Volume 10, Number 5
May 2014


WELCOME to Review of Ophthalmology's Retina Online e-newsletter. Each month, Medical Editor Philip Rosenfeld, MD, PhD, and our editors provide you with this timely and easily accessible report to keep you up to date on important information affecting the care of patients with vitreoretinal disease.

Regeneron and Avalanche Biotechnologies to Collaborate on Development of Next-Generation Gene Therapy Products
Regeneron Pharmaceuticals Inc. and Avalanche Biotechnologies Inc. recently announced the formation of a broad collaboration...

Merge Healthcare to Launch New Retinal Screening Solution
Merge Healthcare Inc. plans to release iConnect Retinal Screening...

And More...

Subfoveal Choroidal Thickness as a Potential Predictor of Visual Outcome and Treatment Response Following Intravitreal Ranibizumab Injections for Typical Exudative AMD

South Korean researchers performed this retrospective study to investigate the prognostic implication of subfoveal choroidal thickness on treatment outcome after intravitreal ranibizumab injections for typical exudative age-related macular degeneration (AMD).

They analyzed 40 eyes of 37 patients who completed six-month follow-up and retrieved patients' data from medical records including best-corrected visual acuity (BCVA). Researchers measured subfoveal choroidal thickness at baseline, three months, and six months using enhanced depth imaging optical coherence tomography (OCT) and they adjusted for age and sex before statistical analysis. Treatment response was after three monthly intravitreal ranibizumab injections. Responders (responder group) were defined as a 100 µm or more decrease or complete resolution of subretinal fluid, whereas nonresponders (nonresponder group) were defined as changes <100 µm or =100 µm increase of subretinal fluid by OCT.

The study researchers reported that mean age at diagnosis was 72.1 ± 8.1 years, and 22 eyes (55.0%) were responders. They also noted that the responder group had thicker subfoveal choroid (257.2 ± 108.3 µm) and smaller lesions (1.3 ± 0.8 µm) at baseline than the nonresponder group (167.1 ± 62.4 µm, p=0.003; and 2.0 ± 1.0 µm, p=0.008). The responder group showed significantly better BCVA and thicker subfoveal choroid than the nonresponder group at three months (p=0.002 and p=0.023) and six months (p=0.004 and p=0.031). Furthermore, stepwise and binary regression analysis demonstrated that subfoveal choroidal thickness was significantly correlated with visual outcome (B=–0.002, p=0.003) and treatment response (B=8.136, p=0.018).

Subfoveal choroidal thickness may be a predictive factor for visual outcome and treatment response in typical exudative AMD after intravitreal ranibizumab injections.

Source: Kang HM, Kwon JH, Yi JH, et al. Subfoveal choroidal thickness as a ptoential predictor of visual outcome and treatment response after intravitreal ranibizumab injections for typical exudative age-related macular degeneration. Am J Ophthalmol. 2014; 157(5):1013–21.

Injection Frequency and Anatomic Outcomes One Year After Conversion to Aflibercept in Patients with Neovascular AMD

The authors of this retrospective review sought to evaluate the clinical, anatomic and functional effects of conversion to aflibercept following ranibizumab and/or bevacizumab in patients with neovascular age-related macular degeneration (AMD).

The primary outcome was change in injection frequency in the year following the change. Secondary outcomes included change in central macular thickness (CMT) at six months and one year, presence of intraretinal and subretinal fluid at six months and visual acuity at one year.

A total of 109 eyes with neovascular AMD were switched to aflibercept and met inclusion criteria. Overall, aflibercept injection frequency was unchanged with patients receiving 7.4 anti-vascular endothelial growth factor (anti-VEGF) injections the year prior to conversion compared with 7.2 aflibercept injections in the year following (p=0.47). However, the change to aflibercept was associated with improvement in CMT from 324 to 295 µm (p=0.0001) at six months and 299 µm (p=0.0047) at one year. There was no effect on visual acuity at one year, the authors noted. They also reported that in a subgroup analysis, patients who had received ≥10 anti-VEGF injections in the year prior had fewer injections (11.1 to 8.4, p<0.0001) and clinic visits (13.9 to 9.6, p<0.0001) as well as a significant decrease in CMT (–35 µm, p=0.02).

