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Nioi M, Napoli PE, Demontis R, Locci E, Fossarello M, d’Aloja E. Postmortem Ocular Findings in the Optical Coherence Tomography Era: A Proof of Concept Study Based on Six Forensic Cases. Diagnostics (Basel) 2021; 11:413. [PMID: 33670928 PMCID: PMC7997319 DOI: 10.3390/diagnostics11030413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 12/14/2022] Open
Abstract
Postmortem analysis of the ocular globe is an important topic for forensic pathology and transplantology. Although crucial elements may be gathered from examining cadaveric eyes, the latter do not routinely undergo in-depth analysis. The paucity of quantitative and objective data that are obtainable using current, invasive necroscopic techniques is the main reason for the limited interest in this highly specialized procedure. The aim of the current study is to describe and to object for the first time the postmortem ocular changes by mean of portable optical coherence tomography for evaluating ocular tissues postmortem. The design involved the postmortem analysis (in situ, and without enucleation) of 12 eyes by portable spectral-domain Optical Coherence Tomography. The scans were performed, in corneal, retinal and angle modality at different intervals: <6 h, 6th, 12th, and 24th hour and after autopsy (25th-72nd hour). The morphological changes in the cornea, sclera, vitreous humor and aqueous humor were easy to explore and objectify in these tissues in first 72 h postmortem. On the other hand, the "in situ" observation of the retina was difficult due to the opacification of the lenses in the first 24 h after death.
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Affiliation(s)
- Matteo Nioi
- Forensic Medicine Unit, Department of Clinical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (R.D.); (E.L.); (E.d.)
| | - Pietro Emanuele Napoli
- Eye Clinic, Department of Surgical Science, University of Cagliari, 09124 Cagliari, Italy; (P.E.N.); (M.F.)
| | - Roberto Demontis
- Forensic Medicine Unit, Department of Clinical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (R.D.); (E.L.); (E.d.)
| | - Emanuela Locci
- Forensic Medicine Unit, Department of Clinical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (R.D.); (E.L.); (E.d.)
| | - Maurizio Fossarello
- Eye Clinic, Department of Surgical Science, University of Cagliari, 09124 Cagliari, Italy; (P.E.N.); (M.F.)
| | - Ernesto d’Aloja
- Forensic Medicine Unit, Department of Clinical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (R.D.); (E.L.); (E.d.)
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OPTICAL COHERENCE TOMOGRAPHY AND HISTOLOGY OF AGE-RELATED MACULAR DEGENERATION SUPPORT MITOCHONDRIA AS REFLECTIVITY SOURCES. Retina 2018; 38:445-461. [PMID: 29210936 DOI: 10.1097/iae.0000000000001946] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Widespread adoption of optical coherence tomography has revolutionized the diagnosis and management of retinal disease. If the cellular and subcellular sources of reflectivity in optical coherence tomography can be identified, the value of this technology will be advanced even further toward precision medicine, mechanistic thinking, and molecular discovery. Four hyperreflective outer retinal bands are created by the exquisite arrangement of photoreceptors, Müller cells, retinal pigment epithelium, and Bruch membrane. Because of massed effects of these axially compartmentalized and transversely aligned cells, reflectivity can be localized to the subcellular level. This review focuses on the second of the four bands, called ellipsoid zone in a consensus clinical lexicon, with the central thesis that mitochondria in photoreceptor inner segments are a major independent reflectivity source in this band, because of Mie scattering and waveguiding. METHODS We review the evolution of Band 2 nomenclature in published literature and discuss the origins of imaging signals from photoreceptor mitochondria that could make these organelles visible in vivo. RESULTS Our recent data pertain to outer retinal tubulation, a unique neurodegenerative and gliotic structure with a highly reflective border, prominent in late age-related macular degeneration. High-resolution histology and multimodal imaging of outer retinal tubulation together provide evidence that inner segment mitochondria undergoing fission and translocation toward the nucleus provide the reflectivity signal. CONCLUSION Our data support adoption of the ellipsoid zone nomenclature. Identifying subcellular signal sources will newly inform clinical.
