Comparisons of ganglion cell-inner plexiform layer loss patterns and its diagnostic performance between normal tension glaucoma and primary open angle glaucoma: a detailed, severity-based study

AIM

To evaluate the patterns of macular ganglion cell-inner plexiform layer (GCIPL) loss in normal tension glaucoma (NTG) and primary open angle glaucoma (POAG) in a detailed, disease severity-matched way; and to assess the diagnostic capabilities of GCIPL thickness parameters in discriminating NTG or POAG from normal subjects.

METHODS

A total of 157 eyes of 157 subjects, including 57 normal eyes, 51 eyes with POAG and 49 eyes with NTG were enrolled and strictly matched in age, refraction, and disease severity between POAG and NTG groups. The average, minimum, superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal GCIPL thickness, and the average, superior, temporal, inferior, and nasal retinal nerve fiber layer (RNFL) thickness were obtained by Cirrus optical coherence tomography (OCT). The diagnostic capabilities of OCT parameters were assessed by area under receiver operating characteristic (AUROC) curves.

RESULTS

Among all the OCT thickness parameters, no statistical significant difference between NTG group and POAG group was found (all P>0.05). In discriminating NTG or POAG from normal subjects, the average and inferior RNFL thickness, and the minimum GCIPL thickness had better diagnostic capabilities. There was no significant difference in AUROC curve between the best GCIPL thickness parameter (minimum GCIPL) and the best RNFL thickness parameter in discriminating NTG (inferior RNFL; P=0.076) and indiscriminating POAG (average RNFL; P=0.913) from normal eyes.

CONCLUSION

Localized GCIPL loss, especially in the inferior and inferotemporal sectors, is more common in NTG than in POAG. Among all the GCIPL thickness parameters, the minimum GCIPL thickness has the best diagnostic performance in differentiating NTG or POAG from normal subjects, which is comparable to that of the average and inferior RNFL thickness.

Choroidal thickness changes in systemic lupus erythematosus patients

Purpose

To compare choroidal thickness (CT) between patients with systemic lupus erythematosus (SLE) without ophthalmologic manifestations and a control group. To study the effects in CT of disease duration, activity index, medication and systemic comorbidities.

Methods

Cross-sectional study where spectral-domain optical coherence tomography with enhanced depth imaging was used to measure CT in 13 locations, subfoveally and at 500-µm intervals along a horizontal and a vertical section from the fovea. Linear regression models were used.

Results

Sixty-eight SLE patients and fifty healthy controls were enrolled. CT multivariable analysis revealed lower values in SLE patients (12.93-26.73 µm thinner) in all locations, except the inferior quadrants (6.48-10.44 µm thicker); however, none of these results reached statistical significance. Contrary to the control group, the normal topographic variation in CT between macular quadrants and from the center to the periphery was not observed in the SLE group. Multivariable analysis in the SLE group alone revealed a significant negative association with anticoagulants (50.10-56.09 µm thinner) and lupus nephritis (40.79-58.63 µm thinner). Contrary to controls, the CT of SLE patients did not respond to changes in mean arterial pressure.

Conclusion

CT in SLE appears to be thinner, particularly in the subset of patients with nephritis and taking anticoagulants, suggesting more advanced systemic vascular disease. Choroidal responses to hemodynamic changes may also be altered in SLE.

Longitudinal changes in the ganglion cell-inner plexiform layer thickness in high myopia: a prospective observational study

AIM

To determine longitudinal changes of the ganglion cell-inner plexiform layer (GC-IPL) thickness in patients with high myopia.

METHODS

The subjects were divided into two groups: a high myopia group (axial length ≥26.0 mm) and a normal control group. Both groups were divided into subgroups based on age (decade): 20s, 30s, 40s and 50s. Twenty eyes were included in each subgroup. After the initial visit, GC-IPL thicknesses were measured three more times with at least a 1-year interval between examinations using spectral domain optical coherence tomography. The average GC-IPL thickness was fitted with linear mixed models.

RESULTS

The average GC-IPL thickness at the first visit was 78.50 ± 8.79 µm and 84.29 ± 6.12 µm in the high myopia and control groups, respectively. In both groups, the average GC-IPL thickness showed a significant change over time. The rate of GC-IPL reduction in individuals aged in their 50s, 40s, 30s and 20s with high myopia were -0.81 µm/year,-0.51 µm/year, -0.28 µm/year and -0.12 µm/year, respectively, and in controls in their 50s, 40s, 30s and 20s, they were -0.31 µm/year,-0.25 µm/year, -0.12 µm/year and -0.02 µm/year, respectively. Additionally, individuals aged in their 50s showed a statistically significant interaction between group and duration (p<0.001).

CONCLUSIONS

Highly myopic eyes had thinner GC-IPL and a significantly greater reduction in GC-IPL over 3 years when compared with normal eyes. Additionally, the reduction rate of the GC-IPL thickness was greater in older patients in both groups, which was more prominent in the high myopia group.

Paracentral acute middle maculopathy as a cause of unexplained visual loss in central retinal vein occlusion

A 79-year-old man presented with unilateral unexplained sudden onset visual loss in the setting of central retinal vein occlusion (CRVO). Non ischemic CRVO in the right eye (RE) was confirmed on fluorescein angiography. Spectral domain optical coherence tomography (SD-OCT) showed absence of macular edema and hyperreflective band-like lesions in the middle retinal layers of the RE suggesting a diagnosis of paracentral acute middle maculopathy (PAMM). Patient was observed and after 3 months, best-corrected visual acuity in the RE spontaneously improved from 38 to 56 ETDRS letters. SD-OCT scans showed thinning of the inner nuclear layer of the RE. OCT angiography in the RE revealed a mild attenuation of the vascular flow signal in the superficial capillary plexus and patchy areas of vascular flow void in the deep capillary plexus, as compared to the fellow eye.

The present case outlines the importance of recognising PAMM as a cause of unexplained visual loss. In the setting of a CRVO with sudden vision loss and absence of macular edema, clinicians should pay attention to any hyperreflectivity and/or to thinning of the middle retinal layers on SD-OCT.

Three-Dimensional Optical Coherence Tomography Imaging For Glaucoma Associated With Boston Keratoprosthesis Type I and II

PRECIS

Three-dimensional (3D) spectral domain optical coherence tomography (OCT) volume scans of the optic nerve head (ONH) and the peripapillary area are useful in the management of glaucoma in patients with a type I or II Boston Keratoprosthesis (KPro).

PURPOSE

The purpose of this study was to report the use of spectral domain OCT in the management of glaucoma in patients with a type I or II Boston KPro.

MATERIALS AND METHODS

This study is an observational case series. Four consecutive patients with KPro implants were referred for glaucoma evaluation. A comprehensive eye examination was performed which included disc photography, visual field testing, and high-density spectral domain OCT volume scans of the ONH and the peripapillary area. 2D and 3D parameters were calculated using custom-designed segmentation algorithms developed for glaucoma management.

RESULTS

Spectral domain OCT parameters provided useful information in the diagnosis and management of 4 KPro patients. OCT parameters which can be used in KPro patients included 2D retinal nerve fiber layer (RNFL) thickness, 3D peripapillary RNFL volume, 3D peripapillary retinal thickness and volume, 3D cup volume, and 3D neuroretinal rim thickness and volume. In 3 of 4 cases where the traditional 2D RNFL thickness scan was limited by artifacts, 3D spectral domain OCT volume scans provided useful quantitative objective measurements of the ONH and peripapillary region. Therefore, 3D parameters derived from high-density volume scans as well as radial scans of the ONH can be used to overcome the limitations and artifacts associated with 2D RNFL thickness scans.

CONCLUSIONS

Spectral domain OCT volume scans offer the possibility to enhance the evaluation of KPro patients with glaucoma by using both 2D and 3D diagnostic parameters that are easily obtained in a clinic setting.

