 weeks and
65% after 8 weeks. There were no complications from the treatment
in any of the eyes.
Conclusions: Most patients showed rapid and significant
improvement of BCVA and resolution of macular edema after laser
photocoagulation. Treatment with 532 nm Nd-YAG laser is a safe
and effective approach for patients suffering from recurrent CSC
with focal leakage. Prospective randomized studies are necessary
to compare laser photocoagulation to other treatment options and to
assess long-term outcome.
Commercial Relationships: Alexandros Topalidis, Carl Zeiss
Meditec (F); Christian Enders, Carl Zeiss Meditec (F), Bayer Vital
Gmbh (R); Max Loidl, Carl Zeiss Meditec (F); Gerhard K. Lang;
Gabriele E. Lang, Boehringer Ingelheim Pharma (R), Alcon Pharma
GmbH (F), Carl Zeiss Meditec (F), Novartis GmbH (R), Bayer Vital
GmbH (F), Novartis GmbH (F), Boehringer Ingelheim Pharma
GmbH (F)
Program Number: 5337 Poster Board Number: B0008
Presentation Time: 3:45 PM–5:30 PM
Association between Axial Length and Subfoveal Scleral
Thickness in Highly Myopic Eyes with Staphyloma
Albert Xing1, Alexander H. Vu1, Michael J. Girard2, 4, Jean
Martial Mari3, Stanley Chang1, Quan V. Hoang1. 1Department of
Ophthalmology, Harkness Eye Institute, Columbia University,
New York, NY; 2Singapore Eye Research Institute, Singapore,
Singapore; 3University of French Polynesia, Tahiti, French Polynesia;
4
Ophthalmic Engineering and Innovation Laboratory, Department
of Biomedical Engineering, National University of Singapore,
Singapore, Singapore.
Purpose: Excessive eye elongation in highly myopic eyes has
been suggested to associate with staphyloma formation and scleral
changes. The purpose of this study is to determine if subfoveal
scleral thickness is associated with axial length using SSOCT images
enhanced by adaptive compensation in highly myopic patients with a
staphyloma.
Methods: A prospective imaging study was performed on 27 eyes of
16 highly myopic patients (> 26 mm of axial length) with a clinical
diagnosis of staphyloma. IOLMaster axial length and swept source
optical coherence tomography (SSOCT, DRI OCT-1, Atlantis,
Topcon) were acquired. Scleral boundaries on 12 mm SSOCT line
scans through the foveal center became more distinct after enhanced
by adaptive compensation using Reflectivity 3.4 software (based on
direct application of pixel intensity exponentiation). Subfoveal scleral
thickness measurements were made on ImageJ (Bethesda, MD).
Univariate regression analysis was used to correlate the subfoveal
scleral thickness with axial length.
Results: Eyes examined had a mean axial length of 30.9 +/- 2.1
mm (mean +/- standard deviation, range 26.6 to 35.5 mm) on
IOLMaster and a subfoveal scleral thickness of 291 +/- 79 microns
These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/
to access the versions of record.
ARVO 2016 Annual Meeting Abstracts
(146 to 508 microns on enhanced SSOCT images). Linear regression
demonstrated a significant association between greater axial length
and lower scleral thickness (p = 0.03). Specifically, a 1 mm increase
in axial length is associated with a 15.5 micron (5.3%) decrease in
subfoveal scleral thickness.
Conclusions: Subfoveal scleral boundaries on SSOCT images
of highly myopic eyes were successfully enhanced by adaptive
compensation. Staphyloma have been reported to occur more often in
extreme cases of high myopia, and scleral thinning may be associated
with increased risk for myopic maculopathy. In such eyes, we find
that greater axial length is associated with lower scleral thickness.
Both axial length and scleral thickness may be useful indicators of
which patients may most benefit from future scleral strengthening
therapies.
Commercial Relationships: Albert Xing, None; Alexander H. Vu,
None; Michael J. Girard, None; Jean Martial Mari;
Stanley Chang, None; Quan V. Hoang, None
Support: This work was supported in part by Career Development
Awards from Research to Prevent Blindness (QVH), K08 Grant
(QVH, 1 K08 EY023595, National Eye Institute, NIH) and the Louis
V. Gerstner Jr. Scholars Program (QVH), and philanthropic support
from Joseph Connors (QVH).
Program Number: 5338 Poster Board Number: B0009
Presentation Time: 3:45 PM–5:30 PM
OCT-ANGIOGRAPHY OF CHOROIDAL
NEOVASCULARIZATION SECONDARY TO PATHOLOGIC
MYOPIA
Chiara Giuffre, Lea Querques, Federico Corvi, Ilaria Zucchiatti,
Andrea Mazzaferro, Livia Tomasso, Eleonora Corbelli,
Adriano Carnevali, Giuseppe Querques, Francesco Bandello. IRCCS
Ospedale San Raffaele, Milano, Italy.
Purpose: Choroidal neovascularization (CNV) is the main cause of
visual loss in highly myopic patients. This study analyzes the ability
of optical coherence tomography angiography (OCT-A) to detect
the presence of myopic choroidal neovascularization and to describe
structural features of myopic CNV on OCT-A.
Methods: We retrospectively analyzed 23 eyes of 20 subjects
affected with CNV secondary to high myopia (>6 Diopters (D) and
>26mm of axial length (AL)). All subjects underwent multimodal
imaging including multicolor imaging, fluorescein angiography (FA),
spectral-domain (SD)-OCT and OCT-A (AngioPlex™, CIRRUS
HD-OCT models 5000, Carl Zeiss Meditec, Inc., Dublin, USA).
The OCT-A features of CNV were analyzed and correlated with the
findings of angiography and SD-OCT.
Results: The OCT-A revealed in all 23 eyes the CNV as a large
hyper-intense vascular anastomotic network. On the basis of
OCT-A images, and on the basis of the literature, we proposed two
types of denomination to describe myopic CNV characteristics:
“interlacing” and “tangled” vascular networks. Fifteen out of 23 eyes
were classified as interlacing, and 8 out of 23 eyes were classified
as tangled. Twelve out of 15 CNV (80%) classified as interlacing
showed activity on both FA and SD-OCT B-scan, whereas 6 out 8
CNV (75%) classified as tangled showed absence of activity.
Conclusions: OCT-A is a very useful tool in the diagnosis of
CNV complicating high myopia. Qualitative evaluation of OCT-A
characteristics may allow recognizing different patterns possibly
corresponding to different degrees of neovascular activity.
Commercial Relationships: Chiara Giuffre, None;
Lea Querques, None; Federico Corvi, None; Ilaria Zucchiatti,
None; Andrea Mazzaferro, None; Livia Tomasso, None;
Eleonora Corbelli, None; Adriano Carnevali, None;
Giuseppe Querques, Novartis (C), Alimera Sciences (C), Heidelberg
(C), Allergan (C), Bayer Schering Pharma (C), Bausch and Lomb
(C), Zeiss (C); Francesco Bandello, Bayer (C), Novartis (C), Alcon
(C), Thrombogenics (C), Hofmann La Roche (C), Farmila Thea
(C), Alimera Science (C), Sanofi Aventis (C), Novagali Pharma (C),
Allergan (C), Genentech (C), Bausch and Lomb (C)
Program Number: 5339 Poster Board Number: B0010
Presentation Time: 3:45 PM–5:30 PM
Persistent choroidal neovascularization in high myopia detected
by optical coherence tomography angiography
Kotomi Suzuki, Takeshi Mizutani, Miho Nozaki, Aki Kato,
Munenori Yoshida, Yuichiro Ogura. ophthalmology, Nagoya city
University, Nagoya, Japan.
Purpose: Optical coherence tomography angiography (OCTA) is
a newly developed technology which can visualize chorioretinal
microcirculation without dye injection. The purpose of this study was
to evaluate myopic choroidal neovascularization (CNV) by OCTA.
Methods: The study design was a retrospective chart review of 11
patients (14 eyes) with mCNV who could maintain fixation during the
scan process. The eyes were scanned using OCTA (3 × 3 mm). OCTA
was performed using XR Avanti OCT (Optovue, Fremont, CA). All
patients were women, and average age was 56.4±12.2 years old.
Nine eyes were also evaluated by fluorescein angiography (FA) and
Indocyanine green angiography (ICGA) using HRA2 (Heidelberg,
Engineering, Dossenheim, Germany). Myopic CNV was defined as
the CNV, which occurred in the eyes with refractive error of greater
than or equal to -6 diopters.
Results: The AngioVue system can divide the retina-choroid layer
into 4 layers: the superficial capillary plexuses, deep capillary
plexuses, outer retina and choroidal vessels. Myopic CNV were
found in outer retina in all eyes. In 2 eyes of 14 eyes (14.2 %),
myopic CNV was also found in the superficial capillary plexuses due
to retinal thinning. In the eyes treated with anti-VEGF therapy, we
could quantify the area of CNV, and follow the regression of CNV.
In twelve eyes without deterioration of visual acuity nor exudative
changes in the retina, CNV were found by OCTA, and myopic CNV
still remained without activity of neovascularization.