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Curcio CA, Zanzottera EC, Ach T, Balaratnasingam C, Freund KB. Activated Retinal Pigment Epithelium, an Optical Coherence Tomography Biomarker for Progression in Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2017; 58:BIO211-BIO226. [PMID: 28785769 PMCID: PMC5557213 DOI: 10.1167/iovs.17-21872] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose To summarize and contextualize recent histology and clinical imaging publications on retinal pigment epithelium (RPE) fate in advanced age-related macular degeneration (AMD); to support RPE activation and migration as important precursors to atrophy, manifest as intraretinal hyperreflective foci in spectral-domain optical coherence tomography (SDOCT). Methods The Project MACULA online resource for AMD histopathology was surveyed systematically to form a catalog of 15 phenotypes of RPE and RPE-derived cells and layer thicknesses in advanced disease. Phenotypes were also sought in correlations with clinical longitudinal eye-tracked SDOCT and with ex vivo imaging–histopathology correlations in geographic atrophy (GA) and pigment epithelium detachments (PED). Results The morphology catalog suggested two main pathways of RPE fate: basolateral shedding of intracellular organelles (apparent apoptosis in situ) and activation with anterior migration. Acquired vitelliform lesions may represent a third pathway. Migrated cells are packed with RPE organelles and confirmed as hyperreflective on SDOCT. RPE layer thickening due to cellular dysmorphia and thick basal laminar deposit is observed near the border of GA. Drusenoid PED show a life cycle of slow growth and rapid collapse preceded by RPE layer disruption and anterior migration. Conclusions RPE activation and migration comprise an important precursor to atrophy that can be observed at the cellular level in vivo via validated SDOCT. Collapse of large drusen and drusenoid PED appears to occur when RPE death and migration prevent continued production of druse components. Data implicate excessive diffusion distance from choriocapillaris in RPE death as well as support a potential benefit in targeting drusen in GA.
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Affiliation(s)
- Christine A Curcio
- Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, Alabama, United States
| | - Emma C Zanzottera
- Eye Clinic, Department of Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan, Milan, Italy
| | - Thomas Ach
- University Hospital Würzburg, Department of Ophthalmology, Würzburg, Germany
| | - Chandrakumar Balaratnasingam
- Center for Ophthalmology and Visual Sciences, Lions Eye Institute, University of Western Australia, Perth, Australia.,Sir Charles Gairdner Hospital, Perth, Australia
| | - K Bailey Freund
- Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, Alabama, United States.,Eye Clinic, Department of Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan, Milan, Italy.,University Hospital Würzburg, Department of Ophthalmology, Würzburg, Germany.,Center for Ophthalmology and Visual Sciences, Lions Eye Institute, University of Western Australia, Perth, Australia.,Sir Charles Gairdner Hospital, Perth, Australia.,Vitreous Retina Macula Consultants of New York, New York, New York, United States.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Institute, New York, New York, United States.,Department of Ophthalmology, New York University Langone School of Medicine, New York, New York, United States
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Vajzovic L, Hendrickson AE, O'Connell RV, Clark LA, Tran-Viet D, Possin D, Chiu SJ, Farsiu S, Toth CA. Maturation of the human fovea: correlation of spectral-domain optical coherence tomography findings with histology. Am J Ophthalmol 2012; 154:779-789.e2. [PMID: 22898189 DOI: 10.1016/j.ajo.2012.05.004] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 05/03/2012] [Accepted: 05/08/2012] [Indexed: 12/16/2022]
Abstract
PURPOSE To correlate human foveal development visualized by spectral-domain optical coherence tomography (SDOCT) with histologic specimens. DESIGN Retrospective, observational case series. METHODS Morphology and layer thickness of retinal SDOCT images from 1 eye each of 22 premature infants, 30 term infants, 16 children, and 1 adult without macular disease were compared to light microscopic histology from comparable ages. RESULTS SDOCT images correlate with major histologic findings at all time points. With both methods, preterm infants demonstrate a shallow foveal pit indenting inner retinal layers (IRL) and short, undeveloped foveal photoreceptors. At term, further IRL displacement forms the pit and peripheral photoreceptors lengthen; the elongation of inner and outer segments (IS and OS, histology) separates the IS band from retinal pigment epithelium. Foveal IS and OS are shorter than peripheral for weeks after birth (both methods). By 13 months, foveal cone cell bodies stack >6 deep, Henle fiber layer (HFL) thickens, and IS/OS length equals peripheral; on SDOCT, foveal outer nuclear layer (which includes HFL) and IS/OS thickens. At 13 to 16 years, the fovea is fully developed with a full complement of SDOCT bands; cone cell bodies >10 deep have thin, elongated, and tightly packed IS/OS. CONCLUSIONS We define anatomic correlates to SDOCT images from normal prenatal and postnatal human fovea. OCT bands typical of photoreceptors of the adult fovea are absent near birth because of the immaturity of foveal cones, develop by 24 months, and mature into childhood. This validates the source of SDOCT signal and provides a framework to assess foveal development and disease.