CORRELATIONS between Functional and Structural Tests Measured by Spectral Domain Optical Coherence Tomography in Severe Glaucoma

Purpose: To evaluate the relationship between visual acuity, visual field and spectral domain optical coherence tomography (OCT) parameters, including retinal nerve fiber layer (RNFL), ganglion cell-internal plexiform layer (GC-IPL) thicknesses, and optic nerve head parameters in patients with severe glaucoma. Material and Methods: Patients with the diagnosis of severe glaucoma were recruited from the data gathered at our glaucoma department. A detailed ophthalmic examination was performed using the Standard Automated Perimetry (the 30-2 SITA standard program was used for VF testing). Cirrus EDI-OCT was used for peripapillary RNFL and GC-IPL thickness measurements. Optic nerve head parameters, including mean cup-to-disc (c/d) ratio, rim area, vertical c/d ratio, cup volume, were also measured by spectral domain OCT. Correlations between these structural parameters and functional parameters (visual acuity, VF parameters) were investigated. Results: Forty-one eyes of 34 patients with severe glaucoma were enrolled in this study. Correlations between BCVA and mean GC-IPL thickness (p = .03), superior GC-IPL thickness (p = .03), inferonasal GC-IPL thickness (p = .01), superonasal GC-IPL thickness (p = .01), superotemporal GC-IPL thickness (p = .04), and rim area (p = .00) were found to be positive statistically significant. There was also a positive statistically significant correlation between MD and inferotemporal GC-IPL thickness (p = .03). Negative statistically significant correlations were found between BCVA and mean c/d ratio (p = .00), vertical c/d ratio (p = .02) and cup volume (p = .00). Discussion: Mean, superior, inferonasal, superonasal, and superotemporal GC-IPL thicknesses and mean c/d ratio, vertical c/d ratio and cup volume were found to be correlated with BCVA in patients with severe glaucoma.

Optical coherence tomography angiography in contractile morning glory syndrome

This study describes the optical coherence tomography and optical coherence tomography angiography features of three eyes of three patients affected by contractile morning glory syndrome. Optical coherence tomography angiography scans of the peripapillary retina revealed a dense microvascular network without any vascular difference between the superficial vascular plexus and the deep vascular plexus around the optic nerve. These optical coherence tomography angiography findings confirm that the contractile movement could be due to the presence of an autonomic cholinergic muscular mechanism in the posterior part of the globe. In fact in our cases, the contractile movement seemed to be induced by massage of the eyeball. Optical coherence tomography angiography is a valid, non-invasive, dyeless, and reliable method that could shed light on the pathogenesis of this rare disease of the optic disk.

Multimodal imaging of pre-Descemet corneal dystrophy

PURPOSE

The aim of this study was to assess structural and histological changes associated with pre-Descemet corneal dystrophy with multimodal in vivo imaging.

METHODS

Retrospective case series including eight corneas from four unrelated male patients with pre-Descemet corneal dystrophy characterized by the presence of punctiform gray opacities located just anterior to the Descemet membrane at slit-lamp examination of both eyes. In vivo confocal microscopy images were obtained in the central, paracentral, and peripheral corneal zones from the superficial epithelial cell layer down to the corneal endothelium in both eyes. Spectral domain optical coherence tomography scans (central and limbal zones) and mapping of both corneas were acquired.

RESULTS

Diffuse small extracellular stromal deposits, presence of enlarged hyperreflective keratocytes in the posterior stroma with either hyperreflective or hyporeflective intracellular dots, and presence of activated keratocytes in the very anterior stroma were observed in all corneas with in vivo confocal microscopy. Spectral domain optical coherence tomography scans showed a hyperreflective line anterior to Descemet's membrane running from limbus to limbus and associated with a second thinner hyperreflective line just beneath Bowman's layer. Fine hyperreflective particles were observed in the posterior, mid, and anterior stroma on optical coherence tomography scans.

CONCLUSION

The clinical presentation and structural anomalies found in isolated sporadic pre-Descemet corneal dystrophy are in favor of a degenerative process affecting corneal keratocytes with no epithelial or endothelial involvement. The maximum damage is found just anterior to the Descemet membrane resulting in pre-Descemet membrane location of stromal opacities. Multimodal imaging of cornea reveals that the disorder affects the whole stroma and it permits better understanding of pre-Descemet corneal dystrophy pathophysiology together with ascertained diagnosis.

Optical Coherence Tomography Characteristics of Quiescent Type 1 Neovascularization in Eyes with Nonexudative Age-related Macular Degeneration

Objectives:

To describe the lesion characteristics of nonexudative, quiescent, asymptomatic type 1 neovascularization (NV) on B-scan and en face spectral domain optical coherence tomography (SD-OCT) in eyes with nonexudative age-related macular degeneration (AMD).

Materials and Methods:

In this retrospective, observational, consecutive case series, 27 patients who were already being followed and treated for exudative AMD in one eye were included in the study for their fellow eyes, which were initially nonexudative but developed exudative findings during follow-up. Initial B-scan and en face SD-OCT, fluorescein angiography (FA), and indocyanine green angiography (ICGA) images of these 27 eyes were examined retrospectively. The characteristic B-scan SD-OCT features of type 1 NV in this silent and asymptomatic stage were described.

Results:

The 27 eyes of 27 patients (13 males and 14 females; mean age 69.5±8.2 years) with nonexudative AMD had a mean best corrected visual acuity (BCVA) of 0.6±0.3 Snellen. Initial B-scan OCT images of all eyes (100%) showed retinal pigment epithelium (RPE) elevations and irregularities caused by a moderately reflective material in the sub-RPE space without fluid accumulation in the intraretinal/subretinal or sub-RPE space. Twenty-four eyes (88.8%) showed sub-RPE hyperreflective lesions consistent with type 1 NV on en face OCT images. While none of the eyes showed signs of type 1 NV in FA, macular plaque was observed in 8 eyes (29.6%) in ICGA. The mean time to onset of exudative findings was 8.3±4.03 months.

Conclusion:

In eyes with nonexudative AMD, there may be quiescent and asymptomatic type 1 NV lesions which do not yet show exudative changes. This NV has characteristic features on B-scan SD-OCT and can also be detected with en face OCT. Detection and close monitoring of these quiescent and inactive type 1 NV lesions during the asymptomatic, pre-exudative period are important for early treatment.

Switching from ranibizumab to aflibercept in choroidal neovascularization secondary to angioid streaks

PURPOSE

To evaluate the efficacy of switching from intravitreal ranibizumab to intravitreal aflibercept in choroidal neovascularization secondary to angioid streaks.

DESIGN

Multicenter retrospective interventional case series.

METHODS

Patients previously treated with intravitreal ranibizumab with at least 12-month follow-up (M12) after switching (M0) to intravitreal aflibercept. Switch to intravitreal aflibercept was decided in cases of refractory or recurrent choroidal neovascularization. Primary endpoint: Change of best-corrected visual acuity using the Early Treatment Diabetic Retinopathy Study letters. Secondary endpoints: Mean change of central macular thickness, absence of intraretinal/subretinal fluid on spectral domain optical coherence tomography and the percentage of eyes with absence of leakage on fluorescein angiography.

RESULTS

Fourteen eyes of 13 patients were included. Mean best-corrected visual acuity was 65.0 ± 21.03 letters at M0 and 63.5 ± 17.30 letters at M12 (p = 0.5). Secondary endpoints: Mean central macular thickness was 344 ± 194.65 µm at M0 and 268 ± 79.97 µm at M12 (p = 0.008). Absence of intraretinal/subretinal fluid was observed in 71%. Fluorescein angiography (nine eyes) showed absence of leakage in 77% (seven eyes).

CONCLUSION

Switching from intravitreal ranibizumab to intravitreal aflibercept represents a therapeutic option in patients with refractory or recurrent choroidal neovascularization secondary to angioid streaks.

Longitudinal changes in outer nuclear layer thickness in soft drusen and reticular pseudodrusen

BACKGROUND

Drusen are seen in the early and intermediate stages of age-related macular degeneration. A retrospective, two-year observational study at a tertiary centre was designed to assess outer nuclear layer thickness in different types of drusen.

METHODS

Patients over 50 years of age with predominant soft drusen or reticular pseudodrusen were included in the study. Fundus photography, infrared, fundus autofluorescence and spectral domain optical coherence tomography were performed at baseline, years one and two. Outer nuclear layer thickness was measured in the nine Early Treatment Diabetic Retinopathy Study subfields, and the rate of thinning was determined using generalised estimating equations models.

RESULTS

Data were analysed from 17 eyes with soft drusen and nine eyes with reticular pseudodrusen. Greater outer nuclear layer thinning was seen overall and in all subfields in reticular pseudodrusen as compared to soft drusen, with statistically significant differences found mostly in superior and nasal subfields of ring 2. The outer nuclear layer was 5-12 μm thinner in eyes with reticular pseudodrusen, and the rate of thinning was greater in eyes with reticular pseudodrusen in the outer superior subfield.