Conclusions: Since myopic CNV is type 2 CNV, OCTA could
clearly detect myopic CNV in outer retina. Our results showed that
OCTA was useful in making diagnosis and follow-up in the eyes
with myopic CNV. However, our findings indicated that OCTA could
detect peristent CNV in high myopia, making decision of treatment
for myopic CNV should be considered with visual symptom, OCT
B-scan and OCTA.
Commercial Relationships: Kotomi Suzuki, None;
Takeshi Mizutani, None; Miho Nozaki, None; Aki Kato;
Munenori Yoshida, None; Yuichiro Ogura, None
Program Number: 5340 Poster Board Number: B0011
Presentation Time: 3:45 PM–5:30 PM
Parapapillary Autofluorescence and Retinal Nerve Fiber
Thickness; Comparison of Emmetropic and High Myopic Eyes
Teresa S. Tee1, 2, Lekha Gopal3, Ian Murray2, Ivan Y-F Leung1, 2.
1
Singapore Polytechnic, Singapore, Singapore; 2Vision Sciences
Lab, University of Manchester, Manchester, United Kingdom;
3
Ophthalmology and Vision Sciences, Khoo Teck Puat Hospital,
Singapore, Singapore.
Purpose: In order to understand autofluorescence (AF) in myopia,
we studied its relationship with retinal nerve fiber layer (RNFL)
thickness. We hypothesize that RNFL thickness affects parapapillary
AF. To test this idea, we compared the AF - RNFL thickness
relationship between emmetropic and high myopic eyes.
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ARVO 2016 Annual Meeting Abstracts
Methods: Twenty-four young and healthy subjects were recruited.
Nine were emmetropes (≤±0.75D) and 15 were high myopes (≥6.00D). Thirty-degree optic disc-centered AF images were captured
using Spectralis HRA+OCT. RNFL segment measurements were
obtained from optic disc cube protocol on Cirrus OCT (Carl Zeiss).
AF intensities were sampled and correlated with RNFL thickness
from corresponding locations (Fig. 1).
Results: RNFL measurements were thickest inferior-temporally
(7 o’clock position) and thinnest nasally (3 o’clock position) in 12
of 24 eyes. AF intensities were highest nasally (3 o’clock position)
and lowest inferior-temporally (7 o’clock position) in 8 and 11
eyes respectively. AF intensity was negatively correlated with
RNFL thickness in 18 eyes (r=-0.935 to -0.579, p<0.05). Of these,
9 were emmetropes (AL: 23.19±0.76mm) and 9 were high myopes
(AL: 26.94±0.91mm). The 6 eyes that showed no correlation were
significantly longer than the 9 myopic eyes that had correlation
between AF signals and RNFL thickness (28.03±0.91mm vs
26.94±0.91mm; p=0.04). In 2 of these 6 eyes, myopic crescent
affected the sampled AF intensity. Four of these 6 eyes were outliers
in the scatterplot between AL and spherical equivalent.
Conclusions: In this pilot study, parapapillary AF is negatively
correlated with RNFL thickness in all emmetropic eyes and most
of the myopic eyes, showing that RNFL may attenuate AF from
underlying retina. Lack of correlation between RNFL thickness and
AF intensity in eyes with longer axial lengths suggests changes in the
parapapillary retinal pigment epithelium or RNFL thickness.
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ARVO 2016 Annual Meeting Abstracts
Figure 1. The infrared image from disc OCT scan (top) was aligned
with the AF image of the optic disc (middle). AF intensities were
sampled from 5x5 pixel squares at the same location as RNFL
measurements. AF intensities of 4 sampling squares were averaged
for each of 12 equal segments. The averaged AF intensity was
negatively correlated with RNFL thickness (indicated around the
periphery) in the corresponding segment (bottom).
Commercial Relationships: Teresa S. Tee, None; Lekha Gopal,
None; Ian Murray; Ivan Y-F Leung, None
Support: SP FYP Grant CLS-15A154
Program Number: 5341 Poster Board Number: B0012
Presentation Time: 3:45 PM–5:30 PM
Comparison of subthreshold micropulse laser (577nm) treatment
and half dose photodynamic therapy in patients with chronic
central serous chorioretinopathy
Paula Scholz, Lebriz Ersoy, Sascha Fauser. Science, University
Hospital Cologne, Cologne, Germany.
Purpose: To compare the treatment outcome of the 577nm
subthreshold micropulse laser (SML) and half dose photodynamic
therapy (PDT) in patients with chronic central serous
chorioretinopathy (cCSC) and persistent subretinal fluid (SRF).
Methods: This retrospective study included 100 eyes of 100
consecutive patients who were treated with the 577nm SML (Supra
Scan, Quantel Medical) (65 eyes) or half dose PDT (62 eyes) for
cCSC. 27 eyes received both therapies. If both treatments were
performed, the minimal interval between the treatments was 3
months. The treatment was applied at the leakage sites seen in the
fluorescein and indocyanine green angiography. The treatment
success was evaluated using best corrected visual acuity (BCVA),
central retinal thickness (CRT) and resolution of SRF in spectral
domain optical coherence tomography (SD-OCT).
Results: In the SML group 47 eyes (72%) responded to therapy at
the last follow-up (6.2± 5.6 months after SML). In 31 eyes (48%) the
SRF disappeared completely.
In the PDT group 40 eyes (65%) responded to therapy at the last
follow-up (5.8± 5.7 months after PDT). In 9 eyes (15%) the SRF
disappeared completely.
The CRT decreased significantly after SML and PDT treatment (mean
CRT before SML: 397±143µm, after SML: 278±96µm, p<0.001;
mean CRT before PDT: 399±84µm, after PDT: 319±86µm, p<0.001).
BCVA showed no significant increase after treatment (Log MAR
before SML: 0.39±0.25, after SML: 0.35±0.3, p=0.052; Log MAR
before PDT: 0.37±0.26, after: 0.35±0.3, p=0.343).
At baseline there was no statistically significant difference in CRT
between the treatment groups (CRT before SML: 397±143µm, PDT:
399±84µm p=0.184). Six weeks after treatment and at the final
follow-up there was a statistically significant lower CRT in the SML
group than in the PDT group (CRT 6 weeks after treatment: SML:
294±85µm, PDT: 330±94µm p=0.004; CRT at final visit SML:
278±96µm, PDT: 319±86µm p=0.003).
Conclusions: Both, the half dose PDT and the 577nm SML are
potent treatments for cCSC with persistent SRF. The SML treatment
leads to a greater decrease in CRT.
Commercial Relationships: Paula Scholz, Quantel Medical (R);
Lebriz Ersoy, None; Sascha Fauser
Program Number: 5342 Poster Board Number: B0013
Presentation Time: 3:45 PM–5:30 PM
Clinical Experience with Eplerenone to Treat Chronic Central
Serous Chorioretinopathy
Bertan D. Cakir, Franziska Fischer, Andreas Stahl, Christoph Ehlken,
Anima Buehler, Gunther R. Schlunck, Daniel Boehringer,
Hansjürgen Agostini, Clemens Lange. Ophthalmology, Eye Center,
Medical Center – University of Freiburg, Freiburg, Germany.
Purpose: Chronic central serous chorioretinopathy (CSC) is a major
vision-threatening eye disease characterized by central subretinale
fluid (SFR) for which there is still no approved treatment. Recent
studies suggest that the corticosteroid pathway in the choroid is
implicated in CSC pathogenesis, and that oral administration of
the aldosterone antagonist eplerenone improves clinical outcome.
However, there is still little clinical data to support this hypothesis.
We performed a retrospective chart review to further investigate the
clinical value of eplerenone treatment in patients with chronic CSC
and to identify possible response predictors.
Methods: 24 patients with chronic CSC resistant to conventional
therapy over at least 4 months were included in this retrospective
study. Patients were initially treated with 25mg/day of oral
eplerenone for one week, followed by a sustained daily dose of
50mg/day. The primary outcome measure was percentage of eyes
achieving complete resolution of SRF recorded by optical coherence
tomography (SD-OCT). Secondary outcomes included changes in
central macular thickness (CMT) and best-corrected visual acuity
(BCVA). Furthermore, baseline SD-OCT images were evaluated for
possible predictors of treatment response.
Results: 29% of patients experienced a complete resolution of SRF
after a median of 106 days of treatment. 33% of patients showed
a transient initial decrease in SRF, and 25% of patients failed to
respond to treatment. Treatment had to be stopped in 13% of patients
because of adverse effects of the eplerenone treatment. In the study
population, CMT decreased from 342 to 275 µm after treatment,
which was associated with a modest improvement in mean BCVA
from 0.35 to 0.3 logMar. Integrity of the ellipsoid zone and the RPE
at baseline were associated with a tendency for a favourable visual
outcome.
Conclusions: This study confirms the proposed clinical value of
eplerenone for treating patients with therapy-resistant CSC. However,
patients presenting widespread RPE changes are less likely to
benefit from eplerenone treatment, which may argue for an earlier
intervention. Patient subgroups with the highest benefit of eplerenone
treatment need to be characterized in subsequent larger studies.
