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Jonas JB, Jonas RA, Bikbov MM, Wang YX, Panda-Jonas S. Myopia: Histology, clinical features, and potential implications for the etiology of axial elongation. Prog Retin Eye Res 2023; 96:101156. [PMID: 36585290 DOI: 10.1016/j.preteyeres.2022.101156] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/27/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Abstract
Myopic axial elongation is associated with various non-pathological changes. These include a decrease in photoreceptor cell and retinal pigment epithelium (RPE) cell density and retinal layer thickness, mainly in the retro-equatorial to equatorial regions; choroidal and scleral thinning pronounced at the posterior pole and least marked at the ora serrata; and a shift in Bruch's membrane opening (BMO) occurring in moderately myopic eyes and typically in the temporal/inferior direction. The BMO shift leads to an overhang of Bruch's membrane (BM) into the nasal intrapapillary compartment and BM absence in the temporal region (i.e., parapapillary gamma zone), optic disc ovalization due to shortening of the ophthalmoscopically visible horizontal disc diameter, fovea-optic disc distance elongation, reduction in angle kappa, and straightening/stretching of the papillomacular retinal blood vessels and retinal nerve fibers. Highly myopic eyes additionally show an enlargement of all layers of the optic nerve canal, elongation and thinning of the lamina cribrosa, peripapillary scleral flange (i.e., parapapillary delta zone) and peripapillary choroidal border tissue, and development of circular parapapillary beta, gamma, and delta zone. Pathological features of high myopia include development of macular linear RPE defects (lacquer cracks), which widen to round RPE defects (patchy atrophies) with central BM defects, macular neovascularization, myopic macular retinoschisis, and glaucomatous/glaucoma-like and non-glaucomatous optic neuropathy. BM thickness is unrelated to axial length. Including the change in eye shape from a sphere in emmetropia to a prolate (rotational) ellipsoid in myopia, the features may be explained by a primary BM enlargement in the retro-equatorial/equatorial region leading to axial elongation.
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Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University, Mannheim, Germany; Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany.
| | - Rahul A Jonas
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | | | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
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Park SA, Sledge D, Monahan CF, Teixeira L, Boyd R, Freeman K, Koehl K, Harman C, Munoz K, Occelli LM, Pirie CG, Davidson H, Petersen-Jones S, Komáromy AM. Atypical chorioretinal lesions in Siberian Husky dogs with primary angle-closure glaucoma: a case series. BMC Vet Res 2022; 18:182. [PMID: 35578341 PMCID: PMC9109312 DOI: 10.1186/s12917-022-03259-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 04/20/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND A number of etiologies for different canine chorioretinal lesions have been proved or suggested but some fundic lesions remain unclear in terms of an etiologic diagnosis, treatment options and prognosis. The purpose of this case series is to describe atypical chorioretinal lesions observed in dogs with primary angle-closure glaucoma (PACG). CASE PRESENTATION Two spayed-female Siberian Huskies (3- and 4-year-old) and one Siberian Husky/Australian Shepherd mixed breed dog (11-month-old) that had multifocal depigmented retinal lesions and PACG were included. PROCEDURES Ophthalmic examination, gross, and histopathologic examination findings are described. One of the dogs underwent further clinical diagnostics. Advanced clinical diagnostics on the fellow, presumed to be non-glaucomatous eye of a dog revealed: pectinate ligament dysplasia by gonioscopy, retinal thinning in the depigmented area and wedge shaped retinal thinning with delayed choroidal vascular perfusion by optical coherence tomography, confocal scanning laser ophthalmoscopy, fluorescein and indocyanine green angiography. Quantifiable maze testing for the same eye revealed mild nyctalopia but the full-field electroretinogram showed no generalized decrease of retinal function. Genetic testing for mutations within the retinitis pigmentosa GTPase regulator gene causing X-linked progressive retinal atrophy in Siberian Huskies was negative. Histopathologic evaluations on enucleated eyes in two dogs confirmed goniodysgenesis, PACG with optic nerve head cupping, and diffuse inner retinal atrophy. In addition, segmental profound retinal atrophy, loss of retinal pigment epithelium, and adhesion of the retina to Bruch's membrane was observed and coincided with multifocal depigmented lesions noted on fundic examination. CONCLUSIONS To our knowledge, this is the first case series with clinical and histopathologic data of chorioretinal lesions, most likely caused by severely impaired choroidal perfusion. Further studies are warranted to elucidate the etiology and pathophysiology, including its possible association with PACG.
