Subretinal hemorrhage is a vision threatening complication of exudative age related macular degeneration(AMD) and polypoidal choroidal vasculopathy(PCV). Timely removal or displacement of subretinal hemorrhage from th...Subretinal hemorrhage is a vision threatening complication of exudative age related macular degeneration(AMD) and polypoidal choroidal vasculopathy(PCV). Timely removal or displacement of subretinal hemorrhage from the central macula, ideally within 7 to 10 days after onset, is critical to allowing potential recovery of vision. Surgical techniques with the use of a bubble to displace the subretinal hemorrhage can now be performed with tissue plasminogen activator to lyze the blood and with or without vitrectomy.展开更多
Background and Objective:Subthreshold laser therapy has emerged as a therapeutic alternative to traditional laser photocoagulation for certain ophthalmic diseases including central serous chorioretinopathy(CSCR),diabe...Background and Objective:Subthreshold laser therapy has emerged as a therapeutic alternative to traditional laser photocoagulation for certain ophthalmic diseases including central serous chorioretinopathy(CSCR),diabetic macular edema(DME),macular edema secondary to branch retinal vein occlusion(BRVO),and age-related macular degeneration(AMD).The objective of this paper is to review and discuss the clinical applications of subthreshold laser and the mechanisms of different subthreshold laser techniques including subthreshold micropulse laser(SMPL),selective retina therapy(SRT),subthreshold nanosecond laser(SNL),endpoint management(EpM),and transpupillary thermotherapy(TTT).Methods:A narrative review of English literature and publicly available information published before November 2021 from literature databases and computerized texts.We discuss the currently available subthreshold laser systems and the advancements made to perform different subthreshold laser techniques for various ophthalmic diseases.We highlight various clinical studies and therapeutic techniques that have been conducted to further understand the effectiveness of subthreshold laser in the clinical setting.We conclude the article by covering emerging subthreshold laser systems that are currently being developed for future clinical use.The PubMed database was utilized for peer-reviewed articles and pertinent information on subthreshold systems was cited from publicly available online websites covering specific systems.Key Content and Findings:Various subthreshold laser systems have been developed to treat certain retinal diseases.Several systems are currently in development for future clinical applications.Conclusions:While conventional laser photocoagulation has been effective in treating various retinal diseases,subthreshold laser systems aim to provide a therapeutic effect without visible signs of damage to the underlying tissue.This technology may be particularly effective in treating macular disorders.Further clinical studies are needed to evaluate their role in the management of retinal diseases.展开更多
History and the principle of laser capture microdissection （LCM）： LCM, also known as laser microdissection and pressure catapulting, is one of the most powerful and useful techniques in various research areas where...History and the principle of laser capture microdissection （LCM）： LCM, also known as laser microdissection and pressure catapulting, is one of the most powerful and useful techniques in various research areas where isolation of heterogeneous cell population is required. The first use of laser as a cell operation method, was originated in early 1920s （Gilbrich-Wille, 2013）, and it became widely used as a microsurgical tool ill early 1960s. In the need of extremely small tissue isolation, laser beam of LCM has been modified and developed over several decades from Ultraviolet （UV） laser beam to high-energy nitrogen, infrared and carbon dioxide lasers （Gilbrich-Wille,展开更多