Commercial Relationships: Bertan D. Cakir; Franziska Fischer,
None; Andreas Stahl, None; Christoph Ehlken, None;
Anima Buehler, None; Gunther R. Schlunck, None;
Daniel Boehringer, None; Hansjürgen Agostini, Formycon
(F), Pixium (F), Allergan (C), Molecular partner (F), Genentech
(F), Roche (C), Novartis (F), Alcon (C), Bayer (F), Zeiss (F);
Clemens Lange, None
Program Number: 5343 Poster Board Number: B0014
Presentation Time: 3:45 PM–5:30 PM
Central serous chorioretinopathy in primary hyperaldosteronism
Elon H. Van Dijk1, Michiel Nijhoff2, Eiko de Jong3, Onno Meijer2,
Aiko De Vries2, Camiel J. Boon1. 1Ophthalmology, Leiden University
Medical Center, LEIDEN, Netherlands; 2Leiden University Medical
Center, Leiden, Netherlands; 3Radboud University Medical Center,
Nijmegen, Netherlands.
Purpose: To describe the ophthalmological characteristics of 13
patients with primary hyperaldosteronism (PA).
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ARVO 2016 Annual Meeting Abstracts
Methods: Prospective cohort study. All patients underwent an
extensive ophthalmological examination.
Results: Thirteen PA patients (9 male, 4 female) were diagnosed
with arterial hypertension for 11.0 ± 11.2 years. Ophthalmological
imaging revealed macular serous subretinal fluid (SRF) on optical
coherence tomography (OCT) in 2 patients (15%). In one of
these patients bilateral chronic central serous chorioretinopathy
(CSC) with polypoidal choroidal neovasculopathy was diagnosed,
which was effectively treated with full-dose photodynamic therapy.
In the other patient with bilateral diffuse hyperfluorescent areas on
fluorescein angiography, the SRF decreased spontaneously after 6
weeks of follow-up. In 5 of the remaining patients (38%) retinal
pigment epithelium alterations resembling findings in CSC and/
or pachychoroid pigment epitheliopathy were seen on multimodal
imaging. The mean subfoveal choroidal thickness was 290.2 ± 65.0
μm.
Conclusions: Retinal abnormalities resembling (subclinical) CSC
may be common in patients with PA. These findings may indicate
that mineralocorticoid-mediated pathways are involved in the
pathogenesis of CSC. A diagnosis of PA should be considered in CSC
patients with hypertension of unknown origin.
Commercial Relationships: Elon H. Van Dijk, None;
Michiel Nijhoff, None; Eiko de Jong, None; Onno Meijer, None;
Aiko De Vries, None; Camiel J. Boon, None
Program Number: 5344 Poster Board Number: B0015
Presentation Time: 3:45 PM–5:30 PM
Subthreshold Focal Grid Laser for Central Serous
Chorioretinopathy: Retrospective Review
Valerie Chen, Keshav Narain. South Bay Retina, Sunnyvale, CA.
Purpose: To see if microperimetry (MP) guided, subthreshold,
532 nm, grid laser can be safely used to treat central serous
chorioretinopathy (CSR) and improve visual acuity (VA) in patients
who failed to respond to lifestyle modification.
Methods: Baseline evaluation and diagnosis required dilated exam,
OCT, fluorescein angiograph, and MP. 35 eyes of 34 CSR patients
were included in this 7-year retrospective review. All patients were
encouraged to improve sleep hygiene, reduce stress, and reduce
caffeine intake (lifestyle modification) for a period of 1-3 months.
23 eyes of 22 patients (20 male, 2 female) that did not improve
received laser. A total of 11 eyes (10 male, 1 female) were placed in
the non-laser group due to spontaneous improvement by the second
visit or refusal of laser.
Results: Laser treated eyes all showed an overall improvement in
VA within six visits over a 9-12 month period. Mean logMAR VA
improved from 0.38 ±0.16 (p <0.07) to 0.18±0.06 (p <0.07). The
median logMAR VA was 0.3 (20/60) at date of initial diagnosis and
logMAR VA 0 (20/20) at final follow up. Of the 23 lasered eyes,14
demonstrated improvement in VA and OCT by the first post-treatment
visit. Of the 11 non-treated patients, 8 had spontaneously improved
while 3 withheld from treatment. No laser-associated side effects
were noted in any of the treated eyes.
Conclusions: Rates of spontaneous improvement without treatment
are consistent with reports on natural history of CSR. Visual recovery
in 14 out of 23 (60%) laser-treated patients after the first posttreatment visit suggests an earlier therapeutic benefit. Patients that
did not resolve spontaneously or receive laser eventually recovered to
VA 20/30 or better, but had significant scotomas. Use of laser in CSR
patients that do not improve within 1-3 months appears to be safe and
effective at stimulating fluid reabsorption, as well as hastening visual
recovery and reducing scotomas. Continued follow-up and use of MP
and OCT in these cohorts should provide information on late-term
consequences of treatment versus non-treatment. We believe the
findings support earlier use of subthreshold laser. Additional study
is needed to elucidate which patients are likely to benefit from this
protocol and what the optimal time to treat would be.
Commercial Relationships: Valerie Chen, None; Keshav Narain,
None
Program Number: 5345 Poster Board Number: B0016
Presentation Time: 3:45 PM–5:30 PM
Fundus Autofluorescence at Test Irradiation Spots after Selective
Retina Therapy for Central Serous Chorioretinopathy
Reina Okada1, Manabu Yamamoto1, Kumiko Hirayama1,
Ayako Yasui1, Takeya Kohno1, Dirk Theisen-Kunde2, Yoko Miura2, 3,
Ralf Brinkmann2, Kunihiko Shiraki1. 1Osaka City University, Osaka,
Japan; 2Medical Laser Center Luebeck, Luebeck, Germany; 3Institute
of Biomedical Optics, University of Luebeck, Luebeck, Germany.
Purpose: To evaluate changes in fundus autofluorescence
(FAF) images at test irradiation in patients with central serous
chorioretinopathy (CSC) after Selective Retina Therapy (SRT).
Methods: Twenty three eyes of 23 CSC patients consisting of 17
males and 6 females were treated. Mean age was 51 years old (range
29 – 68 years old). All subjects had leakage measured by fluorescein
angiography (FA) and persistent serous retinal detachment at the
subfovea longer than 3 months. SRT laser (frequency-doubled,
pulse-stretched Nd:YLF laser; 527 nm, 1.7 µs pulse duration, 100Hz repetition rate, Medical Laser Center Lübeck, Germany) was
used for treatment. Following test spots to determine the irradiation
energy around the upper or lower vessel arcade, the treatment was
performed at the leakage point on FA. FAF images of test irradiation
were detected by two devices, the fundus camera (FC) (TRC50AX, Topcon, Tokyo) and scanning laser ophthalmoscope (SLO)
(Heidelberg Spectralis, Heidelberg, Germany). FAF findings were
divided into hyper- or hypoautofluorescence, which were classified as
plus detected with either or both device at 1, 3, 6 and
12 months postoperatively. The correlation between FAF findings and
optoacoustic (OA) value was examined.
Results: One hundred and 71 test spots were included. Mean
irradiation energy was 97 mJ (range 49 -161 mJ) and mean
logarithm OA value was 2.35 (range 1.28 - 4.18). The rate of
hyperautofluorescence findings decreased as time proceeds compared
with 1 month (64%, 40%, 30% and 27% at 1, 3, 6, 12 months
postoperatively, respectively). The rate of hypoautofluorescence
findings were unchangeable in the full observation period
(73%, 73%, 74% and 73% at 1, 3, 6, 12 months postoperatively,
respectively). The OA values of the test spots presented hyper- or
hypoautofluorescence findings were significantly high compared with
no FAF findings.
Conclusions: Hyperautofluorescence after SRT decreased as time
proceeds, while hypoautofluorescence remained for 1 year. The high
OA value might affect damage around retinal pigment epithelium for
long periods.
Commercial Relationships: Reina Okada; Manabu Yamamoto,
None; Kumiko Hirayama, None; Ayako Yasui, None;
Takeya Kohno, None; Dirk Theisen-Kunde, None; Yoko Miura,
None; Ralf Brinkmann, None; Kunihiko Shiraki, None
Clinical Trial: http://www.umin.ac.jp, UMIN000005396
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ARVO 2016 Annual Meeting Abstracts
Program Number: 5346 Poster Board Number: B0017
Presentation Time: 3:45 PM–5:30 PM
Is micropulse diode laser photocoagulation effective in treating
recalcitrant chronic central serous chorioretinopathy?
Nina-Antonia Striebe, Mohammed Khattab, Christian van
Oterendorp, Josep Callizo, Hans Hoerauf, Nicolas Feltgen. Dpt. of
Ophthalmology, University of Goettingen, Germany, Goettingen,
Germany.
Purpose: There is no standard recommendation for treating chronic
central serous chorioretinopathy (CSC). In recent years Micropulse
laser (MPL) was introduced as a new treatment modality. The
purpose of this study was to analyze the clinical data of chronic CCS
patients treated with MPL, starting from september 2013, when the
Micropulse laser treatment was introduced in our clinic.