To conclude, in this population, switching to aflibercept therapy was not associated with a change in injection frequency or improved visual acuity, but was associated with improved CMT at six months and one year. In patients who received at least 10 anti-VEGF injections in the year prior, the authors found that transitioning to aflibercept was associated with a reduced injection frequency and CMT, suggesting potential cost savings in this population.

Source: Messenger WB, Campbell JP, Faridi A, et al. Injection frequency and anatomic outcomes 1 year following conversion to aflibercept in patients with neovascular age-related macular degeneration. Br J Ophthalmol. 2014;May 2. [Epub ahead of print]. DOI: 10.1136/bjophthalmol-2013-304829.

Outcomes of Individualized Ranibizumab Treatment in Patients with DME

In the following Phase IIIb, multicenter, 12-month, randomized core study and 24-month open-label extension study, scientists evaluated long-term efficacy and safety profiles during three years of individualized ranibizumab treatment in patients with visual impairment due to diabetic macular edema (DME).

Of the 303 patients who completed the randomized RESTORE 12-month core study, 240 entered the extension study. According to the study scientists, in the extension study, patients were eligible to receive individualized ranibizumab treatment as of month 12 guided by best-corrected visual acuity (BCVA) and disease progression criteria at the scientists' discretion. Concomitant laser treatment was allowed according to the Early Treatment Diabetic Retinopathy Study (ETDRS) guidelines, and based on the treatments received in the core study, the extension study groups were referred to as prior ranibizumab, prior ranibizumab + laser, and laser. Change in BCVA and incidence of ocular and nonocular adverse events (AEs) over three years was the main outcome measure.

Overall, 208 patients (86.7%) completed the extension study, the scientists reported. In patients treated with ranibizumab during the core study, they noted that consecutive individualized ranibizumab treatment during the extension study led to an overall maintenance of BCVA and central retinal subfield thickness (CRST) observed at month 12 over the two-year extension study (+8.0 letters, –142.1 µm [prior ranibizumab] and +6.7 letters, –145.9 µm [prior ranibizumab + laser] from baseline at month 36) with a median of 6.0 injections (mean, 6.8 injections; prior ranibizumab) and 4.0 (mean, 6.0 injections; prior ranibizumab + laser). In the prior laser group, the scientists observed a progressive BCVA improvement (+6.0 letters) and CRST reduction (–142.7 µm) at month 36 after allowing ranibizumab during the extension study, with a median of 4.0 injections (mean, 6.5 injections) from months 12 to 35. Patients in all three treatment groups received a mean of less than three injections in the final year. No cases of endophthalmitis, retinal tear, or retinal detachment were reported. The most frequently reported ocular and nonocular adverse effects over three years were cataract (16.3%) and nasopharyngitis (23.3%). Eight deaths were reported during the extension study, but none were suspected to be related to the study drug/procedure.

Ranibizumab was effective in improving and maintaining BCVA and CRST outcomes with a progressively declining number of injections over three years of individualized dosing, the study scientists concluded. Moreover, ranibizumab was generally well-tolerated with no new safety concerns over three years.

Source: Schmidt-Erfurth U, Lang GE, Holz FG, et al; RESTORE Extension Study Group. Three-year outcomes of individualized ranibizumab treatment in patients with diabetic macular edema: the RESTORE Extension Study. Ophthalmology. 2014; 121(5):1045—1053.

Functional and Structural Effects of Ranibizumab vs. Laser in DME

London investigators compared the functional and structural effects of ranibizumab versus macular laser therapy in patients with center-involving diabetic macular edema (DME) in this prospective, randomized, single-masked clinical trial.

They examined 33 eyes of 33 patients with center-involving DME, with best-corrected visual acuity of 55 to 79 Early Treatment Diabetic Retinopathy Study letters at baseline, completing the 48-week study period. The investigators randomized subjects 2:1 to three loading doses of ranibizumab, then retreatment every four weeks as required; or macular laser therapy at baseline, repeated as required every 12 weeks. For exploratory outcome measures, structural imaging studies included greatest linear dimension and area of foveal avascular zone, perifoveal capillary dropout grade, and presence of morphologic features of diabetic macular edema on Spectralis optical coherence tomography (Heidelberg Engineering GmbH). Functional measures consisted of visual acuity, retinal sensitivity in the central four and 12 degrees on microperimetry, color contrast sensitivity protan and tritan thresholds, pattern and full-field electroretinogram amplitudes and implicit times, and multifocal electroretinogram amplitude distribution. These were reported at 12, 24, and 48 weeks.

