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Bijlsma W.R.,University Utrecht | Paridaens D.,Rotterdam Eye Hospital | Kalmann R.,University Utrecht
British Journal of Ophthalmology | Year: 2011

Background: Prednisone pulse therapy is used to treat active non-infectious orbital inflammatory disease to attain faster clinical improvement and to shorten the duration of prednisone treatment. This study addresses the use of intravenous methylprednisolone (IVMP) pulse therapy, in addition to oral prednisone (OP), in the treatment of severe idiopathic orbital inflammation (IOI). Methods: This was a multicentre retrospective cohort study. Patients with severe IOI treated with IVMP pulse and OP therapy (IVMP+OP) were compared with patients with IOI who were treated only with OP. Main outcome measures were duration of prednisone treatment, symptom-free outcome and complications. Results: Between 2000 and 2007, 12 patients with severe IOI were treated with IVMP+OP and 15 patients were treated with OP only. The median treatment duration was 160 (range 34-680) days in the IVMP+OP group and 110 (range 27-730) days in the OP-only group. In patients who had severe IOI, 73% in the IVMP+OP group and 87% in the OP-only group were symptom-free after treatment. No patients developed complications related to prednisone therapy. Conclusion: In our study there was no advantage of treating patients with severe IOI with IVMP+OP in terms of shortened treatment duration, lower cumulative dose or decrease in persistent symptoms. We suggest that the indication of IVMP in the treatment of severe IOI is limited to speeding symptom relief and recovery from optic nerve dysfunction.


Van Cleynenbreugel H.,Rotterdam Eye Hospital | Remeijer L.,Rotterdam Eye Hospital | Hillenaar T.,Rotterdam Eye Hospital | Hillenaar T.,Rotterdam Ophthalmic Institute
Ophthalmology | Year: 2014

Purpose To ascertain preoperative and intraoperative factors that predict the need for endothelial keratoplasty (EK) in patients with Fuchs' endothelial corneal dystrophy (FECD) undergoing cataract surgery. Design Prospective, observational cohort study. Participants Eighty-nine patients (89 eyes) with FECD who require cataract surgery. Methods One month before cataract surgery, we assessed best-corrected visual acuity, contrast sensitivity, straylight, keratometry, ultrasonic pachymetry, intraocular pressure, 7 corneal features of FECD and cataract density at slit-lamp examination, and corneal backscatter using in vivo confocal microscopy (IVCM; Confoscan 4, NIDEK Technologies, Padova, Italy). After surgery, measurements were repeated at 1, 2, and 12 months. We used stepwise binary logistic regression analysis to evaluate 30 preoperative and 5 intraoperative parameters for their ability to predict the postoperative need for EK. Receiver operating characteristic (ROC) curves of the predictive factors were used to identify their optimal cutoff points. Main Outcome Measures Central corneal thickness (CCT) and backscatter at the basal epithelial cell layer (EV). Results After cataract surgery, 35 (39%) of 89 eyes underwent EK to restore vision. Of all preoperative and intraoperative parameters, only CCT and EV were identified as significant factors, predictive of the need for EK. The area under the ROC curve of EV was significantly higher than that of CCT (P = 0.003), whereas a combination of both factors in a linear discriminant function did not improve the predictive value (P = 0.66). As optimal cutoff points, we chose 1894 scatter units for EV and 630 μm for CCT. Both cutoff points correspond with a specificity of 94% and represent sensitivity of 63% for EV and 40% for CCT. Conclusions Backscatter at the basal epithelial cell layer measured by IVCM predicts the need for EK after cataract surgery in patients with FECD. As an indicator for the corneal hydration state, the EV improves patient selection for combined cataract surgery and EK. In deciding whether to perform a triple procedure, CCT remains a less effective, but adequate, alternative. Regardless of the predictive factor used, a tailor-made approach is recommended accounting for individuals' expectations. © 2014 by the American Academy of Ophthalmology Published by Elsevier Inc.


