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Chloe Robson, Nishal Patel; THE 'HALO' AND 'INVERTED FOVEA'; NOVEL THREE-DIMENSIONAL SIGNS OF VITREOMACULAR TRACTION ON OPTICAL COHERENCE TOPOGRAPHY. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5989.
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© ARVO (1962-2015); The Authors (2016-present)
Current diagnosis of Vitreomacular traction (VMT) is based on interpretation of a B-scan image on optical coherence topography (OCT) despite its three-dimensional (3D) structure. We describe two novel 3D signs present in VMT and their possible future application.
We performed a retrospective case series of all eyes treated with intravitreal ocriplasmin for VMT, as per NICE Guidelines, from 03/09/2013 to 06/06/2016 inclusive (n=48). The average age was 76.8 years (48.9% female) and mean duration of follow up was 39.8 days. Data collected included pre-operative and post operative OCT scans and visual acuity (VA). Primary outcomes were VMT release and presence of OCT signs. Secondary outcomes included VA changes and serious complications.
VMT release was demonstrated in 24/48 cases (50%). In the successful group 21/24 (87.5%) had the halo sign pre-operatively compared to 2/24 (8.3%) at follow up demonstrating resolution of signs in 74.2%. The inverted fovea sign was present in 22/24 (91.7%) pre-operatively and 2/24 (8.3%) post-operatively, showing resolution of 83.4%. In the non successful group, both signs were seen in 22/24 (91.7%) cases with 20/24 (83.3%) still present post-operatively showing resolution in 8.3%. The difference between resolution in the successful group versus the non-successful group of the halo sign was 65.9% (95% CI 37.2 to 83 p<0.0001) and for the inverted fovea sign was 75.1% (95% CI 47.23 to 89.1 P<0.0001). In the successful group VA increased from mean LogMAR 0.429 to 0.396 (P=NS). Two cases (4.2%) developed full thickness macular holes following treatment.
These novel signs were shown to be common in this case series and resolved in a greater proportion upon successful treatment. This implies that the signs are a reflection of the abnormal adhesions caused by VMT and provide a better understanding of the macular morphology compared to conventional B-scans. Furthermore, developing a means of quantifying the surface area of these adhesions, using en face swept source imaging, may help improve case selection for better outcomes with ocriplasmin therapy.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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