National Retina Institute

Background: Unexpected results (anomalies) contain essential information regarding the physical consistency of the tested system ("test body") respectively, regarding the physical consistency of the paradigm used to construct the experiment, collect data and analyze measurement results. Based on the priori information and the own information accumulated, in order to facilitate the theoretical and experimental analysis, the complex physical pendulum model composed of three subsystems was adopted, namely: the subsystem of electrical parameters of the environment S1, the subsystem of the mechanical pendulum itself S2 respectively, the disturbing subsystem of celestial bodies S3. Aims: Highlighting nongravitational perturbations of the pendulum at rest. Method(s): The representation in the form of a physical complex system by describing the processes with the help of physical laws (balance sheet equations) and experimentally. Results. A new model of the complex physical system of the pendulum at rest (antenna) and a modern gravitational-electrical paradigm (Mach-Maxwell paradigm) for experiment construction, data collection and analysis of results, respectively Conclusions: The optimal physical consistency of the new paradigm of experiment construction, data collection and analysis of measurement results allows highlighting nongravitational perturbations of the pendulum at rest.

PurposeTo determine the incidence of new choroidal neovascularization (CNV) in eyes with dry age-related macular degeneration (AMD) following subthreshold diode micropulse laser (SDM).MethodIn an observational retrospective cohort study, the records of all patients active in the electronic medical records database were reviewed to identify eyes with dry AMD treated with SDM. Identified eyes were classified by simplified AREDS categories, and analyzed for the primary endpoint of new CNV after treatment.ResultsThe EMR revealed SDM was offered to 373/392 (95%) patients with dry AMD and elected by 363/373 (97%) between 2008–2017. Follow up was available for 354/363 patients (547 eyes, 98%) (range 6–108 mos., avg. 22). CNV risk factors included age (median 84 years, 67% > 80); reticular pseudodrusen (214 eyes, 39%); AREDS category (78% category 3 and 4); and fellow eye CNV (128 eyes, 23%). New CNV developed in 9/547 eyes (1.6%, annualized rate 0.87%). Visual acuity was unchanged. There were no adverse treatment effects.SummaryIn a review of a large group of eyes with exceptionally high-risk AMD, SDM was followed by a very low incidence of new CNV. If confirmed by further study, SDM would offer a new and highly effective treatment to reduce the risk of vision loss from AMD.

To evaluate the safety and efficacy of in-office vitreous sampling (50-100 microL). A prospective, consecutive case series of 578 diagnostic vitreous sample attempts performed between February 23, 2007 and September 31, 2008. A standardized technique of vitreous sampling followed by intravitreal injection of therapeutic medication was performed. All subjects were followed for adverse events after sampling/injection. Out of a total of 578 vitreous sampling attempts, a total of 550 positive diagnostic vitreous samples were collected from 157 eyes of 144 patients. There were a total of 28 "dry" samples in 19 subjects (13 females and 6 males). The rate of dry sample was 4.8% (28 of 578). Complications included transient vitreous hemorrhage (n = 3), transient intraocular inflammation (n = 3), localized, chronic retinal detachment (n = 1). None of the complications resulted in permanent visual sequelae. These complications were no different than those expected from intravitreal injection alone. This prospective study has shown that in-office vitreous sampling of 50 microL to 100 microL is a safe and reproducible procedure. Larger randomized studies will be helpful to further assess the safety and long-term effects of in-office diagnostic vitreous sampling.

National Retina Institute, Chevy, Chase, MD Original study reprint requests: Wico W. Lai, Eye Institute, LKS Faculty of Medicine, The University of Hong Kong, L6-13, 21 Sassoon Road, Pokfulam, Hong Kong. E-mail address: [email protected]

Indocyanine green (ICG) angiograms of each of five patients with retinal pigment epithelium (RPE) detachments were made using first a Topcon fundus camera and then a Heidelberg scanning laser ophthalmoscope (SLO); for each patient, both types of angiograms were obtained on the same day. In each case, the serous fluid appeared bright throughout the fundus camera studies and dark throughout the SLO studies. This study sought to explain the disparity in the appearance of the lesions in the two kinds of images and to determine whether there was dye in the serous fluid. Simple model eyes were constructed to demonstrate the effects of Mie light scatter and integrating sphere behavior of the sclera on ICG image formation by the fundus camera and SLO optics. Analysis was made of both the clinical angiograms and model eye images to structure an explanation for the disparate RPE detachment angiographic images. Indocyanine green fluorescent light from choroidal vessels adjacent to the lesions and scattered by the turbid serous fluid accounted for the lesion brightness seen in the fundus camera images. The models confirmed that SLOs suppress scattered light. The apparent fluorescence of serous fluid beneath RPE detachments in fundus camera early-phase ICG angiogram images is not attributable to the presence of dye; rather, it appears to be attributable to serous fluid light scatter of fluorescent light arising from adjacent fluorescent structures. This light scatter is a consequence of the fundus camera illumination and recording optics and is not present in SLO-generated images. The necessity of understanding such phenomena as absorption, diffraction, polarization, and scatter of light and routinely applying them to ICG angiogram interpretation is underscored when it is shown that they offer simple explanations for unusual or unexpected angiographic results, as in the case of the patients with RPE detachment discussed here.