Methods: Retrospective monocentric functional and morphological
evaluation of MPL-treatment in a consecutive case series of 17
eyes of 17 patients presenting with chronic CSC - defined as
disease duration > 6 months. Prior unsuccessful treatments included
acetazolamide (125 mg twice a day) (n=17) and eplerenone (50 mg
daily) (n=17) and intravitreal injection of bevacizumab (n=4). Mean
follow-up before MPL treatment was 694 days (range 42-5851 days)
and after MPL 246 days (range 41-434 days) respectively. Foveal
thickness was measured with spectral domain OCT.
Results: Mean foveal thickness during pre MPL standard treatment
period was 327 µm (range 180-815 µm) and decreased to 267 µm
(range 154-572 µm) during post MPL treatment period (mean value
of all follow-up timepoints). For the follow-up examinations within
the first 6 months the foveal thickness reduced to 253 µm (range 165418 µm). The difference between the 6 month post MPL and the pre
MPL foveal thickness was statistically significant (p=0,035).
Mean best-corrected visual acuity (BCVA) was at first presentation
0.33 (logMAR), 0.37 (logMAR) prior to MPL and 0.32 (logMAR) at
the end of the follow up.
Six weeks after MPL mean BCVA improved by five to 25 letters in 3
patients, was unchanged in 11 patients and decreased by five letters in
3 patients. At the end of the follow up mean BCVA improved by five
to 25 letters in 5 patients, was unchanged in 8 patients and decreased
by five letters in 4 patients. No adverse events were observed.
Conclusions: Micropulse laser achieved an anatomical improvement
within the first 6 months after treatment in chronic CSC unresponsive
to other treatment modalities. Functional results were highly variable
and not corresponding to the anatomical improvement. A limitation of
the study is the small patient number.
Commercial Relationships: Nina-Antonia Striebe, None;
Mohammed Khattab, None; Christian van Oterendorp, None;
Josep Callizo, None; Hans Hoerauf, None; Nicolas Feltgen, None
Program Number: 5347 Poster Board Number: B0018
Presentation Time: 3:45 PM–5:30 PM
Laboratory Evaluation of Hypercoagulable States May Prove
Unnecessary in Patients with Central Retinal Vein Occlusion
Who are Less Than 56 Years of Age
Qingyun Liu1, Jacquelyn D. Kemmer1, Kornwipa Hemarat1,
J. M. Lahey2, Jay M. Stewart1. 1Ophthalmology, UCSF, San
Francisco, CA; 2Kaiser Permanente Medical Center, Hayward, CA.
Purpose: To investigate whether the results of early laboratory tests
for hypercoagulable states are correlated with the development of
CRVO risk factors later in life and to evaluate necessity of these tests
in younger CRVO patients.
Methods: From January 1995 to December 2014, 55 patients under
56 years of age with CRVO were enrolled in the study. Laboratory
evaluations for hypercoagulable states were performed in all the
patients at the onset of CRVO. After 0 to 205 months follow-up, the
presence of risk factors for CRVO such as hypertension, obesity,
hyperlipidemia, diabetes mellitus, sleep apnea and glaucoma was
determined. Bilateral correlation and logistic regression were
performed to determine the correlations between the results of the
initial laboratory tests and the diagnosis of CRVO risk factors.
Results: The mean follow-up was 130.67±60.10 months. By the end
of this study, 50 patients completed at least 24 months follow-up,
45 patients completed at least 5 years, and 36 patients completed
at least 10 years of follow-up. Fifteen of 55 patients (27.27%) had
at least one positive test result at the onset of CRVO. At the end of
follow-up, 11 patients had been diagnosed with obesity (20%), 29
with hypertension (52.73%), 21 with hyperlipidemia (38.18%), 24
with diabetes mellitus (43.64%), 5 with sleep apnea (9.09%) and
8 with glaucoma (14.55%). Among 36 patients who completed a
minimum 10 years follow-up, 30 patients (83.33%) developed at
least one common risk factor and none of them experienced any
thromboembolic events. There were no correlations between the
results of laboratory tests and diagnosis of any CRVO risk factors in
patients with a minimum of 2 years, 5 years or 10 years follow-up
(P>0.05).
Conclusions: These findings suggest that the results of laboratory
tests evaluating hypercoagulability in young patients with CRVO are
not correlated with later-developed risk factors for CRVO. Many of
the common risk factors for CRVO were present in a high percentage
of patients by the end of the study, suggesting that they still remain
the core etiology for the disease. The value of the thrombophilic tests
is brought into question as none of the patients demonstrated further
clotting or any unusual thrombi with long term follow up.
Commercial Relationships: Qingyun Liu, None;
Jacquelyn D. Kemmer, None; Kornwipa Hemarat, None;
J. M. Lahey, None; Jay M. Stewart
Support: Research to Prevent Blindness and That Man May See, Inc.
Program Number: 5348 Poster Board Number: B0019
Presentation Time: 3:45 PM–5:30 PM
Screening subjects for an extended and long-term observation of
pathologic myopia at hypothesized risk for developing a myopic
choroidal neovascularization
Petrus Chang1, Focke Ziemssen2, Nicole Eter5,
Christian K. Brinkmann1, Gisela Haeusser-Fruh3, Marc Schargus4,
Frank G. Holz1, Steffen Schmitz-Valckenberg1. 1GRADE Reading
Center, Department of Ophthalmology, University of Bonn, Bonn,
Germany; 2Department of Ophthalmology, Eberhard-Karl University
Tuebingen, Tuebingen, Germany; 3Novartis Pharma Nuremberg,
Nuremberg, Germany; 4OSG Augenklinik Schweinfurt-Gerolzhofen,
Schweinfurt-Gerolzhofen, Germany; 5Department of Ophthalmology,
University of Muenster, Muenster, Germany.
Purpose: This prospective study conducted in German in high
myopic Caucasians with pre-defined disease patterns aims to record
the natural history over three years in order to identify potential risk
factors for the development of myopic choroidal neovascularization
(mCNV).
Methods: This is a non-interventional study with yearly visits,
targeting enrollment of 250 subjects in 30 German centers. At each
visit, the assessments include the completion of a standardized
history, ophthalmic exam, and acquisition of multimodal retinal
imaging. In addition to an axial length ≥ 26 mm, at least one of the
following five disease patterns has to be present in the study eye for
inclusion: (1) subfoveal choroidal thinning < 50 µm, (2) choroidal
curvature length >6300µm, (3) lacquer cracks, (4) patchy atrophy
> 5 mm2 or (5) preexisting mCNV in the fellow eye. Eligibility is
independently confirmed by a central reading center (CRC).
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ARVO 2016 Annual Meeting Abstracts
Results: For an interim analysis of baseline data, a total of 191
subjects (mean age: 53.0 years, range 18.2-86.2; mean axial length
30.1 mm, range 26.0 – 35.7) were screened for eligibility by the
CRC. The presence of at least one of the five pre-defined disease
patterns was confirmed in 100 (52%) subjects (mean age: 56.6 years,
range 21.9 – 86.2). The most common disease pattern was subfoveal
choroidal thinning (n = 34), followed by lacquer cracks (n = 31),
preexisting mCNV in the fellow eye (n = 18), followed by patchy
atrophy (n = 14). Finally, a choroidal curvature length >6300 µm
was found in three subjects with an axial length of 34.9 mm. In 51
subjects, more than one of the five disease patterns was present in the
study eye. The mean axial length of the enrolled subjects was 30.1
mm (range, 26.0 – 35.7).
Conclusions: Within the prospective study cohort, there seems to be
a high variability between the extent of eye globe elongation and the
presence of disease patterns in myopic subjects. Identification of high
risk features for the development of mCNV appears to be important
for patient management and visual long-term outcome.
Commercial Relationships: Petrus Chang; Focke Ziemssen,
Novartis Germany (C); Nicole Eter, Novartis (C), Novartis
(F), Novartis (R); Christian K. Brinkmann, None;
Gisela Haeusser-Fruh, Novartis Germany; Marc Schargus, None;
Frank G. Holz, Novartis (F); Steffen Schmitz-Valckenberg,
Novartis (C), Novartis (F)
Program Number: 5349 Poster Board Number: B0020
Presentation Time: 3:45 PM–5:30 PM
One-Year SDOCT Follow Up of Retinoschisis in Eyes with
Choroidal New Vascularization Secondary to High Myopia
Fenghua Wang, Tonghui Feng, Yanping Zhou, Xiaodong Sun, Xun Xu.
Opthalmology, Shanghai Jiaotong University affliated First Peoples
Hospital, Shanghai, China.
Purpose: Macular retinoschisis and choroidal neovascularization
(CNV) are normal change in high myopia eyes. We performed a
retrospective, observational clinical study in a one-year cohort
designed to investigate longitudinal change of macular schisis in
pathological myopia patient with CNV using spectral domain OCT.
Methods:
There were 35 CNV secondary to high myopia included in this study.
All eyes were performed SD OCT using high definition cross scans
and 512*128 raster scans mode, refractive errors and axial length
(AL) at baseline, following by OCT monthly for 12 months. The
OCT images were evaluated by two independent graders for macular
schisis, the height of schisis and retinal thickness.
Results: All patients received at least one injection of Anti-VEGF
agent (median 3). Mean vision acuity was improved from 48 to 69
ETDRS characters. Ten eyes were found combined retinoschisis.