Purpose: To examine the 12- month results of a group of patients treated with combined photodynamic therapy (PDT)- with verteporfin and intravitreal triamcinolone acetonide for choroidal neovascularization (CNV) secon...Purpose: To examine the 12- month results of a group of patients treated with combined photodynamic therapy (PDT)- with verteporfin and intravitreal triamcinolone acetonide for choroidal neovascularization (CNV) secondary to age- related macular degeneration (AMD). Design: Noncomparative case series. Participants: Twenty- six eyes of 26 patients with CNV secondary to AMD. Thirteen with CNV, without restriction to type, were not treated with prior PDT (newly treated group)- . Thirteen patients with prior PDT therapy who experienced visual loss while being treated with PDT alone comprised the remainder (prior PDT group). Methods: Patients with CNV were treated with PDT, immediately followed by an intravitreal injection of4 mg of triamcinolone acetonide. Visual acuity was measured by Early Treatment Diabetic Retinopathy Study protocol refraction. Need for retreatment was based on fluorescein angiographic evidence of leakage at 3- month follow- up intervals. Main Outcome Measures: Visual acuity and retreatment rate. Results: In the newly treated group, the mean acuity change was an improvement of 2.5 lines (last observation carried forward [LOCF], + 2.4 lines; P=0.011, Wilcoxon signed ranks test, as comparedwith baseline acuity) for patients completing the 12- month follow- up. In the prior PDT group, the mean change was an improvement of + 0.44 lines (LOCF, + 0.31 lines; P=0.53). Retreatment rates were 1.24 for the newly treated group and 1.2 for the prior PDT group over the first year. Ten patients (38.5% ) developed an intraocular pressure (IOP) of >24 mmHg during follow- up, a threshold used to institute pressure reduction therapy. No patient developed endophthalmitis. Conclusion: Although the number of patients in this pilot study was limited, the improvement of acuity and the reduced treatment frequency in these patients suggest that combination therapy with PDT and intravitreal triamcinolone acetonide, particularly when used as first- line therapy, merits further investigation. Elevated IOP seems to be the most frequent early side effect of the treatment.展开更多
Purpose: To investigate the autofluorescence characteristics in patients with central serous chorioretinopathy. Design: Observational case series. Participants: Thirty consecutive patients examined in a private referr...Purpose: To investigate the autofluorescence characteristics in patients with central serous chorioretinopathy. Design: Observational case series. Participants: Thirty consecutive patients examined in a private referral practice. Methods: Patients were imaged with autofluorescence photography, fundus photography, fluorescein angiography, and optical coherence tomography (OCT). The mean and standard deviation (SD) of the grayscale values from a 100-pixel-diameter circle centered on the fovea were obtained and normalized with the level of autofluorescence of the posterior pole. Results: There were 30 patients, 23 male (76.7%) and 7 female (23.3%), with a median visual acuity (VA) of 20/25 and a range of 20/15 to 20/400. Stepwise linear regression that included individual fixed effects found that normalized central macular autofluorescence (P < 0.001), pigment mottling in the fovea (P=0.045), subfoveal fluid detected by OCT (P=0.033), and the SD of the central macular autofluorescence (P=0.025) produced a highly significant model (R2=0.92, P< 0.001) predicting VA. Increasing levels of autofluorescence were correlated with accumulation of material on the outer surface of the retina as seen by OCT. Decreased central macular autofluorescence, particularly in those eyes with central geographic retinal pigment epithelial atrophy, was associated with poor VA. Conclusions: This study established that autofluorescence changes occurring in central serous chorioretinopathy with explicit patterns can be measured in a noninvasive manner, and this information can be used to estimate the damage induced by central serous chorioretinopathywith a high degree of statistical significance. We hypothesize that the material on the outer surface of the elevated retina may represent accumulation of photoreceptor outer segments secondary to the lack of direct apposition and phagocytosis by the retinal pigment epithelium.展开更多