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Affiliation(s)
- Shin Ae Park
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, 625 Harrison Street, West Lafayette, IN, 47907, USA.
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA.
| | - Dodd Sledge
- Michigan State University Diagnostic Laboratory, East Lansing, Michigan, USA
| | - Colleen F Monahan
- Michigan State University Diagnostic Laboratory, East Lansing, Michigan, USA
| | - Leandro Teixeira
- Comparative Ocular Pathology Laboratory of Wisconsin, Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Ryan Boyd
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Katie Freeman
- Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, Veterinary Teaching Hospital, Fort Collins, CO, USA
| | - Kristin Koehl
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Christine Harman
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Kirk Munoz
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Laurence M Occelli
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Chris G Pirie
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Harriet Davidson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Simon Petersen-Jones
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - András M Komáromy
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
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Jonas SB, Jonas RA, Panda‐Jonas S, Jonas JB. Histopathology of myopic cobblestones. Acta Ophthalmol 2022; 100:111-117. [PMID: 33960132 DOI: 10.1111/aos.14894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To search for the histological correlate of peripheral 'cobblestones' in highly myopic eyes. METHODS The histomorphometric investigation included histologic sections of enucleated eyes of Caucasian patients. Using light microscopy, we measured the thickness of the retina, Bruch's membrane (BM) and choriocapillaris. RESULTS The study included 50 eyes (mean age:60.6 ± 18.7 years;axial length:26.5 ± 3.8 mm), with cobblestone regions detected in 7 eyes. BM thickness and choriocapillaris thickness in the cobblestone region were thinner (1.1 ± 0.2 µm versus 2.4 ± 0.8 µm; p < 0.001 and 1.6 ± 0.5 µm versus 2.6 ± 1.9 µm; p = 0.02, respectively), and just outside of the cobblestone region they were thicker (3.3 ± 0.6 µm versus 2.4 ± 0.8 µm; p = 0.005 and 5.7 ± 1.6 µm versus 2.6 ± 1.9 µm; p = 0.002, respectively) than in corresponding regions of eyes without cobblestones. Within the group of eyes with cobblestones, BM thickness (1.1 ± 0.2 mm versus 3.3 ± 0.6 mm; p < 0.001), choriocapillaris thickness (1.6 ± 0.5 mm versus 5.7 ± 1.6 mm; p < 0.001) and choriocapillaris density (48±15 µm/300 µm versus 159 ± 66 µm/300 µm;PP=0.002) were significantly lower in the cobblestone region than just outside of the cobblestone region. The cobblestone regions were characterized by firm adhesion of disorganized retina with thinned BM, few retinal pigment epithelium (RPE) islands within cobblestone regions, and absence of regional scleral or overall choroidal thinning. BM was mono-layered within, and double-layered outside of cobblestone regions, with the inner layer missing within the cobblestone region (except for the RPE islands). CONCLUSIONS Peripheral cobblestone regions in highly myopic eyes are characterized by marked BM thinning with absence of an inner BM layer, almost complete RPE absence, choriocapillaris thinning and firm connection of a disorganized retina to BM. These findings may help elucidating the process of axial elongation in myopic eyes.
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Affiliation(s)
| | - Rahul A. Jonas
- Department of Ophthalmology Medical Faculty University of Cologne Cologne Germany
| | - Songhomitra Panda‐Jonas
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda Heidelberg Germany
| | - Jost B. Jonas
- Department of Ophthalmology Medical Faculty Mannheim Ruprecht‐Karls‐University of Heidelberg Mannheim Germany
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Nishitsuka K, Nishi K, Namba H, Kaneko Y, Yamashita H. Peripheral Cystoid Degeneration Finding Using Intraoperative Optical Coherence Tomography in Rhegmatogenous Retinal Detachment. Clin Ophthalmol 2021; 15:1183-1187. [PMID: 33776413 PMCID: PMC7987312 DOI: 10.2147/opth.s306623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/02/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The interaction between the peripheral vitreous and retina is closely associated with the pathogenesis of rhegmatogenous retinal detachment (RRD). This study was conducted to examine the peripheral vitreous and retina in patients with RRD using intraoperative optical coherence tomography (iOCT). Methods This retrospective study included 50 eyes of 50 patients (mean age 59.42 ± 10.80 years) that underwent vitrectomy using iOCT for treating RRD at the Yamagata University Hospital between September 2015 and September 2016. Each patient underwent 25-gauge pars plana vitrectomy that was performed by a single surgeon. During vitreous shaving with ocular indentation, the iOCT findings of the peripheral vitreous and retina were recorded and analyzed postoperatively. Results In all patients, iOCT was able to detect the peripheral retina and vitreous around the vitreous base. Peripheral cystoid degeneration was detected on the peripheral retina of 27 eyes (54%). Furthermore, cystoid degeneration was detected around the retinal tear (5 patients), at the detached retinal area (8 patients), and at the attached retinal area (14 patients). Conclusion iOCT enabled the evaluation of peripheral cystoid degeneration in patients with RRD. Cystoid degeneration might be associated with the pathogenesis of RRD.