CONCLUSIONS

Outer nuclear layer thickness is consistently lower in patients with reticular pseudodrusen compared with soft drusen, irrespective of subfield location. These structural findings may contribute to explain the functional abnormalities observed in patients with reticular pseudodrusen.

Correlation analysis of fundus autofluorescence, spectral domain optical coherence tomography, and visual function in patients with diabetic macular oedema treated with intravitreal ziv-aflibercept

PURPOSE

The aim of this study was to evaluate the correlations between fundus autofluorescence and morphologic parameters as well as visual function in patients with diabetic macular oedema treated with intravitreal ziv-aflibercept.

METHODS

A total of 34 eyes of 20 patients with untreated diabetic macular oedema received an intravitreal injection of ziv-aflibercept at baseline, and 1 and 2 months later. The baseline, 1-month, and two-month best corrected visual acuity determination, contrast sensitivity, spectral domain optical coherence tomography, mean central macular thickness, mean macular cube volume, mean macular cube average thickness, and fundus autofluorescence (decreased, normal, or increased; and single or multiple spots) were measured. Correlation analysis with a determination of Spearman's rank correlation coefficient, regression analysis, agreement between investigators, and Friedman's test were used for statistical analyses.

RESULTS

A direct correlation was observed between baseline fundus autofluorescence and macular cube average thickness at 1 month (r = 0.51, p = 0.020) and between fundus autofluorescence at 1 month and baseline macular cube average thickness (r = 0.50, p = 0.021). Regression analysis showed a coefficient of determination of 0.29 (p = 0.016) between baseline fundus autofluorescence and macular cube average thickness at 1 month.

CONCLUSION

In patients with diabetic macular oedema, the pretreatment baseline degree of foveal fundus autofluorescence might be helpful in predicting macular cube average thickness in patients undergoing treatment with intravitreal ziv-aflibercept in the short term.

A CARE-compliant article: optical coherence tomography for epithelial basement membrane dystrophy: A case report

RATIONALE

The etiology of anterior corneal opacities and the effect of debridement cannot be determined by biomicroscopy. Optical coherence tomography (OCT) helps identify the character and depth of these lesions.

PATIENT CONCERNS

A 45-year-old female complained of progressive blurred vision for a long time. Slit lamp biomicroscopy showed irregular, faint scar-like opacity of anterior cornea in her both eyes. Pentacam Scheimpflug camera tomography showed irregular astigmatism of anterior corneal surface. Anterior segment spectral-domain OCT revealed thickened, hyper-reflective linings, and scattered lesions, mainly in the epithelial layer.

DIAGNOSES

Epithelial basement membrane dystrophy (EBMD).

INTERVENTION

Epithelial debridement and bandage lenses.

OUTCOMES

The cornea became clear and the vision improved soon after debridement. The pathology showed thickened aberrant basement membrane extending into mid-epithelial layer, with microcyst-like lesions also noted.

LESSONS

OCT defines the depth of lesions and helps diagnosis and management of EBMD.

The Effect of Smoking on Macular, Choroidal, and Retina Nerve Fiber Layer Thickness

Objectives

This study aimed to compare the thickness of the macula, choroid, and peripapillary retina nerve fiber layer (RNFL) in smokers with those of healthy, nonsmoking individuals using spectral domain optical coherence tomography (SD-OCT).

Materials and Methods

Sixty-eight healthy smokers with an average of 19.75 pack-years and 71 nonsmoker subjects (control group) were included in the study. Macular thickness, RNFL thickness, and choroidal thickness (CT) were measured by SD-OCT.

Results

The mean age of the smokers was 42.76±6.97 years and that of the control group was 41.15±11.61 years (p=0.32). Inferonasal and temporal RNFL thicknesses were 121.60±27.40 μm and 69.75±9.82 μm in the smokers group and 109.05±21.71 μm and 75.95±15.01 μm in the nonsmoker group, respectively. The differences were statistically significant (p=0.003, p=0.005, respectively). Central macular thickness (CMT) was 222.97±18.95 μm and subfoveal CT was 369.52±105.36 μm in the smoker group, while these values were 222.98±17.72 μm and 347.42±104.63 μm in the nonsmoker group, respectively. There were no significant differences in these comparisons (p=0.99, p=0.49, respectively). A significant negative correlation was found between smoking exposure and nasal and temporal CT.

Conclusion

The results of our study revealed that RNFL thickness was decreased but CMT and CT were not affected in healthy chronic smokers.

Optic nerve head morphology in primary open-angle glaucoma and nonarteritic anterior ischaemic optic neuropathy measured with spectral domain optical coherence tomography

PURPOSE

Optic nerve head (ONH) parameters as well as circumpapillary retinal nerve fibre layer (RNFL) thickness values measured with two different spectral domain optical coherence tomography (SD-OCT) machines (Spectralis^® and Cirrus^® OCT) have been compared between two patient groups, primary open-angle glaucoma (POAG), nonarteritic anterior ischaemic optic neuropathy (NAION) and healthy controls. A comparison of the performance of the two OCT machines was made.

METHODS

Twenty healthy controls, 20 POAG and 20 NAION patients with comparable visual field defects were included. Comparison between groups was made using anova and post hoc t-tests. To evaluate the diagnostic power of OCT to differentiate POAG from NAION, a stepwise linear regression analysis of the rim-RNFL correlation with adjusting covariates (optic disc area and age) was performed. Based on the regression formula, the area under the receiver operator characteristic (AUROC) was calculated.

RESULTS

Both glaucoma and NAION patients showed significantly smaller global RNFL thickness values compared to healthy subjects in t-tests (p < 0.001), while only patients with glaucoma showed significantly smaller global ONH parameters for both devices compared to healthy subjects (p < 0.001). Correlation between global ONH parameters was highly statistically significant (r = 0.93), whereas in t-test a statistically significant difference between the two machines was detected (p < 0.001). Area under the receiver operator characteristic revealed a similarly good discrimination between glaucoma and NAION for Spectralis^® (0.980) and Cirrus^® OCT (0.945).

CONCLUSION

NAION patients have similar RNFL thickness values as do glaucomatous eyes, whereas ONH parameters in NAION eyes were similar to those seen in healthy controls. This difference might help discriminating between these two different disease conditions in a chronic disease stadium, and in this regard, none of the two OCT machines performed better.

Diagnostic Ability of Swept-Source and Spectral-Domain Optical Coherence Tomography for Glaucoma

PURPOSE

To compare the diagnostic abilities of swept-source optical coherence tomography (OCT) [Deep Range Imaging OCT-1 (DRI-OCT)] and spectral-domain OCT (Cirrus HD-OCT) for glaucoma in Korean adults.

MATERIALS AND METHODS

This retrospective study involved measuring peripapillary retinal nerve fiber layer (PP-RNFL) thickness, full macular thickness, and ganglion cell-inner plexiform layer (GC-IPL) thickness on two different OCT systems. We used three-dimensional optic disc scanning of DRI-OCT and included 12 clock-hour sectors for measurement of the PP-RNFL. Areas under receiver operating characteristic curves (AUCs) were calculated and compared to determine how well each system could distinguish control and glaucomatous patients.

RESULTS

Ninety-one healthy and 58 glaucomatous eyes were included. Both systems could clearly distinguish between control eyes and eyes with moderate to severe glaucoma. Among all sectors, the AUC values of areas associated with glaucoma were >0.7 for both OCTs. The PP-RNFL sector of highest AUC value on both OCTs was the inferior sector of the clock-hour map (0.968 and 0.959 in DRI-OCT and Cirrus HD-OCT, respectively). Among macular thickness sectors, AUC values were highest on both OCTs for the outer inferior sector (0.859 and 0.853 in DRI-OCT and Cirrus HD-OCT, respectively). The GC-IPL also provided high diagnostic values (DRI-OCT and Cirrus HD-OCT were the best in the average and inferior sectors, respectively).

CONCLUSION

Although the two OCT systems provided different thickness measurements, DRI-OCT exhibited as good, if not better, diagnostic ability for glaucoma as Cirrus HD-OCT in Korean adults.

Multimodal Imaging in Birdshot Retinochoroiditis

PURPOSE

To describe retinal vascular changes in Birdshot Retinochoroiditis (BSRC) with multimodal imaging techniques and functional values.

METHODS

In this single-center study, 64 eyes of 32 subjects with BSRC were classified according to disease activity and duration and underwent imaging with spectral domain optical coherence tomography, fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and optical coherence tomography angiography (OCTA).