Hillenaar T.,Rotterdam Ophthalmic Institute | Van Cleynenbreugel H.,Rotterdam Eye Hospital | Remeijer L.,Rotterdam Eye Hospital
Ophthalmology | Year: 2012

Purpose: To ascertain the effects of aging on corneal morphology and to illustrate the morphologic diversity of the different layers in the normal cornea as seen by in vivo confocal microscopy (IVCM). Design: Observational cross-sectional study. Participants: A total of 150 healthy subjects, evenly distributed over 5 age categories, comprising 75 men and 75 women. Methods: Both transparent corneas (n = 300) of all subjects were examined in duplicate by white light IVCM (Confoscan 4, NIDEK Technologies, Albignasego, Padova, Italy). After reviewing the IVCM examinations for morphologic variations of the corneal layers, we selected the 8 most common features to illustrate the morphologic diversity. Subsequently, all 600 IVCM examinations were assessed for the presence of these features. We used binary logistic regression analyses to assess the age-relatedness of each feature. Main Outcome Measures: Age distribution of bright superficial epithelial cells, dendriform cells, alterations characteristic of epithelial basement membrane dystrophy (EBMD), tortuous stromal nerves, stromal microdots in the anterior stroma, folds in the posterior stroma, opacification of Descemet's membrane, and corneal guttae. Results: Four features were found characteristic of the aging cornea: stromal microdots in the anterior stroma (P<0.0001), folds in the posterior stroma (P<0.0001), opacification of Descemet's membrane (P<0.0001), and corneal guttae (P<0.0001). Alterations characteristic of EBMD were found in 3% of all eyes and only detected in subjects aged <40 years, suggesting age-relatedness (P = 0.09). Other features, such as bright superficial epithelial cells (n = 38, 13%), dendriform cells (n = 42, 14%), and tortuous stromal nerves (n = 115, 38%), were age-independent. We also found a novel phenotype of corneal endothelium in 4 normal eyes of 2 subjects, which we coined "salt and pepper endothelium." We could not establish whether this novel phenotype represented a morphologic variant of normal endothelium, an early stage of a known corneal endothelial disorder, or a completely new disease entity. Conclusions: Knowledge of the common morphologic variations of the corneal layers and the effects of aging on corneal morphology as seen by IVCM increases our understanding of corneal degenerative disorders and is essential to detect corneal pathology. Our finding of a novel phenotype of corneal endothelium emphasizes the morphologic diversity of this optically transparent tissue. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2012 American Academy of Ophthalmology.


Van Zeeburg E.J.T.,Rotterdam Ophthalmic Institute | Van Zeeburg E.J.T.,Rotterdam Eye Hospital | Maaijwee K.J.M.,Rotterdam Eye Hospital | Missotten T.O.A.R.,Rotterdam Eye Hospital | And 3 more authors.
American Journal of Ophthalmology | Year: 2012

To report and analyze long-term best-corrected visual acuity (BCVA) outcomes following a free autologous retinal pigment epithelium (RPE)-choroid graft translocation in patients with exudative age-related macular degeneration (AMD). Prospective cohort study. setting: Institutional. study population: One hundred and thirty consecutive patients (133 eyes) with AMD underwent RPE-choroid graft translocation between October 2001 and February 2006. All patients had a subfoveal choroidal neovascular membrane with or without hemorrhage and/or an RPE tear. All were either ineligible for or nonresponsive to photodynamic therapy, the standard treatment at the time of surgery. observation procedures: Data collection included preoperative and postoperative visual acuity measurements, fundus photography, fluorescein and indocyanine green angiography, and microperimetry. main outcome measures: Postoperative BCVA. The mean preoperative BCVA was 20/250. Four years after surgery, 15% of the eyes had a BCVA of >20/200, and 5% had a BCVA of <20/40. One patient achieved a BCVA of 20/32, which was maintained at 7 years after surgery. Complications consisted of proliferative vitreoretinopathy (n = 13), recurrent neovascularization (n = 13), and hypotony (n = 2). RPE-choroid graft transplantation may maintain macular function for up to 7 years after surgery, with relatively low complication and recurrence rates. Retinal sensitivity, BCVA data, and fixation on the graft suggest that the graft, rather than simply the removal of submacular hemorrhage and/or choroidal neovascular membrane, was responsible for the preservation of macular function. This surgery may be an alternative for patients with AMD who cannot undergo other standard treatment. © 2012 Elsevier Inc. All Right Reserved.