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Affiliation(s)
- Koichi Nishitsuka
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Katsuhiro Nishi
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroyuki Namba
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yutaka Kaneko
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hidetoshi Yamashita
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
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Denk N, Maloca PM, Steiner G, Booler H, Freichel C, Niklaus S, Schnitzer TK, Hasler PW. Retinal Features in Cynomolgus Macaques ( Macaca fascicularis) Assessed by Using Scanning Laser Ophthalmoscopy and Spectral Domain Optical Coherence Tomography. Comp Med 2020; 70:145-151. [PMID: 32164796 DOI: 10.30802/aalas-cm-19-000088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cynomolgus macaques are an important and commonly used species in preclinical toxicology studies, but structural reports of in vivo retinal findings are rare in this species. The purpose of this study was to diminish this gap and document optical coherence tomography and scanning laser ophthalmoscopy imaging data in the healthy posterior pole of cynomolgus monkeys' eyes at predose examinations. The current study is a retrospective assessment of baseline spectral domain OCT data obtained from the 768 eyes of 384 cynomolgus monkeys (192 males and 192 females) of Mauritian origin. The data set was obtained from studies conducted over a 4-y period in the context of ocular safety evaluations of various compounds under preclinical development. The most prevalent findings were the presence of Bergmeister papilla and intravitreal hyperreflective spots. Less common findings included disorganization of retinal zones, abnormalities of the retinal vasculature, partial posterior vitreous detachment, and abnormally shaped foveal pits. Thoughtful consideration of these physiologic findings will aid in distinguishing normal features from toxic outcomes in future preclinical ophthalmic studies.
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Affiliation(s)
- Nora Denk
- Pharma Research and Early Development (pRED), Pharmaceutical Sciences (PS), Roche Innovation Center Basel, Basel, Switzerland;,
| | - Peter M Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland; Moorfields Eye Hospital, London, United Kingdom; OCTlab Research Laboratory, Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Guido Steiner
- Pharma Research and Early Development (pRED), Pharmaceutical Sciences (PS), Roche Innovation Center Basel, Basel, Switzerland
| | | | - Christian Freichel
- Pharma Research and Early Development (pRED), Pharmaceutical Sciences (PS), Roche Innovation Center Basel, Basel, Switzerland
| | - Stephanie Niklaus
- Pharma Research and Early Development (pRED), Pharmaceutical Sciences (PS), Roche Innovation Center Basel, Basel, Switzerland
| | - Tobias K Schnitzer
- Pharma Research and Early Development (pRED), Pharmaceutical Sciences (PS), Roche Innovation Center Basel, Basel, Switzerland
| | - Pascal W Hasler
- OCTlab Research Laboratory, Department of Ophthalmology, University of Basel, Basel, Switzerland
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Owen LA, Shakoor A, Morgan DJ, Hejazi AA, McEntire MW, Brown JJ, Farrer LA, Kim I, Vitale A, DeAngelis MM. The Utah Protocol for Postmortem Eye Phenotyping and Molecular Biochemical Analysis. Invest Ophthalmol Vis Sci 2019; 60:1204-1212. [PMID: 30924847 PMCID: PMC6440527 DOI: 10.1167/iovs.18-24254] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 01/31/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose Current understanding of local disease pathophysiology in AMD is limited. Analysis of the human disease-affected tissue is most informative, as gene expression, expressed quantitative trait loci, microenvironmental, and epigenetic changes can be tissue, cell type, and location specific. Development of a novel translational treatment and prevention strategies particularly for earlier forms of AMD are needed, although access to human ocular tissue analysis is challenging. We present a standardized protocol to study rapidly processed postmortem donor eyes for molecular biochemical and genomic studies. Methods We partnered with the Utah Lions Eye Bank to obtain donor human eyes, blood, and vitreous, within 6 hours postmortem. Phenotypic analysis was performed using spectral-domain optical coherence tomography (SD-OCT) and color fundus photography. Macular and extramacular tissues were immediately isolated, and the neural retina and retinal pigment epithelium/choroid from each specimen were separated and preserved. Ocular disease phenotype was analyzed using clinically relevant grading criteria by a group of four ophthalmologists incorporating data from SD-OCT retinal images, fundus photographs, and medical records. Results The use of multimodal imaging leads to greater resolution of retinal pathology, allowing greater phenotypic rigor for both interobserver phenotype and known clinical diagnoses. Further, our analysis resulted in excellent quality RNA, which demonstrated appropriate tissue segregation. Conclusions The Utah protocol is a standardized methodology for analysis of disease mechanisms in AMD. It uniquely allows for simultaneous rigorous phenotypic, molecular biochemical, and genomic analysis of both systemic and local tissues. This better enables the development of disease biomarkers and therapeutic interventions.