RESULTS

Mean age of the patients was 60 years (range, 38-74). OCTA revealed capillary loops (58%), telangiectatic vessels (44%), increased intercapillary spaces (52%), altered vascular architecture (53%), and rarefication of C-scans (63%) in retinal layers. Increased rarefications of C-scans (p = 0.0056; p = 0.0046) and altered vascular architecture (p = 0.0120; p = 0.0243) in superficial and deep capillary layers were significantly correlated with disease activity.

CONCLUSION

OCTA adds new insights in a multimodal imaging approach of retinal vascular layer visualization in BSRC and may contribute to existing methods for diagnosing severity and potentially progression of the disease.

The development of a reference database with the Topcon 3D OCT-1 Maestro

Importance

The paper presents the range for measurements taken with a new spectral domain optical coherence tomography (OCT) device to establish a reference database for discrimination purposes.

Objective

To report the range of thickness values for the new Topcon Maestro 3D OCT device with 2 scan size settings: the 12×9 mm wide field and 6×6 mm scans.

Design

Prospective, multicenter cohort study conducted at 7 clinical sites across the USA.

Setting

Primary eyecare clinics within academic, hospital, and private practice locations.

Participants

Healthy volunteers; all enrolled participants underwent a complete ophthalmological examination to confirm healthy ocular status prior to being enrolled in the study.

Main outcome measure

Average and 1st, 5th, 95th, and 99th percentile ranges for OCT parameters Early Treatment Diabetic Retinopathy Study macula full retinal thickness, ganglion cell + inner plexiform layer thickness (GCL + IPL), ganglion cell complex (GCC) thickness, circumpapillary retinal nerve fiber layer (cpRNFL) thickness.

Results

Three hundred and ninety-nine eyes of 399 subjects were included in the analysis. Mean (SD) age was 46.3 (16.3) years (range 18–88 years). Forty-three percent of the subjects were male. Mean (SD) measurements (in μm) for the 12×9 mm wide scan were as follows: foveal thickness=237.079 (20.899), GCL + IPL=71.363 (5.924), GCC=105.949 (8.533), cpRNFL=104.720 (11.829); measurements for the 6×6 mm scans were as follows: foveal thickness=234.000 (20.657), GCL + IPL=71.726 (5.880), GCC=106.698 (9.094), cpRNFL=104.036 (11.341).

Conclusion

The overall normal thickness values reported with Topcon 3D OCT-1 Maestro were like those studies with OCT from different manufactures. The reference limits at the 1st, 5th, 95th, and 99th percentile points establish the thresholds for the quantitative comparison of the cpRNFL and the macula in the human retina to a database of known healthy subjects.

Photoreceptor cells as a source of fundus autofluorescence in recessive Stargardt disease

Bisretinoid fluorophores form in photoreceptor outer segments from nonenzymatic reactions of vitamin A aldehyde. The short-wavelength autofluorescence (SW-AF) of fundus flecks in recessive Stargardt disease (STGD1) suggests a connection to these fluorophores. Through multimodal imaging, we sought to elucidate this link. Flecks observed in SW-AF images often colocalized with foci exhibiting reduced or absent near-infrared autofluorescence signal, the source of which is melanin in retinal pigment epithelial (RPE) cells. With serial imaging, changes in near-infrared autofluorescence (NIR-AF) preceded the onset of fleck hyperautofluorescence in SW-AF images and fleck profiles in NIR-AF images tended to be larger. Flecks in SW-AF and NIR-AF images also corresponded to hyperreflective lesions traversing photoreceptor-attributable bands in horizontal SD-OCT scans. The hyperreflective lesions interrupted adjacent OCT reflectivity bands and were associated with thinning of the outer nuclear layer. These SD-OCT findings are attributable to photoreceptor cell degeneration. Progressive increases and decreases in the SW-AF intensity of flecks were evident in color-coded quantitative fundus autofluorescence maps. In some cases, flecks appeared to spread radially from the fovea to approximately 8° of eccentricity, beyond which a circumferential spread characterized the distribution. Since the NIR-AF signal is derived from melanin and loss of this autofluorescence is indicative of RPE atrophy, the SW-AF of flecks cannot be accounted for by bisretinoid lipofuscin in RPE. Instead, we suggest that the bisretinoid serving as the source of the SW-AF signal, resides in photoreceptors, the cell that is also the site of bisretinoid synthesis.

Spectral domain optical coherence tomography evaluation of macular changes in Eales disease

Purpose:

The purpose of the study was to describe macular changes in treatment-naïve eyes with Eales disease using spectral domain optical coherence tomography (SD-OCT).

Methods:

A cross-sectional study was done on 79 eyes of 66 patients with Eales disease. Best-corrected visual acuity (BCVA), slit-lamp biomicroscopy (SLB), indirect ophthalmoscopy, fundus fluorescein angiography (FFA), and quantitative (central macular thickness [CMT]) and qualitative analysis on SD-OCT were performed.

Results:

Forty-six (58.2%) eyes had macular involvement as assessed with SD-OCT, while in 33 (41.8%) eyes, macula was not affected. Macular edema was the most common feature when macula was affected followed by epiretinal membrane. Mean CMT was higher (315.3 ± 102.3 μm) in eyes with macular involvement than those without it (243.8 ± 19.3 μm). Eyes with active vasculitis involving larger vessels and neovascularization had greater chance of macular involvement. SLB and FFA alone missed 28.3% and 50% eyes with macular abnormalities on SD-OCT, respectively.

Conclusion:

While the clinical description of Eales disease points mainly to a peripheral location, macular involvement can be commonly picked up when SD-OCT is used. Macular involvement when present is associated with a poorer BCVA.

Automated segmentation of hyperreflective foci in spectral domain optical coherence tomography with diabetic retinopathy

We propose an automated segmentation method to detect, segment, and quantify hyperreflective foci (HFs) in three-dimensional (3-D) spectral domain optical coherence tomography (SD-OCT). The algorithm is divided into three stages: preprocessing, layer segmentation, and HF segmentation. In this paper, a supervised classifier (random forest) was used to produce the set of boundary probabilities in which an optimal graph search method was then applied to identify and produce the layer segmentation using the Sobel edge algorithm. An automated grow-cut algorithm was applied to segment the HFs. The proposed algorithm was tested on 20 3-D SD-OCT volumes from 20 patients diagnosed with proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME). The average dice similarity coefficient and correlation coefficient ([Formula: see text]) are 62.30%, 96.90% for PDR, and 63.80%, 97.50% for DME, respectively. The proposed algorithm can provide clinicians with accurate quantitative information, such as the size and volume of the HFs. This can assist in clinical diagnosis, treatment, disease monitoring, and progression.

A Novel Nanoparticle Mediated Selective Inner Retinal Photocoagulation for Diseases of the Inner Retina

A novel nanoparticle mediated methodology for laser photocoagulation of the inner retina to achieve tissue selective treatment is presented.

METHODS

Transport of 527, 577, and 810 nm laser, heat deposition, and eventual thermal damage in vitreous, retina, RPE, choroid, and sclera were modeled using Bouguer-Beer-Lambert law of absorption and solved numerically using the finite volume method. Nanoparticles were designed using Mie theory of scattering. Performance of the new photocoagulation strategy using gold nanospheres and gold-silica nanoshells was compared with that of conventional methods without nanoparticles. For experimental validation, vitreous cavity of ex vivo porcine eyes was infused with gold nanospheres. After ~6 h of nanoparticle diffusion, the porcine retina was irradiated with a green laser and imaged simultaneously using a spectral domain optical coherence tomography (Spectralis SD-OCT, Heidelberg Engineering).

RESULTS

Our computational model predicted a significant spatial shift in the peak temperature from RPE to the inner retinal region when infused with nanoparticles. Arrhenius thermal damage in the mid-retinal location was achieved in ~14 ms for 527 nm laser thereby reducing the irradiation duration by ~30 ms compared with the treatment without nanoparticles. In ex vivo porcine eyes infused with gold nanospheres, SD-OCT retinal images revealed a lower thermal damage and expansion at RPE due to laser photocoagulation.

CONCLUSION

Nanoparticle infused laser photocoagulation strategy provided a selective inner retinal thermal damage with significant decrease in laser power and laser exposure time.

SIGNIFICANCE

The proposed treatment strategy shows possibilities for an efficient and highly selective inner retinal laser treatment.

