Skip to Content
Comparison of Retinal and Choriocapillaris Thicknesses Following Sitting to Supine Transition in Healthy Individuals and Patients With Age-Related Macular Degeneration.
JAMA Ophthalmol. 2014 Dec 18;
Authors: Almeida DR, Zhang L, Chin EK, Mullins RF, Kucukevcilioglu M, Critser DB, Sonka M, Stone EM, Folk JC, Abràmoff MD, Russell SR
Importance: The effects of position on retinal and choroidal structure are absent from the literature yet may provide insights into disease states such as age-related macular degeneration (AMD).
Objective: To evaluate the effect of postural change on retinal and choroidal structures in healthy volunteers and patients with non-neovascular AMD.
Design, Setting, and Participants: Prospective observational case series at an academic tertiary care retina service from September 2013 to April 2014 involving 4 unaffected volunteers (8 eyes) and 7 patients (8 eyes) with intermediate AMD. Healthy volunteers selected for the study had no evidence of ocular disease. Patients with AMD were required to have at least 10 intermediate-sized drusen.
Exposures: Spectral-domain optical coherence tomography with enhanced depth imaging in upright (sitting) and supine positions. Stable imaging was achieved using a rotating adjustable mechanical arm that we constructed to allow the optical coherence tomography transducer to rotate 90°. The Iowa Reference Algorithms were used to quantify choroid and choriocapillaris thicknesses.
Main Outcomes and Measures: Changes in sitting and supine position central macular thickness (in micrometers), total macular volume (in cubic millimeters), choroidal thickness (in micrometers), and choriocapillaris-equivalent thickness (CCET, in micrometers).
Results: Choriocapillaris-equivalent thickness was thinner in healthy participants (9.89 μm; range, 7.15-12.5 μm) compared with patients with intermediate AMD (16.73 μm; range, 10.31-27.38 μm) (P = .02); there was no difference in overall choroidal thickness between the 2 groups (P = .38). There was a 15% CCET reduction among healthy participants when transitioning from a sitting (9.89 μm) to supine (8.4 μm; range, 6.92-10.7 μm) position (P = .02) vs a CCET reduction of 11.1% from sitting (16.73 μm) to supine (14.88 μm; range, 8.76-20.8 μm) positioning (P = .10) in patients with intermediate AMD.
Conclusions and Relevance: Intermediate AMD appears to be associated with an increase in CCET and with a lack of positional responses that are observed in the CCET of normal eyes. Our results suggest that although outer portions of the choroid do not appear to be responsive to modest positional or hydrostatic pressure, the choriocapillaris capacity is, and this is measurable in vivo. Whether this physiologic deviation that occurs in AMD is related to atrophy, inflammation, or changes in autoregulatory factors or growth factors remains to be determined.
PMID: 25521616 [PubMed - as supplied by publisher]
Fishtail on a line technique for capsular tension ring insertion.
J Cataract Refract Surg. 2014 Jul;40(7):1068-70
Authors: Rixen JJ, Oetting TA
UNLABELLED: We describe a capsular tension ring (CTR) insertion technique that is a modification of the previously described fishtail technique. A suture line is used to pull the leading eyelet out through the main incision to form the fish configuration. Similar to the fishtail technique, this insertion technique minimizes the risk for zonular damage or a capsule tear because the CTR is not dialed into the capsular bag. The advantage of the suture line is that it prevents over bending of the CTR during insertion through the main incision, which can occur using the traditional fishtail technique.
FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.
PMID: 24957427 [PubMed - indexed for MEDLINE]
The hybrid lid crease approach to address lateral frontal sinus disease with orbital extension.
Ann Otol Rhinol Laryngol. 2014 Dec;123(12):826-30
Authors: Kopelovich JC, Baker MS, Potash A, Desai L, Allen RC, Chang EH
OBJECTIVE: This study aimed to describe the hybrid lid crease approach in conjunction with functional endoscopic sinus surgery (FESS) for lateral frontal sinus disease with orbital extension.
STUDY DESIGN: Retrospective case review.
METHODS: Patients undergoing hybrid lid crease approach with FESS for frontal sinus disease were reviewed retrospectively. Surgical indications consisted of inverting papilloma with extension into the frontal sinus (n = 1) and frontal sinus mucocele (n = 2). Inclusion criteria included presence of disease in the lateral frontal sinus with extension into the orbital space and erosion of the superior orbital rim. Preoperative and postoperative parameters included complete ophthalmologic exam, endoscopic exam, and computed tomography scan.
RESULTS: We were able to access the frontal sinus and orbit in all 3 cases and address sinus pathology of the lateral frontal sinus and orbit using the lid crease approach with FESS. All patients had improvement in ophthalmologic symptoms and interval disease resolution and were satisfied with their postoperative lid crease incision.
CONCLUSION: The lid crease approach offers direct access to the frontal sinus with minimal dissection through a well-hidden incision. In our case series of lateral frontal sinus pathology with orbital extension, the hybrid lid crease approach with FESS allowed complete eradication of disease without recurrence.
PMID: 24944279 [PubMed - indexed for MEDLINE]