Editors Frank G.Holz Richard F. Spaide Medical Retina With 91 Figures, Mostly in Colour and13tables Springer
ääm mm.m iiiii HHHHHMmi Chapter1 Microperimetry in Macular Disease Klaus Rohrschneider 1.1 Introduction 1 1.2 Instruments 2 1.2.1 Scanning Laser OphthaImoscope 2 1.2.1.1 Fundus Perimetry (Microperimetry) 3 1.2.2 Micro Perimeter 1 4 1.2.2.1 StaticThreshold Fundus Perimetry 4 1.2.2.2 Kinetic Fundus Perimetry 6 1.2.3 Comparison Between SLO Perimetry and MP 1 6 1.2.4 Accuracy of Fundus Perimetry 6 1.2.4.1 StaticThreshold Perimetry... 6 1.2.4.2 Kinetic Perimetry 7 1.2.5 Fundus-related Perimetry Versus Cupola Perimetry 7 1.3 Clinical Implementation 8 1.3.1 Macular Holes 8 1.3.2 Age-related Macular Degeneration 10 1.3.2.1 Geographie Atrophy ofthe RPE 10 1.3.2.2 Choroidal Neovascularization in AMD.. 10 1.3.3 Diabetic Retinopathy 10 1.3.4 Central Serous Chorioretinopathy 14 1.3.5 Stargardt's Disease 15 1.3.6 Vitelliform Macular Dystrophy(Best'sDisease)... 16 1.4 Conclusion 16 Chapter 2 New Developments in cslo Fundus Imaging Giovanni Staurenghi, Grazia Levi, Silvia Pedenovi, Chiara Veronese 2.1 Introduction 21 2.2 Near Infrared Imaging 22 2.2.1 Introduction 22 2.2.2 The Effect of Wavelength on Imaging in the Human Fundus 22 2.2.3 Comparison of Light Tissue Interactions for Visible and Near Infrared Wavelengths UsingSLO 22 2.2.4 Mode of Imaging 22 2.2.5 Contrast ofthe Fundus 23 2.2.6 Fundus Features 23 2.2.7 Imaging of Pathological Features in Direct and Indirect Mode 23 2.3 Blue Autofluorescence Imaging 23 2.3.1 Autofluorescence and the Eye 24 2.3.1.1 Fluorescence ofthe Retinal Pigment Epithelium 24 2.3.1.2 How to Evaluate RPE Autofluorescence 24 2.3.2 Fundus Autofluorescence Changes in Early AMD 25 2.3.3 Fundus Autofluorescence Changes in Choroidal Neovascularization in AMD.. 26 2.3.4 Fundus Autofluorescence Changes in Geographie Atrophy in AMD 26 2.3.5 Fundus Autofluorescence in Acute and Chronic Recurrent Central Serous Chorioretinopathy 27
2.3.6 2.3.7 2.4 2.4.1 2.4.2 2.4.2.1 2.4.2.2 2.4.2.3 2.4.3 2.4.4 Fundus Autofluorescence in Stargardt's Macular Dystrophy-Fundus Flavimaculatus.. 27 Fundus Autofluorescence in Patients with Macular Holes.. 28 Wide-Field Contact Lens System.. 28 Introduction.. 28 Materials and Methods..... 29 Structure ofa Wide-Field Contact Lens System.. 29 Limit and Advantage of a Wide-Field Contact Lens System.. 29 Technique for Performing the Examination.. 29 OtherTechniques of Execution of Wide-field Fluorescein Angiograms.... 30 Clinical Application.. 