Van Cleynenbreugel H.,Rotterdam Eye Hospital | Remeijer L.,Rotterdam Eye Hospital | Hillenaar T.,Rotterdam Ophthalmic Institute
Cornea | Year: 2011

Purpose: To determine the correlation between the intraoperative donor lenticule thickness in Descemet stripping automated endothelial keratoplasty (DSAEK) and both the best-corrected visual acuity (BCVA) and endothelial cell density (ECD) at 6 months. To describe relevant surgical considerations with regard to the choice of microkeratome head. Design: Prospective case series. Methods: Thirty-five patients (37 eyes) undergoing DSAEK were included in this prospective case series. Intraoperative donor lenticule thickness, assessed by ultrasound pachymetry, was compared with BCVA and ECD 6 months postoperatively. Results: Mean BCVA logarithm of the minimal angle of resolution (logMAR) was 0.58 preoperatively and 0.29 6 months postoperatively. Three eyes were excluded from BCVA analysis. The average donor lamellae thickness was 175 μm. Mean ECD loss was 39% 6 months postoperatively compared with that preoperatively. There was no correlation between donor lamella pachymetry and BCVA logMAR and ECD at 6 months in this series (P = 0.13 and P = 0.09, respectively). Analogous to our findings, a review of published reports on donor pachymetry in DSAEK did not provide data to suggest a correlation between donor corneal thickness and postoperative BCVA or ECD. Conclusions: Donor lenticule thickness does not have a direct effect on 6-month postoperative visual acuity or endothelial cells. Efforts should be made to reduce surgical trauma to the lenticule rather than adhering to a strict depth when cutting the graft. We propose using the Moria 350 μm microkeratome head for corneal thickness more than 600 μm and the 300 footplate for corneal thickness less than 600 μm. Copyright © 2011 by Lippincott Williams & Wilkins.


Van Bree M.C.J.,Rotterdam Ophthalmic Institute | Van Den Berg T.J.T.P.,Royal Netherlands Academy of Arts and science | Zijlmans B.L.M.,Rotterdam Eye Hospital
Ophthalmology | Year: 2013

Purpose: To study the effect of posterior capsule opacification (PCO) morphology and severity on different aspects of visual function (VF): the small-angle domain (visual acuity [VA], contrast sensitivity [CS]) and large-angle domain (straylight; logarithm of the straylight parameter s [log{s}]). To evaluate whether straylight is a valuable additional indicator for appropriate posterior capsulotomy referral. Design: Prospective, comparative study. Participants and Controls: For the study population, 240 pseudophakic eyes with PCO and a capsulotomy indication were selected. For the reference population, 99 pseudophakic eyes without PCO were selected. Methods: The relation between PCO morphology and PCO severity and the precapsulotomy and postcapsulotomy logarithm of the minimum angle of resolution (logMAR), logarithm of CS (log[CS]), and log(s) values were determined. The PCO severity was assessed with retroillumination using evaluation of posterior capsule opacification (EPCO) software. Precapsulotomy logMAR and log(s) values were used to predict functionally significant logMAR and log(s) improvement after capsulotomy. Main Outcome Measures: The logMAR, log(CS), and log(s) improvements of ≥0.20 log units were considered functionally significant (i.e., treatment effect). Precapsulotomy logMAR and log(s) values, above which a treatment effect (improvement ≥0.20 log units) can be expected with ≥50% probability, were determined and called cutoff values. Results: Postcapsulotomy VF improvement was related to precapsulotomy VF values: Postcapsulotomy improvement was largest in cases with substantially impaired precapsulotomy VF parameters. Visual function deterioration was related to PCO severity rather than PCO morphology. The PCO severity (EPCO score) assessed with retroillumination has a progressive, linear relation with log(s) and a curvilinear relation with logMAR. Reflected light examination is expected to overestimate functional PCO severity. The precapsulotomy cutoff value was ≥1.44 for log(s) and ≥0.21 for logMAR. Conclusions: The linear relation between retroillumination PCO severity and log(s) indicates that log(s) is sensitive to low PCO severity, whereas the curvilinear relation between PCO severity and logMAR indicates that logMAR is unaffected by low PCO severity. Straylight is a sensitive, additional indicator for capsulotomy referral, especially in less severe cases of PCO. In ophthalmic practice, the precapsulotomy log(s) cutoff value of 1.44 can be used as an indicator for beneficial capsulotomy referral. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2013 American Academy of Ophthalmology.