Ranibizumab-treated subjects gained 6.0 vs. 0.9 letters lost for laser, demonstrated improved tritan and protan color contrast thresholds, and improved retinal sensitivity, the investigators observed. Additionally, they reported that electrophysiologic function improved after ranibizumab therapy. No safety issues were evident. Better retinal thickness reduction and structural improvement in optical coherence tomography features of DME were seen with ranibizumab therapy than in the laser group. There was no evidence of progressive ischemia with ranibizumab therapy.

In conclusion, ranibizumab therapy in the treatment of DME seems to improve retinal function and structure as demonstrated by this evaluation of different assessment methods.

Source: Comyn O, Sivaprasad S, Peto T, et al. A randomized trial to assess functional and structural effects of ranibizumab versus laser in diabetic macular edema (the LUCIDATE study). Am J Ophthalmol. 2014;157(5):960–970.

The Incidental Findings of AMD During Screening for Diabetic Retinopathy

The purpose of this prospective study was to determine the reliability of detecting age-related macular degeneration (AMD) during screening for diabetic retinopathy (DR).

A total of 2,003 subjects with diabetes mellitus who underwent photographic screening for DR were included and the reliability of detecting AMD lesions was tested by interobserver and intraobserver agreement. Additionally, the sensitivity and specificity of diagnosing AMD at different grades of severity were tested using the consensus grading of a group as the reference standard.

It was reported that DR affected 24.7% of the subjects and that the age-standardized prevalence of early AMD was 17.9%, and late AMD was 0.1%. The interobserver and intraobserver agreement for grading AMD was substantial (k=0.72 and 0.71 respectively, p<0.001). It was equally good in those with different severities of DR. There was also no difference in sensitivity and specificity of detecting AMD in those with different levels of DR (sensitivity 62% to 68% and specificity 97% to 98%).

Intermediate- and high-risk AMD that warrant treatment with zinc and antioxidant supplements could be reliably detected during screening for diabetic retinopathy.

Source: Gangwani R, Lai WW, Sum R, et al. The incidental findings of age-related macular degeneration during diabetic retinopathy screening. Graefes Arch Clin Exp Opthalmol. 2014;252(5):723–729.

Time to Clinically Significant VA Gains Following Ranibizumab Treatment for RVO

The post hoc analyses of two Phase III clinical trials assessing efficacy and safety of ranibizumab in patients with branch retinal vein occlusion (RVO) (Ranibizumab for the Treatment of Macular Edema following Branch Retinal Vein Occlusion: Evaluation of Efficacy and Safety [BRAVO] study) and central RVO (Ranibizumab for the Treatment of Macular Edema after Central Retinal Vein Occlusion Study: Evaluation of Efficacy and Safety [CRUISE]) over 12 months sought to assess time to first achievement of clinically significant visual acuity (VA) gains from baseline in patients with RVO receiving ranibizumab versus sham treatment.

A total of 789 (BRAVO, n=397; CRUISE, n=392) were included. There was randomization to monthly intraocular ranibizumab injections (0.3 mg/0.5 mg) or sham. After six monthly injections (treatment period), patients meeting prespecified criteria received as-needed (pro re nata [p.r.n.]) ranibizumab at their assigned dose (sham patients, ranibizumab 0.5 mg) through month 12 (observation period). BRAVO patients meeting specific eligibility criteria could receive rescue laser treatment once during the treatment and once during the observation periods.

Time to first gain of 15 letters or more from baseline, analyzed using Kaplan-Meier methods, was the main outcome measure. To evaluate the effect of delaying ranibizumab treatment, sham patients' VA data also were analyzed, with month six considered as baseline to assess vision gains during the six months of receiving ranibizumab p.r.n.

Median time to first 15-letter or more gain from baseline was 12.0 (sham), 4.8 (ranibizumab 0.3 mg), and 4.0 months (ranibizumab 0.5 mg) in BRAVO and 12.2, 5.9, and 5.2 months, respectively, in CRUISE. The cumulative proportion of patients who had ever gained ≥15 letters from baseline by month 12 was 50% (sham), 68% (ranibizumab 0.3 mg), and 71% (ranibizumab 0.5 mg) in BRAVO and 42%, 61%, and 66%, respectively, in CRUISE. After six months of ranibizumab p.r.n. treatment, a cumulative 10.8% (BRAVO) and 26.2% (CRUISE) of initially sham-treated patients ever gained ≥15 letters.