Fovea were involved in six eyes. Outer layer retinoschisis was
observed in 9 eyes at baseline and the number did not change at
Month 12. The inner layer schisis was observed in 3 eyes at baseline
and 4 at Month 12. Mean height of schisis was 189±67microns at
baseline and 196±102 microns at Month 12. There is no significant
difference between the heights at different time point.
Conclusions: Retinoschisis in macular in PM CNV patients were not
rare. One-year follow-up did not suggest significant progression of
retinoschisis in the these eyes received intravitreal injection.
Commercial Relationships: Fenghua Wang; Tonghui Feng, None;
Yanping Zhou, None; Xiaodong Sun, None; Xun Xu, None
Support: NSFC81470640
Clinical Trial: www.readingcenter.sjtu.edu.cn, 2013RCT001
Program Number: 5350 Poster Board Number: B0021
Presentation Time: 3:45 PM–5:30 PM
Automated Diagnosis and Segmentation of Branch Retinal Artery
Occlusion in SD-OCT
Jingyun Guo, Xinjian Chen. Soochow University, Suzhou, China.
Purpose: Branch retinal artery occlusion (BRAO) is caused by
closure of the vessel, disrupting nutrition supply of the corresponding
retinal area and resulting in edema because of ischemia and anoxia.
Quantitative assessment of the volume of blocked regions on is
needed to evaluate the severity.
Methods: 23 subjects diagnosed with branch retinal artery
occlusion (12 of acute phase and 11 of chronic phase) were
included and underwent macular-centered SD-OCT (Topcon,
512×64×480 voxels, 11.72×93.75×3.50µm3, or 512×128×480 voxels,
11.72×46.88×3.50µm3). Automated diagnosis and segmentation
of BRAO was realized as follows. First, an AdaBoost classifier is
designed to differentiate BRAO of acute phase, BRAO of chronic
phase and normal retina. Then, BRAO regions of acute phase and
chronic phase are segmented separately. To segment BRAO in
chronic phase, a thickness model is built. While for segmenting
BRAO in acute phase, a two-step segmentation is performed:
initialization and segmentation. During the initialization phase, the
Bayesian posterior probability is utilized to compute the probability
map. In the segmentation phase, an advanced GSGC method [1]
is applied, in which initialization results are fully utilized as the
constraints when constructing the energy function. BRAO regions
were labeled in each slice of all subjects as the ground truth, under
the supervision of an experienced ophthalmologist. The segmentation
results were compared with the ground truth.
Results: Patients with BRAO can be diagnosed and the blocked
regions can be segmented automatically using the proposed method
(Fig. 1). The accuracy of AdaBoost classifier is 94.3%, the true
positive volume fraction (TPVF) and the false positive volume
fraction (FPVF) for acute phase were 91.1%, 5.5%; for chronic phase
were 90.5%, 8.7%, respectively.
Conclusions: Automated diagnosis and segmentation of BRAO has
been achieved, which provides shape, position, and size information
to ophthalmologist. We are starting to evaluate the correlation
between BRAO volume and visual ability.
Commercial Relationships: Jingyun Guo, None; Xinjian Chen
Support: Grant 2014CB748600
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to access the versions of record.
ARVO 2016 Annual Meeting Abstracts
Program Number: 5351 Poster Board Number: B0022
Presentation Time: 3:45 PM–5:30 PM
Caspase-9 inhibition by Pen1-XBir3 abrogates retinal edema
Maria Avrutsky1, Ying Jean1, Guy Salvesen2, Carol M. Troy1, 3.
1
Pathology and Cell Biology, Columbia University, New York, NY;
2
Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA;
3
Neurology, Columbia University, New York, CA.
Purpose: Macular edema results from fluid accumulation in the
macula due to leaky blood vessels, and is a common complication
of diabetes and retinal vein occlusion (RVO). Despite available
therapies, an estimated 50% of patients do not respond to treatment.
We identified caspase-9, a protease traditionally associated with
apoptosis, as an essential component in edema formation. To test the
therapeutic potential of modulating caspase-9 activity in edema, we
developed a highly-specific caspase-9 inhibitor by utilizing the XBir3
domain of XIAP.
Methods: We induced retinal edema in 2-4 month-old C57Bl/6J
mice, and endothelial cell specific caspase-9 knockout (caspase9Flox/Tek-Cre) mice. We employed two models of retinal edema:
intravitreal injection of hypertonic saline (5μl, 10X PBS), and RVO.
RVO was achieved by tail-vein injection of rose bengal (150μl, 5mg/
mL), followed by laser photocoagulation of retinal veins using 50mW
output and 2.5 sec laser duration. In vivo analyses – optical coherence
tomography (OCT) and fluorescein angiography - were conducted
with the Micron IV system (Phoenix Research Labs). We generated
Pen1-XBir3 by crosslinking XBir3 to a cell permeant peptide, Pen1
(1:2 molar ratio, incubated at 37°C for 2 hrs). Mice received eyedrops
containing 10μg Pen1-XBir3 immediately following retinal injury.
Results: Both injury models induce acute retinal edema as measured
by OCT (injection model N=3, P<0.01; RVO model N=5, P<.001),
fluorescein angiography, fluorescein-dextran leakage in retinal
flatmounts (N=4, P<.05), and H&E staining of retinal cross-sections
(injection model N=3, P<0.001). Concomitantly, caspase-9 and
VEGF levels increase after injury, as measured by western blot
and immunohistochemistry. Caspase-9 Flox/Tek-Cre mice develop
substantially less edema compared to wildtype animals (injection
model N=3, P<.05), confirming the importance of endothelial
expression of caspase-9 in edema formation. Our findings reveal that
Pen1-XBir3 inhibits caspase-9 activity, and can be delivered to the
retina via eyedrop. Pen1-XBir3 reduces the severity of retinal edema
(injection model N=3, P<0.01; RVO model N=10, P<.001) and
prevents the induction of VEGF (N=4, P<0.05) in both models.
Conclusions: Our studies indicate that endothelial caspase-9 plays an
essential role in regulating edema pathogenesis. Moreover, Pen1XBir3 abrogates the edema and may be a potential novel therapy for
individuals suffering from macular edema.
Commercial Relationships: Maria Avrutsky, None; Ying Jean,
None; Guy Salvesen, None; Carol M. Troy, None
Support: R01NS081333, T32 EY013933
Program Number: 5352 Poster Board Number: B0023
Presentation Time: 3:45 PM–5:30 PM
Intravenous fibrinolysis in acute non-arteritic central retinal
artery occlusion - revisited
Martin S. Spitzer1, Sven Poli2, Florian Haertig2, Nicolas Feltgen3,
Max Schultheiss1. 1Tuebingen University Eye Center, Tuebingen,
Germany; 2Department of Neurology, University Hospital Tuebingen,
Tuebingen, Germany; 3Department of Ophthalmology, University of
Goettingen, Goettingen, Germany.
Purpose: Central retinal artery occlusion (CRAO) is an
ophthalmologic emergency that often results in severe loss of vision
or even blindness. However, no evidence-based therapy exists for the
treatment of non-arteritic CRAO. In previous prospective randomized
trials (intra-arterial and intravenous fibrinolysis) so far only one
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ARVO 2016 Annual Meeting Abstracts
patient has been treated within the first 4.5 hours after symptom
onset.
Methods: In this case series, we report on seven patients who
received intravenous fibrinolysis within the first 4.5 hours after
symptom onset.
Results: The mean Log(MAR) visual acuity increased from
2.5 (“hand motion”) (SD ± 0.23) to 1.1 (“20/250”)(SD ± 0.76).
Furthermore, the visual field improved dramatically in four out of
seven patients. No adverse events were observed in this case series.
The outcome was far superior compared to the results of previous
trials in which lysis could not be performed so promptly.
Conclusions: Intravenous fibrinolysis within the first 4.5 hours after
symptom onset could be an effective and safe treatment in CRAO.
Thus, a new prospective, randomized, placebo controlled trial is
needed which only enrolls CRAO patients with a very recent onset.
Commercial Relationships: Martin S. Spitzer, None;
Sven Poli, None; Florian Haertig, None; Nicolas Feltgen, None;
Max Schultheiss, None
Program Number: 5353 Poster Board Number: B0024
Presentation Time: 3:45 PM–5:30 PM
Ultra-widefield Indocyanine Green Angiography in Central
Serous Chorioretinopathy and Pachychoroid Pigment
Epitheliopathy
Jesse J. Jung1, Quan V. Hoang2, Soraya Rofagha1, 7, David Sarraf3, 5,
K Bailey Freund4, 6. 1East Bay Retina Consultants, Inc., Oakland, CA;
2
Department of Ophthalmology, Edward S. Harkness Eye Institute,
Columbia College of Physicians and Surgeons, New York, NY;
3
Retinal Disorders and Ophthalmic Genetics Division, Stein Eye
Institute, University of California, Los Angeles, Los Angeles, CA;
4
Vitreous Retina Macula Consultants of New York, New York, NY;
5
Department of Ophthalmology, Greater Los Angeles VA Healthcare
Center, Los Angeles, CA; 6Department of Ophthalmology, New
York University School of Medicine, New York, NY; 7Department
of Ophthalmology, University of California, San Francisco, San
Francisco, CA.
