Alan R. Berger

En Face Optical Coherence Tomography in Diagnosis of Persistent Subretinal Fluid & Outer Retinal Folds after Rhegmatogenous Retinal Detachment Repair

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Purpose To evaluate the role of en face optical coherence tomography (OCT) as a diagnostic tool for the detection of persistent subretinal fluid (PSRF) and outer retinal folds (ORF) following successful rhegmatogenous retinal detachment (RRD) repair. Design Observational post hoc analysis of two prospective surgical trials. Participants All patients with gradable (signal strength ≥ 5 and no segmentation error) 6x6 mm macular cube scans using spectral-domain OCT (SD-OCT) (Carl Zeiss Meditec, Jena, Germany) obtained between 1 and 2 months postoperatively were included in this study. Methods Scans were assessed for the presence or absence of PSRF or ORFs using en face OCT and cross-sectional B scans by two masked graders with any disagreements adjudicated by the third senior masked grader. Main Outcome Measure Sensitivity, specificity and predictive accuracy {using area under curve (AUC)} of en face OCT in comparison to cross-sectional OCT as the gold standard Results Two hu...

Persistent subfoveal fluid in pneumatic retinopexy versus pars plana vitrectomy for rhegmatogenous retinal detachment: posthoc analysis of the PIVOT randomised trial

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Purpose To assess the incidence of persistent subfoveal fluid (PSFF) in pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV) following rhegmatogenous retinal detachment (RRD) repair and to determine its association with functional outcomes. Methods Posthoc analysis of the PIVOT randomised trial. Eyes with gradable en face and cross-sectional spectral-domain optical coherence tomography (SD-OCT) scans at 1–2 months postoperatively were included. Primary outcome was the proportion of patients with PSFF following PnR versus PPV at 1–2 months postoperatively. Secondary outcomes included association of PSFF with Early Treatment Diabetic Retinopathy Study (ETDRS) letter score at 3, 6 and 12 months and metamorphopsia score (MCHARTs) at 12 months. Results Of 176 participants enrolled in PIVOT, 158 (89.8%) had gradable SD-OCT scans. Intergrader agreement was 0.870 (Cohen’s kappa). The incidence of PSFF was 16% (13/81) following PnR and 10.4% (8/77) following PPV (p...

Longitudinal Assessment of Ellipsoid Zone Recovery using En Face Optical Coherence Tomography after Retinal Detachment Repair

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Purpose Suboptimal functional outcomes following rhegmatogenous retinal detachment (RRD) repair may be related to photoreceptor abnormalities including alterations of the ellipsoid zone (EZ) which may not be apparent on cross-sectional optical coherence tomography (OCT). This study assessed EZ recovery using en face OCT following RRD repair and its association with visual acuity. Design Post hoc analysis of a randomized controlled trial. Methods Patients with macula-off RRD were followed at 3, 6, 12 and 24 months post-operatively and annually thereafter. En face OCT of the EZ slab were analyzed. Hyporeflective areas were co-localized with EZ abnormalities on cross-sectional OCT B-Scans and measured by two masked graders. Primary outcome was change in area of EZ hyporeflectivity from 3 to 24 months and its association with ETDRS visual acuity recovery was also assessed. Results 271 images of 61 patients were assessed. Mean area of hyporeflectivity significantly decreased from 3 to 24...

Does Projection Artifact Removal Improve Visualization of Images in Optical Coherence Tomography Angiography?

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Purpose: This study assesses the frequency of projection artifacts in optical coherence tomography angiography (OCTA) en face images and compares images before and after applying a 3-dimensional projection artifact removal (3D-PAR) algorithm. Methods: This is a single-center, retrospective study that included consecutive patients with any underlying diagnosis who had OCTA obtained from January to March 2017. Patients with various retinal diseases and also healthy eyes were included. All participants underwent imaging with a scan area of 3 mm × 3 mm. The 4 default en face slabs were analyzed: superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina (OR), and choriocapillaris (CC). Images were qualitatively analyzed before and after 3D-PAR by 2 independent graders. Results: None of the SCP images had projection artifact before or after 3D-PAR. Scans of the DCP presented projection artifact in 96.5% of the cases. After 3D-PAR, 14.7% had a complete improvement...

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