Ocular parameters before and after steep Trendelenburg positioning for robotic-assisted laparoscopic radical prostatectomy

Purpose

Intraocular pressure (IOP) increases in patients in a steep Trendelenburg position during robotic-assisted laparoscopic radical prostatectomy (RALP). We hypothesized that a steep Trendelenburg position during RALP, an unusual systemic condition involving a transiently increased IOP, may induce ocular pathology that can be detected by detailed evaluations long after the surgery. This study aims to explore ocular structural and functional parameters in patients before and in the long term after the surgery.

Patients and methods

A comparative observational study was performed. A total of 44 eyes of 22 male patients scheduled for RALP at Aichi Medical University from August 2012 to July 2013 were included. Clinical parameters before and after RALP were compared. Perioperative IOP was measured immediately post-induction of anesthesia in the flat supine position (T1), immediately post-steep Trendelenburg position (T2), and prior to returning to a flat supine position while in a steep Trendelenburg position (T3). The thicknesses of the peripapillary retinal nerve fiber layer, ganglion cell complex (GCC), and central fovea were measured with spectral domain optical coherence tomography. Humphrey perimetry was performed before and at 3 and 6 months after surgery.

Results

The average IOPs (mmHg) at each stage were T1=10.4, T2=21.7, and T3=29.6, and differed significantly. The mean visual acuity (logarithm of the minimal angle of resolution), IOP, mean deviation, and pattern standard deviation measured by the Humphrey field analyzer showed no statistically significant difference before and after surgery. The ganglion cell complex and retinal nerve fiber layer thicknesses measured at each location and the central fovea thicknesses measured before and after surgery did not differ significantly.

Conclusion

No significant disorders in ocular structural and functional parameters were found until long after RALP.

Peripapillary sparing in RDH12-associated Leber congenital amaurosis

BACKGROUND

Peripapillary sparing is a characteristic that is traditionally described as pathognomonic for Stargardt disease.

MATERIALS AND METHODS

We present a multimodal assessment of four Leber congenital amaurosis (LCA) cases with congenital macular atrophy and severely attenuated electroretinogram findings caused by bilallelic mutations in RDH12.

RESULTS

Fundus autofluorescence imaging revealed a general loss of retinal pigment epithelium across the macula except for the peripapillary region in both eyes of all patients. Spectral domain-optical coherence tomography confirmed relative preservation in this area along with retinal thinning and excavation throughout the rest of the macula. LCA was diagnosed based on clinical exam and retinal imaging, and subsequently confirmed with genetic testing.

CONCLUSIONS

Peripapillary sparing is a novel phenotypic feature of RDH12-associated LCA.

Spectral Domain Optical Coherence Tomography: An In Vivo Imaging Protocol for Assessing Retinal Morphology in Adult Zebrafish

The present study outlines a protocol for examining retinal structure in zebrafish, a popular model organism for ocular studies, using spectral domain optical coherence tomography (SD-OCT). We demonstrate how this live imaging modality can be used to obtain high quality images of several retinal features, including the optic nerve, retinal vasculature, and the cone photoreceptor mosaic. Retinal histology sections were obtained from imaged fish for comparison with SD-OCT cross-sectional B-scans. Voronoi domain analysis was used to assess cone photoreceptor packing regularity at 3, 6, and 12 months. SD-OCT is an effective in vivo technique for studying the adult zebrafish retina and can be applied to disease models for longitudinal serial monitoring.

Nerve Fiber Layer Thickness and Characteristics Associated with Glaucoma in Community Living Older Adults: Prelude to a Screening Trial?

PURPOSE

To examine the associations of nerve fiber layer (NFL) thickness with other ocular characteristics in older adults.

METHODS

Participants in the Beaver Dam Eye Study (2008-2010) underwent spectral domain optical coherence tomography (SD-OCT) scans of the optic nerve head, imaging of optic discs, frequency doubling technology (FDT) perimetry, measurement of intraocular pressure (IOP), and an interview concerning their history of glaucoma and use of drops to lower eye pressure. Self-reported histories of glaucoma and the use of drops to lower eye pressure were obtained at follow-up examinations (2014-2016).

RESULTS

NFL thickness measured on OCTs varied by location around the optic nerve. Age was associated with mean NFL thickness. Mean NFL was thinnest in eyes with larger cup/disc (C/D) ratios. Horizontal hemifield defects or other optic nerve-field defects were associated with thinner NFL. NFL in persons who reported taking eye drops for high intraocular pressure was thinner compared to those not taking drops. After accounting for the presence of high intraocular pressure, large C/D ratios or hemifield defects, eyes with thinner NFL in the arcades were more likely (OR = 2.3 for 30 micron thinner NFL, p = 0.04) to have incident glaucoma at examination 5 years later.

CONCLUSION

Retinal NFL thickness was associated with a new history of self-reported glaucoma 5 years later. A trial testing the usefulness of NFL as part of a screening battery for predicting glaucoma in those previously undiagnosed might lead to improved case finding and, ultimately, to diminishing the risk of visual field loss.

Assessment of ischemia in acute central retinal vein occlusion from inner retinal reflectivity on spectral domain optical coherence tomography

Purpose

To determine the relationship between different spectral domain optical coherence tomography (SD-OCT) signs of retinal ischemia in acute central retinal vein occlusion (CRVO) and whether they predict anterior segment neovascularization (ASNV).

Design

Retrospective, observational study.

Subjects

Thirty-nine consecutive patients with acute CRVO and 12 months of follow-up.

Methods

We graded baseline SD-OCTs for increased reflectivity of the inner retina, loss of definition of inner retinal layers, presence of a prominent middle-limiting membrane (p-MLM) sign, and presence of paracentral acute middle maculopathy (PAMM). Graders were masked with respect to all clinical information.

Results

The intraclass correlation coefficients (ICCs) of grading–regrading by graders 1 and 2 were 0.8104, 95% confidence interval (CI) (0.6686, 0.8956), and 0.7986, 95% CI (0.6475, 0.8892), respectively. The intragrader coefficients of repeatability (COR) for graders 1 and 2 were 0.94 and 0.92, respectively. The ICC of graders 1 compared with 2 was 0.8039, 95% CI (0.6544, 0.8916). The intergrader COR was 0.80. SD-OCT grades of baseline ischemia were not associated with baseline visual acuity (VA), central subfield mean thickness (CSMT), or relative afferent pupillary defect; 12-month VA, CSMT, change in VA, change in CSMT, number of antivascular endothelial growth factor injections or corticosteroid injections, or proportion of eyes developing ASNV. SD-OCT grades of ischemia did not correlate with the proportion of eyes having the p-MLM sign or PAMM. PAMM and p-MLM are milder signs of ischemia than increased reflectivity of the inner retinal layers. Eyes with PAMM can evolve, losing PAMM and gaining the p-MLM sign.

Conclusion

Grading of ischemia from SD-OCT in acute CRVO was repeatable within graders and reproducible across graders for the graders in this study. SD-OCT signs of ischemia are not correlated with each other and do not reliably predict subsequent ASNV. Close monitoring of eyes with acute CRVO continues to be the safest method to avoid missing ASNV and neovascular glaucoma.

Foveal Layer Morphology Detected on Spectral Domain Optical Coherence Tomography and its Correlation with Visual Acuity in Asian Indian Premature Infants in their First Year of Life

PURPOSE

To report foveal microanatomy imaged on handheld spectral domain optical coherence tomography (SDOCT) and correlate it with visual acuity in Asian Indian premature infants.

METHODS

A retrospective analysis of 32 Asian Indian premature infants, 10 with Type 2 retinopathy of prematurity (ROP), were imaged between 3 and 12 months of corrected postmenstrual age (PMA) on the handheld SDOCT (Envisu 2300, Bioptigen, DNC, USA). The foveal findings on these images were correlated with visual acuity measured using Teller acuity cards. The study cohort was divided into three groups based on the corrected age, 3-<6 months, 6-<9 months, and 9-12 months. SDOCT images of the foveal center were analyzed for inner retinal layer (IRL) persistence or fusion and presence of the external limiting membrane (ELM), inner segment-outer segment or the ellipsoid zone (EZ), and the outer segment-retinal pigment epithelium (OS-RPE) layers.

RESULTS

The mean visual acuity of the three groups was 1.60, 1.63, and 1.23 logMAR, respectively (p < 0.001). Visual acuity significantly correlated with all four layers (IRL fusion, ELM, EZ, and OS-RPE in the 3-<6-month group [p < 0.001], IRL fusion only in 6-<9-month group (p < 0.001), and IRL fusion and EZ in the 9-12-month group (p < 0.001 and p = 0.01, respectively).

