Symposium (ISS) - Heidelberg Engineering · 11.20 New Techniques for Imaging Diabetic Retinopathy...

12th International Symposium (ISS)

October 10-11, 2014 The Grand Tarabya Hotel · Istanbul · Turkey

Abstract Book

Course DirectorMurat Karacorlu, Turkey

FacultySerra Arf, TurkeySanjay G. Asrani, USABalwantray Chauhan, CanadaBora Eldem, TurkeyK. Bailey Freund, USAFrank G. Holz, GermanyFelipe A. Medeiros, USASung Chul Park, USAAli Osman Saatci, TurkeyFigen Sermet, TurkeyGiovanni Staurenghi, Italy

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Deckblatt Abstract Book_ISS 2014.indd 1 25.09.2014 16:25:19

12th International SPECTRALIS® Symposium (ISS) October 10-11, 2014 The Grand Tarabya Hotel · Istanbul · Turkey

Course Director: Murat Karacorlu (Turkey)

Faculty: Serra Arf (Turkey), Sanjay G. Asrani (USA), Balwantray Chauhan (Canada), Bora Eldem (Turkey),

K. Bailey Freund (USA), Frank G. Holz (Germany), Felipe A. Medeiros (USA), Sung Chul Park (USA), Ali Osman Saatci (Turkey), Figen Sermet (Turkey), Giovanni Staurenghi (Italy)

Scientific Program

Friday, October 10, 2014

09.00 Registration and Welcome Coffee

Innovation I - Moderators: Murat Karacorlu, K. Bailey Freund

09.50 Welcome Note (Murat Karacorlu)

10.00 MultiColor Imaging (Giovanni Staurenghi) – page 9

10.20 Update on Fundus Autofluorescence Imaging (Frank Holz) – page 11

10.40 In-Vivo 3D Analysis of Optic Nerve Head (Sung Chul Park) – page 13

11.00 Imaging the Choroidal Anatomy (Murat Karacorlu) – page 15

11.20 New Techniques for Imaging Diabetic Retinopathy Leukostasis and Hyperpermeability (Balamurali K. Ambati) – page 17

11.30 Ultra-Widefield Imaging (Sarah Thiele) – page 19

11.40 Coffee Break

Innovation II - Moderators: Serra Arf, Frank Holz

12.10 Enhanced Vitreous Imaging (EVI) (Giovanni Staurenghi) – page 21

12.30 Fundus Autofluorescence Imaging in Macular Dystrophies (Figen Sermet) – page 23

12.50 Towards Structure-Function Correlation (Frank Holz) – page 25

13.10 Transverse Section Imaging of the Temporal Raphe with OCT (Balwantray Chauhan) – page 27

13.30 Lunch

14.30 All Poster Session Starts - Presentation Posters: 01, 02, 04, 05 / Moderators: Giovanni Staurenghi, Murat Karacorlu

AMD - Moderators: Ali Osman Saatci, Giovanni Staurenghi

15.00 Refining the Diagnosis and Management of CNV in AMD (K. Bailey Freund) – page 29

15.20 Correlation of 3D SD OCT and Fluorescein Angiography in Neovascular AMD (Mustafa Guzey) – page 31

15.30 Fundus Autofluorescence Imaging in Non-Exudative AMD (Figen Sermet) – page 33

15.50 Probing Geographic Atrophy - Refined Phenotyping and Longitudinal Variations (Frank Holz) – page 35

16.10 The CSC, Type 1 Neovascularization, and PCV Connection (K. Bailey Freund) – page 37

16.30 Coffee Break

Special Guest Lecture – Moderator: Murat Karacorlu

17.00 SPECTRALIS SD-OCT at the International Space Station (NASA) – not available!

17.30 Welcome Reception


Saturday, October 11, 2014

08.30 Welcome Coffee

Glaucoma - Moderators: Sung Chul Park, Felipe A. Medeiros

09.00 MultiColor + OCT: The Interface of Retina and Glaucoma (Sanjay G. Asrani) – page 39

09.20 Assessment of RNFL for Glaucoma Diagnosis with SD-OCT (Felipe A. Medeiros) – not available!

09.40 Glaucoma as a Laminopathy (Sung Chul Park) – page 41

10.00 Impact of SPECTRALIS Anatomic Positioning System (APS) Acquisition on Diagnostic Accuracy in Glaucoma (Balwantray Chauhan) – page 43

10.30 Coffee Break

Clinical Retina I - Moderators: Figen Sermet, K. Bailey Freund

11.00 High-Resolution SD-OCT Findings in Hereditary Retinal Dystrophies (Serra Arf) – page 45

11.20 Multimodal Imaging of RAP Lesions (Giovanni Staurenghi) – page 47

11.40 Scatter Photocoagulation in Persistant Macular Edema due to RVO (Bora Eldem) – page 49

12.00 Uveitic Macular Edema: Fluorescein Angiography vs OCT (Ali Osman Saatci) – page 51

12.20 Retinal Imaging based Patient Selection for Intravitreal Ocriplasmin in Symptomatic Vitreomacular Traction and Macular Holes (Simone Müller) – page 53

12.30 Lunch

13.30 All Poster Session Starts – Presentation Posters 03, 06-09 / Moderators: K. Bailey Freund, Frank Holz

Clinical Retina II - Moderators: Bora Eldem, Murat Karacorlu

14.00 Foveal and Choroidal Imaging in Albinism and Retinopathy of Prematurity (Murat Karacorlu) – page 55

14.20 MultiColor Imaging in Acute Macular Neuroretinopathy (Gabriella De Salvo) – page 57

14.30 New Multimodal Imaging Findings in the White Dot Syndromes (K. Bailey Freund) – page 59

14.50 Bietti's Crystalline Retinopathy - Usual and Rare Clinical Features (Ali Osman Saatci) – page 61

15.10 Management of CSR by Multimodal Imaging (Serra Arf) – page 63

15.30 Relationship between Choroidal Expansion and IOP Increase During Water Drinking Test in Healthy Subjects and Patients with Exfoliation Syndrome (Sibel Kadayifcilar) – page 65

15.40 The SPECTRALIS Unveiling the Weird and the Wonderful (Gerbrecht Willemse) – page 67

15.50 END / Coffee Break

16.45 Meet in Hotel Lobby for Evening Event

17.00 Boarding of boat in front of Grand Tarabya Hotel

17.15 Boat Departure to Historic City Center of Istanbul

21.00 Approximate Return by Bus to Hotels (Grand Tarabya, Sheraton Maslak, Le Meridien)


Poster Presentations Poster 01: Satar Baghrizabehi, Slovenia: Macular Detachment Secondary to Congenital Pit of the Optic Disc: Case Report – page 69

Poster 02: Mahesh Gopalakrishnan, India: Case Report 1: Use of Wide Angle ICGA for Diagnosis of Peripheral Polypoidal Choroidal Vasculopathy (PCV) – page 71 Case Report 2: Use of Fundus Autofluorescence in Emboli causing Retinal Artery Occlusion – page 73 Case Report 3: OCT and FAF Features of Combined Hamartoma of Retina and RPE – page 75

Poster 03: Omar Khan, USA: OCT: A Potential In-Vivo Retinal -Synuclein Biomarker in Parkinson’s Disease – page 77

Poster 04: Mariano Cozzi, UK: Case Report: Multimodality Imaging in a Case of Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis (SNIFR) – page 79

Poster 05: Ameli Gabel-Pfisterer, Germany: Two Cases of Unusual Pediatric Retinal Disease Diagnosed by Spectralis OCT – page 81

Poster 06: Firat Helvacioglu, Turkey: Effects of Misalignment in OCT Scans – page 83

Poster 07: Ziya Kapran, Turkey: The Role of Muller Cell Complex in the Formation of Eccentric Macular Hole Formation after Vitrectomy with Internal Limiting Membrane Peeling for the Treatment of Epiretinal Membrane – page 85

Poster 08: Ji Eun Lee, South Corea: Choroidal Watershed Zone and Growth of Polypoidal Choroidal Vasculopathy – page 87

Poster 09: Inyoung Chung, South Corea: Topographic Relationship between Choroidal Watershed Zone and Submacular Idiopathic Choroidal Neovascularization – page 89

12th International SPECTRALIS® Symposium (ISS) Faculty Members October 10-11, 2014 · The Grand Tarabya · Istanbul, Turkey

Course Director:

Prof. Murat Karacorlu, MD, MSc, FEBO Retina Institute Istanbul, Turkey

Dr. Karacorlu is a Professor of Ophthalmology and Director of the Istanbul Retina Institute. His main areas of scientific interest are age related macular degeneration, retinovascular and hereditary retinal diseases, retinopathy of prematurity and vitreoretinal surgery. Dr. Karacorlu graduated from Istanbul University. He received his MD degree from Istanbul University and MSc degree in Biomedical Engineering Institute of Bosphorus University and completed his fellowship training in Louisiana State University. His academic accomplishments include authorship or co-authorship of five textbooks and over 200 scientific writings. He has given numerous named lectureships including Dr. Richard Stein Conference. Professor Karacorlu has published extensively in peer-reviewed journals such as American Journal of Ophthalmology, Retina, Acta Ophthalmologica, Graefe's Archive for Clinical and Experimental Ophthalmology, BJO and Eye. He is the Associate Editor of Acta Ophthalmologica and a reviewer for numerous prestigious journals including Ophthalmology, Invest Opthal Vis Sci, AJO, BJO and Retina. He is a member of many professional societies, including EVER, ARVO, AAO, ASRS, EURETINA and EVRS. Dr. Karacorlu has served as a board member of the Turkish Society of Ophthalmology and Chairman of the Retina Section of this society. He has also served as President of the Scientific Committee at the Congress of the SOE in 2001 and has been a member of many organizational committees of national and international congresses, such as the International Ocular Inflammation Society, the Afro-Asian Council of Ophthalmology and the EVRS.

Faculty Members:

Assoc. Prof. Serra Arf, MD Istanbul Retina Institute, Istanbul, Turkey

Dr. Serra Arf is Head of the Medical Retina Division at Istanbul Retina Institute. She completed ophthalmology residency at Istanbul University Cerrahpasa School of Medicine, Department of Ophthalmology and did research fellowship at Cleveland Clinic and Louisiana State University Eye Center. Dr. Arf has performed OCT studies starting with the first generation equipment. She has trained many opthalmologists and continues to serve in this field. She has extensive experience in hereditary retinal and choroidal diseases with primary emphasis on their electrophysiological characteristics. In addition to her work with IRE, she actively consults on the retinopathy of prematurity in neonatal intensive care units of several hospitals. Along with her clinical work she has played a leading role in many research efforts pertaining to the study of retinal diseases. Dr. Arf has served as the President of the Turkish Ophthalmological Society, Medical Retina Division since 2012.

