OCT and Macular Diseases

1
OCT and Macular Diseases

• I.Moroz, A.Alhalel, H.Desatnik, Y.Moisseiev G.
  Triester
• Goldschleger Eye Institute
• Sheba Medical Center
• Tel Hashomer

2
NORMAL
RPE Choriocapillaries
OPL
IPL
NFL
Photoreceptors
Large choroidal vessels

• Color difference represents different optical
  properties and not necessarily different tissue
  morphology

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T.D

• 71 year old female.
• Hypermetropia 6.00 4.00.
• BE advanced cataract.
• Susp old Uveitis.
• BE VA cc 6/12.
• LE ECCE PCIOL 9/01

4
T.D

• 1week post op. VA sc 6/12.
• 7 weeks blurred vision 6/120 cc 6/12 hazy in
  center.
• Susp CME on exam.
• FA CME.
• Allergic reaction to FA !!!

5
T.D

• Treatment sterodex, voltaren.
• 3 months post op. subtenon celeston.
• VA no improvement 6/120 ph 6/40
• 7 months post op. persistent CME.
• Kenalog injection.

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T.D

• Post kenalog injection VA improved 6/18.
• 4 months post injection decrease in VA 6/60 ph
  6/30.
• OCT was done.

500 micron
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T.D

• Second kenalog inj.
• One week post injection VA improves 6/60 ph
  6/8.5.
• OCT was done

No CME 180 micron
8
T.D

• 3 months post second kenalog inj
• VA decreased to 6/12.
• Visual disturbances.
• OCT was done

Recurrent CME 457 micron
9
4 month post 1st. IVK
2 weeks post 2nd IVK.
3 months post 2nd IVK.
10

• Third kenalog injection?
• Intravitreal device?

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Triamicinolone Acetonide

• Corticosteroid suspension.
• Delivered rapidly to site of action.
• Therapeutic levels in vitreous cavity for up to 3
  months.

12
Triamicinolone Acetonide

• Treatment for
• Subretinal CNV.
• Macular edema due to
• DiabeticRetinopathy.
• Uveitis.
• BRVO, CRVO.
• Pseudohakia.

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Intravitreal Triamcinolone for Refractory
Diabetic Macular Edema (1)

• Martidis MD et. al Wills Eye Hospital Ophth.
  May 2002
• 16 eyes, CSME s/p grid x2.
• OCT thicker than 300 micron.
• IVK injection 4mg.
• 3-6 months F.U.
• CME decreased in thickness.

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Intravitreal Triamcinolone for Refractory
Diabetic Macular Edema (2)

• Martidis MD et. al Wills Eye Hospital Ophth.
  May 2002
• 8 eyes F.U 6 months.
• Reinjection to 3 of 8 eyes due to recurrence of
  CME.

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Intravitreal Triamcinolone for Uveitic Cystoid
Macular edema An Optical Coherence Tomography
Study (1)

• Antcliff, et al London,England Ophtha. April
  2001
• 6 pt. with Uveitis and chronic CME refractive to
  all treatments.
• Injection of 2mg TA intravitreal.
• 5 of 6 pt. had complete anatomical resolution of
  CME within 1 week.

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Intravitreal Triamcinolone for Uveitic Cystoid
Macular edema An Optical Coherence Tomography
Study (2)

• Duration of the treatment effect lasted from 6
  weeks to 3 months when cystoid spaces began to
  return.
• Before intravitreal injection none of the pt.
  showed any benefit from orbital floor steroids,
  whereas afterward 3 of the 6 responded.