31 Chapter 3 Genetics of Age-Related Macular Degeneration: Update Hendrik P.N. Scholl, Monika Fleckenstein, Peter Charbel Issa, Claudia Keilhauer, Frank G. Holz, Bernhard H.F. Weber 3.1 Introduction: Genetic Influence on AMD.. 35 3.2 Analysis of Candidate Genes for AMD 36 3.3 Linkage and Association StudiesinAMD 38 3.4 Complement Factor H Gene 38 3.5 LOC387715 43 3.6 Factor B 44 3.7 Gene-Gene and Gene-Environment Interaction in AMD 45 3.8 Conclusions 46 Chapter 4 Anti-VEGF Treatment for Age- Related Macular Degeneration Todd R. Klesert, Jennifer I. Lim 4.1 Basic Science 53 4.1.1 4.1.2 4.1.3 4.1.4 4.1.5 4.2 4.2.1 4.2.2 4.2.3 4.3 4.3.1 4.3.2 4.3.3 4.4 4.4.1 4.4.2 4.4.3 4.5 Historical Perspective 53 VEGFIsoforms 54 VEGF Expression 54 VEGF Receptors 54 VEGFActivity 55 Current Anti-VEGF Therapies 55 Aptamers: Pegaptanib Sodium (Macugen) 55 Monoclonal Antibodies: Ranibizumab (Lucentis) 56 Monoclonal Antibodies: Bevacizumab (Avastin) 58 Anti-VEGF Therapy: Practical Considerations 60 Intravitreal Injection Technique 60 Safety Considerations 60 Bevacizumab (Avastin) Preparation: Compounding Pharmacies 61 Future Anti-VEGF Therapies 61 VEGFTrap 61 Small Interfering RNAs 62 ReceptorTyrosine Kinase Inhibitors 63 Conclusion 64 Chapter 5 Intravitreal Injections: Techniques and Sequelae Heinrich Heimann 5.1 Introduction 67 5.2 Complications of Intravitreal Injections 68 5.2.1 Methodology 69 5.2.2 Perioperative Complications 69 5.2.2.1 Conjunctival Hemorrhage...69 5.2.2.2 Conjunctival Scarring 72 5.2.2.3 Pain 72 5.2.2.4 Punctate Keratitis and Corneal Edema 72 5.2.2.5 Vitreous Reflux 72 5.2.2.6 Traumatic Cataract 72 5.2.2.7 Cataract Progression 73 5.2.2.8 Retinal Perforation 73 5.2.2.9 Vitreous Floaters 74 5.2.2.10 Vitreous Hemorrhage 74 5.2.2.11 Retinal Toxicity 74 5.2.2.12 Intraocular Inflammation 74
5.2.2.13 Uveitis and Pseudoendophthalmitis 75 5.2.2.14 Endophthalmitis 76 5.2.2.15 Retinal Artery and Vein Occlusion 78 5.2.2.16 Retinal Detachment 78 5.2.2.17 Acute Rise in Intraocular Pressure 79 5.2.2.18 Ocular Hypertension and Glaucoma 79 5.3 SurgicalTechnique for Intravitreal Injection 80 5.3.1 Guidelines and Preferred Practice Survey 81 5.3.2 Preoperative Assessment and Preparation 81 5.3.2.1 Concomitant Eye Diseases.. 81 5.3.2.2 Preoperative Assessment... 87 5.3.2.3 Preoperative Medication 81 5.3.2.4 Location 81 5.3.2.5 Preparation ofthe Eye and OcularAdnexa 81 5.3.2.6 PreparationoftheSurgeon.. 84 5.3.2.7 Preparation ofthe Drug 84 5.3.3 Injection 84 5.3.3.1 Syringe and Needle 84 5.3.3.2 Position ofthe Injection 84 5.3.3.3 EntryPath 84 5.3.3.4 Advancementof Needle and Injection 84 5.3.4 Postoperative Assessment.. 84 5.3.4.1 Assessment Immediately Following the Injection 84 5.3.4.2 Topical Therapy 85 5.3.4.3 Follow-up Examinations 85 Chapter 6 Combination Therapies for Choroidal Neovascularization Richard F. Spaide 6.1 Introduction 90 6.2 Angiogenesis 90 6.2.1 Development ofcnv 91 6.2.2 Cancer and Angiogenesis... 