This review summarises the current evidence base and provides guidelines for obtaining good refractive outcomes following cataract surgery. Important background information is also provided. In summary, the requiremen...This review summarises the current evidence base and provides guidelines for obtaining good refractive outcomes following cataract surgery. Important background information is also provided. In summary, the requirements are:(1) standardisation of biometry equipment used for axial length and keratometry measurement and the use of optical or immersion ultrasound biometry;(2) sutureless cataract surgery with "in the bag" intraocular lens(IOL) placement;(3) an appropriate 3rd, 4th or 5th Generation IOL power formula should be used;(4) IOL formula constants must be optimized;(5) under certain conditions, the refractive outcome of the 2nd eye can be improved based on the refractive error of the first eye; and(6) results should be audited for refinement and to ensure that standards are met.展开更多
PURPOSE: To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) that had areas of retinal pigment epithelial loss. DESIGN: Observational case report. METHODS: A 67-year-old woman with a history ...PURPOSE: To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) that had areas of retinal pigment epithelial loss. DESIGN: Observational case report. METHODS: A 67-year-old woman with a history of uterine cancer presented with 4 months of bilateral visual loss. RESULTS: Although B-scan ultrasonography revealed both small shallow serous retinal and choroidal detachments in the periphery, the choroid was normal in thickness. Fluorescein angiography revealed numerous nummular-shaped areas of transmission defects suggesting retinal pigment epithelium loss. Autofluorescence photography showed complete absence of autofluorescence in these nummular areas, and optical co-herence tomography showed segmental areas with lack of any signal from affected areas of the retinal pigment epithelium, suggesting complete loss of retinal pigment epithelium cells. CONCLUSIONS: Although the fundus findings in BDUMPhave been attributed to the proliferation of uveal melanocytic cells in the outer choroid in previous papers, our patient had nummular areas of loss of the retinal pigment epithelium as the apparent reason for visual decline.展开更多
Background:To evaluate a fully automated vascular density(VD),skeletal density(SD)and fractal dimension(FD)method for the longitudinal analysis of retinal vein occlusion(RVO)eyes using projection-resolved optical cohe...Background:To evaluate a fully automated vascular density(VD),skeletal density(SD)and fractal dimension(FD)method for the longitudinal analysis of retinal vein occlusion(RVO)eyes using projection-resolved optical coherence tomography angiography(OCTA)images and to evaluate the association between these quantitative variables and the visual prognosis in RVO eyes.Methods:Retrospective longitudinal observational case series.Patients presenting with RVO to Creteil University Eye Clinic between October 2014 and December 2018 and healthy controls were retrospectively evaluated.Group 1 consisted of central RVO(CRVO)eyes,group 2 consisted of eyes with branch RVO(BRVO)and group 3 of healthy control eyes.OCTA acquisitions(AngioVue RTVue XR Avanti,Optovue,Inc.,Freemont,CA)were performed at baseline and last follow up visit.VD,SD,and FD analysis were computed on OCTA superficial and deep vascular complex(SVC,DVC)images at baseline and final follow up using an automated algorithm.Logistic regression was performed to find if and which variable(VD,SD,FD)was predictive for the visual outcome.Results:Forty-one eyes,of which 21 consecutive eyes of 20 RVO patients(13 CRVO in group 1,8 BRVO in group 2),and 20 eyes of 20 healthy controls were included.At the level of SVC,VD and FD were significantly lower in RVO eyes compared to controls(P<0.0001 and P=0.0008 respectively).Best-corrected visual acuity(BCVA)at last follow-up visit was associated with baseline VD(P=0.013),FD(P=0.016),and SD(P=0.01)at the level of the SVC,as well as with baseline FD at the DVC level(P=0.046).Conclusions:Baseline VD,SD,and FD are associated with the visual outcome in RVO eyes.These parameters seem valuable biomarkers and may help improve the evaluation and management of RVO patients.展开更多