CONCLUSIONS

The study provides insights into our understanding of a premature infant's foveal maturation in the first year. Inner retinal fusion or maturation is the most important event that correlates with better visual acuity throughout the first year. In addition, between 9 and 12 months PMA, the completion of the EZ at the foveal center positively influenced visual acuity. The presence of ROP did not influence development of the layers, but the sample size was small for subgroup analysis.

Why Poor Vision Despite an Attached Retina following Primary Vitrectomy in Egyptian Patients?

OBJECTIVE

To correlate findings on spectral domain optical coherence tomography (SD-OCT) and best-corrected visual acuity (BCVA) following primary vitrectomy for rhegmatogenous retinal detachment (RRD).

METHODS

In this prospective, interventional, non-randomized case series, 71 eyes with RRD of intermediate severity underwent primary vitrectomy followed by SD-OCT one month later. Main outcome measures were inner segment/outer segment (IS/OS) junction line and external limiting membrane (ELM) disruption.

RESULTS

All patients achieved reattachment with mean BCVA of 0.77 ± 0.36 logMAR. There was statistically significant correlation between each length of IS/OS and ELM defect on the one hand, and BCVA on the other hand.

CONCLUSION

The extent of IS/OS and ELM disruption explains the poor visual outcome in successful RD surgery with an otherwise normal foveal contour.

Surgical Treatment of Subretinal Fibrosis Caused Macular Detachment in Vogt-Koyanagi-Harada Disease: A Pioneer Study

PURPOSE

To describe surgical outcomes of macular detachment caused by subretinal fibrosis (SRF) in Vogt-Koyanagi-Harada disease (VKH).

METHODS

Retrospective review of VKH patients who underwent SRF removal surgery.

RESULTS

Seven eyes of six VKH patients with preoperative BCVA ranging from light perception to 20/250 were included. Six eyes underwent uncomplicated SRF removal with C3F8 or silicone oil (SO) tamponade and the following optional primary or subsequent procedures: intravitreal injection of triamcinolone acetonide, SO removal, lensectomy, or phacoemulsification with intraocular lens (IOL) implantation. All six eyes had attached macula and improved BCVA at the last visit (ranging from 20/2000 to 20/67) compared to baseline; the other eye, however, showed no light perception after surgery due to optic nerve injury.

CONCLUSIONS

In VKH patients, macular detachment caused by SRF can be treated with surgery with generally favorable outcomes. Extreme caution should be taken to avoid optic nerve injury.

Macular morphology and response to ranibizumab treatment in patients with wet age-related macular degeneration

PURPOSE

The purpose of this study was to assess whether specific characteristics of spectral domain optical coherence tomography (SD-OCT) affect structural and functional outcomes and number of injections needed in ranibizumab (0.05 mL of 10 mg/mL Lucentis solution)-treated wet age-related macular degeneration (AMD) patients.

PATIENTS AND METHODS

This retrospective case series included 62 newly diagnosed wet AMD patients treated with three monthly intravitreal ranibizumab injections followed by monthly follow-up and pro re nata retreatment. The presence of dome-shaped pigment epithelial detachment (PED), disruption of the retinal pigment epithelium (RPE), and subretinal and intraretinal fluid was associated with changes in Early Treatment of Diabetic Retinopathy Study visual acuity, central macular thickness (CMT), and number of injections needed during the 6-month follow-up.

RESULTS

The presence of PED was associated with lower values of CMT at presentation (399 μm [±132 μm] vs 310 μm [±51 μm], P=0.005). The presence of RPE disruption was associated with worse visual acuity in month 6 (0.36 [±0.22] vs 0.61 [0.45], P=0.027) and fewer injections (4.23 [±0.92] vs 3.55 [±0.60], P=0.007). The presence of intraretinal fluid at presentation was associated with worse visual acuity outcomes in month 4 (P=0.045) but not in month 6.

CONCLUSION

The dome-shaped PED was associated with lower CMT at presentation, but it did not affect response to treatment. RPE disruption was associated with worse functional outcomes with fewer injections. Intraretinal fluid at presentation may suggest delayed response to treatment. Individualized SD-OCT analysis could lead to individualized approach to wet AMD patients. SD-OCT can offer imaging biomarkers to assess the prognosis of anti-VEGF treatment in AMD patients.

What rates of glaucoma progression are clinically significant?

Clinically important rates of glaucoma progression (worsening) are ones that put a patient at risk of future functional impairment or reduction of vision-related quality of life. Rates of progression can be evaluated through measuring structural or functional changes of the optic nerve. Most treated eyes do not progress at rates that will lead to future visual impairment, but there are a significant proportion (3-17%) of eyes, that are at risk of impairment even under clinical care. While very fast rates of progression (e.g. MD progression of -1.5 dB/year) are generally problematic, much slower rates also may be deleterious for young patients, particularly those diagnosed with late disease. As a result, it is important to consider life expectancy, disease severity and vision-related quality of life based treatment targets to estimate future prognosis when evaluating whether a rate of glaucoma progression can be clinically relevant.

Quantitative spectral domain optical coherence tomography thickness parameters in type II diabetes

Purpose:

To elucidate the changes in retinal thickness and individual layer thickness in subjects with diabetic retinopathy (DR) using spectral domain optical coherence tomography (SDOCT).

Materials and Methods:

A total of 251 eyes from 170 subjects were included in this study. The study sample was subdivided into nondiabetic subjects; subjects with diabetes but no DR; subjects with mild, moderate, and severe nonproliferative DR (NPDR); and proliferative DR. Various retinal thickness parameters were assessed using SDOCT.

Results:

The mean age of the study population was 55.34 ± 9.02 years (range: 32–80 years) and 56.6% of the subjects were males. Men had significantly greater central foveal thickness, central subfield thickness, retinal nerve fiber layer thickness, and retinal thickness in all the quadrants of 3 mm and 6 mm zones compared to women (P < 0.001). Superior (293.11 ± 25.46 vs. 285.25 ± 19.17; P = 0.044) and temporal (282.10 ± 25.26 vs. 272.46 ± 16.21; P = 0.011) quadrants showed an increased retinal thickness in any DR group when compared with diabetic subjects without DR. Photoreceptor layer thickness was significantly reduced in diabetic subjects with no DR when compared with nondiabetic subjects and also in cases of severe NPDR when compared with mild and moderate NPDR.

Conclusion:

Here, we analyze the quantitative retinal thickness parameters in diabetic subjects using SDOCT. Neuronal degenerative changes such as photoreceptor and retinal pigment epithelial thinning in case of DR are also reported.

Correlation of spectral domain optical coherence tomography findings in sub-silicone oil foveal depression space and visual outcome in eyes undergoing silicone oil removal

Background/Purpose:

To describe small hyper-reflective spherical bodies in sub-silicone oil-foveal depression (SSO-FD) space using spectral domain optical coherence tomography (SD-OCT) and its effect on visual outcomes in eyes undergoing silicone oil removal (SOR).

Methods:

This was a prospective interventional comparative study comprising 42 eyes undergoing SOR with clear media. All patients underwent detailed clinical examination and SD-OCT scan of fovea pre-operatively and at 30 days and 90 days postoperatively. Patients were divided into Group A (n = 21) and Group B (n = 21) depending on presence or absence, respectively, of small hyper-reflective spherical bodies in the SSO-FD space in preoperative scans. The findings between SD-OCT and best-corrected visual acuity were correlated and analyzed.

Results:

The mean age of patients was 41.9 years (range, 23–60 years) in Group A and 45.6 years (range, 23–60 years) in Group B. Twenty-one eyes showed small hyper-reflective spherical bodies on SD-OCT imaging. These were thought to represent emulsified silicone oil globules trapped in the potential space created by silicone oil meniscus and foveal pit, which is the SSO-FD space. These bodies were absent in all post SOR scans of Group A and Group B. Group A had significant visual improvement (p = 0.0001) after SOR with clearance of these hyper-reflective bodies as compared to Group B(p = 0.356).

Conclusion:

We conclude that these small hyper-reflective spherical bodies in the SSO-FD space were most likely emulsified silicone oil globules and correlated with significant visual improvement with their clearance after silicone oil removal.

