4,836,670 6/1989 Hutchinson ............................. 351A210 4,950,069 8/1990 Hutchinson ............................. 351A210 5,036,347 7/1991 Tsunekawa et al. ... ... 354/400 5,204,703 4/1993 Hutchinson et al. .. ... 351/210 5,214,455 5/1993 Penney et al. .......................... 351A210 5,220,361 6/1993 Lehmer et al. .... 351A226 5,231,674 7/1993 Cleveland et al.. ... 382/6 5,416,317 5/1995 Nishimura et al. 250/221 5,481,622 1/1996 Gerhardt et al. ... ... 38.2/03 5,491,757 2/1996 Lehmer et al. ......................... 382/128

Aim: To evaluate macular anatomy in patients with X linked retinoschisis (XLRS) using spectral-domain optical coherence tomography (SD-OCT). Methods: Consecutive observational case series. Clinical features were obtained through retrospective chart review. Only eyes without prior surgical interventions and those scanned with SD-OCT were included. The OCT images were analysed. Results: Fourteen eyes of seven males with XLRS scanned with SD-OCT, age 5 to 45 years, were identified. On clinical examination, stellate spoke-like cystic maculopathy was present in nine eyes, and an atrophic foveal lesion in five eyes. SD-OCT revealed cystoid spaces accounting for retinal splitting in the inner nuclear layer in 12 eyes, and outer plexiform layer in two eyes of one patient. A few small cysts, not accounting for the foveal splitting, were seen in the outer nuclear layer in four eyes and in the ganglion cell layer and/or nerve fibre layer in six eyes. Conclusions: SD-OCT localised the foveomacular retinoschisis in XLRS to the retinal layers deeper than the nerve fibre layer. In the present study, the foveomacular schisis was seen most frequently in the inner nuclear layer.

Purpose: To evaluate the short-term safety of systemic bevacizumab (Avastin, Genentech, Inc., South San Francisco, CA) and its effects on visual acuity (VA) and subfoveal choroidal neovascularization (CNV) in patients with neovascular age-related macular degeneration (AMD).Design: Open-label, single-center, uncontrolled clinical study.Participants: Age-related macular degeneration patients with subfoveal CNV (N = 9) and best-corrected VA letter scores of 70 to 20 (approximate Snellen equivalent, 20/40-20/400).Methods: Patients were treated at baseline with an infusion of bevacizumab (5 mg/kg), followed by 1 or 2 additional doses given at 2-week intervals. Safety assessments were performed at all visits. Ophthalmologic evaluations included protocol VA measurements and ocular examinations, along with optical coherence tomography (OCT) imaging, fluorescein angiography, and indocyanine green angiography.Main Outcome Measurements: Safety assessments were performed, along with assessments of changes from baseline in VA scores, OCT measurements, and angiographic lesion characteristics.Results: There were no serious ocular or systemic adverse events identified. By 6 weeks, the only adverse event identified was a mild elevation of systolic blood pressure (BP) (+ 12 mmHg; P = 0.035), and this elevation was controlled by either changing or initiating anti hypertensive medication. By 12 weeks, the elevation of systolic BP was no longer significant (P = 0.51). In the study eyes, significant increases in VA were evident within 1 week of treatment, and by 12 weeks, the median and mean VA letter scores increased by 8 letters (P = 0.011) and 12 letters (P = 0.008), respectively. The median and mean central retinal thickness measurements decreased by 157 mu m (P = 0.008) and 177 mu m (P = 0.001), respectively. In the fellow eyes at 12 weeks, the median and mean VA letter scores increased by 27 letters (P = 0.018) and 16 letters (P = 0.012), and the median and mean central retinal thickness measurements decreased by 59 mu m (P = 0.028) and 92 mu m (P = 0.06). In all study eyes, angiography revealed a marked reduction or an absence of leakage from CNV.Conclusion: Overall, bevacizumab therapy was well tolerated, with an improvement in VA, OCT, and angiographic outcomes. Although these preliminary results are promising, a randomized controlled clinical trial is necessary before concluding that systemic bevacizumab therapy is safe and effective for patients with neovascular AMD.