Hillenaar T.,Rotterdam Ophthalmic Institute | Van Cleynenbreugel H.,Rotterdam Eye Hospital | Verjans G.M.G.M.,Erasmus Medical Center | Wubbels R.J.,Rotterdam Ophthalmic Institute | Remeijer L.,Rotterdam Eye Hospital
Ophthalmology | Year: 2012

Purpose: To investigate the role of in vivo confocal microscopy (IVCM) in the detection of inflammatory activity and follow-up of herpetic stromal keratitis (HSK). Design: Prospective observational cohort study. Participants: Thirty-eight patients with active HSK. Methods: Within 7 days after diagnosis of active HSK, both eyes of each patient were examined by slit-lamp biomicroscopy and white-light IVCM (Confoscan 4; Nidek Technologies, Padova, Italy). The HSK-affected eyes were followed up at 1, 3, 6, and 12 months, whereas the unaffected fellow eyes were reexamined after 12 months. Three patients did not complete follow-up and were excluded for data analyses. All IVCM examinations were assessed for morphologic alterations characteristic of inflammatory activity and for corneal backscatter. As secondary outcome parameters, best-corrected visual activity (BCVA), central corneal thickness (CCT), intraocular pressure (IOP), and endothelial cell density (ECD) were determined at each study visit. We used repeated-measures analysis of variance to assess changes during the 12-month follow-up period and paired t tests to compare HSK-affected eyes with fellow eyes. Main Outcome Measures: Presence of dendriform cells, pseudoguttae, and keratic precipitates, and follow-up of mean corneal backscatter. Results: An increase of dendriform cells and pseudoguttae often accompanied stromal infiltration. Because these IVCM parameters were indiscernible or overlooked at slit-lamp examination, they proved to be excellent indicators of inflammatory activity. At 12 months' follow-up, mean corneal backscatter had decreased significantly by 36%, but still fell outside the normal range in 24 (69%) of the HSK-affected eyes. By using slit-lamp in conjunction with IVCM, we detected 17 recurrences in 14 of 35 patients (40%). Three of these recurrences were missed by slit-lamp, and 6 of these were missed by IVCM. At 12 months' follow-up, BCVA (-9 letters), CCT (-36 μm), and ECD (-313 cells/mm 2) were significantly lower, whereas IOP (1.8 mmHg) was significantly higher, in HSK-affected eyes compared with fellow eyes. Conclusions: The data presented demonstrate that IVCM is complementary to slit-lamp examination in the follow-up of HSK, particularly because of its power to detect early signs of intracorneal inflammatory activity. Therapy guidance based on morphologic assessment and corneal backscatter measurement by combined IVCM and slit-lamp examination may improve the outcome of HSK. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2012 American Academy of Ophthalmology.


Vermeer K.A.,Rotterdam Eye Hospital | Mo J.,VU University Amsterdam | Weda J.J.A.,VU University Amsterdam | Lemij H.G.,Rotterdam Eye Hospital | And 2 more authors.
Biomedical Optics Express | Year: 2014

We present a method, based on a single scattering model, to calculate the attenuation coefficient of each pixel in optical coherence tomography (OCT) depth profiles. Numerical simulations were used to determine the model's response to different depths and attenuation coefficients. Experiments were performed on uniform and layered phantoms with varying attenuation coefficients. They were measured by a 1300 nm OCT system and their attenuation coefficients were evaluated by our proposed method and by fitting the OCT slope as the gold standard. Both methods showed largely consistent results for the uniform phantoms. On the layered phantom, only our proposed method accurately estimated the attenuation coefficients. For all phantoms, the proposed method largely reduced the variability of the estimated attenuation coefficients. The method was illustrated on an in-vivo retinal OCT scan, effectively removing common imaging artifacts such as shadowing. By providing localized, per-pixel attenuation coefficients, this method enables tissue characterization based on attenuation coefficient estimates from OCT data. © 2013 Optical Society of America.