Purpose: To demonstrate the role of ultra-widefield indocyanine
green angiography (UWICGA) in identifying choroidal pathology
in both central serous chorioretinopathy (CSC) and pachychoroid
pigment epitheliopathy (PPE).
Methods: This prospective, cohort study evaluated 15 eyes (8
patients) with a diagnosis of CSC or PPE who were imaged with
multimodal imaging including UWICGA (Optos, Marlborough, MA,
USA). Detailed analyses of the patterns of UWICGA imaging were
correlated with the findings of clinical history and examination and
enhanced depth/spectral-domain optical coherence tomography. For
continuous variables, an independent 2-tailed t-test was performed.
Statistical significance was defined as p<0.05.
Results: Fifteen eyes (10 CSC, 5 PPE) of 8 patients (all male)
were evaluated. Within the CSC cohort, the age was 47.6 +/-6.6
(mean +/- standard deviation) and in the PPE cohort was 43.3 +/-6.9
(p=0.22). Five patients were White, 2 Asian and 1 Hispanic. Two
patients had a history of steroid use. Four had acute symptoms
(<6 months) and 4 had chronic symptoms (≥6 months). Two eyes
had a history of recurrent CSC with 2 prior episodes that did not
require treatment. Mean best-corrected visual acuity in the CSC
eyes was 20/34 (range: 20/20-20/126) and in the PPE eyes, was
20/20 (range 20/20-20/25, p=0.12). Mean central foveal thickness
in the CSC eyes was 312.3 +/-109.4 and in PPE eyes was 271.0
+/-23.3 (p=0.43). Mean subfoveal choroidal thickness (SFCT) was
566.3 +/-60.1 in CSC eyes and 511.6 +/-45.0 (p=0.098) in PPE
eyes. Eight out of 10 eyes (80%) had subretinal fluid (SRF) in the
CSC eyes and 0/5 (0%) had SRF in the PPE eyes. All 10 CSC eyes
had posterior hyperautofluorescence with 4 having a focal pattern,
4 with a guttering pattern and 2 having a diffuse pattern. All CSC
and PPE eyes demonstrated early dilated choroidal vessels and late
hyperpermeability on UWICGA. Nine of 10 (90%) CSC eyes had all
4 vortex veins dilated whereas 1 eye had 3 dilated vortex veins. Four
of 5 (80%) PPE eyes had all 4 vortex veins dilated whereas 1 eye had
3 dilated vortex veins.
Conclusions: Multimodal imaging including UWICGA enables
visualization of choroidal hyperpermeability in CSC and PPE.
Choroidal congestion and dilated vortex veins correspond to
increased SFCT in CSC and PPE suggesting that these entities share a
common choroidal vascular abnormality.
Commercial Relationships: Jesse J. Jung, Carl Zeiss Meditec (C),
Optos (C); Quan V. Hoang, None; Soraya Rofagha, Carl Zeiss
Meditec (C); David Sarraf; K Bailey Freund, ThromboGenics
(C), Heidelberg Engineering (C), Optovue (C), Optos (C), Ohr
Pharmaceutical (C), Genentech (C), REGENXBIO (C)
Program Number: 5354 Poster Board Number: B0025
Presentation Time: 3:45 PM–5:30 PM
Lysophosphatidic Acids and Autotaxin in Retinal Vein Occlusion
Ivanka Dacheva1, Christoph Ullmer3, Karolina Ceglowska2, 1,
Everson Nogoceke3, Katarzyna Nowomiejska2, Stephan Müller3,
Guido Hartmann3, Gonzalo Durán-Pacheco3, Florian Kretz1,
Gerd U. Auffarth1, Michael Koss1. 1University of Heidelberg,
Heidelberg, Germany; 2Medical University of Lublin, Lublin, Poland;
3
Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel,
Switzerland.
Purpose: Lysophosphatidic acids (LPAs) are bioactive lipids with
proinflammatory and angiogenic properties. Therefore, they may play
a role in inflammatory and proliferative retinal diseases.
The aim of this retrospective case series was to analyze the levels of
LPAs and their biosynthetic enzyme - autotaxin (ATX), in undiluted
vitreous of untreated patients with retinal vein occlusion (RVO).
Methods: Sixty-four vitreous samples (40 RVO, 24 controls with
idiopathic floaters) were analyzed using liquid chromatography
- mass spectrometry (LC/MS) for LPAs 16:0, 18:0, 18:1, 20:4,
and ELISA kits or Luminex technology for ATX, angiopoetin-1
(ANG-1), interleukin-6 (IL-6), interleukin-7 (IL-7), interleukin-8
(IL-8), monocyte chemoattractant protein-1 (MCP-1), pigment
epithelium-derived factor (PEDF), vascular endothelial growth factor
(VEGF). LPA and ATX levels were correlated with the best corrected
visual acuity (BCVA), central macular thickness (CMT), average
retinal thickness (AvT), vitreal cytokine levels and with each other.
Results: Levels of every LPA species tested and ATX were
significantly increased in the vitreous fluid from all patients with
RVO (total LPAs: 968.0±842.3 nM) compared to controls (total
LPAs: 225.2±292.8 nM, p<.0001). Vitreal ATX levels were higher in
RVO patients (2.5±1.02 nM) compared to controls as well (1.9±1.0
nM; p=.005). There were strong positive correlations between
the vitreal levels of IL-6, IL-8, MCP-1, VEGF and LPAs and no
correlations between LPAs or ATX with ANG-1 and PEDF.
Conclusions: Levels of LPAs and ATX were positively correlated
with proinflammatory cytokines and VEGF and might thus play an
important role in the development of macular edema secondary to
RVO.
Commercial Relationships: Ivanka Dacheva, None;
Christoph Ullmer; Karolina Ceglowska, None; Everson Nogoceke,
Hoffmann-La Roche; Katarzyna Nowomiejska, None;
Stephan Müller, F. Hoffmann-La Roche Ltd; Guido Hartmann, F.
Hoffmann-La Roche Ltd; Gonzalo Durán-Pacheco, F. HoffmannLa Roche Ltd; Florian Kretz, None; Gerd U. Auffarth, None;
Michael Koss, Hoffmann-La Roche (C)
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ARVO 2016 Annual Meeting Abstracts
Program Number: 5355 Poster Board Number: B0026
Presentation Time: 3:45 PM–5:30 PM
Clinical characteristics and response to photodynamic therapy in
severe phenotypes of chronic central serous chorioretinopathy
Danial Mohabati1, Elon H. Van Dijk1, Mays Talib1, Eiko de Jong2,
Sascha Fauser3, Carel C. Hoyng2, Suzanne Yzer4, Camiel J. Boon1.
1
Ophthalmology, Leiden University Medical Center, Leiden,
Netherlands; 2Ophthalmology, Radboud University Medical Center,
Nijmegen, Netherlands; 3Ophthalmology, University Eye Clinic of
Cologne, Cologne, Germany; 4Rotterdam Eye Hospital, Rotterdam,
Netherlands.
Purpose: To explore the clinical characteristics of severe cases of
chronic central serous chorioretinopathy (cCSC) and to assess the
outcome of photodynamic therapy (PDT) in these cases.
Methods: We retrospectively reviewed the medical records of 27
cCSC patients (35 eyes) treated with half-dose or half-time PDT
between 2005 and 2015. Severe cCSC was defined as CSC existing
for more than 6 months combined with at least one of the following
findings: posterior cystoid retinal degeneration (PCRD) on optical
coherence tomography (OCT), multiple hotspots or diffuse leakage
on fluorescein angiography (FA), RPE atrophy larger than 5 optic
disc diameters, an epiretinal membrane in the macula, and best
corrected visual acuity (BCVA) less than 60 EDTRS letters. Eyes
with suspected drusen-associated age-related macular degeneration,
choroidal neovascularization, or polypoidal choroidal vasculopathy,
were excluded. The main outcome measures included BCVA,
reduction of central retinal thickness (CRT), and resolution of
subretinal fluid (SRF) on OCT. Statistical analyses were performed
using a paired samples t-test.
Results: The mean age in this cohort was 57 years and 74% of cases
were male. On inclusion PCRD was found in 16 eyes. Twenty-six
eyes had multiple hotspots or diffuse leakage on FA. RPE atrophy
was seen in 16 eyes. Three eyes had developed a macular epiretinal
membrane, and 16 eyes had a BCVA of less than 60 ETDRS letters.
The mean BCVA before therapy was 61 ETDRS letters, which
significantly increased to 68 ETDRS letters at first post-therapy
follow-up (mean= 7 weeks) (P= 0.002), and to 67 ETDRS letters at
final visit (mean= 58 weeks post-therapy) (P= 0.011). The mean CRT
reduction on OCT was 121 µm (±113 SD) at first follow-up posttherapy, and 105 µm (±114 SD) at final visit. In 23 cases (66%) there
was a complete resolution of SRF at first follow-up. This number
increased to 28 (80%) at the final visit. PCRD showed a complete
resolution after PDT in 69% of these eyes.