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Affiliation(s)
- Leah A. Owen
- Department of Ophthalmology and Visual Sciences, University of Utah, School of Medicine, Salt Lake City, Utah, United States
| | - Akbar Shakoor
- Department of Ophthalmology and Visual Sciences, University of Utah, School of Medicine, Salt Lake City, Utah, United States
| | - Denise J. Morgan
- Department of Ophthalmology and Visual Sciences, University of Utah, School of Medicine, Salt Lake City, Utah, United States
| | - Andre A. Hejazi
- Department of Ophthalmology and Visual Sciences, University of Utah, School of Medicine, Salt Lake City, Utah, United States
| | | | - Jared J. Brown
- Utah Lions Eye Bank, Salt Lake City, Utah, United States
| | - Lindsay A. Farrer
- Departments of Medicine (Biomedical Genetics), Neurology, Ophthalmology, Epidemiology, and Biostatistics, Boston University Schools of Medicine and Public Health, Boston, Massachusetts, United States
| | - Ivana Kim
- Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
| | - Albert Vitale
- Department of Ophthalmology and Visual Sciences, University of Utah, School of Medicine, Salt Lake City, Utah, United States
| | - Margaret M. DeAngelis
- Department of Ophthalmology and Visual Sciences, University of Utah, School of Medicine, Salt Lake City, Utah, United States
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, United States
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, Utah, United States
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Silverstein SM, Paterno D, Cherneski L, Green S. Optical coherence tomography indices of structural retinal pathology in schizophrenia. Psychol Med 2018; 48:2023-2033. [PMID: 29233210 DOI: 10.1017/s0033291717003555] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Prior optical coherence tomography (OCT) studies of schizophrenia have identified thinning of retinal layers. However, findings have varied across reports, and most studies have had serious methodological limitations. To address unresolved issues, we determined whether: (1) retinal thinning in schizophrenia occurs independently of comorbid medical conditions that affect the retina; (2) thinning is independent of antipsychotic medication dose; (3) optic nerve parameters are abnormal in schizophrenia; and (4) OCT indices are related to visual and cognitive impairments common in schizophrenia. METHODS A total of 32 people with schizophrenia and 32 matched controls participated. Spectral domain OCT generated data on retinal nerve fiber layer (RNFL), macula, and ganglion cell-inner plexiform layer (GCL-IPL) thickness, in addition to cup volume and the cup-to-disc ratio at the optic nerve head. Subjects with schizophrenia also completed measures of symptoms, visual processing, and IQ. RESULTS The groups did not differ on RNFL, macula, or GCL-IPL thickness. However, thinning of these layers was related to the presence of diabetes or hypertension across the sample as a whole. The schizophrenia group demonstrated enlarged cup volume and an enlarged cup-to-disc ratio in both eyes, which were unrelated to medical comorbidity, but were related to increased cognitive symptoms. CONCLUSIONS Past reports of retinal thinning may be artifacts of medical comorbidity that is over-represented in schizophrenia, or other confounds. However, optic nerve head abnormalities may hold promise as biomarkers of central nervous system abnormality, including cognitive decline, in schizophrenia.