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Prof. Sanjay G. Asrani, MD Duke University, Durham North Carolina, USA Sanjay Asrani MD is Professor of Ophthalmology and serves as Head of Glaucoma OCT Reading Center and as Clinical Director of the Duke Eye Center at Cary. His clinical expertise is in Glaucoma (including laser and conventional surgery), cataract surgery and glaucoma implant surgery. Dr. Asrani is the recipient of numerous awards, including the Career Development Award from Research to Prevent Blindness, Inc, the Helen Keller Scientist Award from the American Glaucoma Society, America’s Top Ophthalmologists from Consumers Research Council and the Achievement Award from the American Academy of Ophthalmology. Dr. Asrani has over 65 peer reviewed publications and serves on the editorial board of EyeNet. He actively pursues research on pressure fluctuations, drug delivery and new imaging modalities for glaucoma. Dr. Asrani’s research focus is on the development of new imaging technology for the early diagnosis of glaucoma using SD OCT to image retinal ganglion cells as well as the trabecular meshwork and Schlemm's canal.

Prof. Balwantray C. Chauhan, PhD Dalhousie University, Halifax NS, Canada Balwantray Chauhan is Professor and Research Director of Ophthalmology and Visual Sciences, and Professor of Physiology and Biophysics at Dalhousie University. He is also the holder of first endowed Chair in Vision Research at Dalhousie. He obtained his Ph.D. at the University of Wales, Cardiff and his postdoctoral training at the University of British Columbia under the supervision of Dr. Stephen Drance. Dr. Chauhan’s clinical research interests are in the diagnosis of early changes in the visual field and optic disc in glaucoma. He has devised new strategies for detecting glaucomatous progression and conducted additional research leading to their translation to clinical practice. A key contribution in this area is the Topographical Change Analysis (TCA), a widely used technique for identifying changes in optic disc topography with modern imaging techniques such as scanning laser tomography. Dr. Chauhan is the principal investigator of the Canadian Glaucoma Study, a multicentre study and the largest of its kind, investigating the risk factors for the progression of open-angle glaucoma. His research is shedding new information on the nature and mode of glaucomatous progression. His research interests also include experimental models of optic nerve damage. This work complements his clinical research and address research questions to provide new clues about the aetiology of glaucoma and possible new avenues of therapy. Recent areas of activity include studies of neuron-glia interaction in the retina and optic nerve, in vivo imaging of retinal ganglion cells and neuroprotection, He conducts his basic science research in the Retina and Optic Nerve Research Laboratory, a multidisciplinary facility he was instrumental in establishing. This laboratory of 6 principal investigators from 4 departments in the Dalhousie Medical Faculty, and over 25 students, fellows and technicians is unique in the country and provides an excellent opportunity for discovery and training. Dr. Chauhan holds research grants for both his clinical (since 1991) and basic science (since 1997) research from the Canadian Institutes of Health Research (CIHR) and other public and private sector agencies. He is a member of the CIHR Group in Retina of 4 scientists at Dalhousie involved in collaborative basic science research.

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Prof. Bora Eldem, MD, FEBO Hacettepe University, Ankara, Turkey Dr. Eldem is Professor in Ophthalmology, and Chair of Hacettepe University,Ophthalmology Department in Ankara. Prof. Eldem graduated from Hacettepe University Medical School in 1979 where he completed a medical residency program at the Ophthalmology Department in 1983. He became an associate professor in 1990 and full professor in 1996. He completed his fellowship at Moorfields Eye Hospital, Retinal Diagnostic Department in London. Prof. Eldem speaks English and German, is married and has one daughter. Within his field of specialty, his main field of interest include the diagnosis as well as medical and surgical treatments of vitreo-retinal disorders, uveitis and Behcet’s disease. Member of several International Societies such as ARVO, ASRS, EVRS, EURETINA. Currently serving as the President of Turkish Ophthalmological Society and Country Delegate to International Council of Ophthalmology (ICO),Union of European Medical Specialists (UEMS) and European Board of Ophthalmology (EBO) and also country coordinator and Principal Investigator of different Randomised Controlled Trials (RCT) related to AMD, DME and RVO.

K. Bailey Freund, MD Vitreous Retina Macula Consultants of New York Clinical Professor of Ophthalmology, NYU School of Medicine K. Bailey Freund, MD specializes in all retinal disorders including macular degeneration, diabetic retinopathy, and retinal vascular diseases and is an expert in difficult-to-diagnose and rare conditions. He has initiated and conducted many clinical trials for treatments for retinal diseases. Dr. Freund is a Clinical Professor of Ophthalmology at New York University School of Medicine. He is a senior partner at Vitreous Retina Macula Consultants of New York. He is an attending surgeon at Manhattan Eye, Ear and Throat Hospital and New York Presbyterian Hospital. Dr. Freund is a member of the Retina Society, Macula Society, and the American Society of Retina Specialists. He is on the Editorial Board of the journal Retina and is an Associate Editor for Retinal Cases & Brief Reports. He has authored over 180 peer-reviewed scientific manuscripts and has written numerous book chapters. He has received numerous awards including the prestigious Young Investigator Award from the Macula Society. He is a graduate of Williams College and the New York University School of Medicine and completed his residency training in general ophthalmology and fellowship in medical and surgical retina at the Manhattan Eye, Ear, and Throat Hospital. Dr. Freund is also a prominent collector of vintage magic apparatus.

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Prof. Frank G. Holz, MD, FEBO University Eyeclinic of Bonn, Germany Frank G. Holz is Professor and Chairman of the Department of Ophthalmology at the University of Bonn, Germany. His major clinical interest is medical and surgical retina. His main research interests include the pathogenesis, biomarkers and new therapies for macular and retinal diseases including age-related macular degeneration. He has a keen interest in innovative retinal imaging technologies and image analysis strategies. He was a scholar of the German National Academic Foundation (Studienstiftung des deutschen Volkes), trained at the University of Heidelberg, Germany, and the University of Chicago/Pritzker School of Medicine, and passed a fellowhip at Moorfields Eye Hospital, London, with Prof. Alan C. Bird. Professor Holz has been a cofounder of the Priority Program AMD of the German Research Council (DFG) and founded the GRADE Reading Center Bonn to perform digital image analysis in clinical natural history and interventional trials with a focus on dry AMD. He is a Board Member of the German Ophthalmological Society (DOG) and EURETINA, Member of the Club Jules Gonin, the European Academy of Ophthalmology (EAO), the Macula Society, the Gass Club, Editor-in-Chief of Der Ophthalmologe, and serves a reviewer for many peer reviewed journals. He has received numerous awards including the Pro Retina Macular Degeneration Research Award, the Leonhard-Klein Award for Ocular Surgery, the Alcon Research Institute (ARI) Award and the Senior Achievement Award of the AAO. He published more than 300 articles in peer-reviewed journals and is editor of several books on retinal diseases.

Prof. Felipe A. Medeiros, MD Hamilton Glaucoma Center, UCSD Shiley Eye Center, La Jolla, USA Felipe A. Medeiros, M.D., Ph.D. is Professor of Ophthalmology and the Ben and Wanda Hildyard Chair for Diseases of the Eye at the UCSD School of Medicine. He is also Medical Director of the Hamilton Glaucoma Center, University of California San Diego and Director of Vision Function Research at the same institution. Dr. Medeiros has been ranked as one of the Top 5 Glaucoma Researchers in the World over the past decade (source: Annals of Library and Information Studies, Vol. 60, June 2013, pp. 98-106 and http://www.expertscape.com/blog/2013/11/07/press-release-expertscape-ranks-top-experts-institutions-glaucoma-disease-research-treatment/). His research interests encompass many different areas in glaucoma, including identification of risk factors for development and progression of disease and methods and strategies for diagnosis, follow-up and management of glaucoma. He has published over 200 peer-reviewed publications in major Ophthalmology journals, 40 book chapters and 4 books on the evaluation of the optic nerve, visual field, intraocular pressure and progression of glaucoma. He is the principal investigator on a National Institutes of Health (NIH) R01 grant to evaluate functional impairment in glaucoma. His laboratory is currently evaluating the impact of the disease on activities of daily living in patients with glaucoma, using techniques such as driving simulation and virtual reality. The results of this research will have major impact in the understanding of how glaucoma affects quality of life and how physicians can better determine which patients are at higher risk for developing impairment from the disease.

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Dr. Medeiros is also the recipient of several awards/honors in Ophthalmology, including the World Glaucoma Association Research Award, the Ronald Lowe Medal from the Australian and New Zealand Ophthalmology Society, the American Glaucoma Society Mid-Career and Clinician-Scientist Awards, South African Glaucoma Society honorary member, Federal University of Sao Paulo Special Recognition Award, Iranian Society of Ophthalmology Recognition Award, Best Doctors in America, the American Academy of Ophthalmology Editor’s Choice and the American Academy of Ophthalmology Achievement Award. He is an elected member of the Glaucoma Research Society and has also served as a member on the World Health Organization (WHO) Committee on Prevention of Blindness. He served as a member of the Research Committee of the American Glaucoma Society and on the Advisory Board of the World Glaucoma Association. Dr. Medeiros is member of the Editorial Board of the Journal of Glaucoma and International Glaucoma Review.

Sung Chul Park, MD New York Eye and Ear Infirmary, New York, USA Dr. Park is Assistant Professor of Ophthalmology at Icahn School of Medicine at Mount Sinai. He is also the Director of Glaucoma Clinic, Peter Crowley Research Scientist, and Director of Moise and Chella Safra Advanced Ocular Imaging Laboratory at the New York Eye and Ear Infirmary of Mount Sinai. He is a clinician-scientist in the field of ophthalmology and his areas of expertise include glaucoma, complicated cataract, anterior segment disorders, minimally invasive glaucoma/cataract surgery, ocular imaging, and perimetry. He pioneered the new field of in vivo three-dimensional high-resolution imaging and analysis of the optic nerve head in human glaucoma, discovering a new set of pathogenic mechanisms of the development and progression of glaucoma. He also elucidated the risk factors and progression pattern of central visual field loss in glaucoma and revealed that patients with central visual field loss would benefit from visual field tests with centrally condensed test points.

