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*All required fields must be completed. Please include non-medical questions and correspondence only. If this is an emergency referral, please contact our office directly, Jacksonville 800.237.3846, Daytona Beach 800.555.6590, Lake Mary 877.357.3846. Our regular office hours are 8AM to 5PM Monday through Friday.
Jaya B Kumar, Karen M Wai, Justin P Ehlers, Rishi P Singh, Aleksandra V Rachitskaya. British Journal of Ophthalmology, BMH Journals. 2018/3/12
Aims To investigate the relationship between subfoveal choroidal thickness (SFCT), visual acuity (VA), optical coherence tomography (OCT) features and total anti-vascular endothelial growth factor (VEGF) treatments to determine whether SFCT serves as a prognostic factor in age-related macular degeneration (AMD).
Methods This is a retrospective case series of 62 consecutive treatment-naive patients with exudative AMD followed for 1 year and treated with treat-and-extend or pro re nata anti-VEGF protocols. SFCT was measured at three locations using Cirrus HD-OCT (the foveal centre and 500 um nasal and temporal to the fovea) at presentation, 3, 6 and 12 months. Demographic characteristics, OCT imaging biomarkers and VA were recorded.
Results Mean SFCT at baseline was 187 µm (range: 70–361 µm). There was a trend of decreasing SFCT at 1 year (173 µm) compared with 3 months (175 µm) and baseline (188 µm) (p=0.2). There was no correlation between baseline SFCT and presence of subretinal fluid (p=0.2), intraretinal fluid (p=0.6) or subretinal hyper-reflective material (p=0.4) at baseline. The mean number of injections at 1 year was 6.6 (range: 2–12). Increased SFCT at baseline showed statistically significant correlation with a higher number of intravitreal injections at 1 year (p=0.004). Eyes with SFCT>1 SD above the mean required 50% more injections compared with others. There was no association between SFCT on presentation with baseline and 1 year VA (p=0.7 and p=0.2).
Conclusions SFCT in naïve patients with exudative AMD may be an important prognostic tool in determining treatment burden. Patients with thicker subfoveal choroid may require increased intravitreal injections.
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Jaya B. Kumar, MD, Justis P. Ehlers, MD, Sumit Sharma, MD, Sunil K. Srivastava, MD, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio. 2018/10
To evaluate the feasibility and usefulness of intraoperative OCT (iOCT) for uveitis-related vitreoretinal surgeries.
Prospective consecutive case series.
Seventy-three consecutive patients (74 eyes) with a uveitis-related diagnosis.
Eyes undergoing surgery for a uveitis-related diagnosis in the prospective Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization During En Face Retinal and Ophthalmic Surgery (DISCOVER) iOCT study. Intraoperative OCT was performed at various surgical milestones. Clinical details and evaluation of the role of iOCT were assessed. A standardized surgeon survey was completed to evaluate the usefulness of iOCT during surgery.
Percentage of patients in whom iOCT provided valuable feedback and altered surgical decision making.
Seventy-four consecutive eyes with a uveitis-related diagnosis were enrolled in the DISCOVER study. Successful imaging was obtained in 72 of 73 eyes (98.6%). Intraoperative OCT provided valuable feedback for fluocinolone acetonide implant placement in 11 of 13 eyes (84.6%), for chorioretinal biopsies in 13 of 16 eyes (81.2%), and for retinal detachment (RD) repairs in 20 of 27 eyes (74.1%). In subretinal and chorioretinal biopsies, iOCT altered surgical decision making in 38% of patients. In uveitis-related RD repairs, iOCT resulted in alterations in the surgical procedure in 48% of patients, predominantly related to additional membrane peeling.
Intraoperative OCT during uveitis-related vitreoretinal surgery seems to provide valuable additional information that can impact surgical decision making and may enhance outcomes.
DISCOVER (Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization during En Face Retinal and Ophthalmic Surgery), ERM (epiretinal membrane), iOCT (intraoperative OCT), RD (retinal detachment)
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