Purpose: The leading cause of visual impairment among patients with diabetes is diabetic macular edema, which has several patterns. In our study we aimed to assess which retinal layers show thickness changes in diffuse diabetic macular edema (dDME). Methods: 11 eyes with background retinopathy and dDME on optical coherence tomography (OCT) examination and 8 control healthy eyes were enrolled in our study with 1.0 best corrected visual acuity (mean age 54 [37-67] years and 53 [36-67] years, respectively). Standard macular mapping was performed in all eyes using a Stratus OCT™ device. All OCT images were segmented using an algorithm of our own design, average thickness data were obtained for the following cellular layers: retinal nerve fiber layer (RNFL), ganglion cell layer and internal plexiform layer complex (GCL+IPL), inner nuclear layer (INL), outer plexiform layer (OPL) and outer nuclear layer (ONL). Results: Average layer thickness significantly increased in all layers in the dDME group except for the RNFL. (RNFL: 41.93±2.05 vs. 42.91±2.84 [p=0.62], GCL+IPL: 71.99±1.04 vs. 75.80±3.42 [p=0.006], INL: 34.34±1.90 vs. 37.55±1.39 [p=0.003], OPL: 34.47±2.25 vs. 37.40±2.01 [p=0.013], ONL: 83.48±4.34 vs. 94.67±11.65 [0.025], results are mean μm±SD). Conclusions: Our results show that all cellular layers of the retina except for the RNFL are thicker in eyes with diffuse diabetic macular edema. It remains an open question how various cellular layers of the retina are involved in retinal thickening in the case of diffuse diabetic macular edema.

Purpose: Optical coherence tomography (OCT) enables high resolution, cross-sectional imaging of the retina. The various retinal layers can be distinguished on OCT images using an algorithm of our own design. In the present study we aimed to assess the intraobserver variability of the segmentation algorithm. Methods: Ten eyes of five healthy subjects were involved in the study (mean age 29 years). Standard macular mapping was performed using a Stratus OCT™ device. All OCT images were segmented using an algorithm of our own design, average thickness and volume data were obtained for the following cellular layers: retinal nerve fiber layer (RNFL), ganglion cell layer and internal plexiform layer complex (GCL+IPL), inner nuclear layer (INL), outer plexiform layer (OPL) and outer nuclear layer (ONL). A manual correction tool was developed to overwrite the automatic segmentation in particular cases where the algorithm failed. The segmentation of the same OCT scans was repeated after one week, and the Coefficient of Repeatability (CR) was calculated in order to assess the accuracy of all measurements. Results: The CR results for the thickness of the various cellular layers of the retina (in the order as they appeared above) were as follows: 0.47μm, 1.47μm, 0.50μm, 0.57μm, and 0.26μm. Similarly, the CR for the volumetric measurements were 0.054mm3, 0.057mm3, 0.017mm3, 0.015mm3, 0.014mm3, 0.025mm3, respectively. Conclusions: The volumetric and thickness results for the various cellular layers of the retina obtained with our custom segmentation algorithm are highly reproducible. According to our results the measurement accuracy of our algorithm is below the resolution of the Stratus OCT device.

PATIENTS AND METHODS: Fifty eyes from 50 normal subjects (29 men and 21 women, aged 22 to 68 years) were scanned with a prototype Cirrus HD-OCT system (5 μm axial resolution) (Carl Zeiss Meditec, Inc.). The proprietary Cirrus segmentation algorithm was used to produce retinal thickness maps, which were then averaged over 9 regions defi ned by a circular target centered at the true fovea location. The macular thickness of 13 subjects scanned with both HD-OCT and StratusOCT were compared.