He has more than 120 peer-reviewed articles, abstracts and book chapters including top ophthalmology journals such as Ophthalmology, IOVS, and JAMA Ophthalmology. He has given more than 50 lectures in the US, Germany, Netherlands, Australia, France, Hong Kong, China, India, South Korea and Saudi Arabia. He is an expert reviewer for 10 top peer-reviewed journals including Ophthalmology, IOVS, and JAMA Ophthalmology. He has been honored with 16 nationally or internationally recognized awards, grants and scholarships from the American Glaucoma Society, New York Glaucoma Research Institute grants, American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, and World Glaucoma Association. Dr. Park received his medical degree from Seoul National University, College of Medicine. After his ophthalmology residency and glaucoma fellowship at the Samsung Medical Center, Seoul, Korea, he joined the New York Eye and Ear Infirmary in 2009 and finished a clinical and a research glaucoma fellowship in 2010 and in 2011, respectively. He is a member of 8 professional societies including Association for Research in Vision and Ophthalmology, American Glaucoma Society, American Academy of Ophthalmology, and World Glaucoma Association Associate Advisory Board. He is also serving as an organizer of international academic meetings including theWorld Ophthalmology Congress, Asia Pacific Academy of Ophthalmology Congress, and Glaucoma Foundation Optic Nerve Rescue and Restoration Think Tank.

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Prof. Ali Osman Saatci, MD Dokuz Eylul University, Izmir, Turkey

Dr. Saatci is a Professor at the Department of Ophthalmology of Dokuz Eylül University, Izmir, Turkey. He completed his residency training in Department of Ophthalmology of Hacettepe University in Ankara in 1989. He worked as a retina fellow with Dr. Richard S. Ruiz at Hermann Eye Center, University of Texas in Houston. He became an Associate Professor in 1994 and Professor in 2000. Dr Saatci has an indefinitely valid ECFMG certificate and is the member of SİGMA Xi Scientific Society, Euretina, ARVO and American Academy of Ophthalmology. He is in the editorial board of the journals Retina-Vitreus and Türkiye Klinikleri Oftalmoloji. He served as a reviewer for the journals Acta Ophthalmologica, BMC Ophthalmology, Indian Journal of Ophthalmology, Archives of Ophthalmology, Current Eye Research, Ophthalmic Epidemiology, Expert Review of Ophthalmology, Ocular Pharmacology and Terapeutics, Drugs, Ophthalmic Genetics, MN Oftalmoloji and Turkish Journal of Ophthalmology. He is the coauthor of more than 95 peer-reviewed manuscripts published in Pubmed Journals including AJO, Archives of Ophthalmology, Journal of Cataract and Refractive Surgery, BJO, Ophthalmologica and Ophthalmic Surgery Lasers and İmaging.

Prof. Figen Sermet (formerly Batioglu), MD Ankara University, Ankara, Turkey

Dr. Figen Sermet is Professor of Ophthalmology and the chief of Ophthalmology Department, Ankara University in Turkey. She got her medicine degree at Hacettepe University in 1985 and residency in Ankara University in 1992. She became assistant professor in 1996, associate professor in 1999 and professor in 2006. In July-August 2009, she had been in Columbia University Edward Harkness Eye Clinic as a visiting professor.

She is the associate editor of Medical Network Ophtalmology Journal in Turkey. She is also a board member in Turkish Ophthalmological Society Retina Unit as well as Ankara University Medical Faculty Behcet’s Disease Multidisciplinary Unit. Moreover Dr. Figen Sermet has memberships of Ocular İnflammation Society and Euretina. Her main area of scientific interests are retinal diseases, vitreoretinal surgery, retinal imaging, retinopathy of prematurity and uveitis. She has more than 150 national and international peer-rewieved articles. She is the principle or co-investigator in multicenter studies.

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Prof. Giovanni Staurenghi, MD Sacco Hospital, University of Milano, Italy

Giovanni Staurenghi, presently Professor of Ophthalmology is Chairman of the University Eye Clinic at Department of Biomedical and Clinical Science “Luigi Sacco” University of Milan Italy.

He got his degree at the University of Pavia (Italy) in 1986 and his residency at the University of Milan(Italy) in 1990. He was research fellow at the Schepens Eye Research Institute from 1991 to 1992 and Visiting Scientist at the same Institute from 1992 to 1993. He became associate professor in 1999 and full professor in 2007.

His research, publications and lectures have an important bearing on retinal degeneration; in particular his work is oriented on different types of imaging and treatment. He has been a member of ARVO since 1988, Macula Society since 2004, Ophthalmic Photographer Society since 2006 and American Accademy of Ophthalmology since 2007.

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MultiColor Imaging

Giovanni Staurenghi, MD

Sacco Hospital, University of Milano, Italy

The interpretation of MultiColor imaging could be somehow difficult. A series of new instruments are right now on the market. Heidelberg Spectralis uses simultaneous three lasers: blue for the blue channel, green for the green channel and infrared for the red channel. Nidek F10 has the possibility to acquire sequentially different imges obtained with blu, green and red lasers and the software sequentially create the multicolor image. These two instrument use also a confocal mode. Optos use only two laser, green and red to obtain a multicolor image. A regular color fundus picture is obtained using white light and collecting all the visible spectrum. Because of all these differences the multicolor images are different from color pictures. Using color and multicolor image comparisons a series of these differences will be underline.

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Notes _______________________________________________________________________________

12th International SPECTRALIS® Symposium (ISS)

Oct 10-11, 2014, Istanbul, Turkey

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Update on Fundus Autofluorescence Imaging

Frank G. Holz, M. Fleckenstein, S. Schmitz-Valckenberg, P. Charbel-Issa

Department of Ophthalmology, University of Bonn, Germany

Purpose: The spectrum of clinical applications of fundus autofluorescence imaging has been expanding in recent years. Herein, recent developments and findings using this imaging modality will be reviewed.

Methods: The Spectralis instrument allows for both blue und green fundus autofluorescence imaging. Signals derived from fundus autofluorescence can now be quantified (quantitative autofluorescence imaging – qAF). To accomplish standardized measurements, a reference fluorophore is inserted into the optical pathway of the Spectralis instrument. Besides the generation of reference values in normal probands, patients with a wide variety of retinal diseases were examined.

Results: Fundus autofluorescence imaging provides information over and above conventional imaging modalities including fundus photography and fluorescein- or indocyanine green angiography. Thereby, refined phenotyping can be performed, e.g. in various retinal diseases with the common downstream pathogenetic pathway of outer retinal atrophy. Specific disease entities may be associated with discrete patterns of abnormality. The use of qAF has been shown to be useful to distinguish ABCA4-related macular dystrophies from other forms of macular dystrophies.

Conclusions: Fundus autofluorescence imaging is a non-invasive examination technique that is a helpful tool both for research application and for clinical routine. Due to the absorption properties of luteal pigment, FAF-imaging is also suitable to determine macular pigment optical density which may show variation with certain diseases. qFAF will be useful for monitoring therapeutic effects of pharmacological interventions targeting the visual cycle as well as for natural history studies in monogenic and complex macular retinal diseases.

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Notes _______________________________________________________________________________



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In-Vivo 3D analysis of Optic Nerve Head

Sung Chul (Sean) Park, MD

New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA

Purpose: Although optic nerve head is a complex 3-dimensional (3D) structure, clinical optic disc examination evaluates its superficial portions only. SD-OCT imaging with eye tracking enables 3D analysis of the optic nerve head by obtaining serial high-resolution cross-sectional images. Normal eyes and those with various pathologic conditions may be assessed in more detail using 3D SD-OCT analysis.

Methods: Serial enhanced depth imaging (EDI) OCT scans of the optic nerve head were obtained from subjects with various optic nerve conditions for volumetric analysis. Normal lamina cribrosa (LC) structure was evaluated through 3D reconstruction of the LC images. The location and extent of focal LC defects in glaucoma were labeled using 3D reconstruction and spatially correlated with clinical optic disc changes in glaucoma. In vivo 3D structure of central optic disc pits were also evaluated and its association with visual deficit was investigated. EDI OCT findings of optic nerve head drusen (ONHD) were characterized and structure-function relationship was assessed using 3D analysis of the ONHD mass.

Results: In normal eyes, the LC had a central ridge that spanned horizontally and appeared to be a supporting structure of the LC. The size, location and shape of focal LC defects in glaucomatous eyes varied considerably among glaucomatous eyes. Laminar holes corresponded to acquired pits of the optic nerve (APON) almost precisely. Laminar disinsertions were often obscured from clinical view by the scleral and neuroretinal rims partially or completely. Central optic disc pits were full-thickness defects in the LC, which appeared to cause no visual loss. Hyporeflective core surrounded by short, horizontal hyperreflective bands are characteristic OCT findings of ONHD. Early visual field defects caused by ONHD were often missed in standardized automated perimetry. Circumpapillary retinal nerve fiber layer thickness assessment appeared to be a better strategy for monitoring ONHD.

Conclusions: A variety of optic nerve head conditions can be evaluated in vivo using 3D SD-OCT imaging, which may be helpful in the clinical diagnosis and monitoring of such conditions.

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Notes _______________________________________________________________________________



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Imaging The Choroidal Anatomy

Murat Karacorlu, MD, MSc, FEBO

Istanbul Retina Institute, Istanbul Turkey

The microcirculation of the eye has been a subject of investigation for many years, and different techniques have been employed to study it. These techniques include standard histologic sections, flat preparation of digested tissue, injections of india ink, plastic corrosion casting, indocyanin green angiography and optical coherence tomography (OCT).

Use of new OCT modalities, including enhance depth imaging OCT, image averaging have led to increased visualization of the choroidal anatomy. The correlation of these new anatomical findings with other imaging modalities results increased understanding of many eye diseases. Optical coherence tomography is now proven to be an effective noninvasive tool to evaluate the choroid and to detect choroidal changes in pathologic states. In this presentation OCT techniques to examine the choroid will be described.

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Notes _______________________________________________________________________________



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New Techniques for Imaging Diabetic Retinopathy Leukostasis and Hyperpermeability

Balamurali K. Ambati, MD, PhD, MBA

Professor of Ophthalmology Moran Eye Center, University of Utah, USA

Purpose: To determine whether cardinal features of diabetic retinopathy such as leukostasis and hyperpermeability can be imaged in an animal model of Type 1 diabetes.

Methods: Six month old Ins2Akita mice (on C57BL6/J background) were used as a model of nonproliferative diabetic retinopathy (wild-type C57Bl/6 were control) and assessed for and in vivo leukocyte adherence and rolling, and retinal vascular leakage.

To assess leukostasis, anesthesia and dilation, acridine orange injected into the tail vein of mice. Imaging was accomplished using Heidelberg Spectralis with a 488nm laser. Utilizing the movie mode, videos were captured at 15.4 frames per second imaging in High Speed mode. Leukocyte adherence, rolling, and velocity were measured by a masked operator. To assess leakage, the near-infrared fluorophore ZW800-NHS ester was aminated and then coupled anhydrously with aminated 100nm polystyrene latex beads. After vortexing, ZW800/microsphere (ZW800m) solution was injected via by tail vein). Imaging was accomplished using Heidelberg Spectralis using the indocyanine green (ICG) angiography camera (excitation laser 789 nm).