Background:To assess the sensitivity,specificity,positive predictive value and negative predictive value of anterior chamber tap for the diagnosis of bacterial endophthalmitis on a population with high prevalence.Meth...Background:To assess the sensitivity,specificity,positive predictive value and negative predictive value of anterior chamber tap for the diagnosis of bacterial endophthalmitis on a population with high prevalence.Methods:Retrospective,single centre,case series study.We reviewed all medical records with clinical diagnosis of bacterial endophthalmitis in our hospital from January 1st,2000 to December 31st 2014.From each record,we documented general demographic data,best corrected visual acuity and vitreous and aqueous tap microbiological results.All cases were further divided according to the endophthalmitis aetiology to perform individual calculations of sensitivity,specificity,positive predictive value,negative predictive value,accuracy and prevalence.We used the results of the vitreous tap as the gold standard for diagnosis of bacterial endophthalmitis.We excluded those records in which the aqueous and vitreous samples were not taken simultaneously or had an incomplete microbiological report.Significance were assessed with chi squared statistics,with an alpha value of 0.05 for statistical significance.Results:A total of 190 cases fulfilled the inclusion/exclusion criteria.Positive culture rate from vitreous samples was 64.74%.Positive culture rate from aqueous sample was 32.11%.Bacteria isolated from aqueous samples matched those isolated from vitreous samples 78.68%of the time.The overall sensitivity was 38.21%,specificity:75.51%,positive predictive value:79.66%,negative predictive value:32.74%(p=0.08).Subgroup analysis showed that anterior chamber taps in cases of post-surgical endophthalmitis had a moderate to low sensitivity(37.73%),high specificity(93%)and high positive predictive value(95%)(p<0.04).Conclusion:The sensitivity and specificity of anterior chamber tap are low and should not be used for critical therapeutic decisions in patients with suspected bacterial endophthalmitis.In cases of post-surgical endophthalmitis,the result of an anterior chamber tap could be used for therapeutic guidance,but only in conjunction with clinical presentation and in the absence of a better method for diagnosis.展开更多
文摘Subretinal hemorrhage is a vision threatening complication of exudative age related macular degeneration(AMD) and polypoidal choroidal vasculopathy(PCV). Timely removal or displacement of subretinal hemorrhage from the central macula, ideally within 7 to 10 days after onset, is critical to allowing potential recovery of vision. Surgical techniques with the use of a bubble to displace the subretinal hemorrhage can now be performed with tissue plasminogen activator to lyze the blood and with or without vitrectomy.
文摘Background and Objective:Subthreshold laser therapy has emerged as a therapeutic alternative to traditional laser photocoagulation for certain ophthalmic diseases including central serous chorioretinopathy(CSCR),diabetic macular edema(DME),macular edema secondary to branch retinal vein occlusion(BRVO),and age-related macular degeneration(AMD).The objective of this paper is to review and discuss the clinical applications of subthreshold laser and the mechanisms of different subthreshold laser techniques including subthreshold micropulse laser(SMPL),selective retina therapy(SRT),subthreshold nanosecond laser(SNL),endpoint management(EpM),and transpupillary thermotherapy(TTT).Methods:A narrative review of English literature and publicly available information published before November 2021 from literature databases and computerized texts.We discuss the currently available subthreshold laser systems and the advancements made to perform different subthreshold laser techniques for various ophthalmic diseases.We highlight various clinical studies and therapeutic techniques that have been conducted to further understand the effectiveness of subthreshold laser in the clinical setting.We conclude the article by covering emerging subthreshold laser systems that are currently being developed for future clinical use.The PubMed database was utilized for peer-reviewed articles and pertinent information on subthreshold systems was cited from publicly available online websites covering specific systems.Key Content and Findings:Various subthreshold laser systems have been developed to treat certain retinal diseases.Several systems are currently in development for future clinical applications.Conclusions:While conventional laser photocoagulation has been effective in treating various retinal diseases,subthreshold laser systems aim to provide a therapeutic effect without visible signs of damage to the underlying tissue.This technology may be particularly effective in treating macular disorders.Further clinical studies are needed to evaluate their role in the management of retinal diseases.