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Affiliation(s)
| | | | | | - Stuart Green
- Department of Ophthalmology,Robert Wood Johnson University Hospital,New Brunswick, NJ,USA
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Moreira-Neto CA, Bergeron S, Coblentz J, Zoroquiain P, Maloney S, Mastromonaco C, Esposito E, Romano A, Belfort Neto R, Moreira CA, Burnier JV, Burnier M. Optimizing optical coherence tomography and histopathology correlation in retinal imaging. Can J Ophthalmol 2018; 54:280-287. [PMID: 30975355 DOI: 10.1016/j.jcjo.2018.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/21/2018] [Accepted: 06/28/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To develop a methodology to correlate optical coherence tomography (OCT) images and histopathological sections from the same eye. Part 1: To determine the best fixative for optimal OCT and histopathological analysis in post-mortem eyes. Part 2: A protocol is proposed to correlate histopathological features and OCT scans from the same post-mortem eyes. DESIGN Experimental study. PARTICIPANTS Part 1: Twenty-three rabbit eyes and 14 post-mortem human eyes. Part 2: Nineteen post-mortem human eyes. METHODS Part 1: Six different fixatives were tested, and specimens were evaluated on 4 criteria: globe shape, structure opacification, retinal detachment, and nuclear details. Part 2: Based on the findings from Part 1, fixed human eyes were imaged using OCT. Orientation-controlled histopathological processing was performed to obtain serial tissue sections from paraffin embedded tissue, which were matched to corresponding OCT images. RESULTS Part 1: Of the 6 fixatives, 2% glutaraldehyde and Davidson's solution met the proposed criteria in rabbit eyes. Of these, glutaraldehyde showed similar results in human eyes and was selected for Part 2. Part 2: Using anatomical landmarks, cross-sectional histopathological sections in the same orientation as the OCT images were correlated to their corresponding OCT images. Retinal lesions such as a macular hole, an epiretinal membrane, and the presence of drusen were easily correlated, proving the reliability of our methodology. Moreover, the photoreceptor's inner/outer junction was correlated to a hyperreflective band on OCT. CONCLUSIONS A standardized protocol was developed to correlate OCT images and histopathological findings by generating serial cross-sections of the retina, which can be used to better understand otherwise ambiguous OCT findings.
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Affiliation(s)
- Carlos A Moreira-Neto
- Pathology Department, McGill University, Montreal, Que., Canada; Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil; Hospital de Olhos do Paraná, Curitiba, Brazil.
| | | | - Jacqueline Coblentz
- Pathology Department, McGill University, Montreal, Que., Canada; Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
| | | | - Shawn Maloney
- Pathology Department, McGill University, Montreal, Que., Canada
| | | | | | - André Romano
- Pathology Department, McGill University, Montreal, Que., Canada; Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
| | - Rubens Belfort Neto
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
| | - Carlos A Moreira
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil; Hospital de Olhos do Paraná, Curitiba, Brazil
| | - Julia V Burnier
- Pathology Department, McGill University, Montreal, Que., Canada; Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
| | - Miguel Burnier
- Pathology Department, McGill University, Montreal, Que., Canada; Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
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Intraoperative Optical Coherence Tomography Imaging of the Peripheral Vitreous and Retina. Retina 2018; 38:e20-e22. [PMID: 29210938 DOI: 10.1097/iae.0000000000001979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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McNabb RP, Grewal DS, Mehta R, Schuman SG, Izatt JA, Mahmoud TH, Jaffe GJ, Mruthyunjaya P, Kuo AN. Wide field of view swept-source optical coherence tomography for peripheral retinal disease. Br J Ophthalmol 2016; 100:1377-82. [PMID: 26755643 DOI: 10.1136/bjophthalmol-2015-307480] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/14/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS To assess peripheral retinal lesions and the posterior pole in single widefield optical coherence tomography (OCT) volumes. METHODS A wide field of view (FOV) swept-source OCT (WFOV SSOCT) system was developed using a commercial swept-source laser and a custom sample arm consisting of two indirect ophthalmic lenses. Twenty-seven subjects with peripheral lesions (choroidal melanomas, choroidal naevi, sclerochoroidal calcification, retinitis pigmentosa, diabetic retinopathy, retinoschisis and uveitis) were imaged with the WFOV SSOCT. Volumes were taken in primary gaze. Using the optic nerve to fovea distance as a reference measurement, comparisons were made between the lateral FOV of the WFOV SSOCT, current generation spectral-domain OCT (SDOCT) and widefield scanning laser ophthalmoscopy (SLO) of the same eyes. RESULTS Peripheral pathologies were captured with WFOV SSOCT in 26 of the 27 subjects. The one not captured was in the far nasal periphery and was not seen in the primary gaze volume. Posterior pole associated pathologies were captured in all subjects. Current generation SDOCT had a mean lateral FOV of 2.08±0.21 optic nerve to fovea distance units, WFOV SSOCT had an FOV of 4.62±0.62 units and SLO had an FOV of 9.35±1.02 units. CONCLUSIONS WFOV OCT can be used to examine both peripheral retinal pathology and the posterior pole within a single volume acquisition. SLO had the greatest FOV, but does not provide depth information. Future studies using widefield OCT systems will help further delineate the role of WFOV OCT to quantitatively assess and monitor peripheral retinal disease in three dimensions.