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Affiliation(s)
- Lejla Vajzovic
- Department of Ophthalmology, Duke University Eye Center, Durham, NC 27710, USA
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Curcio CA, Messinger JD, Sloan KR, Mitra A, McGwin G, Spaide RF. Human chorioretinal layer thicknesses measured in macula-wide, high-resolution histologic sections. Invest Ophthalmol Vis Sci 2011; 52:3943-54. [PMID: 21421869 PMCID: PMC3175964 DOI: 10.1167/iovs.10-6377] [Citation(s) in RCA: 171] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 12/05/2010] [Accepted: 02/02/2011] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To provide a comprehensive description of chorioretinal layer thicknesses in the normal human macula, including two-layer pairs that can produce a combined signal in some optical coherence tomography (OCT) devices (ganglion cell [GCL] and inner plexiform [IPL] layers and outer plexiform [OPL] and outer nuclear [ONL] layers). METHODS In 0.8-μm-thick, macula-wide sections through the foveola of 18 donors (age range, 40-92 years), 21 layers were measured at 25 locations by a trained observer and validated by a second observer. Tissue volume changes were assessed by comparing total retinal thickness in ex vivo OCT and in sections. RESULTS Median tissue shrinkage was 14.5% overall and 29% in the fovea. Histologic laminar boundaries resembled those in SD-OCT scans, but the shapes of the foveolar OPL and ONL differed. Histologic GCL, IPL, and OPLHenle were thickest at 0.8. to 1, 1.5, and 0.4 mm eccentricity, respectively. ONL was thickest in an inward bulge at the foveal center. At 1 mm eccentricity, GCL, INL, and OPLHenle represented 17.3% to 21.1%, 18.0% to 18.5%, and 14.2% to 16.6% of total retinal thickness, respectively. In donors ≥ 70 years of age, the RPE and choroid were 17.1% and 29.6% thinner and OPLHenle was 20.8% thicker than in donors <70 years. CONCLUSIONS In this study, the first graphic representation and thickness database of chorioretinal layers in normal macula were generated. Newer OCT systems can separate GCL from IPL and OPLHenle from ONL, with good agreement for the proportion of retinal thickness occupied by OPLHenle in OCT and histology. The thickening of OPLHenle in older eyes may reflect Müller cell hypertrophy associated with rod loss.
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Affiliation(s)
- Christine A Curcio
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama 35294-0019, USA.
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Boon CJ, Klevering BJ, Cremers FP, Zonneveld-Vrieling MN, Theelen T, Den Hollander AI, Hoyng CB. Central Areolar Choroidal Dystrophy. Ophthalmology 2009; 116:771-82, 782.e1. [PMID: 19243827 DOI: 10.1016/j.ophtha.2008.12.019] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Revised: 09/23/2008] [Accepted: 12/04/2008] [Indexed: 10/21/2022] Open
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Brown NH, Koreishi AF, McCall M, Izatt JA, Rickman CB, Toth CA. Developing SDOCT to assess donor human eyes prior to tissue sectioning for research. Graefes Arch Clin Exp Ophthalmol 2009; 247:1069-80. [PMID: 19225801 DOI: 10.1007/s00417-009-1044-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 01/06/2009] [Accepted: 01/12/2009] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND To compare spectral domain optical coherence tomography (SDOCT) cross-sectional images of human central retina obtained from donor eyes with and without age-related macular degeneration (AMD) to corresponding histopathology from light micrographs. To establish the utility of SDOCT for localizing pathology in the posterior eyecup, for identifying ocular disease in donor eyes, or for directing subsequent sectioning of retinal lesions for research. METHODS Seven consecutive human donor eyes were selected based on age. The eyes, with the anterior segment removed, were imaged by SDOCT with a focusing aspheric lens. Four eyes were from donors with a clinical history of AMD, and three were from age-matched donors with no history of AMD. Histopathological correlation of morphological changes detected in three eyes by SDOCT was obtained for comparison to step serial-sectioned light microscopy images of the formalin-fixed, paraffin-embedded retina. A simplified imaging setup was tested on an enucleated porcine eye for comparison. RESULTS AMD pathology was detected and localized in four eyes by SDOCT. The SDOCT images correlated with the histopathology observed by light microscopy in each sectioned eye. Pathologies included a subfoveal neovascular lesion with subretinal fluid, peripapillary neovascularization, epiretinal membrane, foveal cyst, choroidal folds, and drusen. Similar imaging was possible with the simplified setup. CONCLUSIONS SDOCT imaging identified retinal disease of the posterior eyecup in human donor eyes. Pathology detected with SDOCT was verified by light microscopy in three eyes, supporting the utility of SDOCT as a screening tool for research.