Relapse of choroidal neovascularization in Bietti's crystalline retinopathy following anti-vascular endothelial growth factor therapy: A case report

Choroidal neovascularization secondary to retinitis pigmentosa is rarely observed in clinical practice. The present study describes a case of atypical retinitis pigmentosa, crystalline retinal pigmentary degeneration, complicated by choroidal neovascularization (CNV) in a 26-year-old man presenting with blurred vision in the right eye. Heidelberg multimodality imaging was performed to achieve a confirmed diagnosis. Bevacizumab was injected once intravitreally. The 3-month follow-up included visualization of the lesion's regression with spectral domain optical coherence tomography (SD-OCT). However, at 3 months after the injection, the CNV reoccurred. To the best of our knowledge, this is the first time that a case of CNV secondary to retinitis pigmentosa, in which the diagnosis was confirmed via multimodality imaging and the therapeutic efficacy was evaluated by SD-OCT, has been reported in China.

Morphological and functional outcomes following modified early treatment diabetic retinopathy study laser in diabetic macular edema

Aim:

The aim was to report morphological and functional outcomes following modified early treatment diabetic retinopathy study (ETDRS) laser in diabetic macular edema (DME).

Materials and Methods:

Structural and functional changes using spectral domain optical coherence tomography (OCT) and microperimetry (MP) were studied before and 4 months after laser in 37 eyes with clinically significant macular edema (ME) requiring modified ETDRS laser treatment. Paired t-test was used to compare pre and postlaser outcomes P < 0.05 was considered statistically significant.

Results:

Central foveal thickness showed a significant reduction after laser P = 0.004. There was a significant reduction in mean retinal thickness (MRT) and retinal volume in all the quadrants of ETDRS except for the temporal and nasal quadrants in outer 6 mm ring. Maximum reduction in MRT was seen in eyes with DME having neurosensory detachment (382.66 μ to 292.61 μ). Retinal sensitivities reduced in all quadrants following laser, however, fixation patterns showed improvements. The change in VA was positively correlated to change in MRT (r = 0.468, P = 0.032).

Conclusion:

Laser not only causes structural benefits such as reduction of retinal thickness and volume, it also causes improvement of fixation patterns.

The hyper-fluorescent transitional bands in ultra-late phase of indocyanine green angiography in chronic central serous chorioretinopathy

BACKGROUND AND OBJECTIVES

Chronic central serous chorioretinopathy (CSCR) is regarded as a type of severe diffuse retinal pigment epitheliopathy. There is an atrophic tract at level of retinal pigment epithelium (RPE) due to hyper-permeability of choroidal vessels, along with photoreceptor (PR) atrophy. Indocyanine green angiography (ICGA) is considered a gold standard for diagnosis. The purpose of this work is to investigate the hyper-fluorescent transitional bands (HFTB) between hypo-fluorescent and normal regions of the retina in the ultra-late phase of ICGA in CSCR.

METHODS

26 chronic CSCR eyes and 12 relative normal eyes received spectral domain optical coherence tomography (SD-OCT), and ICGA at the 24th hour after indocyanine green (ICG) intravenous injection.

RESULTS

In the ultra-late phase, images showed homogenous fluorescence in all normal eyes. On the contrary, geographical hypofluorescent lesions with atrophy of RPE was noted in 26 chronic CSCR eyes. Moreover, HFTB with intact RPE and disrupted PR was detected in 20 out of 26 chronic CSCR eyes (76.9%).

CONCLUSIONS

The HFTB may indicate the early damage in chronic CSCR. Ultra-late ICGA can monitor not only metabolic status by endogenous melanin, but also membrane function in RPE by exogenous ICG molecule.

Restricted Summed-Area Projection for Geographic Atrophy Visualization in SD-OCT Images

PURPOSE

To enhance the rapid assessment of geographic atrophy (GA) across the macula in a single projection image generated from three-dimensional (3D) spectral-domain optical coherence tomography (SD-OCT) scans by introducing a novel restricted summed-area projection (RSAP) technique.

METHODS

We describe a novel en face GA visualization technique, the RSAP, by restricting the axial projection of SD-OCT images to the regions beneath the Bruch's membrane (BM) boundary and also considering the choroidal vasculature's influence on GA visualization. The technique analyzes the intensity distribution beneath the retinal pigment epithelium (RPE) layer to fit a cross-sectional surface in the sub-RPE region. The area is taken as the primary GA projection. A median filter is then adopted to smooth the generated GA projection image. The RSAP technique was evaluated in 99 3D SD-OCT data sets from 27 eyes of 21 patients presenting with advanced nonexudative age-related macular degeneration and GA. We used the mean difference between GA and background regions and GA separability metric to measure GA contrast and distinction in the generated images, respectively. We compared our results with two existing GA projection techniques, the summed-voxel projection (SVP) and Sub-RPE Slab techniques.

RESULTS

Comparative results demonstrate that the RSAP technique is more effective in displaying GA than the SVP and Sub-RPE Slab. The average of the mean difference between GA and background regions and the GA separability based on SVP, Sub-RPE Slab, and RSAP were 0.129/0.880, 0.238/0.919, and 0.276/0.938, respectively.

CONCLUSIONS

The RSAP technique was more effective for GA visualization than the conventional SVP and Sub-RPE Slab techniques. Our technique decreases choroidal vasculature influence on GA projection images by analyzing the intensity distribution characteristics in sub-RPE regions. The generated GA projection image with the RSAP technique has improved contrast and distinction.

TRANSLATIONAL RELEVANCE

Our method for automated generation of GA projection images from SD-OCT images may improve the visualization of the macular abnormalities and the management of GA.

Nitric oxide and oxidative stress is associated with severity of diabetic retinopathy and retinal structural alterations

BACKGROUND

The aim of the study was to determine plasma nitric oxide (NO) and lipid peroxide (LPO) levels in diabetic retinopathy and its association with severity of disease.

DESIGN

Prospective observational study.

PARTICIPANTS

A total of 60 consecutive cases and 20 healthy controls were included.

METHODS

Severity of retinopathy was graded according to early treatment diabetic retinopathy study (ETDRS) classification. Photoreceptor inner segment ellipsoid band (ISel) disruption and retinal pigment epithelium (RPE) alteration were graded using spectral domain optical coherence tomography. Data were statistically analyzed.

MAIN OUTCOME MEASURES

Plasma thiobarbituric acid reactive substances, NO assay and reduced glutathione (GSH) were measured using standard protocol.

RESULTS

Increased severity of diabetic retinopathy was significantly associated with increase in plasma levels of LPO (P < 0.05), NO (P < 0.001) and decrease in plasma levels of GSH (P < 0.0001), ISel disruption (P < 0.001) and RPE topographic alteration (P < 0.01).

CONCLUSION

Increased plasma NO levels are associated with increased severity of diabetic retinopathy. For the first time, it has been demonstrated that increased plasma LPO, NO and decreased GSH levels are associated with in vivo structural changes in inner segment ellipsoid and RPE.

The Use of Spectral-Domain Optical Coherence Tomography to Detect Glaucoma Progression

Detection of progression and measurement of rates of change is at the core of glaucoma management, and the use of Spectral Domain Optical Coherence Tomography (SD-OCT) has significantly improved our ability to evaluate change in the disease. In this review, we critically assess the existing literature on the use of SD-OCT for detecting glaucoma progression and estimating rates of change. We discuss aspects related to the reproducibility of measurements, their accuracy to detect longitudinal change over time, and the effect of aging on the ability to detect progression. In addition, we discuss recent studies evaluating the use of combined structure and function approaches to improve detection of glaucoma progression.

Multifunctional 1050 nm Spectral Domain OCT System at 147 kHz for Posterior Eye Imaging

We report a newly developed multifunctional 1050 nm spectral domain optical coherence tomography (SD-OCT) system working at 147 kHz A-scan rate for posterior eye imaging. It is demonstrated through in-vivo experiments that this system delivers not only superior performance of posterior eye structural imaging but also detailed visualization of microcirculation network in retina. The choroid of the eye with either myopic or normal conditions can clearly be visualized through the entire scanning volume. These results indicate great potential in applying this new system for clinical studies.

Spectral domain optical coherence tomography cross-sectional image of optic nerve head during intraocular pressure elevation

AIM

To analyze changes of the optic nerve head (ONH) and peripapillary region during intraocular pressure (IOP) elevation in patients using spectral domain optical coherence tomography (SD-OCT).

METHODS

Both an optic disc 200×200 cube scan and a high-definition 5-line raster scan were obtained from open angle glaucoma patients presented with monocular elevation of IOP (≥30 mm Hg) using SD-OCT. Additional baseline characteristics included age, gender, diagnosis, best-corrected visual acuity, refractive error, findings of slit lamp biomicroscopy, findings of dilated stereoscopic examination of the ONH and fundus, IOP, pachymetry findings, and the results of visual field.