Results: Diabetic mice experience increased leukocyte adherence and rolling in retinal capillaries and slower leukocyte velocities. ZW800m imaging demonstrated hyperfluorescence outside of retinal vessels in diabetic but not control mice.

Conclusions: Leukostasis can be observed in vivo with acridine orange leukocyte fluorography and ZW-800 microbeads can demonstrate hyperpermeability, providing 2 novel functional measures of retinal vasculature.

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Ultra-Widefield Imaging

Sarah Thiele, Julia S. Steinberg, Viola Graham, Monika Fleckenstein, Steffen Schmitz-Valckenberg, Frank G. Holz


Purpose: To evaluate a novel ultra-widefield non-contact lens for confocal scanning laser ophthalmoscopy (cSLO).

Methods: Acquisition of different cSLO imaging modalities, including near-infrared reflectance (NIR), bluepeak fundus autofluorescence (FAF) as well as fluorescein (FA) and indocyanine green angiography (ICGA), was carried out in different retinal diseases (Spectralis HRA+OCT, Heidelberg Engineering, Germany). Images at different field sizes were obtained by changing the lens of the camera head (standard lens, widefield lens and ultra-widefield lens).

Results: Following changing the lens within a few seconds, evenly illuminated and non-distorted images with high contrast were obtained far beyond the vascular arcades with the ultra-widefield lens using FA and ICGA. Detection of retinal neovascularization, non-perfused retinal areas and distribution of laser scars following laser treatment was accomplished. Although the resolution was inferior compared to the 55° and 30° x 30° degree lenses, even subtle changes such as reticular drusen were still visible far beyond the vascular arcades by NIR imaging with the ultra-widefield lens. FAF imaging was possible in young patients, particularly with retinal dystrophies and a presumably enhanced metabolic load of intrinsic fluorophores. Lens opacities were associated with reduced image quality in the FAF images.

Conclusions: Retinal cSLO imaging at high-resolution of the retinal periphery far beyond the vascular arcades is possible using the non-contact ultra-widefield lens in the clinical setting. Visualization of peripheral retinal areas in one image may allow for mapping and monitoring of pathological alterations that are not identifiable by standard posterior pole imaging. This will be helpful for the assessment of the extension of retinal diseases in order to improve patient management.

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Enhanced Vitreous Imaging (EVI)



The vitreous visualization and in particular the visualization of Vitreous Macular Adhesion (VMA) and Vitreous Macular Tractions (VMT) are more important now with the introduction of new drug treatments. The presentation wants to give suggestions about the visualization of vitreous body. Some of the tricks were suggested by C. E. Pang as published on JAMA Ophthalmol.

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Fundus Autofluorescence Imaging in Macular Dystrophies

Figen Sermet (formerly Batioglu)

Ankara University Faculty of Medicine Ophthalmology Department Ankara, Turkey

Purpose: To review and update fundus autofluorescence (FAF) findings of macular dystrophies.

Methods: This review includes updated information regarding the FAF findings of patients with macular dystrophies and this information is supported with FAF images of clinical cases.

Results: Retinal dystrophies, refers to a group of inherited diseases characterized by the deposition of a highly autofluorescent material at the level of the retinal pigment epithelium. Progressive accumulation of lipofuscin within retinal pigment epithelial cells is involved in the pathogenesis of retinal dystrophies. Fundus autofluorescence is a noninvasive imaging technology that provides information on the distribution of lipofuscin within the retinal pigment epithelial cells. Also it can reveal otherwise invisible manifestations of distrupted RPE metabolism secondary to photoreceptor dysfunction.

Conclusion: FAF imaging has an important role in the diagnosis, follow-up, detailed description of the phenotype and to provide insights into the natural history and underlying pathophysiology of retinal dystrophies that include lipofuscinopathies and disorders of photoreceptors.

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Towards Structure-Function Correlation

Frank G. Holz, S. Schmitz-Valckenberg, J. Steinberg, W.M. Harmening


Purpose: Morphological abnormalities may have a very different impact on subsequent functional impairment. To better understand disease processes and to manage patients more accurate structure-function correlations are being sought by various approaches.

Methods: Determination of retinal sensitivity using both photopic and scotopic microperimetry were topographically aligned with cSLO- and SD-OCT images. An adaptive optics SLO system was used to for combining microstimulation with high speed eye tracking.

Results: Correlation of microperimetric findings and morphological alterations allows better evaluation of the functional impact of such changes. In macular telangiectasia type 2 with well defined, progressing juxtafoveal scotomas the role of alterations in different anatomic layers of the retina was elucidated. Topographic alignment in the context of reticular drusen show a marked impairment of scotopic versus normal photopic retinal sensitivities. With a AO-SLO function test individual cone photoreceptor sensitivities can be probed (“sigle cell psychophysics”).

Conclusions: Structure-function correlations can now be accomplished with high precision and accurate topographic alignment. This approach adds to the understanding of disease processes and will be useful in interventional studies as well as in clinical routine.

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Transverse Section Imaging of the Temporal Raphe with OCT

Balwantray C. Chauhan, PhD

Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada

There has been considerable debate about the arrangement and composition of the temporal raphe in the human retina. In postmortem studies, Vrabec showed that axons of retinal ganglion cells temporal to the fovea are forced to take an arched course above and below the papillomacular bundle and that the temporal raphe generally represents a watershed midline. However, there is scarce published literature on the relationship between the orientation of the papillomacular bundle and the temporal raphe. This presentation will discuss the orientation of the temporal raphe with respect to the fovea to Bruch’s Membrane Opening axis with Transverse Section Imaging.

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Refining the Diagnosis and Management of CNV in AMD

K. Bailey Freund, MD

Vitreous Retina Macula Consultants of New York, New York, NY USA

Purpose: To correlate long-term visual outcomes of neovascular age-related macular degeneration (AMD) patients treated with anti-vascular endothelial growth factor (VEGF) therapy using a Treat and Extend Regimen (TER) with baseline characteristics including neovascular phenotype.

Methods: Retrospective review of consecutive patients with treatment-naive neovascular AMD. Neovascular lesions were classified using fluorescein angiography (FA) and an anatomic classification based on FA and optical coherence tomography (OCT).

Results: 185 patients (210 eyes) with a mean (±SD) age of 81.2 (±7.9) years received a mean number of 8.3 (±1.6) intravitreal anti-VEGF injections/year during a mean follow-up of 3.6 years (range 1 to 6.6 years), with a retention rate of 62.9%. The mean visual acuity (VA) improved from 20/90 at baseline to 20/68 at 1 year, 20/70 at 3 years and 20/75 at 6 years. The number of injections and the anatomic classification were independent predictors of VA at 6 months, 1, 2, 3 and 4 years. Patients with Type 1 neovascularization had better visual outcomes and received more injections than the other neovascular subtypes. There were no serious adverse events.

Conclusions: A TER provided sustained long-term visual gains. Eyes with Type 1 neovascularization had better visual outcomes than other neovascular subtypes.

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Correlation of 3D Spectral Domain Optical Coherence Tomography and Fluorescein Angiography in Neovascular AMD

Mustafa Guzey1, Gonul Altun2, Huseyin Ozcan2, Ayhan Saglık2, Omer Faruk Yilmaz1, Gulsah Gormus1 1 Harran University School of Medicine, Department of Ophthalmology-Retina, Sanliurfa Turkey 2 M. Akif Inan Education and Research Hospital, Department of Ophthalmology, Sanliurfa Turkey

Purpose: To correlate the morphologic characteristics of choroidal neovascularisation (CNV) and related lesions in age-related macular degeneration (AMD) using 3D images with Spectral Domain Optical Coherence Tomography (SD-OCT) and conventional fundus fluorescein angiography (FFA).

Methods: Twenty-one patients (25 eyes) diagnosed as CNV in patients with neovascular AMD by color fundus photography and FFA were examined by SD-OCT (Spectralis®, Heidelberg Engineering). The diagnostic criteria for CNV on FFA were heterogeneous pathological hyperfluorescence with late leakage in the macular region associated with pigment epithelial detachment (PED) and stippled hyperfluorescent dots. The results of 3D-OCT were analyzed and compared with that of FFA.

Results: OCT provided realistic 3D cross-sectional images of the retina, RPE, and CNV in patients with neovascular AMD. The main characteristics of neovascular AMD were fibrotic CNV, serous detachment of neurosensorial epithelium, and hemorrhagic or serous PED with 3D-OCT. FFA and OCT images showed a significant correlation between FFA patterns and 3D-OCT features such as serous detachments and retinal thickness.

Conclusions: The major characteristic of 3D-OCT of neovascular AMD is fibrotic CNV combined with serous and hemorrhagic detachment of neurosensorial epithelium or PED. A tomographic notch in the PED may be diagnostically important as an indication of CNV. OCT cannot replace conventional diagnostic techniques. This method provides some additional information and 3D-OCT may be able to characterize the relation of the membrane to the RPE and imaging may be possible through hemorrhage in patients with neovascular AMD.

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Fundus Autofluorescence Imaging in Non-Exudative AMD

Figen Sermet (Formerly Batioglu)

Ankara University Faculty of Medicine Ophthalmology Department, Ankara, Turkey

Purpose: To review fundus autofluorescence (FAF) patterns in patients with non-exudative age-related macular degeneration (AMD) and to emphasize the risky patterns for the development of choroidal neovascularisation (CNV) and geographic atrophy progression.

Methods: This review includes updated information regarding the FAF findings of patients with non-exudative AMD including geographic atrophy and this information is supported with FAF images of clinical cases.

Results: Fundus autofluorescence is a noninvasive imaging technology that provides information on the distribution of lipofuscin within the retinal pigment epithelial cells. Progressive accumulation of lipofuscin within retinal pigment epithelial cells is involved in the pathogenesis of age-related macular degeneration. In early non-exudative AMD and at the junctional zone of geographic atrophy, different FAF patterns are identified. Description of these patterns is helpful in the determination of prognostic factors, characteristics of high risk, follow up of the course of the disease, and investigation of the correlations between phenotypic and genotypic characteristics.

Conclusion: Fundus autofluorescence has emerged as a noninvasive tool for imaging early AMD as well as geographic atrophy and identifying their autofluorescent features. It helps to improve our understanding of the pathophysiology of early AMD and the mechanisms of disease progression as well as to identify high risk FAF patterns as a predictor for CNV development.