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Affiliation(s)
- Ninita H Brown
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
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Boon CJF, van Schooneveld MJ, den Hollander AI, van Lith-Verhoeven JJC, Zonneveld-Vrieling MN, Theelen T, Cremers FPM, Hoyng CB, Klevering BJ. Mutations in the peripherin/RDS gene are an important cause of multifocal pattern dystrophy simulating STGD1/fundus flavimaculatus. Br J Ophthalmol 2007; 91:1504-11. [PMID: 17504850 PMCID: PMC2095453 DOI: 10.1136/bjo.2007.115659] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM To describe the phenotype and to analyse the peripherin/RDS gene in 10 unrelated families with multifocal pattern dystrophy simulating Stargardt disease (STGD1). METHODS The probands of 10 families and 20 affected family members underwent an ophthalmic examination including dilated fundus examination, fundus autofluorescence imaging and optical coherence tomography (OCT). In all probands and in selected family members, fluorescein angiography, electrophysiological testing and visual field analysis were performed. Blood samples were obtained from affected and unaffected family members for analysis of the peripherin/RDS gene. RESULTS All 10 probands carried mutations in the peripherin/RDS gene. Nine different mutations were identified, including six mutations that were not described previously. All probands showed a pattern dystrophy with yellow-white flecks in the posterior pole that strongly resembled the flecks seen in STGD1, on ophthalmoscopy as well as on autofluorescence and OCT. Clinical findings in the family members carrying the same mutation as the proband were highly variable, ranging from no visible abnormalities to retinitis pigmentosa. CONCLUSIONS Mutations in the peripherin/RDS gene are the major cause of multifocal pattern dystrophy simulating STGD1/fundus flavimaculatus. This autosomal dominant disorder should be distinguished from autosomal recessive STGD1, in view of the different inheritance pattern and the overall better visual prognosis.
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Affiliation(s)
- Camiel J F Boon
- Department of Ophthalmology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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Ghazi NG, Knape RM. Optical coherence tomography of peripheral retinal lesions in enucleated human eye specimens with histologic correlation II. Curr Eye Res 2007; 31:1047-9. [PMID: 17169843 DOI: 10.1080/02713680601013033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To report optical coherence tomography (OCT)-histologic correlations of two peripheral retinal lesions (PRLs) and to emphasize the feasibility of OCT imaging in fixed tissue specimens. METHODS We studied seven formalin-fixed human eyes two of which contained two common peripheral retinal lesions. OCT scans were performed through these lesions and the vitreous base area, and the images were correlated with corresponding histologic sections. RESULTS Two PRLs including a retinal break and pars plana cysts in addition to the pars plicata and anterior vitreous were successfully imaged. Their optical characteristics correlated well with histology. OCT findings that may help differentiate the hyaloid face and vitreous skirt were also observed. CONCLUSIONS The correlation between OCT images and corresponding histologic sections demonstrates the feasibility of OCT imaging in fixed tissue specimens. Optical characteristics of the vitreous noted in this study may be helpful in understanding disease processes involving the vitreomacular interface.
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Affiliation(s)
- Nicola G Ghazi
- Department of Ophthalmology, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
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