This retrospective analysis shows that >50% of patients treated with monthly ranibizumab achieved clinically significant vision gains during the initial six months of treatment, which were largely maintained using p.r.n. treatment to 12 months. In comparison, <50% of patients initially randomized to sham (and later receiving ranibizumab 0.5 mg p.r.n. treatment) ever achieved clinically significant vision gains. These results suggest that initiating treatment immediately after diagnosis may provide the greatest vision gains. The potential benefits of early treatment should be evaluated further in prospective clinical studies.

Source: Thach AB, Yau L, Hoang C, Tuomi L. Time to clinically significant visual acuity gains after ranibizumab treatment for retinal vein occlusion: BRAVO and CRUISE trials. Ophthalmology. 2014; 121(5):1059–1066.

Impact of Early Peripheral Laser Photocoagulation of Nonperfused Retina on Vision in Patients with CRVO

This prospective, proof-of-concept study randomized 22 central retinal vein occlusion (CRVO) patients into two arms to evaluate the effect of the combination of ranibizumab and laser photocoagulation to peripheral retinal areas of nonperfusion in patients with non-ischemic central retinal vein occlusion (CRVO) without neovascularizations.

The RL group (ranibizumab + laser; n=10) received ranibizumab with additive laser photocoagulation, while the control R group (n =12) was treated with ranibizumab only. All patients received three initial monthly ranibizumab injections followed by PRN regimen. Changes in best-corrected visual acuity (BCVA) and in central retinal thickness (CRT) were documented over six months.

It was reported that median of BCVA improved in the RL group from 65 ETDRS letters (interquartile range IQR=10 letters) at baseline to 70 (IQR=23.2) letters at month six. In the control R group, BCVA remained stable [baseline: 61 (IQR=19.5) and month six: 61 (IQR=22) letters]. CRT decreased between baseline and final visit in the RL group from 547 (IQR=513) µm to 246.5 (IQR=346.3) µm, and in the control group from 637.5 (IQR=344) µm to 423 (IQR=737) µm. More pronounced improvements in BCVA were seen in the RL group (medians=14 vs. 6.5 letters) although the observed group differences were not statistically significant due to small samples.

It was determined that the selective laser photocoagulation of peripheral areas of nonperfusion seems to lead to additional visual improvement in patients with CRVO. A larger replication trial is necessary to confirm the results of this proof of concept study.

Source: Rehak M, Tilgner E, Franke A, et al. Early peripheral laser photocoagulation of nonperfused retina improves vision in patients with central retinal vein occlusion (results of a proof of concept study). Graefes Arc Clin Exp Ophthalmol. 2014; 252(5):745–752.

Half-Fluence vs. Half-Dose PDT in Chronic CSC

Researchers in Italy aimed to compare the efficacy and safety of half-fluence with half-dose photodynamic therapy (PDT) in chronic central serous chorioretinopathy (CSC) in the following multicenter retrospective comparison study.

They performed a review of 56 patients affected by chronic CSC, including 28 patients (31 eyes) who received half-fluence PDT and 28 patients (29 eyes) who received half-dose PDT. They assessed best-corrected visual acuity (BCVA), central foveal thickness (CFT), and resolution of subretinal fluid on optical coherence tomography (OCT) at one and 12 months.

According to the researchers, the mean logarithm of the minimum angle of resolution BCVA improved significantly (p<0.001), both in the half-fluence group (from 0.187 [± 0.187] to 0.083 [± 0.164]) and in the half-dose group (from 0.126 [± 0.091] to 0.068 [± 0.091]), at 12 months, without significant difference between the two groups. At one month, they observed a complete resolution of subretinal fluid in 19 half-fluence-treated eyes (61.3%) and in 25 half-dose-treated eyes (86.2%) (p=0.04). They also found that at 12 months, a complete resolution of subretinal fluid was achieved in 26 half-fluence-treated eyes (83.9%) and 29 half-dose-treated eyes (100%) (p=0.0529). Additionally, nine eyes (29%) in the half-fluence group and five eyes (17.2%) in the half-dose group had at least one recurrence of subretinal fluid during the follow-up. Overall, there were 15 and five recurrences in the half-fluence PDT and half-dose PDT groups, respectively (p=0.07). In no eye of either groups was atrophy of the retinal pigment epithelium observed in the area of treatment.