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Probing Geographic Atrophy – Refined Phenotyping and Longitudinal Variations

Frank G. Holz, M. Fleckenstein, M. Göbel, J. Steinberg, S. Schmitz-Valckenberg


Purpose: Geographic atrophy due to age-related macular degeneration (AMD) represents an important unmet need. Recent advances in imaging technology have had only allowed to identify areas of atrophy and measure growth, but have also provided pathogenetic clues, identification of predictors of progression and refined phenotyping.

Methods: In the context of the prospective longitudinal FAM- and SIGHT- studies patients with geographic atrophy were examined with a standardized protocol for fundus autofluorescence as well as near-infrared reflection imaging. Lesion growth rates were determined using the region finder image analysis software. Directional spread of atrophy towards the center versus towards the periphery was measured in eyes with foveal sparing at baseline.

Results: Refined phenotyping in eyes with late onset geographic atrophy allowed for identification of specific disease entities. Predictors based on morphological findings were determined which impact progression rates over time. Directional spread can now be quantified to model disease progression with regard to reduction in initially spared foveal retina.

Conclusions: Imaging modalities including cSLO-fundus autofluorescence imaging and SD-OCT images have added substantially to the understanding of the advanced form of dry AMD. Lesion growth rates are now accepted as main outcome parameters in interventional clinical trials in patients with geographic atrophy due to AMD. The relatively uniform clinical characteristics of central atrophy can mimick various, heterogenous forms of macular diseases. Serial examinations are also helpful in clinical routine to educate and manage patients.

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Notes _______________________________________________________________________________



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The CSC, Type 1 Neovascularization, and PCV Connection



Purpose: To describe pachychoroid neovasculopathy, a form of type 1 [sub-retinal pigment epithelium (RPE)], neovascularization occurring over areas of increased choroidal thickness and dilated choroidal vessels.

Methods: A retrospective, observational case series of patients who underwent comprehensive ophthalmic examination and multimodal imaging with fundus photography, fundus autofluorescence (AF), spectral-domain optical coherence tomography (SD-OCT), enhanced-depth imaging optical coherence tomography (EDI-OCT), fluorescein angiography and indocyanine green angiography (ICGA).

Results: In all eyes, there was type 1 neovascularization overlying a localized area of choroidal thickening and dilated choroidal vessels seen with EDI-OCT. With ICGA, there were large choroidal veins and choroidal hyperpermeability seen beneath the area of the neovascular tissue in all eyes. No eyes had evidence of submacular exudative detachment or AF changes to suggest antecedent acute or chronic central serous chorioretinopathy (CSC). No eyes had drusen or degenerative changes to suggest age-related macular degeneration (AMD) or other degenerative diseases. In one patient, the fellow unaffected eye demonstrated RPE abnormalities best seen with fundus AF overlying focal dilated choroidal vessels seen with EDI-OCT and associated choroidal hyperpermeabillity seen with ICGA, consistent with the diagnosis of pachychoroid pigment epitheliopathy. All eyes showed the appearance of polypoidal structures within the neovascular tissue.

Conclusion: Pachychoroid neovasculopathy falls within a spectrum of diseases associated with choroidal thickening that includes pachychoroid pigment epitheliopathy, CSC and polypoidal choroidal vasculopathy (PCV), and should be considered as a possible diagnosis in eyes with features of type 1 neovascularization and choroidal thickening in the absence of characteristic AMD or degenerative changes. Pachychoroid neovasculopathy may occur as a focal abnormality within the macula, even in myopic eyes with normal subfoveal choroidal thickness. Pachychoroid neovasculopathy can ultimately progress to the development of PCV.

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Multicolor + OCT: The Interface of Retina and Glaucoma

Sanjay Asrani, MD

Duke University, Durham, North Carolina, USA

Purpose: Early detection and treatment compliance have remained significant challenges in the treatment of glaucoma. Multicolor scanning laser imaging combined with optical coherence tomography (OCT) can be very useful for both early detection as well as educating and convincing patients about the presence of disease.

In many cases of co-existing retinal diseases in the presence of glaucoma, the addition of multicolor scanning laser imaging with the Spectralis increases understanding of the structures of the eye and avoids missing such co-existing pathology. A number of cases that demonstrate the usefulness of the technology will be presented.

Methods: One hundred consecutive patients with a diagnosis of glaucoma or retinal pathology underwent multicolor with OCT cross sectional scanning.

Results: In 16% of eyes with clinically noted retinal pathology, co-existing diagnosis of glaucoma was made with the aid of multicolor OCT. In 38% of eyes with a clinical glaucoma diagnosis, co-existing diagnosis of retinal pathology was made with the aid of multicolor OCT. Blue and green reflectance images were ideal for detecting surface pathology such as nerve fiber layer defects.

Conclusions: Multicolor scanning laser imaging is an additional modality that supplements visual field tests and OCT imaging to help confirm clinical judgments and educate patients using descriptive images. It provides a full picture of the retina to aid in diagnosis especially in eyes with coexisting retinal diseases and glaucoma. It is particularly useful for glaucoma diagnosis because it allows the clinician to visualize the nerve fiber layer in exquisite detail supplementing OCT technology. Cross-sectional OCT measurements do not always match a patient’s visual field test results or their description of visual deficits. Multicolor scanning laser imaging combined with OCT imaging corroborates to help complete the puzzle.

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Glaucoma as a Laminopathy

Sung Chul (Sean) Park, MD

New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA

Purpose: The lamina cribrosa (LC) is considered the primary and principal site of retinal ganglion cell (RGC) injury in glaucoma. The term laminopathy has recently been introduced and defined as a disorder disrupting the normal structure or function of the lamina cribrosa in the optic nerve head. In this talk, three types of laminopathies that were investigated decades ago in histologic studies and recently revisited in imaging studies are discussed.

Methods: Serial enhanced depth imaging (EDI) OCT scans of the optic nerve head were obtained from glaucoma patients. First, position of the anterior LC surface relative to the Bruch’s membrane opening was assessed to investigate its posterior displacement in glaucomatous eyes compared to normal eyes. Second, EDI OCT scans were reviewed for the presence of focal LC defects and spatial correlation between focal LC defects and conventional glaucomatous damage were investigated. Third, LC thickness was compared between normal and glaucomatous eyes and its diagnostic capability for glaucoma was assessed.

Results: The LC was posteriorly displace in glaucomatous eyes compared to normal eyes, as well as in eyes with visual field defects compared to fellow eyes with no visual field defects. EDI OCT visualized focal LC defects of various shapes and sizes in glaucomatous eyes. Focal LC defects were spatially correlated with neuroretinal rim loss, retinal nerve fiber layer (RNFL) defects, disc hemorrhage and visual field defects and were associated with faster visual field progression. LC thinning occurred in glaucoma and the diagnostic ability of LC thickness for glaucoma was comparable to that of RNFL thickness. Posterior laminar displacement and laminar thinning occurred mostly at earlier stages of glaucoma.

Conclusions: Posterior LC displacement, focal LC defects, and LC thinning are characteristic in vivo features of the LC in glaucoma. Laminopathy may be the cause or trigger of RGC axonopathy in glaucoma. Studies on cellular and molecular mechanisms of laminopathy and RGC axonopathy are needed to elucidate the causal relationship between these two pathologies.

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Impact of SPECTRALIS Anatomic Positioning System (APS) Acquisition on Diagnostic Accuracy in Glaucoma

Balwantray C. Chauhan, PhD

Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada

The Spectralis Anatomic Positioning System (APS) takes into account the individual variation in the fovea to Bruch’s membrane opening angle in the acquisition and analysis of neuroretinal rim and retinal nerve fibre layer measurements. A new normative database for the Spectraiis was established and the diagnostic accuracy of the new normative database was compared to the existing one. The results argue that anatomically and geometric accurate indices lead to more accurate diagnosis of glaucoma.

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High Resolution SD-OCT Findings in Hereditary Retinal Dystrophies

Serra Arf, MD

Istanbul Retina Institute, Istanbul, Turkey

Purpose: To determine the SD-OCT findings of important hereditary retinal dystrophies.

Methods: We reviewed the patients of Istanbul Retina Institute with a diagnosis of classic Retinitis Pigmentosa, Cone Dystrophy, Stargardt’s disease, and Juvenile Foveoschisis to establish specific SD-OCT findings. We also searched the literature for the OCT findings of foveoschisis, and evaluated their results combining with our 18 patients.

Results: The OCT image of early and mid stage retinitis pigmentosa has three characteristic findings. 1. Inside the foveal and perifoveal areas ELM and IS/OS band are intact. 2. Outside these areas ELM and IS/OS band are absent. 3. Outside these areas outer nuclear layer is very thin. At the end stage a diffuse atrophic retina appears. The OCT pattern is reversed in cone dystrophies; the disorganization of the IS/OS junction is limited to the fovea and the perifoveal zone. In the OCT of late stage Stargardt's disease, attenuation of retinal layers and enhanced choroidal reflectivity are seen. We tried to establish OCT based stages of juvenile foveoschisis, which composed of three different stages such as cystic stage, intermediate stage, and atrophic stage. We have applied OCT to introduce three distinct stages of juvenile foveoschisis: cystic stage, intermediate stage, and atrophic stage.

Conclusions: SD-OCT is an important imaging modality for diagnosing hereditary retinal diseases, and determining their progression.

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Multimodal Imaging of RAP lesions



The modern approach to retinal diagnosis includes the analysis of multimodal imaging: color picture (CP), infrared imaging (IR), autofluorescence imaging (AF), optical coherence tomography (OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA). The definition of classic choroidal neovascularization, divided into predominantly classic and minimally classic, and occult choroidal neovascularization, could be better classified in different type of neovascularization such as type 1 and 2 choroidal neovascularization, retinal angiomatous proliferation (RAP) or type 3.

I. RAP A. CP: Small flame hemorrhage in perimacular area B. IR: Presence of reticular pseudodrusen C. AF: Possible visualization of cystic lesions with blue autofluorescence D. OCT

1. In OCT, presence (not always) of cystoid edema 2. In OCT, presence (not always) of interrupted retinal pigment epithelial (RPE) layer of

a RPE detachment with more reflective, usually oval area E. FA and ICGA

1. Feeding retinal vessel bigger than surroundings perifoveal vessels (blood shunting) 2. Leakage in late ICGA 3. In stereo ICGA floating net (Floating means between retinal vessel layer and choroidal

vessels.) 4. In case of RPE detachment: In FA the “hot spot” is always in the center of

detachment. F. Indirect sign

1. If you have a RPE detachment that disappears immediately after anti-vascular endothelial growth factor (anti-VEGF) treatment, there is a good chance that it was a RAP.