We previously developed a technique to acquire a SLO (scanning laser ophthalmoscope) like fundus intensity image from the raw spectra measured with spectral-domain optical coherence tomography (OCT), the same spectra used to generate a 3D OCT data set. This technique offers simultaneous fundus and OCT images and, therefore, solves the problem of registering a cross sectional OCT image to fundus features. However, the registration of high density OCT images is still an unsolved problem because no useful fundus image can be generated from the high density scans. High density OCT images can significantly improve the image quality and enhance the visualization of retinal structure, especially the structure of small lesions. We have developed a feature-based algorithm, which can register a high density OCT image on the fundus image generated from normal density scans. The algorithm was successfully tested for both normal and diseased eyes.

PURPOSE: To report clinical and optical coherence tomography (OCT) features in patients with idiopathic macular hole and extensive subretinal fluid (extending at least I disk diameter from the center of the hole).DESIGN: Retrospective, consecutive, noncomparative case series.METHODS: The case records of two patients with idiopathic macular holes with extensive subretinal fluid were reviewed.RESULTS: Both patients presented with reduced visual acuity (20/200 and 20/400). OCT demonstrated attachment of the posterior hyaloid to the inner retina, a full,thickness macular hole, cystoid macular edema (CME), and extensive subretinal fluid. After surgery, both patients achieved macular hole closure and improvement in visual acuity (20/60 and 20/30). Postoperatively, OCT showed a normal foveal contour, complete hole closure, and resolution of the CME and subretinal fluid.CONCLUSIONS: In patients with macular hole and extensive subretinal fluid, improved visual acuity and hole closure can be achieved. Preoperative OCT in these patients demonstrates vitreoretinal interface abnormalities, CME, and extensive subretinal fluid. These changes resolve postoperatively.

To determine whether bevacizumab could improve visual acuity and optical coherence tomography outcomes in a patient with macular edema from central retinal vein occlusion, an intravitreal injection of bevacizumab (1.0 mg) was given. Prior intravitreal injections of triamcinolone acetonide resulted in vision improvement but worsening cataract and borderline glaucoma. Within 1 week of the bevacizumab injection, visual acuity improved from 20/200 to 20/50 and optical coherence tomography revealed resolution of the cystic maculopathy. The improvements were maintained for at least 4 weeks. Intravitreal injections of bevacizumab may provide another treatment option for patients with macular edema from vein occlusions.

Segmentation of retinal layers from OCT images is fundamental to diagnose the progress of retinal diseases. In this study we show that the retinal layers can be automatically and/or interactively located with good accuracy with the aid of local coherence information of the retinal structure. OCT images are processed using the ideas of texture analysis by means of the structure tensor combined with complex diffusion filtering. Experimental results indicate that our proposed novel approach has good performance in speckle noise removal, enhancement and segmentation of the various cellular layers of the retina using the STRATUSOCTTM system.

A high-speed spectral-domain optical coherence tomography (OCT) system was built to image the human retina in vivo. A fundus image similar to the intensity image produced by a scanning laser ophthalmoscope (SLO) was generated from the same spectra that were used for generating the OCT sectional images immediately after the spectra were collected. This function offers perfect spatial registration between the sectional OCT images and the fundus image, which is desired in ophthalmology for monitoring data quality, locating pathology, and increasing reproducibility. This function also offers a practical way to detect eye movements that occur during the acquisition of the OCT image. The system was successfully applied to imaging human retina in vivo.

This article reviews pegaptanib sodium, a compound developed by Eyetech Pharmaceuticals Inc. and Pfizer Inc., for the treatment of neovascular age-related macular degeneration (AMD). Traditional treatment approaches to neovascular AMD have included destructive therapies such as thermal laser photocoagulation and photodynamic therapy; the use of pegaptanib sodium heralds a new treatment approach that is a non-destructive therapy based on the inhibition of vascular endothelial growth factor activity in the eye. This diminishes the neovascular drive in the pathologically hyperpermeable state of the diseased eye. Pegaptanib sodium is one of the first therapeutics belonging to the class of compounds known as aptamers. The chemistry, mechanism of action, pharmacokinetics and rationale for the clinical use of the drug are reviewed. The article highlights and summarises the results of the multi-centre, randomised, sham-controlled clinical trials with pegaptanib sodium to treat subfoveal choroidal neovascularisation in AMD. In addition, the safety profile is reviewed.