Conclusions: A single PDT treatment with reduced settings appears
to be an effective therapeutic intervention for short term and long
term anatomical recovery in severe cCSC. Despite the significant
improvement of visual acuity in these cases, the final BCVA did not
rise above an average of 67 ETDRS letters. This may be caused by
permanent photoreceptor damage due to a prolonged cCSC.
Commercial Relationships: Danial Mohabati, None;
Elon H. Van Dijk, None; Mays Talib, None; Eiko de Jong, None;
Sascha Fauser, None; Carel C. Hoyng, None; Suzanne Yzer, None;
Camiel J. Boon, None
Program Number: 5356 Poster Board Number: B0027
Presentation Time: 3:45 PM–5:30 PM
The 12-months Results of Selective Retina Therapy (SRT) for the
Treatment of Diabetic Macular Edema in Korean Patients
Young Jung Roh1, Ralf Brinkmann2, Young Gun Park1. 2PeterMonnik-Weg 4, Luebeck, Germany.
Purpose: Selective retina therapy (SRT) selectively targets the RPE
and spares the neurosensory retina without causing microscotoma.
This is a prospective, nonrandomized interventional case series study
to investigate the safety and efficacy of Selective retina therapy(SRT)
in Korean patients with diabetic macular edema for 12-months
follow-up.
Methods: Twenty-three eyes of 21 patients with clinically significant
DME were treated with SRT and followed for 12 months. Thirteen
eyes (57%) had completed follow-up. Patients underwent a bestcorrected visual acuity (BCVA) evaluation in Early Treatment
Diabetic Retinopathy Study (ETDRS) letters. Microperimetry was
employed to measure the macular sensitivity within the central
10° field, and the central macular thickness (CMT) and maximum
macular thickness (MMT) were measured. Retreatment and rescue
therapy was performed based on study protocol. Data were analyzed
by the paired t-test.
Results: The mean ETDRS letters increased from 69.5 ± 11.9 to 71.3
± 9.8 at 12-months. Although the CMT was not significantly reduced
from 331.1 ± 98.92 to 303.01 ± 66.47 μm, the MMT significantly
decreased from 446.77 ± 78.49 μm to 408.5 ± 59.62 μm (P=0.025).
The macular sensitivity increased from 21.5 ± 3.4db to 22.5 ± 3.5db
(P=0.001). Additional SRT was performed for nine eyes (69.2%) and
rescue treatment with anti-VEGF agents were needed for five patients
(38.5%).
Conclusions: SRT proved to be efficacious and safe for the treatment
of diabetic macular edema throughout the 12-month follow up. To
evaluate its long-term efficacy, further studies are required with larger
numbers of patients and longer observational follow-up periods.
Commercial Relationships: Young Jung Roh, None;
Ralf Brinkmann; Young Gun Park, None
Support: the South Korean government-affiliated ministry of Trade,
Industry and Energy (M000004912-00192937)
Clinical Trial: the Clinical Research Information Service in Korea,
KCT0001415
Program Number: 5357 Poster Board Number: B0028
Presentation Time: 3:45 PM–5:30 PM
Comparison of visual and anatomical outcomes of half-dose
photodynamic therapy and 689 nm laser treatment (pseudo-PDT)
in eyes with chronic central serous chorioretinopathy
Andrea Russo1, Anna Cancarini1, Elena Gambicorti1, Sarah Duse1,
Nicolò Scaroni1, Ciro Costagliola2, Francesco Semeraro1. 1Eye
Clinic, University of Brescia, Brescia, Italy; 2Eye Clinic, University
of Molise, Campobasso, Italy.
Purpose: Acute central serous chorioretinopathy (CSC) is a common
disorder in middle-aged patients, characterized by serous retinal
detachment in the macular region. We evaluated half-dose verteporfin
photodynamic therapy (hd-PDT) versus 689 nm laser treatment in
chronic CSC.
Methods: This was a pilot study of eyes with chronic CSC. A total of
20 patients were enrolled consecutively and randomized in a 1:1 ratio
to receive hd-PDT (group 1) or 689 nm laser treatment delivering
95 J/cm2 by application of an intensity of 805 mW/cm2 over 118
seconds, using a spot size with a 3000 μm diameter (group 2). Bestcorrected visual acuity (BCVA) and central macular thickness (CMT)
findings were compared between groups.
Results: The baseline characteristics were similar, and no significant
differences between the groups were found. Both groups had
significant BCVA improvements (7.3 ± 1.3 vs 7.6 ± 1.5 ETRDS
letters in group 1 and 2, respectively; P = 0.64), as well as CMT
reductions (-102.5 ± 13.6 vs -96.1 ± 20.5 µm in group 1 and 2,
respectively; P = 0.42) at 16 weeks. Measured parameters were not
significantly different between groups at any time point examined.
Complete photoreceptor recovery, defined as a continuous ellipsoid
zone with a discernible interdigitation zone, was observed at 16
weeks in 7 and 6 patients in group 1 and 2, respectively.
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ARVO 2016 Annual Meeting Abstracts
Conclusions: Both hd-PDT and 689 nm laser treatment were
effective in treating chronic CSC. No significant differences in visual
or anatomical outcomes were observed. Additional larger studies are
warranted to corroborate our results.
OCT series demonstrating the resolution of central serous
chorioretinopathy in a 43-year-old male. A: baseline; B: 3 weeks after
689 nm laser treatment; C: 6 weeks after treatment.
OCT series depicting the reabsorption of a chronic foveal detachment
in dome-shaped macula following 689 nm laser treatment, in
a 51-year-old male. A: baseline; B: 4 weeks after 689 nm laser
treatment.
Commercial Relationships: Andrea Russo, None;
Anna Cancarini, None; Elena Gambicorti, None; Sarah Duse,
None; Nicolò Scaroni, None; Ciro Costagliola, None;
Francesco Semeraro, None
Program Number: 5358 Poster Board Number: B0029
Presentation Time: 3:45 PM–5:30 PM
Therapeutic response of patients with Diabetic macular edema
(DME) with micropulsed yellow laser 577nm and intravitreal
bevacizumab
Geovanni J. Rios, SERGIO ROJAS. RETINA, HOSPITAL DE LA
LUZ, MEXICO, Mexico.
Purpose: The aim of the study is to evaluate the therapeutic response
of diabetic macular edema combining intravitreal bevacizumab +
macular micropulsed yellow 577 nm laser treatment.
Methods: Patients from the Retina Department at “Hospital Nuestra
Señora de la Luz” Mexico City diagnosed with diabetic macular
edema were treated with intravitreal bevacizumab (monthly) + a
single macular grid laser session with micropulsed yellow 577nm
on the platform Iridex IQ 577. The parameters used: Spot: 100
microns / Lens: Volk Superquad / Power: 500 mW / Time: 200 ms
/ Duty cycle: 5%. At Month and 3 months of follow-up treatment
we measured best corrected visual acuity (BCVA), central macular
thickness (CMT) and macular volume (MV) with spectral domain
Optical Coherence Tomography. Statistical Student t test was used to
assess response to treatment.
Results: Combined therapy after 1 month follow-up, achieved
an improvement in BCVA of 0.12 logMAR, with a reduction of
407 microns to 366 microns in central macular thickness (CMT),
a reduction on macular volume of 10.32 to 9.82 mm3 being an
average of 0.5 mm3 after the first month of treatment, being similar at
3 months of follow up and statistically significant. (p< 0.05)
Conclusions: Combined therapy in patients with diabetic macular
edema is effective, being an alternative treatment therapy,
antiangiogenic + macular yellow micropulsed laser.
Commercial Relationships: Geovanni J. Rios, None;
SERGIO ROJAS, None
Program Number: 5359 Poster Board Number: B0030
Presentation Time: 3:45 PM–5:30 PM
Navigated retinal photocoagulation (NaviLas®) as an
alternative therapy in patients with refractory central serous
chorioretinopathy
Jan Klonner, Juliane Schlomberg, Anne Rübsam, Tina DietrichNtoukas, Sibylle Winterhalter, Antonia Joussen, Bert Müller.
Department of Ophthalmology, Charité - Medical University Berlin
Campus Virchow, Berlin, Germany.
Purpose: There are different therapeutic strategies in the treatment
of central serous chorioretinopathy (CSC). Laser coagulation of
source points visible in the fluorescein angiography is a possibility,
usually in patients with chronic CSC (more than 6 months) without
improvement, spontaneous, or under treatment with acetazolamide
or spironolactone. Due to the risk of photoreceptor damage and
possible central scotoma, conventional laser treatmeant is usually not
recommended close to the foveal avascular zone. We hypothesize that
NaviLas® (OD-OS, Teltow, Germany) offers a safe way of navigated
and assisted, FAG image based, lasercoagulation of juxta- and
parafoveal source points.
Methods: Retrospective analysis of 10 eyes from 10 subjects (mean
age 43.4 ± 8.2 years) with chronic refractory CSC, which were
treated between 2013-2015 in our clinic with NaviLas® at source
points in the macular area, 6 of them juxtafoveal. We analyzed the
best-corrected visual acuity (BCVA) before and one month after
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ARVO 2016 Annual Meeting Abstracts
treatment, as well as the average central retinal thickness (meanCRT)
in SD-OCT (Heidelberg Engineering©, Heidelberg, Germany).