Siepman T.A.M.,Erasmus University Rotterdam | Bettink-Remeijer M.W.,Rotterdam Eye Hospital | Hintzen R.Q.,Erasmus University Rotterdam
Journal of Neurology | Year: 2010

Optical coherence tomography (OCT) and scanning laser polarimetry (GDx ECC) are non-invasive methods used to assess retinal nerve fiber layer (RNFL) thickness, which may be a reliable tool used to monitor axonal loss in multiple sclerosis (MS). The objectives of this study are (1) to compare OCT with the GDx ECC; (2) to assess and compare the RNFL thickness in subgroups of MS. Ophthalmologic examination and RNFL assessment by OCT and GDx were performed in 65 MS patients (26 relapsing-remitting (RRMS), ten secondary-progressive (SPMS), 29 primary-progressive (PPMS)). Twenty-eight patients (43%) had a history of optic neuritis (ON). Adjustments were made for age and disease duration. RNFL thickness was reduced in eyes with previous ON (p < 0.01). No differences were found between PPMS and relapse-onset MS. OCT and GDx ECC measurements were moderately correlated (rho = 0.73, p < 0.01). Visual fieldmean deviation (MD) values correlated with OCT means (r = 0.44, p < 0.01) and GDx ECC TSNIT average (r = 0.41, p < 0.01). In patients without previous ON, EDSS correlated with MD (r = -0.36, p < 0.01), visual field-pattern standard deviation (PSD) (r = 0.30, p < 0.05), OCT means (r = -0.31-0.30, p < 0.05) and macular volume (r = -0.37, p < 0.01). For MSIS-29 physical impact score, significant correlations were found with MD (r = -0.48, p < 0.01) and PSD (r = 0.48, p < 0.01). Conclusions: No differences between PPMS and relapse-onset MS subgroups were found. RNFL thickness was reduced in eyes with previous ON. Although OCT and GDx ECC findings were moderately correlated and showed significant correlations with measures of visual function in patients without previous ON, EDSS correlated significantly with visual and OCT measures, but not with GDx ECC. © Springer-Verlag 2010.


Vermeer K.A.,Rotterdam Eye Hospital | van der Schoot J.,Rotterdam Eye Hospital | Lemij H.G.,Rotterdam Eye Hospital | de Boer J.F.,Rotterdam Eye Hospital | de Boer J.F.,VU University Amsterdam
Investigative Ophthalmology and Visual Science | Year: 2012

PURPOSE. We present spatial retinal nerve fiber layer (RNFL) attenuation coefficient maps for healthy and glaucomatous eyes based on optical coherence tomography (OCT) measurements. Quantitative analyses of differences between healthy and glaucomatous eyes were performed. METHODS. Peripapillary volumetric images of 10 healthy and 8 glaucomatous eyes were acquired by a Spectralis OCT system. Per A-line, the attenuation coefficient of the RNFL was determined based on a method that uses the retinal pigment epithelium as a reference layer. The attenuation coefficient describes the attenuation of light in tissue due to scattering and absorption. En-face maps were constructed and visually inspected. Differences between healthy and glaucomatous eyes were analyzed (Mann-Whitney U test), both globally (average values) and spatially (concentric and per segment). RESULTS. RNFL attenuation coefficient maps of healthy eyes showed relatively high and uniform values. For glaucomatous eyes, the attenuation coefficients were much lower and showed local defects. Normal and glaucomatous average RNFL attenuation coefficients were highly significantly different (P < 0.0001) and fully separable. The RNFL attenuation coefficient decreased with increasing optic nerve head distance for both groups, with highly significant differences for all distances (P < 0.001). The angular dependency showed high superio- and inferiotemporal and low nasal values, with most significant differences superio- and inferiotemporally. CONCLUSIONS. Maps of RNFL attenuation coefficients provide a novel way of assessing the health of the RNFL and are relatively insensitive to imaging artifacts affecting signal intensity. The highly significant difference between normal and glaucomatous eyes suggests using RNFL attenuation coefficient maps as a new clinical tool for diagnosing and monitoring glaucoma. Copyright 2012 The Association for Research in Vision and Ophthalmology, Inc.

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