文摘History and the principle of laser capture microdissection （LCM）： LCM, also known as laser microdissection and pressure catapulting, is one of the most powerful and useful techniques in various research areas where isolation of heterogeneous cell population is required. The first use of laser as a cell operation method, was originated in early 1920s （Gilbrich-Wille, 2013）, and it became widely used as a microsurgical tool ill early 1960s. In the need of extremely small tissue isolation, laser beam of LCM has been modified and developed over several decades from Ultraviolet （UV） laser beam to high-energy nitrogen, infrared and carbon dioxide lasers （Gilbrich-Wille,
文摘Purpose: To examine the 12- month results of a group of patients treated with combined photodynamic therapy (PDT)- with verteporfin and intravitreal triamcinolone acetonide for choroidal neovascularization (CNV) secondary to age- related macular degeneration (AMD). Design: Noncomparative case series. Participants: Twenty- six eyes of 26 patients with CNV secondary to AMD. Thirteen with CNV, without restriction to type, were not treated with prior PDT (newly treated group)- . Thirteen patients with prior PDT therapy who experienced visual loss while being treated with PDT alone comprised the remainder (prior PDT group). Methods: Patients with CNV were treated with PDT, immediately followed by an intravitreal injection of4 mg of triamcinolone acetonide. Visual acuity was measured by Early Treatment Diabetic Retinopathy Study protocol refraction. Need for retreatment was based on fluorescein angiographic evidence of leakage at 3- month follow- up intervals. Main Outcome Measures: Visual acuity and retreatment rate. Results: In the newly treated group, the mean acuity change was an improvement of 2.5 lines (last observation carried forward [LOCF], + 2.4 lines; P=0.011, Wilcoxon signed ranks test, as comparedwith baseline acuity) for patients completing the 12- month follow- up. In the prior PDT group, the mean change was an improvement of + 0.44 lines (LOCF, + 0.31 lines; P=0.53). Retreatment rates were 1.24 for the newly treated group and 1.2 for the prior PDT group over the first year. Ten patients (38.5% ) developed an intraocular pressure (IOP) of >24 mmHg during follow- up, a threshold used to institute pressure reduction therapy. No patient developed endophthalmitis. Conclusion: Although the number of patients in this pilot study was limited, the improvement of acuity and the reduced treatment frequency in these patients suggest that combination therapy with PDT and intravitreal triamcinolone acetonide, particularly when used as first- line therapy, merits further investigation. Elevated IOP seems to be the most frequent early side effect of the treatment.
文摘Purpose: To investigate the autofluorescence characteristics in patients with central serous chorioretinopathy. Design: Observational case series. Participants: Thirty consecutive patients examined in a private referral practice. Methods: Patients were imaged with autofluorescence photography, fundus photography, fluorescein angiography, and optical coherence tomography (OCT). The mean and standard deviation (SD) of the grayscale values from a 100-pixel-diameter circle centered on the fovea were obtained and normalized with the level of autofluorescence of the posterior pole. Results: There were 30 patients, 23 male (76.7%) and 7 female (23.3%), with a median visual acuity (VA) of 20/25 and a range of 20/15 to 20/400. Stepwise linear regression that included individual fixed effects found that normalized central macular autofluorescence (P < 0.001), pigment mottling in the fovea (P=0.045), subfoveal fluid detected by OCT (P=0.033), and the SD of the central macular autofluorescence (P=0.025) produced a highly significant model (R2=0.92, P< 0.001) predicting VA. Increasing levels of autofluorescence were correlated with accumulation of material on the outer surface of the retina as seen by OCT. Decreased central macular autofluorescence, particularly in those eyes with central geographic retinal pigment epithelial atrophy, was associated with poor VA. Conclusions: This study established that autofluorescence changes occurring in central serous chorioretinopathy with explicit patterns can be measured in a noninvasive manner, and this information can be used to estimate the damage induced by central serous chorioretinopathywith a high degree of statistical significance. We hypothesize that the material on the outer surface of the elevated retina may represent accumulation of photoreceptor outer segments secondary to the lack of direct apposition and phagocytosis by the retinal pigment epithelium.
文摘This review summarises the current evidence base and provides guidelines for obtaining good refractive outcomes following cataract surgery. Important background information is also provided. In summary, the requirements are:(1) standardisation of biometry equipment used for axial length and keratometry measurement and the use of optical or immersion ultrasound biometry;(2) sutureless cataract surgery with "in the bag" intraocular lens(IOL) placement;(3) an appropriate 3rd, 4th or 5th Generation IOL power formula should be used;(4) IOL formula constants must be optimized;(5) under certain conditions, the refractive outcome of the 2nd eye can be improved based on the refractive error of the first eye; and(6) results should be audited for refinement and to ensure that standards are met.
文摘PURPOSE: To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) that had areas of retinal pigment epithelial loss. DESIGN: Observational case report. METHODS: A 67-year-old woman with a history of uterine cancer presented with 4 months of bilateral visual loss. RESULTS: Although B-scan ultrasonography revealed both small shallow serous retinal and choroidal detachments in the periphery, the choroid was normal in thickness. Fluorescein angiography revealed numerous nummular-shaped areas of transmission defects suggesting retinal pigment epithelium loss. Autofluorescence photography showed complete absence of autofluorescence in these nummular areas, and optical co-herence tomography showed segmental areas with lack of any signal from affected areas of the retinal pigment epithelium, suggesting complete loss of retinal pigment epithelium cells. CONCLUSIONS: Although the fundus findings in BDUMPhave been attributed to the proliferation of uveal melanocytic cells in the outer choroid in previous papers, our patient had nummular areas of loss of the retinal pigment epithelium as the apparent reason for visual decline.