2. Other eye if advanced neovascular membrane, usually a retinal choroidal anastomosis

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Scatter Photocoagulation in Persistent Macular Edema due to RVO

Bora Eldem, MD, FEBO

Prof. of Ophthalmol., Chair of Hacettepe Univ. Ophthalmol. Dept., Ankara, Turkey

The role of targeted photocoagulation to the areas of capillary drop out in retinal vein occlusion which was unresponsive to anti-VEGF treatment due to macular edema will be discussed. A literature review will be presented against other treatment strategies in a scenario described above.

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Uveitic Macular Edema: Fluorescein Angiography vs OCT

Ali Osman Saatci, MD

Dokuz Eylül University, Izmir, Turkey

Purpose: To present a detailed review of the place of optic coherence tomography (OCT) and fluorescein angiography (FA) in the diagnosis of uveitic macular edema.

Methods: Interpretation of latest literature and sharing of the author’s clinical experience.

Results: As macular edema is the cause of persistent visual loss in many uveitic cases, detection of macular edema is crucial to achieve a better visual and anatomic outcome. The most valuable diagnostic tests are FA and OCT. While FA is important not only to detect edema but it is also helpful to investigate perfusion status of the macula, disc involvement, disease activity and vascular bed evaluation. On the other hand, SD-OCT is important to demonstrate edema both qualitatively and quantitatively.Vitreoretinal interface problems and subretinal fluid presence can only be shown with OCT:

Conclusions: FA and OCT most certainly complement each other. Whenever one test is negative, the other test should also be employed to verify the presence of macular edema.

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Retinal Imaging based Patient Selection for Intravitreal Ocriplasmin in Symptomatic Vitreomacular Traction and Macular Holes

S. Müller, S. Schmitz-Valckenberg, F. G. Holz


Purpose: Intravitreal Ocriplasmin represents a novel pharmacological treatment option in patients with symptomatic vitreomacular traction (VMT) and small full-thickness macular holes (FTMH). Patient selection based on defined retinal imaging criteria is crucial to achieve high success rates. We demonstrate suitable imaging protocols and present a case series with outcomes and challenges following Ocriplasmin therapy.

Methods: The vitreoretinal interface was examined using Spectralis Domain optical coherence tomography (SD-OCT, Heidelberg Engineering) as well as the multicolor mode. A focus change of +2 dpt. enabled the detailed imaging of the posterior hyaloid membrane. In order to acurately visualize macular holes and small vitreomacular adhesions, rectangular raster volume scans, a series of parallel B-scans, were compared to radial volume scans containing at least 4 B-scans at regular angular intervals. Retrospective analysis of anatomical and functional outcome after intravitreal injection of 125 µg ocriplasmin was performed in 13 patients suffering from symptomatic vitreomacular adhesion (VMA) and macular holes, respectively.

Results: Radial volume scans were superior to raster volume scans in visualization of small macular holes (≤200µm) and focal VMT. Detailed visualization of the vitreoretinal interface was enabled by a change of focus by +2dpt. By this protocol, ocriplasmin effects were more readily and accurately detected. Due to the possibility of spontaneous resolution, OCT-imaging immediately prior to injection appears mandatory.

Out of 11 treated eyes with symptomatic vitreomacular adhesion a resolution of VMA was observed in 8 eyes (72,7%), 4 within 7 days and 4 within 3 months after injection. Out of 2 cases of small primary macular holes, one closure was observed after injection.The rate of resolution of the VMA depended on previously determined baseline criteria, while the overall success rate was 69,2%.The overall increase in visual acuity averaged 0,143 logMAR, 2 ETDRS-lines gain when VMA-resolution occurred, 1 ETDRS-line loss when VMA-resolution was absent.

We also observed a change in central foveal thickness that ranged from 359,9µm prior to and 274,2 µm after injection.Anatomically 7/13 (53,9%) patients showed a transient dissolution of the outer segment ellipsoid zone with 6/7 (85,7%) cases presenting a VMA-resolution.

Conclusions: The rational selection of appropriate patients for pharmacological treatment of symptomatic vitreomacular adhesion with intravitreal ocriplasmin is crucial in order to achieve optimal outcomes.

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Foveal and Choroidal Imaging in Albinism and Retinopathy of Prematurity

Murat Karacorlu, MD, MSc, FEBO


Albinism is hereditary disorder of melanin biosynthesis associated with absent or reduced melanin pigment in the eye and often in the skin and hair. Normal foveal development is arrested in individual with albinism. “Foveal Morphology” and “Cone Specialization” may offer valuable insight in albinism which can be examined by SD-OCT imaging. It has also been suggested that retinopathy of prematurity (ROP) is associated with arrest in the foveal development, particularly affecting the centrifugal inner retinal layer migration and sparing photoreceptor maturation, as evidenced by persistance of the inner retinal layers and a flat foveal pit. In this presentation the importance of foveal morphology, photoreceptor maturity and choroidal thickness will be discussed.

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MultiColor imaging in Acute Macular Neuroretinopathy

Gabriella De Salvo, MD

Ophthalmology Department, University Hospital Southampton, Southampton, UK

Purpose: To evaluate the role of multicolor imaging (MC) in the diagnosis and follow up of acute macular neuroretinopathy (AMN) type 2 and to compare its features to the infrared reflectance (IR) and spectral domain optical coherence tomography (SD-OCT).

Methods: MC, IR and SD-OCT were performed in 4 patients who presented complaining of central scotoma and did not have any visible fundus features.

Results: AMN was identified as an area of hypo-reflectance on both MC and IR in 6 eyes of 4 patients. The condition was bilateral in 2 patients and unilateral in the other 2. SD-OCT confirmed its location in the outer retina below the outer plexiform layer. Subsequent follow up demonstrated improvement of symptoms and this was objectively confirmed on both MC and IR by gradual decrease of hypo-reflectance, and a partial recovery of the ellipsoid zone on SD-OCT.

Conclusions: MC is a new non invasive modality imaging which allows the detection of fine anatomic retinal details. In our patients MC imaging was as detailed as IR reflectance in the detection of AMN type 2. We believe that MC should be routinely used to complement SD-OCT in the diagnosis and follow up of this rare inflammatory condition.

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New Multimodal Imaging Findings in the White Dot Syndromes



Purpose: To evaluate the characteristics of the multiple evanescent white dot syndrome (MEWDS), multifocal choroiditis and panuveitis (MCP), punctate inner choroidopathy (PIC) and acute posterior multifocal placoid pigment epitheliopathy (APMPPE) using multimodal imaging.

Methods: This was a retrospective review of the multimodal imaging obtained in eyes diagnosed white dot syndromes (MEWDS, PIC, MCP, and APMPPE). The features of these eyes, as determined from color fundus photography, Multicolor imaging, spectral-domain optical coherence tomography, fundus autofluorescence, and angiography, were compared across diagnostic categories.

Results: New multimodal imaging findings in these conditions include the following: 1) The acute lesions of MEWDS show zonal disruption of the ellipsoid zone that appears hyperautofluorescent on fundus autofluorescence related to reduced photoreceptor pigment density. 2) The lesions of MCP and PIC appear as nodular collections under the retinal pigment epithelium. These solid retinal pigment epithelium detachments appeared to rupture leading to inflammatory infiltration of the subretinal space and outer retina, often with a widespread loss of the outer retinal architecture beyond the confines of the inflammatory exudate. The pattern of inflammatory involvement seen by multimodal imaging did not vary between PIC and MCP. 3) In APMPPE, Ultra-widefield angiography shows subclinical lesions anterior to the equator representing choriocapillaris filling defects that are silent on FAF. In the macula, OCT shows focal of areas inner choroidal lucency beneath the affected RPE and outer retina.

Conclusion: In MEWDS, the primary site of involvement appears to be the outer retina. In MCP and PIC, despite names suggesting predominantly choroidal involvement, the principle sites involved appears to be the subretinal pigment epithelium and outer retinal spaces. Because both MCP and PIC target the same essential structures in the same phenotypic manner and are treated the same way when active, there seems to be limited clinical utility in differentiating them. In contrast, the primary site of involvement in APMPPE appears to be the inner choroid with the RPE and outer retina affected secondarily.

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Bietti 's Crystalline Retinopathy - Usual and Rare Clinical Features

Ali Osman Saatci, MD

Dokuz Eylül University, Izmir, Turkey

Purpose: To present a detailed review of usual and rare clinical features of Bietti’s crystalline dystrophy (BCD).

Methods: Interpretation of latest literature and sharing of the author’s clinical experience.

Results: BCD is caused by the germline mutation in CYP4V2 gene. Hallmark of the disease is the typical crystalline deposits located in the retina and sometimes limbal cornea together with progressive chorioretinal atrophy. Subretinal neovascularization, macular hole, cystoid macular edema and subfoveal neurosensory detachment are among the previously reported rare features. Spectral domain OCT is an important tool to demonstrate BCD’s characterictic findings such as outer retinal tubulations, intraretinal highly reflective spots and bright reflective plaque on top of the Bruch membrane previously not known in pre-OCT era.

Conclusions: New imaging modalities such as SD-OCT reveal the rare features of BCD in utmost detail.

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Management of CSC by Multimodal Imaging

Serra Arf, MD


Purpose: To evaluate the diagnostic value of distinct imaging modalities in eyes with central serous chorioretinopathy (CSC).

Methods: The patients of Istanbul Retina Institute presenting with a clinical diagnosis of CSC were retrospectively evaluated for six techniques: fundus autofluorescence, (FAF) fluorescein angiography (FA), indocyanine green angiography ICG), optical coherence tomography (OCT), microperimetry (MP1), and multifocal electroretinography (mfERG).

Results: FAF helps us to understand if the observed CSC is a first occurrence or a recurrence, and how much retinal pigment epithelial damage damage (RPE) there is. Granular hypoautofluorescenc eappears to signify incomplete loss of RPE tissue. Confluent hypoautofluorescence correlates with RPE atrophy and associated atrophy of the outer retina. Classically, FA demonstrates an expanding point of fluorescein leakage with late pooling into a serous detachment, or a smokestack fluorescein pattern. In longstanding CSC, FA findings include hyperfluorescent window defects, and occasionally leaking points. The staining of the choroid in mid-phase ICG angiography is the primary evidence of choroidal hyperpermeability in CSC. OCT allows detection of serous retinal detachment and pigment epithelial detachment. EDI-OCT (Enhanced Depth Imaging-OCT) shows that the choroid is abnormally thick even in the asymptomatic fellow eyes, which decreases after photodynamic therapy. MP1 was able to show that retinal sensitivity is significantly decreased in CSC. We found that eyes with resolved CSC can have lower retinal sensitivity in the central macula than control eyes, even after good visual acuity has been obtained. mfERG indicates that there is more widespread retinal dysfunction in CSC than is appreciated on clinical examination.