97 6.3 Normalization of Tumor Vasculature 92 6.4 Two-Component Model of CNV 94 6.5 Two-Component Model and Therapy 94 6.5.1 Are There Cytokines to Block OtherThanVEGF? 95 6.6 Combination Therapies 96 6.6.1 Anti-VEGF Biologics and PhotodynamicTherapy. 96 6.6.2 Anecortave Acetate and Photodynamic Therapy. 97 6.6.3 Intravitreal Triamcinolone and Photodynamic Therapy. 97 6.6.4 Triamcinolone and Anti- VEGFTherapy 97 6.6.5 Triamcinolone and Anecortave Acetate 98 6.7 Conclusion 99 Chapter 7 Nutritional Supplementation in Agerelated Macular Degeneration Hanna R. Coleman, Emily Y. Chew 7.1 Introduction 705 7.2 Risk Factors 705 7.3 Age-Related Eye Disease Study 706 7.4 Lutein/Zeaxanthin 706 7.5 Zinc 706 7.6 Vitamin E 707 7.7 Dietary Fat Intake 707 7.8 Age-Related Eye Disease Study 2 707 7.9 Conclusion 708 Chapter 8 New Perspectives in Geographie Atrophy Associated with AMD Steffen Schmitz-Valckenberg, Monika Fleckenstein, Hendrik P.N. Scholl, Frank G. Holz 8.1 Introduction 7 74 8.1.1 Basics 7 74 8.1.2 Development and Spread of Atrophy 7 75 8.2 Fundus Autofluorescence Imaging in Geographie Atrophy 7 76 8.3 Quantification of Atrophy Progression 7 77
8.4 Risk Factors 7 78 8.4.1 Genetic Factors 7 78 8.4.2 Systemic Risk Factors 118 8.4.3 Ocular Risk Factors 119 8.5 Development of CNV in Eyes withga 122 8.6 Visual Function in GA Patients 123 8.6.1 Measurement of Visual Acuity 123 8.6.2 Contrast Sensitivity 124 8.6.3 Reading Speed 124 8.6.4 Fundus Perimetry 724 Chapter 9 Diabetic Macular Edema: Current Treatments Florian K.P. Sutter, Mark C. Gillies, Horst Heibig 9.1 Introduction 131 9.2 Epidemiology 131 9.3 Pathophysiology 132 9.4 Diabetic Macular Edema and Laboratory Science 132 9.5 Qualityofüfe 133 9.6 Diagnosis and Screening... 133 9.7 Types of Diabetic Macular 9.7.1 Clinically Significant Macular 9.7.2 Focal Diabetic Macular 9.7.3 Diffuse Diabetic Macular 9.7.4 Cystoid Macular 9.7.5 Ischemic Macular Edema.. 134 9.7.6 OCT Patterns of Diabetic Macular 9.8 Treatment 135 9.8.1 Systemic Treatment 135 9.8.1.1 Glycemic Control 135 9.8.1.2 Blood Pressure Control 135 9.8.1.3 Reducing Levels of Blood Lipids 135 9.8.1.4 Treatment of Renal Dysfunction and Anemia... 736 9.8.1.5 Smoking 136 9.8.2 Systemic Pharmacotherapy 136 9.8.2.1 PKC-ß Inhibitors 736 9.8.2.2 9.8.2.3 9.8.3 9.8.4 9.8.4.1 9.8.4.2 9.8.4.3 9.8.4.4 9.8.4.5 9.8.4.6 9.8.4.7 9.8.4.8 9.8.4.9 9.9 Aldose Reductase and AGE Inhibitors 736 Antioxidants 736 ATeam Approach to the Prevention of Loss of Vision in People with Diabetes 737 Local Ophthalmie Treatment 738 Focal Macular Laser 138 Grid Macular Laser 738 Recent Trends in Macular Laser Therapy 738 Micropulsed, Sub-threshold "Selective" Laser Therapy... 