The impact of central foveal thickness and integrity of the outer retinal layers in the visual outcome of uveitic macular edema

Efficacy and Safety of 0.19-mg Fluocinolone Acetonide Implant in Postoperative Cystoid Macular Edema after Pars Plana Vitrectomy: The ILUvien in Postoperative CYstoid Macular eDema Study

PURPOSE

To assess the efficacy and safety of 0.19-mg fluocinolone acetonide (FAc) intravitreal implant (Iluvien) in treating chronic postoperative cystoid macular edema (PCME) after pars plana vitrectomy.

DESIGN

Retrospective multicentric case series in clinical settings.

SUBJECTS

Patients with chronic PCME who underwent vitrectomy in tertiary care centers in France.

METHODS

Review of charts and OCT scans.

MAIN OUTCOME MEASURES

The primary end points were the best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Secondary end points were the intraocular pressure (IOP); proportion of patients maintaining a BCVA ≥20/40; need for additional nonstudy treatment; differences between eyes that underwent a single and multiple surgeries; and OCT biomarkers of better BCVA.

RESULTS

Forty-nine eyes of 49 patients with a mean follow-up of 24.5 ± 3.87 months were included. The mean BCVA increased from 0.40 ± 0.26 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.32 ± 0.24 logMAR at month 24 (P = 0.0035). The mean CRT decreased from 409 ± 139 μm at baseline to 340 ± 92 μm at month 24 (P = 0.0001). The mean IOP was 14.0 ± 4 mmHg at baseline and remained stable at 14.03 ± 4.1 mmHg at month 24 (P = 0.99). During the follow-up, the IOP exceeded 21 mmHg in 9 eyes, with one eye requiring cyclophotocoagulation. The BCVA was ≥20/40 in 47% of eyes (95% confidence interval [CI], 34%-61%) at baseline and in 58% of eyes at month 24 (95% CI, 41%-73%). At month 18, the likelihood of achieving a BCVA ≥20/40 was higher in eyes with intact external limiting membrane and ellipsoid zone. Additional dexamethasone (DEX) implant was injected in 14 eyes (28.6%). The treatment burden of 2.45 ± 1.35 DEX implant/y was decreased to 0.57 ± 0.60 DEX implant/y after FAc implantation (P = 0.001).

CONCLUSIONS

Fluocinolone acetonide implant improved the BCVA, reduced the CRT, and allowed reducing treatment burden in eyes with chronic PCME after vitrectomy. The safety profile was acceptable.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Macular Thickness and Volume by Spectral-Domain Optical Coherence Tomography and their Related Factors in the Elderly Population

Purpose

To determine the distribution of macular thickness and macular volume in an elderly healthy population 60 years of age and above and their determinants.

Methods

The sampling was performed using a multistage stratified random cluster sampling method on the geriatric population 60 years of age and above in Tehran, Iran. All participants underwent optometric examinations, slit-lamp examination, and optical biometry. Retinal imaging was performed by spectral-domain optical coherence tomography.

Results

The means ± standard deviation and 95% confidence interval of central macular thickness (CMT), average macular thickness (AMT), and macular volume were 221 ± 33 (218-223) μm, 267 ± 29 (265-269) μm, and 8.36 ± 0.44 (8.33-8.39) mm3, respectively. The CMT was significantly lower in females than males (β: -5.77; P = 0.002). The AMT was significantly lower in females than males (β = -10.32; P < 0.001) and was significantly directly related to intraocular pressure (β = 0.63; P = 0.038). The macular volume was significantly lower in females than males (β = -0.13; P < 0.001) and decreased with age (β = -0.01; P < 0.001). In addition, the macular volume had a significant inverse and direct relationship with axial length (β = -0.04; P = 0.011) and keratometry (β = 0.03; P < 0.001).

Conclusions

Macular thickness in the Iranian geriatric population was slightly less than the populations studied in other countries. The role of sex should also be taken into account in the interpretation of macular thickness findings.

Measurement of Foveal Retinal Thickness in Myopic Patients Using Different Display Modes on Optical Coherence Tomography: A Retrospective, Cross-Sectional Study

INTRODUCTION

The aim of this work is to investigate the differences in the measurement of foveal retinal thickness in myopic patients between two display modes (1:1 pixel and 1:1 micron) on optical coherence tomography (OCT).

METHODS

Horizontal OCT line scan through the central fovea was used for manual measurement of foveal retinal thickness under the two display modes, and the values were compared using Wilcoxon signed-rank test. Correlations between the OCT image tilting angle (OCT ITA) and differences in OCT measurement were analyzed by Spearman's test.

RESULTS

127 participants with a median age of 28 years, a median spherical equivalent (SE) of - 8.5 D, and a median axial length (AL) of 27.04 mm. There were significant differences between the two display modes, with a median absolute difference (median relative difference) of 13.33 μm (2.75%) for the central foveal thickness (CFT), 5.33 μm (1.28%) for the Henle fiber and outer nuclear layer thickness (HFL + ONL), 3 μm (6.47%) for the external limiting membrane to ellipsoid zone distance (ELM-EZ), and 4 μm (8.77%) for the ellipsoid zone to retinal pigment epithelium distance (EZ-RPE) (all p < 0.05). The differences in foveal retinal thickness between the two display modes were significantly correlated with the OCT ITA (r = 0.732 for CFT, 0.561 for HFL + ONL, 0.642 for ELM-EZ, and 0.471 for EZ-RPE, all p < 0.05).

CONCLUSIONS

Disparities between the two display modes were found in the manual measurement of foveal retinal thickness and correlated to the OCT ITA.