Aims: To introduce new terminology and validate its reliability for the analys is of optical coherence tomography (OCT) scans, compare clinical detection of cy stoid macular oedema (CMO)and subretinal fluid (SRF) with...Aims: To introduce new terminology and validate its reliability for the analys is of optical coherence tomography (OCT) scans, compare clinical detection of cy stoid macular oedema (CMO)and subretinal fluid (SRF) with OCT findings, and to s tudy the effect of photodynamic therapy (PDT) on the foveal morphology. Methods: Patients with subfoveal, predominantly classic choroidal neovascularisation (CN V) secondary to age related macular degeneration (AMD) undergoing PDT were evalu ated with refraction protocol best corrected logMAR visual acuity (VA), slit lam p biomicroscopy, stereoscopic fluorescein angiography (FFA), and OCT. New termin ologies introduced to interpret the OCT scans were: neuroretinal foveal thicknes s (NFT), bilaminar foveal thickness (BFT), outer high reflectivity band thicknes s (OHRBT), intraretinal fluid (IRF), subretinal fluid (oSRF), and vitreomacular hyaloid attachment (VMHA). Results: Fifty six eyes of 53 patients were studied. VA was better in eyes with a thinner outer high reflectivity band (OHRBT) (p=0.0 2) and BFT (p=0.05). BFT was less in eyes that had undergone a greater number of PDT treatments (p=0.04). There was poor agreement between OCT and clinical exam ination in the detection of CMO and subretinal fluid (κ.=0.289 and κ.=0.165 re spectively). To validate the interpretation and measurements on OCT, two groups of 20 scans were analysed by two independent observers. There was good agreement between the observers in the detection of IRF,oSRF, and VMHA (p< 0.001). Measur ements of NFTand BFThad a high reproducibility, and of OHRBT reproducibility was low. Conclusions: New terminology has been introduced and tested. OCT appears t o be superior to clinical examination and FFAin the detection of CMO. In this st udy, better vision was associated with a thinner OHRBT and/or the absence of SRF giving insight into the biological effect of PDT.展开更多
To determine the efficacy of a combination of 5- fluorouracil and low- molecular- weight heparin (LMWH) to improve the outcome of surgery for established proliferative vitreoretinopathy (PVR). Double- masked, prospect...To determine the efficacy of a combination of 5- fluorouracil and low- molecular- weight heparin (LMWH) to improve the outcome of surgery for established proliferative vitreoretinopathy (PVR). Double- masked, prospective, randomized, placebocontrolled clinical trial. Three tertiary- referral teaching hospital vitreoretinal surgical units. One hundred fifty- seven patients with established PVR (grade C, anterior or posterior) undergoing vitrectomy surgery. All patients underwent vitreoretinal surgery and silicone oil exchange with or without membrane peeling and/or retinectomy. Patients were randomly allocated to perioperative infusion with or without 5- fluorouracil (200 μ g/ml) and LMWH (5 IU/ml) in Hartmann’ s solution for 1 hour. The primary outcome measure was defined as posterior retinal reattachment after removal of silicone oil without any reoperations at 6 months. Secondary outcome measures recorded were posterior retinal reattachment, localized/tractional retinal detachment, visual acuity, macular pucker, hypotony, glaucoma, keratopathy, and cataract. Removal of silicone oil and reoperations were also recorded. Overall, at 6 months 84% of patients had full retinal reattachment and 94% had stable posterior retinal reattachment. There was no significant difference in success in the primary outcome measure (56% , treatment group; 51% , placebo group; P=0.59) or in secondary outcome measures or rates of complications. Secondary macular pucker occurred less often in the treatment group (6% vs. 17% at 6 months, P=0.068). A perioperative infusion of combined 5- fluorouracil and LMWH does not significantly increase the success rate of vitreoretinal surgery for established PVR.展开更多
文摘Aims: To introduce new terminology and validate its reliability for the analys is of optical coherence tomography (OCT) scans, compare clinical detection of cy stoid macular oedema (CMO)and subretinal fluid (SRF) with OCT findings, and to s tudy the effect of photodynamic therapy (PDT) on the foveal morphology. Methods: Patients with subfoveal, predominantly classic choroidal neovascularisation (CN V) secondary to age related macular degeneration (AMD) undergoing PDT were evalu ated with refraction protocol best corrected logMAR visual acuity (VA), slit lam p biomicroscopy, stereoscopic fluorescein angiography (FFA), and OCT. New termin ologies introduced to interpret the OCT scans were: neuroretinal foveal thicknes s (NFT), bilaminar foveal thickness (BFT), outer high reflectivity band thicknes s (OHRBT), intraretinal fluid (IRF), subretinal fluid (oSRF), and vitreomacular hyaloid attachment (VMHA). Results: Fifty six eyes of 53 patients were studied. VA was better in eyes with a thinner outer high reflectivity band (OHRBT) (p=0.0 2) and BFT (p=0.05). BFT was less in eyes that had undergone a greater number of PDT treatments (p=0.04). There was poor agreement between OCT and clinical exam ination in the detection of CMO and subretinal fluid (κ.=0.289 and κ.=0.165 re spectively). To validate the interpretation and measurements on OCT, two groups of 20 scans were analysed by two independent observers. There was good agreement between the observers in the detection of IRF,oSRF, and VMHA (p< 0.001). Measur ements of NFTand BFThad a high reproducibility, and of OHRBT reproducibility was low. Conclusions: New terminology has been introduced and tested. OCT appears t o be superior to clinical examination and FFAin the detection of CMO. In this st udy, better vision was associated with a thinner OHRBT and/or the absence of SRF giving insight into the biological effect of PDT.
文摘To determine the efficacy of a combination of 5- fluorouracil and low- molecular- weight heparin (LMWH) to improve the outcome of surgery for established proliferative vitreoretinopathy (PVR). Double- masked, prospective, randomized, placebocontrolled clinical trial. Three tertiary- referral teaching hospital vitreoretinal surgical units. One hundred fifty- seven patients with established PVR (grade C, anterior or posterior) undergoing vitrectomy surgery. All patients underwent vitreoretinal surgery and silicone oil exchange with or without membrane peeling and/or retinectomy. Patients were randomly allocated to perioperative infusion with or without 5- fluorouracil (200 μ g/ml) and LMWH (5 IU/ml) in Hartmann’ s solution for 1 hour. The primary outcome measure was defined as posterior retinal reattachment after removal of silicone oil without any reoperations at 6 months. Secondary outcome measures recorded were posterior retinal reattachment, localized/tractional retinal detachment, visual acuity, macular pucker, hypotony, glaucoma, keratopathy, and cataract. Removal of silicone oil and reoperations were also recorded. Overall, at 6 months 84% of patients had full retinal reattachment and 94% had stable posterior retinal reattachment. There was no significant difference in success in the primary outcome measure (56% , treatment group; 51% , placebo group; P=0.59) or in secondary outcome measures or rates of complications. Secondary macular pucker occurred less often in the treatment group (6% vs. 17% at 6 months, P=0.068). A perioperative infusion of combined 5- fluorouracil and LMWH does not significantly increase the success rate of vitreoretinal surgery for established PVR.