739 Vitrectomy 739 Intravitreal Steroids 739 Periocular Steroids 740 Intravitreal Anti-VEGF Antibodies 740 Cataract Surgery 747 Current Clinical Practice/ Recommendations 747 Chapter10 Treatment of Retinal Vein Occiusions Rajeev S. Ramchandran, R. Keith Shuler, Sharon Fekrat 10.1 Introduction 747 10.2 Pathophysiology 748 10.3 Branch and Central Vein Occlusion Studies 748 10.3.1 Background 748 10.3.2 Branch Vein Occlusion Study 749 10.3.3 Central Vein Occlusion Study 749 10.4 Systemic Pharmacologic Treatments 750 10.5 Targeting Macular Edema.. 757 10.6 Intravitreal Pharmacotherapy 757 10.6.1 Background 757 10.6.2 Intravitreal Triamcinolone: BRVO 753 10.6.3 Intravitreal Triamcinolone: CRVO 753 10.6.4 Fluocinolone Acetonide Intravitreal Implant 753
10.6.5 Standard of Care vs. Corticosteroid for Retinal Vein Occlusion Study 754 10.6.6 I ntravitrea I Anti-VEG F Therapy 755 10.7 SurgicalTreatments 756 10.7.1 BRVO 756 10.7.2 CRVO 756 10.7.2.1 Laser-Induced Venous Chorioretinal Anastomosis. 756 10.7.2.2 RecombinantTissue Plasminogen Activator 756 10.7.2.3 RadialOpticNeurotomy... 757 10.7.2.4 Intravitreal Triamcinolone: As AdjunctiveTherapy 758 10.8 Prevention Systemic Factor Control 758 10.9 Conclusion 758 Chapter11 New Perspectives in Stargardt's Disease Noemi Lois 11.1 Introduction 766 11.2 EpidemiologyandClinical Findings 766 11.3 Imaging Studies 769 11.3.1 Fluorescein Angiography.. 769 11.3.2 Indocyanine Green Angiography 770 11.3.3 Fundus Autofluorescence.. 770 11.3.4 Optical Coherence Tomography 772 11.4 Electrophysiology and Psychophysics 772 11.5 Histopathology 774 11.6 Differential Diagnosis 774 11.7 Genetics and Molecular Biology 774 11.8 Animal Models of STGD- FFM 777 11.9 Current and Future Treatments 777 Chapter12 Idiopathic Macular Teiangiectasia Peter Charbel Issa, Hendrik P.N. Scholl, Hans-Martin Helb, Frank G. Holz 12.1 Introduction 183 12.2 Type 1 Idiopathic Macular Teiangiectasia 183 12.2.1 Epidemiology 783 12.2.2 Diagnostic Approach and Clinical Findings 785 12.2.3 Functional Implications... 785 12.2.4 Pathophysiological Considerations 786 12.2.5 Therapy 786 12.3 Type 2 Idiopathic Macular Teiangiectasia 787 12.3.1 Epidemiology 788 12.3.2 Diagnostic Approach and Clinical Findings 788 12.3.3 Functional Implications 789 12.3.4 Associated Diseases 792 12.3.5 Pathophysiological Considerations 792 12.3.6 TherapeuticApproaches... 793 12.4 Type 3: Idiopathic Macular Teiangiectasia 794 12.5 Perspectives 794 Chapter 13 Artificial Vision Peter Walter 13.1 Introduction 799 13.2 Current Concepts for Restoring Vision Using Electrical Stimulation 200 13.3 Interfacing the Neurons 200 13.3.1 Epiretinal Stimulation 207 13.3.2 Subretinal Approach 203 13.3.3 Transchoroidal, Transscleral, and Suprachoroidal Stimulation 203 13.3.4 Optic Nerve Approach 204 13.3.5 Cortical Prosthesis 204 13.4 Pixel Vision and Filters 204 13.5 Outlook 206 13.6 Conclusion 206 Subject Index 277