RESULTS

The 24 patients were selected and divided into two groups: group 1 patients had no history of IOP elevation or glaucoma (n=14), and group 2 patients did have history of IOP elevation or glaucoma (n=10). In each patient, the study eye with elevated IOP was classified into group H (high), and the fellow eye was classified into group L (low). The mean deviation (MD) differed significantly between groups H and L when all eyes were considered (P=0.047) and in group 2 (P=0.042), not in group 1 (P=0.893). Retinal nerve fiber layer (RNFL) average thickness (P=0.050), rim area (P=0.015), vertical cup/disc ratio (P=0.011), cup volume (P=0.028), inferior quadrant RNFL thickness (P=0.017), and clock-hour (1, 5, and 6) RNFL thicknesses (P=0.050, 0.012, and 0.018, respectively), cup depth (P=0.008), central prelaminar layer thickness (P=0.023), mid-inferior prelaminar layer thickness (P=0.023), and nasal retinal slope (P=0.034) were significantly different between the eyes with groups H and L.

CONCLUSION

RNFL average thickness, rim area, vertical cup/disc ratio, cup volume, inferior quadrant RNFL thickness, and clock-hour (1, 5, and 6) RNFL thicknesses significantly changed during acute IOP elevation.

Photoreceptor inner segment ellipsoid band integrity on spectral domain optical coherence tomography

Spectral domain optical coherence tomography cross-sectional imaging of the macula has conventionally been resolved into four bands. However, some doubts were raised regarding authentication of the existence of these bands. Recently, a number of studies have suggested that the second band appeared to originate from the inner segment ellipsoids of the foveal cone photoreceptors, and therefore the previously called inner segment-outer segment junction is now referred to as inner segment ellipsoidband. Photoreceptor dysfunction may be a significant predictor of visual acuity in a spectrum of surgical and medical retinal diseases. This review aims to provide an overview and summarizes the role of the photoreceptor inner segment ellipsoid band in the management and prognostication of various vitreoretinal diseases.

Clinical application of optical coherence tomography in combination with functional diagnostics: advantages and limitations for diagnosis and assessment of therapy outcome in central serous chorioretinopathy

Purpose

While identifying functional and structural parameters of the retina in central serous chorioretinopathy (CSCR) patients, this study investigated how an optical coherence tomography (OCT)-based diagnosis can be significantly supplemented with functional diagnostic tools and to what degree the determination of disease severity and therapy outcome can benefit from diagnostics complementary to OCT.

Methods

CSCR patients were evaluated prospectively with microperimetry (MP) and spectral domain optical coherence tomography (SD-OCT) to determine retinal sensitivity function and retinal thickness as outcome measures along with measures of visual acuity (VA). Patients received clinical care that involved focal laser photocoagulation or pharmacotherapy targeting inflammation and neovascularization.

Results

Correlation of clinical parameters with a focus on functional parameters, VA, and mean retinal sensitivity, as well as on the structural parameter mean retinal thickness, showed that functional measures were similar in diagnostic power. A moderate correlation was found between OCT data and the standard functional assessment of VA; however, a strong correlation between OCT and MP data showed that diagnostic measures cannot always be used interchangeably, but that complementary use is of higher clinical value.

Conclusion

The study indicates that integrating SD-OCT with MP provides a more complete diagnosis with high clinical relevance for complex, difficult to quantify diseases such as CSCR.

Spectral domain optical coherence tomography characteristics in diabetic retinopathy

Purpose:

To report the appearance of diabetic retinopathy lesions using spectral domain optical coherence tomography (SD-OCT).

Materials and Methods:

A total of 287 eyes of 199 subjects were included. All the subjects underwent complete ophthalmic examination including SD-OCT.

Results:

The appearance of various lesions of diabetic retinopathy and the retinal layers involved were reported. In subjects with macular edema the prevalence of incomplete PVD was 55.6%.

Conclusion:

SD-OCT brings new insights into the morphological changes of the retina in diabetic retinopathy.

Asymmetrical behaviour of disappearance of reticular pseudodrusen in both eyes during long-term follow-up with spectral domain optical coherence tomography

Objective: To describe asymmetrical disappearance of reticular pseudodrusen (RPD) in patients with age-related macular degeneration (AMD).

Methods: SDOCTs and infrared images of four patients with RPD were retrospectively collected and evaluated during long-term follow-up of up to 47 months (range 35–47 months).

Results: Unilateral fading of RPD was detected on SDOCTs and infrared images in eyes with and without choroidal neovascularisation (CNV) and intravitreal injections. Presence of RPD in the fellow eyes remained stable in three cases, in one case very few RPD newly developed. Three of the four cases demonstrated unilateral outer retinal atrophy following regression of RPD.

Conclusions: This report highlights that RPD may almost completely disappear after occurrence and treatment of CNV in neovascular AMD, but also in dry AMD without any treatment and that this phenomenon may be unilateral.

Varicella Zoster-related Occlusive Retinal Vasculopathy--A Rare Presentation

PURPOSE

To report a case of occlusive retinal vasculopathy following varicella zoster infection in an immunocompetent adult.

DESIGN

Observational case report.

METHODS

A patient with defective vision following chickenpox was evaluated with fluorescein angiography, spectral domain optical coherence tomography and fundus auto fluorescence.

RESULTS

Fundus showed multiple cotton wool spots and a well-demarcated zone of retinal ischemia in the posterior pole with normal optic disc without any evidence of anterior or posterior uveitis. Fluorescein angiography, spectral domain optical coherence tomography and fundus auto fluorescence findings revealed occlusive vasculopathy as the cause of defective vision.

CONCLUSIONS

We report a hitherto undescribed case of purely occlusive vasculopathy following varicella zoster infection without features of vasculitis or anterior and posterior uveitis in an immunocompetent individual.

Relative sensitivity and specificity of 10-2 visual fields, multifocal electroretinography, and spectral domain optical coherence tomography in detecting hydroxychloroquine and chloroquine retinopathy

BACKGROUND

The purpose of this study was to determine the relative sensitivity and specificity of 10-2 visual fields (10-2 VFs), multifocal electroretinography (mfERG), and spectral domain optical coherence tomography (SD-OCT) in detecting hydroxychloroquine retinopathy.

METHODS

A total of 121 patients taking hydroxychloroquine (n=119) or chloroquine (n=2) with 10-2 VF, mfERG, and SD-OCT tests were retrospectively reviewed. Rates of test abnormality were determined.

RESULTS

Retinopathy was present in 14 and absent in 107. Eleven of 14 (78.6%) patients with retinopathy were overdosed. Twelve (85.7%) had cumulative dosing greater than 1,000 g. The sensitivities of 10-2 VF, mfERG, and SD-OCT in detecting retinopathy were 85.7%, 92.9%, and 78.6%, respectively. The specificities of 10-2 VF, mfERG, and SD-OCT in detecting retinopathy were 92.5%, 86.9%, and 98.1%, respectively. Positive predictive values of 10-2 VF, mfERG, and SD-OCT in detecting retinopathy were less than 30% for all estimates of hydroxychloroquine retinopathy prevalence. Negative predictive values were >99% for all tests.

CONCLUSION

Based on published estimates of hydroxychloroquine retinopathy prevalence, all three tests are most reliable when negative, allowing confident exclusion of retinopathy in patients taking ≤6.5 mg/kg/day. Each test is less useful in allowing a confident diagnosis of retinopathy when positive, especially in patients taking ≤6.5 mg/kg/day.

Deferoxamine retinopathy: spectral domain-optical coherence tomography findings

BACKGROUND

To describe the spectral domain optical coherence tomography (SD-OCT) findings of a patient who developed pigmentary retinopathy following high-dose deferoxamine administration.

CASE PRESENTATION

A 34-year-old man with thalassemia major complained of nyctalopia and decreased vision following high-dose intravenous deferoxamine to treat systemic iron overload. Fundus examination revealed multiple discrete hypo-pigmented lesions at the posterior pole and mid-peripheral retina. Recovery was partial following cessation of desferrioxamine six weeks later. A follow-up SD-OCT showed multiple accumulated hyper-reflective deposits primarily in the choroid, retina pigment epithelium (RPE), and inner segment and outer segment (IS/OS) junction.

CONCLUSION

Deferoxamine retinopathy primarily targets the RPE-Bruch membrane-photoreceptor complex, extending from the peri-fovea to the peripheral retina with foveola sparing. An SD-OCT examination can serve as a simple, noninvasive tool for early detection and long-term follow-up.