Half-dose PDT induced a more rapid reabsorption of the fluid, a more lasting effect, and equal safety with respect to half-fluence PDT, the study researchers determined.

Source: Nicol√≥ M, Eandi CM, Alovisi C, et al. Half-fluence versus half-dose photodynamic therapy in chronic central serous chorioretinopathy. Am J Ophthalmol. 2014;157(5):1033–37.

PDT for Chronic CSC

To assess the visual and anatomic outcomes of central serous chorioretinopathy (CSC) after verteporfin photodynamic therapy (PDT), investigators conducted this retrospective case series.

They surveyed members of the Macula Society to retrospectively collect data on PDT treatment for CSC. They collected patient demographic information, PDT treatment parameters, fluorescein angiographic information, optical coherence tomography (OCT) metrics, pre- and post-treatment visual acuity (VA), and adverse outcomes online using standardized forms. Visual acuities over time and presence or absence of subretinal fluid (SRF) served as the main outcome measures.

Data were submitted on 265 eyes of 237 patients with CSC with a mean age of 52 (standard deviation [± 11]) years; 61 were women (26%). The investigators reported that mean baseline logarithm of the minimum angle of resolution (logMAR) VA was 0.39 ± 0.36 (20/50) and that baseline VAs were ≥20/32 in 115 eyes (43%), 20/40 to 20/80 in 97 eyes (37%), and ≤20/100 in 47 eyes (18%). Normal fluence was used for PDT treatment in 130 treatments (49%), half-fluence was used in 128 treatments (48%), and very low fluence or missing information was used in seven treatments (3%). The number of PDT treatments was one in 89%, two in 7%, and three in 3% of eyes. Post-PDT follow-up ranged from one month to more than one year. Post-PDT VA was correlated with baseline VA (r=0.70, p<0.001). Visual acuity improved three or more lines in <1%, 29%, and 48% of eyes with baseline VA ≥20/32, 20/40 to 20/80, and ≤20/100, respectively, the study investigators noted. Moreover, subretinal fluid resolved in 81% by the last post-PDT visit. There was no difference in the response to PDT when analyzed by age, race, fluence setting, fluorescein angiography leakage type, corticosteroid exposure, or fluid location (subretinal or pigment epithelial detachment; all p>0.01). Complications were rare. Retinal pigment epithelial atrophy was seen in 4% of patients, and acute severe visual decrease was seen in 1.5% of patients.

In conclusion, PDT was associated with improved VA and resolution of SRF. Adverse side effects were rare.

Source: Lim JI, Glassman AR, Aiello LP, et al; Macula Society CSC Collaborative Study Group, Research and Education Comittee and Website Committee. Collaborative retrospective Macula Society study of photodynamic therapy for chronic central serous chorioretinopathy. Ophthalmology. 2014;121(5):1073–1078.

Effects of Chlorogenic Acid and Coffee on Hypoxia-Induced Retinal Degeneration

This study explored whether chlorogenic acid (CGA) and coffee have protective effects against retinal degeneration.

Under hypoxic conditions, the viability of transformed retinal ganglion (RGC-5) cells was significantly reduced by treatment with the nitric oxide (NO) donor S-nitroso-N-acetylpenicillamine (SNAP). However, pretreatment with CGA attenuated cell death in a concentration-dependent manner. In addition, CGA prevented the up-regulation of apoptotic proteins such as Bad and cleaved caspase-3. Similar beneficial effects of both CGA and coffee extracts were observed in mice that had undergone an optic nerve crush (ONC) procedure. CGA and coffee extract reduced cell death by preventing the down-regulation of Thy-1.

These in vitro and in vivo studies demonstrated that coffee and its major component, CGA, significantly reduce apoptosis of retinal cells induced by hypoxia and NO, and that coffee consumption may help in preventing retinal degeneration.

Source: Jang H, Ahn HR, Jo H, et al. Chlorogenic acid and coffee prevent hypoxia-induced retinal degeneration. J Agric Food Chem. 2014;62(1):182–191.