Conclusions: Implementing a variety of examination techniques allows us to make the correct diagnosis of CSC. These techniques are also helpful for follow-up, and for interpretation of the treatment results. Each technique contributes at least one unique insight and none could be entirely superseded by another technique.

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Relationship between Choroidal Expansion and Intraocular Pressure Increase During Water Drinking Test in Healthy Subjects and Patients with Exfoliation Syndrome

Sibel Kadayifcilar, Sibel Kocabeyoglu, Salih Uzun, Mehmet C Mocan, Murat Irkec

Hacettepe University School of Medicine, Department of Ophthalmology Ankara, Turkey

Purpose: To evaluate the changes in choroidal thickness (CT) and intraocular pressure (IOP) during water drinking test (WDT) in patients with exfoliation syndrome (XFS).

Methods: Twenty eyes of 20 patients with XFS and 20 eyes of 20 healthy subjects underwent measurements of subfoveal CT (with the EDI mode of Heidelberg Spectralis OCT), IOP, systolic and diastolic blood pressure (SBP and DBP) before and 30 and 60 minutes after WDT. WDT involved ingestion of 1 liter of water within 5 minutes. Chi-Square test and ANOVA were used for the statistical analysis.

Results: There were no significant differences between groups with respect to age (p=0.238), gender (p=1.000), central corneal thickness (p=0.714), axial length (p=1.000), DBP (p=0.350), SBP (p=0.064) and IOP (p=0.234) before water ingestion. The choroid was thinner in the XFS group (285.1±69.1 μm) when compared to controls (339.4±81.2 μm) (p=0.028) at baseline. CT was found to be significantly increased at 30-min and 60-min following water ingestion in the XFS group (p<0.001), whereas in the control group an increase was found only at 60-min time point (p=0.028). Mean IOP was higher at both time points with respect to their respective baseline values in both XFS (p=0.002; p<0.001) and control (p=0.038; p=0.002) eyes. No correlation was detected between increase in CT and IOP in either group.

Conclusions: Choroidal expansion during WDT does not appear to be an important mechanism for IOP elevation in either healthy eyes or those with XFS. Furthermore, the similarity of IOP increase when compared to controls suggests that trabecular outflow facility is not impaired in eyes with XFS.

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The SPECTRALIS Unveiling the Weird and the Wonderful

Gerbrecht Maria (Marissa) Willemse, MD

Pretoria Eye Institute, Pretoria, South Africa

Purpose: I would like to demonstrate in much detail the magnificent capabilities of the Heidelberg in diseases as rare as Takayasu’s arteritis and as weird as fly larvae in the cornea and retina.

Methods: Takayasu's disease (also known as "aortic arch syndrome” and the "pulseless disease") is a form of large vessel granulomatous vasculitis with massive intimal fibrosis and vascular narrowing, affecting often young or middle-aged women of Asian descent. In my talk I would like to detail the spectrum of eye manifestations in Takayasu’s arteritis by using the SPECTRALIS “tracking laser tomography”

Myiasis is defined as the infestation of live vertebrates (humans and/or animals) with dipterous larvae (true flies). I would like to demonstrate the ability of the Heidelberg to capture pictures of the fly larvae in both the retina and the cornea. Showing the magnitude of the damage left by these parasites. Cross section OCT is also used to show the larvae in the cornea-scleral junction next to the canal of Schlemm

Conclusions: The precision capabilities of the Heidelberg SPECTRALIS tracking laser tomography is shown in the detailed images and follow-up videos of the Takayasu’s Arteritis patient. While the OCT scanning abilities and the images captured of the fly near the anterior chamber angle shows the diversity of images possible with the SPECTRALIS.

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Poster Presentation 01

Macular Detachment Secondary to Congenital Pit of the Optic Disc:

Case Report

Satar Baghrizabehi MD,

Dep. of Ophthalmology General Hospital of Rakican, Slovenia

Purpose: We are going to present a patient with macular detachment in the right eye, secondary to congenital pit of the optic disc.

Methods: We present one case of serous macular detachment occurring in association with optic pits or related cavitary anomalies and identify a rhegmatogenous etiology. Patient was treated with vitrectomy, and gas tamponade.

Results: Pretreatment visual acuity was 20/100 and Posttreatment acuity was improved to 20/30.

Conclusions: 2 months postoperativly, the macular elevation gradually resolved, and the OCT showed the flattening of the outer layer detachment in the fovea. At the last ophthalmologic evaluation, OCT revealed complete resolution of the detachment , and visual acuity was 20/30.

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Case Report 1: Use of Wide Angle ICGA for Diagnosis of Peripheral Polypoidal Choroidal Vasculopathy (PCV)

Mahesh Gopalakrishnan, MD

Giridhar Eye Institute, Ernakulam, India

Case summary 1 (peripheral PCV): 78 year old female patient presented on 5/4/2014 with diminution of vision since 2 weeks sudden in onset and progressive in nature. BCVA was 6/9, N6 and CF2m, N36 in right eye and left eye respectively. Anterior segment examination was normal.Fundus examination revealed sub retinal fluid, subretinal exudates and retinal haemorrhages in left eye periphery and mid periphery with sub retinal scars in right eye periphery. Right eye OCT revealed focal ellipsoid layer disruption with epiretinal membrane while a massive pocket of subretinal fluid with sub retinal hyperreflective dots were present at and temporal to macula in left eye. FFA revealed extensive area of window defect and staining in temporal quadrant corresponding to the scar and chorioretinal atrophic patches in both eyes. Wide angle ICG demonstrated vast areas of hypofluorescence in the temporal quadrant with multiple circular areas of hyperfluorescence which appeared early and persists till late suggestive of polyp. Diagnosis of peripheral polyps were made and 2 doses of intravitreal avastin combined with focal laser to the polyps were performed which resulted in complete resolution of sub retinal fluid at macula with improvement in visual acuity to 6/40,N18 in left eye.

Points for discussion: Use of wide angle ICGA for diagnosis of peripheral polypoidal choroidal vasculopathy (PCV)

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Case Report 2:

Use of Fundus Autofluorescence in Emboli Causing Retinal Artery Occlusion



Case summary 2 (CRAO with emboli):

Patient 1: 31 year old male patient presented on 9/9/12 with defective vision in left eye since 1 day, sudden in onset. Patient gave medical history of aortic valve stenosis and migraine. BCVA was 6/9 and 6/12p in right eye and left eye respectively. Anterior segment examination was normal. Fundus examination showed retinal whitening in superior quadrant with normal macula. Superior branch of central retinal artery showed white calcific emboli just anterior to lamina cribrosa. FFA showed delayed filling of superotemporal and superonasal artery and their branches, normal choroidal fluorescence was masked in superior quadrant while macula appeared normal. Goniomassage was done for 20 minutes with anterior chamber paracentesis . antibiotic, steroid and IOP lowering medication was started topically. Patient was reviewed next day with improvement in vision to 6/6,N6 left eye. Complete cardiovascular examination was ordered. OCT revealed inner retinal layer thickening. FAF revealed emboli as hyperautofluorecsent spot in the disc. Patient was was advised aortic valve replacement surgery by his consulting cardiologist.

Patient 2: 68 year old female patient presented on 8/8/2014 with defective vision in left eye since 2 weeks, sudden in onset. Patient gave medical history of diabetes since 2 years, transient ischaemic attacks and recurrence of operated mass near left mandible. BCVA was 6/7.5 and 6/9 in right eye and left eye respectively. Anterior segment examination revealed early cataract changes. Fundus examination showed retinal whitening in inferior quadrant with normal macula. Inferior branch of central retinal artery showed white calcific emboli just anterior to lamina cribrosa. Both eyes showed few microaneurysms. Complete cardiovascular examination was ordered. FAF revealed emboli as hyperautofluorecsent spot in the disc. Carotid imaging revealed calcific plaque with 60% stenosis and was advised LCA stenting by her consulting cardiologist.

Points for Discussion: Use of Fundus Autofluorescence in Emboli causing retinal artery occlusion.

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Case Report 3:

OCT and FAF Features of Combined Hamartoma of Retina and RPE



Case summary 3: 24 year old patient presented with accidentally detected retinal problem while undergoing a medical check up. Visual acuity 6/6,N6 OU unaided. There were peripapillary changes. Fundus autofluorescence and Spectral OCT with field defects confirmed Combined hamartoma of retina and retinal pigment epithelium.

Points for Discussion: OCT and FAF features of Combined hamartoma of Retina and RPE.

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OCT: A Potential In-Vivo Retinal α-Synuclein Biomarker in Parkinson’s Disease

Jessica Chorostecki, BSc1; Aashka Shah, BSc1; Ginny Bao, BSc1; Fen Bao, MS1; Christina Caon, MSN, NP-C1; Carla Santiago, MS1; Edwin George, MD, PhD1; Navid Seraji-Bozorgzad, MD1; Elliot Frohman, MD, PhD2; Omar Khan, MD1

1Department of Neurology, Wayne State University School of Medicine, Detroit, USA

2Department of Neurology, University of Texas Southwestern Medical Center, Dallas, USA

Purpose: Optical coherence tomography (OCT) allows high-resolution in-vivo examination of retinal structure injury in neurodegenerative disorders. -synuclein is a major protein deposited in PD and other neurodegenerative diseases. Segmentation of the retinal structure using the Spectral domain (SD) OCT provides a unique opportunity to examine degenerative aspects that may be relevant to pathology in PD.

Methods: Patients with definite PD and healthy controls (HC) were enrolled. All subjects underwent SD-OCT using a SPECTRALIS® system and segmentation using Heidelberg Engineering beta software.

Results: Patients with co-morbidities that could affect retinal structure were excluded. Fifty-six PD eyes (n=28, mean age 65.3 yrs) and 22 HC eyes (n=11, mean age 57.4 yrs) were included. Mean retinal thickness was 8.32 mm3 in PD and 8.62 mm3 in HC (p=0.02). Segmentation analysis showed mean RNFL as 0.93 mm3 in PD and 0.91 mm3 in HC (p=0.98). Mean GCL was 0.98 mm3 in PD and 1.07 mm3 in HC (p=0.03). Mean combined INL and ILP were 0.93 mm3 in PD and 1.00 mm3 in HC (p=0.03). However, mean OPL was 0.81 mm3 in PD and 0.78 mm3 in HC (p=0.02).

