Macular Degeneration: Taban M

Taban M, Sharma S, Williams DR, Waheed N, Kaiser PK. · Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA. · Ophthalmology. · Pubmed #19410954 No free full text.

Abstract: PURPOSE: To compare automated retinal thickness values generated by the fast macular thickness maps (FMTM) and customized 6-radial line scans (RLS) versus manual retinal measurements on Stratus optical coherence tomography (OCT) (Carl Zeiss Meditec, Dublin, CA). DESIGN: Prospective, observational case series. PARTICIPANTS: Patients with subfoveal choroidal neovascularization (CNV) caused by age-related macular degeneration (AMD), diabetic macular edema (DME), or branch/central retinal vein occlusion (RVO). METHODS: Patients were prospectively imaged using the FMTM and customized RLS patterns on Stratus OCT at the same sitting. Each scan was evaluated for errors in retinal segmentation (i.e., correct retinal boundaries [CRB]). Automated values were recorded while central retinal thickness measurements were determined manually for both patterns. The presence or absence of epiretinal phenomenon, cystoid spaces, pigment epithelial detachment, and subretinal fluid was also noted. MAIN OUTCOME MEASURES: Errors in retinal segmentation at and outside the fovea (i.e., CRB) and percentage of automated values within a clinically acceptable margin (+/-25 mum) of the manual central retinal thickness. RESULTS: A total of 147 eyes of 147 patients (95 eyes with exudative AMD, 41 eyes with DME, and 11 eyes with macular edema caused by RVO) were included. For wet AMD, the total number of CRB at the fovea and outside the fovea was 363 (63.7%) and 360 (63.2%), respectively, in FMTM and 428 (75.1%) and 426 (74.7%), respectively, in RLS (P<0.0001 for both). For DME and RVO, the total number of CRB at the fovea and outside the fovea was 274 (87.8%) and 256 (82.1%), respectively, in FMTM and 287 (92.0%) and 270 (86.5%), respectively, in RLS (P = 0.11, P = 0.15, respectively). Some 40% and 56% of automated foveal center point thicknesses on FMTM and RLS, respectively, were within +/-25 mum of the manual central retinal thickness for AMD (P = 0.042), versus 94% and 81% for DME and RVO, respectively (P = 0.07). CONCLUSIONS: For exudative AMD, the RLS protocol provides fewer segmentation errors than the FMTM protocol, and its automated retinal thickness values (e.g., foveal center point, central subfield) correlate better with manual retinal thickness measurement than FMTM. In DME and RVO, however, both protocols provide similar and low segmentation errors, and their automated results are close to manual measurements. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Taban M, Singh RP, Chung JY, Lowder CY, Perez VL, Kaiser PK. · Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. · Am J Ophthalmol. · Pubmed #17601427 No free full text.

Abstract: PURPOSE: To report an association between uveitis and sterile endophthalmitis after intravitreal triamcinolone acetonide injection. DESIGN: Retrospective case series. METHODS: A retrospective analysis of all patients receiving intravitreal triamcinolone injection at the Cole Eye Institute from January 2006 through September 2006 was carried out to evaluate for the occurrence of bacterial or sterile endophthalmitis. Indication for treatment, ocular history, best-corrected Snellen visual acuity, and clinical examination findings were recorded from the clinical charts before injection and at last follow-up. RESULTS: A total of 310 eyes received intravitreal triamcinolone injection for various causes, including age-related macular degeneration (AMD), diabetic retinopathy, vascular occlusion, and cystoid macular edema (CME) resulting from uveitis. There were no cases of culture-positive infectious endophthalmitis. There were six cases (1.9%) of sterile endophthalmitis. Of these six cases, four had prior history of uveitis, whereas only 20 of the 310 cases had a prior history of uveitis. All six patients sought treatment within three days of injection, and all recovered rapidly. Presenting visual acuity was either counting fingers or hand movements. Median best-corrected visual acuity before injection was 20/100(+), whereas median final visual acuity was 20/80(-). CONCLUSIONS: Patients with a history of uveitis may be at increased risk of experiencing sterile endophthalmitis resulting from intravitreal triamcinolone injection.