Regeneron and Avalanche Biotechnologies to Collaborate on Development of Next-Generation Gene Therapy Products

Regeneron Pharmaceuticals Inc. and Avalanche Biotechnologies Inc. recently announced the formation of a broad collaboration to discover, develop and commercialize novel gene therapy products for the treatment of ophthalmologic diseases. The collaboration covers novel gene therapy vectors and proprietary molecules, discovered jointly by Avalanche and Regeneron, and developed using the Avalanche Ocular BioFactory. Under the terms of the agreement, Avalanche will receive an up-front cash payment, contingent payments of up to $640 million upon achievement of certain development and regulatory milestones, plus a royalty on worldwide net sales of collaboration products. Plus, Avalanche has the option to share in development costs and profits for products directed toward two collaboration therapeutic targets selected by Avalanche. Regeneron has a time-limited right of first negotiation for certain rights to Avalanche's gene therapy product targeting vascular endothelial growth factor currently under development for the treatment of wet age-related macular degeneration, upon completion of the ongoing Phase IIa trial. Click here for additional details.

Source: Regeneron Pharmaceuticals Inc., May 2014.

Merge Healthcare to Launch New Retinal Screening Solution

Merge Healthcare Inc. plans to release iConnect Retinal Screening, an end-to-end retinal screening solution allowing providers to quickly identify and diagnose patients with diabetic retinal disease. According to the company, its interoperable, subscription-based service leverages Merge's cloud infrastructure (iConnect Cloud Archive and Merge Eye Care PACS) to streamline operational workflow, reduce financial costs and enable the improvement of clinical care quality. iConnect Retinal Screening allows providers to efficiently capture retinal images through an automated camera, reducing the need for staff to receive specialty training. Images are transferred via the cloud to a reading center, where trained technicians and pathologists identify, diagnose and deliver results. iConnect Retinal Screening is currently undergoing a pilot program launch and is scheduled for availability by the end of Q2. The first phase of the solution will offer diabetic retinopathy screenings. Future stages of the solution will include screenings for glaucoma, age-related macular degeneration, and other serious neurological disease. Additional information is available here.

Source: Merge Healthcare Inc., April 2014.

Ohr Pharmaceutical Completes Enrollment of Phase II Clinical Trial of Squalamine Eye Drops in Wet AMD

Ohr Pharmaceutical has completed the enrollment of its OHR-002 Phase II clinical trial evaluating Squalamine Eye Drops for the treatment of the wet form of age-related macular degeneration (AMD). The randomized, double-masked, placebo-controlled study has enrolled 142 patients, and Ohr expects to announce interim data on the first 60 patients completing the protocol in June this year. Final data are expected in the first calendar quarter of 2015. For further details, click here.

Source: Ohr Pharmaceutical Inc., April 2014.

Preclinical Data on Sustained Release of Avastin Using Tethadur Presented

At the recent 2014 Association for Research in Vision and Ophthalmology Annual Meeting, pSivida Corp. presented the first peer-reviewed preclinical data demonstrating the use of the company's Tethadur technology to provide sustained release of Avastin. The data from preclinical studies concluded that long-term sustained release of antibodies such as Avastin is achievable with Tethadur, a form of pSivida's BioSilicon technology, and that the release of the antibodies is controllable over a wide range by adjusting the pore size and surface area of Tethadur. The study evaluated the effect of pore size in Tethadur on Avastin release over a period of three weeks. Want to know more? Visit pSivida's website.

Source: pSivida Corp., May 2014.

Study Reports That High-Frequency Ultrasound Can Be Used to Screen Eyes for Disease-Specific Conditions After Death

A new study from the Lions Eye Institute for Transplant & Research and the Eye Institute at the University of South Florida demonstrates that commonly used clinical techniques to image the anterior segment of the eye can be adapted to screen the posterior segment of post-mortem eyes for preclinical research. Investigators employed high-frequency ultrasound to successfully image retinal structures in post-mortem eyes, but this additional technique can be used to screen post-mortem eyes for disease-specific conditions. Optical coherence tomography imaging of the macula identified much of the anatomy seen in an in vivo scan, although post-mortem retinal changes imposed some limitations. A high-frequency (40 mHz) ultrasound biomicroscopy showed recognizable retinal landmarks in the posterior pole and correlated well with the pathology seen on the OCT images, such as epiretinal membranes causing macular puckering. The findings were presented at the recent 2014 Association for Research in Vision and Ophthalmology Annual Meeting.

Source: The Lions Eye Institute for Transplant & Research, May 2014.


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