文摘Background:To evaluate a fully automated vascular density(VD),skeletal density(SD)and fractal dimension(FD)method for the longitudinal analysis of retinal vein occlusion(RVO)eyes using projection-resolved optical coherence tomography angiography(OCTA)images and to evaluate the association between these quantitative variables and the visual prognosis in RVO eyes.Methods:Retrospective longitudinal observational case series.Patients presenting with RVO to Creteil University Eye Clinic between October 2014 and December 2018 and healthy controls were retrospectively evaluated.Group 1 consisted of central RVO(CRVO)eyes,group 2 consisted of eyes with branch RVO(BRVO)and group 3 of healthy control eyes.OCTA acquisitions(AngioVue RTVue XR Avanti,Optovue,Inc.,Freemont,CA)were performed at baseline and last follow up visit.VD,SD,and FD analysis were computed on OCTA superficial and deep vascular complex(SVC,DVC)images at baseline and final follow up using an automated algorithm.Logistic regression was performed to find if and which variable(VD,SD,FD)was predictive for the visual outcome.Results:Forty-one eyes,of which 21 consecutive eyes of 20 RVO patients(13 CRVO in group 1,8 BRVO in group 2),and 20 eyes of 20 healthy controls were included.At the level of SVC,VD and FD were significantly lower in RVO eyes compared to controls(P<0.0001 and P=0.0008 respectively).Best-corrected visual acuity(BCVA)at last follow-up visit was associated with baseline VD(P=0.013),FD(P=0.016),and SD(P=0.01)at the level of the SVC,as well as with baseline FD at the DVC level(P=0.046).Conclusions:Baseline VD,SD,and FD are associated with the visual outcome in RVO eyes.These parameters seem valuable biomarkers and may help improve the evaluation and management of RVO patients.
文摘Background:To assess the sensitivity,specificity,positive predictive value and negative predictive value of anterior chamber tap for the diagnosis of bacterial endophthalmitis on a population with high prevalence.Methods:Retrospective,single centre,case series study.We reviewed all medical records with clinical diagnosis of bacterial endophthalmitis in our hospital from January 1st,2000 to December 31st 2014.From each record,we documented general demographic data,best corrected visual acuity and vitreous and aqueous tap microbiological results.All cases were further divided according to the endophthalmitis aetiology to perform individual calculations of sensitivity,specificity,positive predictive value,negative predictive value,accuracy and prevalence.We used the results of the vitreous tap as the gold standard for diagnosis of bacterial endophthalmitis.We excluded those records in which the aqueous and vitreous samples were not taken simultaneously or had an incomplete microbiological report.Significance were assessed with chi squared statistics,with an alpha value of 0.05 for statistical significance.Results:A total of 190 cases fulfilled the inclusion/exclusion criteria.Positive culture rate from vitreous samples was 64.74%.Positive culture rate from aqueous sample was 32.11%.Bacteria isolated from aqueous samples matched those isolated from vitreous samples 78.68%of the time.The overall sensitivity was 38.21%,specificity:75.51%,positive predictive value:79.66%,negative predictive value:32.74%(p=0.08).Subgroup analysis showed that anterior chamber taps in cases of post-surgical endophthalmitis had a moderate to low sensitivity(37.73%),high specificity(93%)and high positive predictive value(95%)(p<0.04).Conclusion:The sensitivity and specificity of anterior chamber tap are low and should not be used for critical therapeutic decisions in patients with suspected bacterial endophthalmitis.In cases of post-surgical endophthalmitis,the result of an anterior chamber tap could be used for therapeutic guidance,but only in conjunction with clinical presentation and in the absence of a better method for diagnosis.