Conclusions: Our findings demonstrate that total retinal thickness, GCL, ILP, and INL but not RNFL are significantly thinner in patients with PD compared to HC. This supports the loss of retinal ganglion cells and their dendrites along with amacrine cells in PD. In contrast, OPL was significantly thicker in PD than controls. This finding corresponds with mRNA expression studies showing aggregation of -synuclein in OPL. Deposition of -synuclein has also been reported in the deeper layers of retina in recent PD autopsy studies. Larger and longitudinal studies are warranted to explore these findings as a potential biomarker in PD.

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Case report: Multimodality Imaging in a Case of Stellate Nonhereditary

Idiopathic Foveomacular Retinoschisis (SNIFR)

Mariano Cozzi, MD; Sergio Pagliarini, MD

University Hospitals Coventry & Warwickshire, Rugby, UK

A 55-year-old female complaining of blurred vision was found to have best corrected visual acuities of 6/9 in both eyes. The patient had bilateral peripheral retinoschisis that on fundoscopy had no apparent posterior extension.

Multimodality imaging contributed to demonstrate the magnitude of the retinoschisis extension into the vascular arcades. Multicolour imaging readily visualised the stellate features of foveal retinoschisis in one eye. A modified OCT acquisition protocol inclusive of en face allowed to appreciate the extent of the macular schisis and its continuity with the peripheral retinoschisis.

The lack of family history, the absence of known predisposing conditions, the particular morphologic features and other characteristics make this case compatible with features of the newly described Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis (SNIFR). Multimodality imaging with en face OCT are an essential tool for the correct diagnosis and a better disease understanding.

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Two Cases of Unusual Pediatric Retinal Disease Diagnosed by Spectralis OCT

Ameli Gabel-Pfisterer, MD

Eye-Department Klinikum Ernst-von-Bergmann Potsdam, Germany

Purpose: We report on two cases of retinal diagnosis wit Spectralis in children. A nine year old boy and a ten year old girl presented in our clinic with a longstanding and an acute severe decrease of visual acuity, respectively.

Methods: Both children’s best corrected visual acuity was assessed, visual field testing was performed, as well as examination of the anterior and posterior segment. Spectralis-OCT and Fluorescein Angiography were done.

Results: Anterior segments of both children were clear and normal. Spectralis-OCT showed vertical cystoid spaces in the inner plexiform layer of both eyes of the boy, suggesting a x-chromosomal retinoschisis. At the posterior pole of the girl´s eye, subretinal fluid, as well as fluid in the outer plexiform layer was found, corresponding to the FLA finding of a leaking choroidal neovascular membran with adjacent haemorrhage. After a single injection of avastin, visual acuity increased significantly.

Conclusions: Even in children of young age, Spectralis-OCT is a very sensitive and easy-to-perform method of diagnosis.

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Effects of Misalignment in OCT Scans

Firat Helvacioglu1, MD, O. Murat Uyar2, MD, FEBO, FICO, Sadik Sencan3, MD, Zeki Tunc4, MD, Ziya Kapran3, MD

1 Assistant Professor MD, Department of Ophthalmology, Maltepe University School of Medicine, Istanbul, Turkey

2 MD, Department of Ophthalmology, Maltepe University School of Medicine, Istanbul, Turkey

3 Department of Ophthalmology, Maltepe University School of Medicine, Istanbul, Turkey

4Associate Professor MD, Department of Ophthalmology, Maltepe University School of Medicine, Istanbul, Turkey

Purpose: To evaluate the effect of misalignment on the measurements of retinal nerve fiber layer (RNFL) by spectral-domain optical coherence tomography (OCT).

Methods: A total of 42 eyes from 21 healthy young subjects underwent RNFL measurements with RTVue spectral-domain OCT (Optovue Inc, Fremont, California, USA). Two baseline measurements with perfectly aligned central circle to the borders of the optic nerve and four misaligned measurements which were misaligned towards to four quadrants were taken. The differences in RNFL between the baseline and misaligned measurements were analyzed with a new algorithm.

Results: The average RNFL scores of the first two baseline measurements have good correlation (c=0.930) and good reproducibility scores (0.15 ± 0.07). Superior misaligned measurements had significantly lower superior quadrant score and higher inferior quadrant score similar nasal and little higher temporal scores (p1,2,4<0.001, p3=0.553 ). Inferior misaligned measurements had significantly higher superior quadrant score and lower inferior quadrant score with similar temporal and little lower nazal scores (p1,2<0.001, p3=0.315, p4=0.016). Nasal misaligned measurements had significantly higher temporal quadrant score and lower nasal quadrant score with little lower superior and inferior scores (p1,2,4<0.001 p3=0.005). Temporal misaligned measurements had significantly higher nasal quadrant score and lower temporal quadrant score with similar superior and little higher inferior scores (p1,2,4<0.001, p3= 0.943).

Conclusions: Good alignment of the central circle to the borders of optic nerve is crucial to have correct and repeatable RNFL measurements. Misalignment to a quadrant resulted in falsely low readings at that quadrant and falsely high readings at the opposite quadrant.

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The Role of Muller Cell Complex in the Formation of Eccentric Macular Hole Formation after Vitrectomy with Internal Limiting Membrane Peeling for the Treatment of Epiretinal Membrane

Ziya Kapran1, MD, Firat Helvacioglu2, MD, Osman Murat Uyar3 MD, Ozlem Cam3, MD, Sadik Sencan1, MD

1Professor MD, Department of Ophthalmology, Maltepe University School of Medicine, Istanbul, Turkey

2 Assistant Professor MD, Department of Ophthalmology, Maltepe University School of Medicine, Istanbul, Turkey

3 MD, Department of Ophthalmology, Maltepe University School of Medicine, Istanbul, Turkey

Purpose: To evaluate the anatomical and clinical features of four patients who developed an eccentric macular hole after surgery for idiopathic epimacular proliferation.

Methods: Four patients are described with eccentric retinal holes, two located temporally and two located nasally to the macula, which developed after pars plana vitrectomy and uncomplicated ILM removal for idiopathic epimacular proliferation (n = 4), with the use of trypan blue.

Results: Eccentric macular holes developed 2 months to 12 months (mean, 4.7 months) after epimacular proliferation peeling. The mean horizontal and vertical diameters of the holes were 527 μ and 501 μ. The mean distance to foveal centre was 3124 μ. The ILM was peeled in addition to the epimacular proliferation in all of the cases. Final visual acuities after a mean follow-up period of 37.2 months were 0.61 Snellen lines.

Conclusions: Eccentric macular hole formation is an infrequent complication of pars plana vitrectomy with internal limiting membrane peeling for epiretinal membrane. Holes were seen on the unpeeled areas of the macula. We believe, that intact ILM is essential for hole formation. These holes are asymptomatic, have not required any treatment and have not caused any complications in up to 6.5 years of follow-up.

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Choroidal Watershed Zone and Growth of Polypoidal Choroidal Vasculopathy

Ji Eun Lee,1,2 Min Kyu Shin,1 Ik Soo Byon,1,3 Sung Who Park,1,2

1 Dep. of Ophthalmology, College of Medicine, Pusan National University, South Corea

2 Medical Research Institute, Pusan National University Hospital, South Corea

3 Research Institute for Convergence of Biomedical Science and Technology, Yangsan Pusan National University Hospital, South Corea

Purpose: To investigate the topographic relationship between growth of polypoidal choroidal vasculopathy (PCV) and choroidal watershed zones (CWZ) using indocyanine green angiography (ICGA).

Methods: In this retrospective, interventional case series, we examined 25 eyes of 25 patients that had a PCV lesion smaller than CWZs at baseline, and identified growth of the lesion. CWZs were traced in early phase ICGA at baseline, and PCV lesions were traced in mid- and late phases. Those traces were overlapped and topographic relationship between CWZs and PCV growth was evaluated.

Results: Enlargement of PCV lesions was shown in the serial ICGA in nineteen patients (76.0%), and PCV growth was postulated based on the structure of PCV in six patients (24.0%). The topographical relationship between CWZs and PCV growth was demonstrated in all cases. The shape of the PCV lesion conformed to the CWZ, and the growing direction of the branching vascular network was aligned to the direction of the CWZ extending to the periphery. In 11 patients who had enlargement beyond the CWZ boundary, PCV growth was more prominent within the CWZ than in the adjacent area outside the CWZ.

Conclusions: A topographical relationship between PCV growth and CWZ suggest that a choroidal circulation is a predisposition for growth of PCV.

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Topographic Relationship between Choroidal Watershed Zone and Submacular

Idiopathic Choroidal Neovascularization

Inyoung Chung1, Hyun Woong Kim2, Ji Eun Lee3

1 Gyeongsang National University Hospital, Jin-ju, South Korea 2 Busan Baik Hospital, Inje University, Busan, South Korea 3 Pusan National University Hospital, Busan, South Korea

Purpose: To investigate the topographic relationship between idiopathic choroidal neovascularization (CNV) and choroidal watershed zones (CWZ) by using indocyanine green angiography (ICGA).

Design: Multicenter, retrospective, interventional case series.

Methods: The medical records and ICGA of 44 patients (44 eyes) who were diagnosed with idiopathic CNV were reviewed. CWZ was defined as hypofluorescence that disappeared during the early phase of ICGA. CWZ was classified, and its topographic relationship with CNV was evaluated. Visual acuity and recurrence were analyzed according to CWZ types.

Results: The patients’ eyes were classified as follows: subfoveal CNV, 16 eyes; juxtafoveal, 12 eyes; and extrafoveal, 16 eyes. Vertical CWZ was the most common type (24 eyes; 54.5%), followed by stellate CWZ (18 eyes; 40.9%). Among them, 8 eyes had isolated areas of delayed choroidal filling in the macula, in addition to the categorized CWZs. The topographical relationship between the CWZs and CNV was determined for 41 eyes (93.2%), as the CNV was located within the CWZs in 38 eyes and at the margin in 3 eyes. Subfoveal CNV in 2 eyes and juxtafoveal CNV in 1 eye developed outside the CWZ. Extrafoveal CNV was located within the CWZ in all eyes. No statistical significance existed in visual acuity or recurrence regarding CWZ types.

Conclusions: A topographical relationship was found between CNV and the CWZs in idiopathic CNV by using an ICGA analysis. Our results suggest that a CWZ is a predisposition for the development of CNV in young patients with a choroidal hypoxic mechanism.

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Heidelberg Engineering GmbH · Tiergartenstr. 15 · 69121 Heidelberg· Germany Phone +49 6221 6463-0 · Fax +49 6221 646362 · www.HeidelbergEngineering. com

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Symposium (ISS) - Heidelberg Engineering · 11.20 New Techniques for Imaging Diabetic Retinopathy...

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