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Affiliation(s)
- Ryan P McNabb
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Dilraj S Grewal
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rajvi Mehta
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Stefanie G Schuman
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joseph A Izatt
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Tamer H Mahmoud
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Glenn J Jaffe
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Prithvi Mruthyunjaya
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Anthony N Kuo
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
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The Onion Sign in Neovascular Age-Related Macular Degeneration Represents Cholesterol Crystals. Ophthalmology 2015; 122:2316-26. [PMID: 26298717 DOI: 10.1016/j.ophtha.2015.07.008] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To investigate the frequency, natural evolution, and histologic correlates of layered, hyperreflective, subretinal pigment epithelium (sub-RPE) lines, known as the onion sign, in neovascular age-related macular degeneration (AMD). DESIGN Retrospective observational cohort study and experimental laboratory study. PARTICIPANTS Two hundred thirty eyes of 150 consecutive patients with neovascular AMD and 40 human donor eyes with histopathologic diagnosis of neovascular AMD. METHODS Spectral-domain optical coherence tomography (SD OCT), near-infrared reflectance (NIR), color fundus images, and medical charts were reviewed. Donor eyes underwent multimodal ex vivo imaging, including SD OCT, before processing for high-resolution histologic analysis. MAIN OUTCOME MEASURES Presence of layered, hyperreflective sub-RPE lines, qualitative analysis of their change in appearance over time with SD OCT, histologic correlates of these lines, and associated findings within surrounding tissues. RESULTS Sixteen of 230 eyes of patients (7.0%) and 2 of 40 donor eyes (5.0%) with neovascular AMD had layered, hyperreflective sub-RPE lines on SD OCT imaging. These appeared as refractile, yellow-gray exudates on color imaging and as hyperreflective lesions on NIR. In all 16 patient eyes, the onion sign persisted in follow-up for up to 5 years, with fluctuations in the abundance of lines and association with intraretinal hyperreflective foci. Patients with the onion sign disproportionately were taking cholesterol-lowering medications (P=0.025). Histologic analysis of 2 donor eyes revealed that the hyperreflective lines correlated with clefts created by extraction of cholesterol crystals during tissue processing. The fluid surrounding the crystals contained lipid, yet was distinct from oily drusen. Intraretinal hyperreflective foci correlated with intraretinal RPE and lipid-filled cells of probable monocytic origin. CONCLUSIONS Persistent and dynamic, the onion sign represents sub-RPE cholesterol crystal precipitation in an aqueous environment. The frequency of the onion sign in neovascular AMD in a referral practice and a pathology archive is 5% to 7%. Associations include use of cholesterol-lowering medication and intraretinal hyperreflective foci attributable to RPE cells and lipid-filled cells of monocyte origin.
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Kothari A, Narendran V, Saravanan VR. In vivo sectional imaging of the retinal periphery using conventional optical coherence tomography systems. Indian J Ophthalmol 2012; 60:235-9. [PMID: 22569394 PMCID: PMC3361828 DOI: 10.4103/0301-4738.95885] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Optical coherence tomography (OCT) has transformed macular disease practices. This report describes the use of conventional OCT systems for peripheral retinal imaging. Thirty-six eyes with peripheral retinal pathology underwent imaging with conventional OCT systems. In vivo sectional imaging of lattice degeneration, snail-track degeneration, and paving-stone degeneration was performed. Differences were noted between phenotypes of lattice degeneration. Several findings previously unreported in histopathology studies were encountered. Certain anatomic features were seen that could conceivably explain clinical and intraoperative behavior of peripheral lesions. Peripheral OCT imaging helped elucidate clinically ambiguous situations such as retinal breaks, subclinical retinal detachment, retinoschisis, choroidal nevus, and metastasis. Limitations of such scanning included end-gaze nystagmus and far peripheral lesions. This first of its kind study demonstrates the feasibility of peripheral retinal OCT imaging and expands the spectrum of indications for which OCT scanning may be clinically useful.
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Affiliation(s)
- Abhishek Kothari
- Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
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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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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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