Results: Before laser treatment 3 of 10 patients recieved a treatment
trial of acetazolamide and spironolactone, 2 patients spironolactone
only and 5 patients acetazolamide only. In all of the patients treatet
with NaviLas®, with 3 to 5 laserspots per source point, we found a
significant improvement in visual acuity from 0.28 ± 0.19 LogMAR
to 0.16 ± 0.22 (p = 0.01 at α <0.05) and a significant reduction in
mean CRT from 439, 4 ± 116.1 to 273.6 ± 69,1 (p = 0.005 at α
<0.05). No patient experienced a treatment-induced visual loss.
Conclusions: Laser treatment with NaviLas® using eye tracking
and FA based planning options seems to be a safe and effective
alternative therapy in patients with chronic refractory CSC. In the
current follow-up period, all patients were stabilized and displayed a
lack of recurrence of original symptoms. We found a total resorption
of subretinal fluid in 7 of 10 subjects. However, further studies with
larger numbers of patients and longer follow-up times are planned to
investigate long term effects.
Commercial Relationships: Jan Klonner, None;
Juliane Schlomberg, None; Anne Rübsam;
Tina Dietrich-Ntoukas, None; Sibylle Winterhalter, None;
Antonia Joussen, None; Bert Müller, None
Program Number: 5360 Poster Board Number: B0031
Presentation Time: 3:45 PM–5:30 PM
Results of treating branch retinal vein occlusion with intravitreal
ranibizumab injections for one year using a treat and extend
regimen and predictive factors for macula edema
Mika Hosogi, Yuki Morizane, Shuhei Kimura, Mio Hosokawa,
Shinichiro Doi, Fumio Shiraga. Ophthalmology, Okayama university,
Okayama city, Japan.
Purpose: The best approach to treating branch retinal vein occlusion
(BRVO) with vascular endothelial growth factor inhibitors remains
controversial. We evaluated the therapeutic efficacy of intravitreal
ranibizumab injection (IVR) for BRVO using a treat and extend
(TAE) regimen in a retrospective, observational clinical study and
also explored predictive factors for the recurrence of macular edema
(ME).
Methods: Thirty seven eyes of 37 patients (16 men, 21 women; mean
age ± SD: 70.3 ± 12.4 y) newly diagnosed with BRVO were treated
with IVR using a TAE regimen for one year. Monthly injections
continued until the central retinal thickness (CRT) was ≤ 300 μm, as
determined by optical coherence tomography, when the re-treatment
interval was extended by 4 weeks, up to a maximum of 12 weeks. If
the CRT was > 300 μm, the interval was reduced by 2 weeks. The
main outcome measures were changes in the best corrected visual
acuity (BCVA) and the CRT and the annual number of IVR injection.
We also investigated the predictive factors for the recurrence of ME
by assessing prognostic variables, including age, sex, BCVA, CRT,
and occlusion site, and the presence of non-perfused areas over 5
optic discs in diameter, serous retinal detachment, and a history of
high blood pressure.
Results: After 1 y, the mean BCVA (logarithm of the minimal angle
of resolution, log MAR) improved significantly from 0.40 ± 0.33 to
0.09 ± 0.21 (p < 0.0002, paired t-test) and the mean CRT decreased
significantly from 443.9 ± 110.2 μm to 270.6 ± 65.8 μm (p < 0.0001,
paired t-test). The mean number of IVR injections was 6.0 ± 2.0 per
year (range 4 - 12). Edema recurred in 20 cases (64.5%). Predictive
factors for the recurrence of ME identified by univariate analyses
were a high logMAR BCVA (p = 0.008, Wilcoxon rank-sum test),
older age (p = 0.028, Wilcoxon rank-sum test), and occlusion of a
major vain (p = 0.001, Fisher’s exact test), which was the only factor
also identified by multivariate logistic regression (p = 0.034, odds
ratio = 0.009).
Conclusions: A TAE regimen for IVR therapy in BRVO was highly
effective in improving and maintaining both BCVA and CRT at 1
year. Patients with major vein occlusions may be at particular risk of
recurrence of ME.
Commercial Relationships: Mika Hosogi, None; Yuki Morizane,
None; Shuhei Kimura, None; Mio Hosokawa, None;
Shinichiro Doi, None; Fumio Shiraga
Program Number: 5361 Poster Board Number: B0032
Presentation Time: 3:45 PM–5:30 PM
Incidence and Clinical Features of Neovascularization of the Iris
following Acute Central Retinal Artery Occlusion
Youngho Jung1, 2, Se Joon Woo1, 2. 1Ophthalmology, Seoul National
University Bundang Hospital, Seoul, Korea (the Republic of);
2
Ophthalmology, Seoul National University College of Medicine,
Seoul, Korea (the Republic of).
Purpose: To investigate the incidence of neovascularization of the
iris (NVI) and clinical features of patients with NVI following acute
central retinal arterial occlusion (CRAO).
Methods: A retrospective review of 214 consecutive CRAO patients
who visited one tertiary hospital between January 2009 and January
2015 was conducted. In total, 110 patients were eligible for this study
after excluding patients with arteritic CRAO, a lack of follow-up,
iatrogenic CRAO secondary to cosmetic filler injection, or NVI
detected before CRAO attack. Fluorescein angiography (FA) was
applied until retinal arterial reperfusion was achieved, typically
within one to three months.
Results: The incidence of NVI was 10.9% (12 out of 110 patients).
Neovascular glaucoma was found in seven (6.4%) patients. The
mean time to NVI diagnosis after CRAO events was 3.0 months
(range: one week to 15 months). The cumulative incidence was 5.5%
at three months, 7.3% at six months, and 10.9% at 15 months (Fig.
2). Severely narrowed ipsilateral carotid arteries were observed in
only three (25.0%) patients. The other nine patients (75%) showed
no predisposing conditions for NVI, such as proliferative diabetic
retinopathy or central retinal vein occlusion. Reperfusion rate and
prevalence of diabetes were significantly different between patients
with NVI and patients without NVI (reperfusion: 0.0% (NVI) vs.
94.7% (no NVI), p<0.001; diabetes: 50.0% (NVI) vs. 17.3% (no
NVI), p=0.017).
Conclusions: CRAO may lead to NVI caused by chronic ischemia
from reperfusion failure. Our results indicate that follow-up FA
is important to evaluate retinal artery reperfusion after acute
CRAO events, and that prophylactic treatment such as panretinal
photocoagulation should be considered if retinal arterial perfusion is
not recovered.
Commercial Relationships: Youngho Jung, None; Se Joon Woo,
None
Program Number: 5362 Poster Board Number: B0033
Presentation Time: 3:45 PM–5:30 PM
Ischemic injury of the papillomacular bundle is a predictive
marker of poor vision in eyes with branch retinal artery occlusion
Kwan Hyuk Cho, Se Joon Woo, Kyu Hyung Park, Sang Joon Park.
Ophthalmology, Seoul National University Bundang Hospital,
Bundang-gu, Korea (the Republic of).
Purpose: To propose a novel prognostic feature of spectral domainoptical coherence tomography (SD-OCT) in macula-involving branch
retinal artery occlusion (BRAO).
Methods: We analyzed 66 eyes diagnosed with acute BRAO
involving the macula from our hospital RAO registry. At
These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/
to access the versions of record.
ARVO 2016 Annual Meeting Abstracts
presentation, a detailed ophthalmic and medical history was obtained
from all patients, and all underwent a comprehensive ophthalmic
evaluation, which included visual acuity examination, fundus
photography, fluorescein angiography, and SD-OCT. This evaluation
was performed at each follow-up visit.
Results: The 66 eyes diagnosed with acute BRAO involving the
macula were divided into 2 groups according to initial vision: Good
Vision (≥ 20/40, 29 eyes, 44%) and Poor Vision (< 20/40, 37 eyes,
56%). The Poor Vision group was further divided into Improvement
(18 eyes, 27%) and Non-Improvement (19 eyes, 28%) groups,
according to visual recovery at the final examination. Among
multiple OCT parameters, the involvement of papillomacular bundle,
but not that of the central fovea, was consistently observed in the
Poor Vision group (P < 0.001) and more significantly in the NonImprovement (P < 0.001) group. Papillomacular bundle-involvement
features included signs of inner retinal ischemia, including inner
retinal thickening, inner retinal hyperreflectivity, and loss of layer-bylayer integrity. Loss of layer-by-layer integrity was seen consistently
in the Non-Improvement group. Quantitative analysis of inner retinal
thickness also supported this association.
Conclusions: In eyes with macula-involving BRAO, ischemic injury
of the papillomacular bundle at the acute stage, as seen on OCT,
correlates closely with poor vision and can explain the poor visual
prognosis.
Three-dimensional images of Good Vision (Top panel) and Poor
Vision–Non improvement group (Bottom panel) in patients with
branch retinal artery occlusion.
Commercial Relationships: Kwan Hyuk Cho, None; Se Joon Woo,
None; Kyu Hyung Park, None; Sang Joon Park
Flow diagram showing the selection and subgrouping of the enrolled
eyes with branch retinal artery occlusion (BRAO).
These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/
to access the versions of record.