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Ali N, Thotathil A, Niederer R. Letter to the Editor: Comment on Fonollosa et al.'s "Hyper-Reflective Outer Nuclear Layer (HONL) in Vogt-Koyanagi-Harada Disease and Sympathetic Ophthalmia". Ocul Immunol Inflamm 2024; 32:437-439. [PMID: 37318224 DOI: 10.1080/09273948.2023.2217919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/21/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Nazima Ali
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Aliyah Thotathil
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Rachael Niederer
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Te Whatu Ora, Auckland, New Zealand
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Beckman M, Clevenger L, DeBenedictis MJ, Yuan A, Sharma S. A novel ocular phenotype associated with pathogenic variants in MFSD8 leading to macular dystrophy. Ophthalmic Genet 2023; 44:606-609. [PMID: 36861499 DOI: 10.1080/13816810.2023.2183224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND The major facilitator superfamily domain-containing protein 8 (MFSD8) pathogenic variants are classically associated with autosomal recessive neuronal ceroid lipofuscinosis-7. Case reports have recently demonstrated an association of MFSD8 variants causing autosomal recessive macular dystrophy with central cone involvement without neurologic sequelae. We report a patient with a novel ocular phenotype associated with MFSD8 pathogenic variants causing macular dystrophy without systemic findings. CASE PRESENTATION A 37-year-old female presented with a 20-year history of progressive bilateral vision loss. Fundus examination was notable for a slight pigmentary ring around the fovea in both eyes. Optical coherence tomography (OCT) of the macula showed bilateral subfoveal ellipsoid zone loss without outer retinal changes. Fundus autofluorescence (FAF) demonstrated foveal hypo-autofluorescence (AF) in both eyes as well as hyper-AF nasally to the optic nerve in the perifoveal area. Full-field and multifocal electroretinography demonstrated cone dysfunction with diffuse macular changes in both eyes. Subsequent genetic testing identified two pathogenic MFSD8 variants. The patient had no neurologic symptoms consistent with variant-late infantile neuronal ceroid lipofuscinosis. CONCLUSION MFSD8 pathogenic variants are known to cause macular dystrophies. We report a novel MFSD8-associated macular dystrophy phenotype demonstrating foveal-limited disease with cavitary changes on OCT without inner retinal atrophy and foveal-specific changes on FAF. A threshold model can explain how a hypomorphic missense variant heterozygous with a loss-of-function nonsense variant can lead to a predominantly ocular phenotype with preserved neurologic function. We recommend careful monitoring of these patients for future signs of both retinal and systemic disease progression.
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Affiliation(s)
- Madeline Beckman
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | - Alex Yuan
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sumit Sharma
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Lee S, Kim KT, Kim DY, Chae JB, Seo EJ. Outer nuclear layer recovery as a predictor of visual prognosis in type 1 choroidal neovascularization of neovascular age-related macular degeneration. Sci Rep 2023; 13:5045. [PMID: 36977729 PMCID: PMC10050211 DOI: 10.1038/s41598-023-32184-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 03/23/2023] [Indexed: 03/30/2023] Open
Abstract
To investigate the changes in outer nuclear layer (ONL) thickness during anti-vascular endothelial growth factor (VEGF) treatment in type 1 choroidal neovascularization (CNV) and its impact on vision. Type 1 CNV eyes (n = 94) were retrospectively compared to normal control eyes (n = 35). Along with best-corrected visual acuity (BCVA), the location of CNV, foveal ONL thickness, and subretinal fluid height were measured using optical coherence tomography (OCT) and analyzed. Visual outcome and OCT biomarkers were compared. As a result, the CNV group had thinner foveal ONL and worse BCVA compared to the control group. ONL thickness recovered partially along with visual improvement following 3 monthly initial loading doses of aflibercept injections, and it correlated with the final BCVA during the 1-year follow-up. Eyes achieved foveal ONL recovery over + 10 µm had lower subfoveal CNV (45.5%) and showed better visual outcomes than eyes with stationary ONL or suboptimal ONL recovery (76.0%, p = 0.012). In conclusion, type 1 CNV eyes that recovered foveal ONL thickness at initial loading of anti-VEGF demonstrated good final visual outcome during the 1-year follow-up. Monitoring the foveal ONL thickness during early anti-VEGF treatment can give information about the visual outcomes in type 1 CNV.
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Affiliation(s)
- Seungheon Lee
- Department of Ophthalmology, College of Medicine, Chungbuk National University Hospital, Chungbuk National University, 776, Sunhwan-1-Ro, Seowon-Gu, Cheongju, 28644, Korea
| | - Kyung Tae Kim
- Department of Ophthalmology, College of Medicine, Chungbuk National University Hospital, Chungbuk National University, 776, Sunhwan-1-Ro, Seowon-Gu, Cheongju, 28644, Korea
| | | | | | - Eoi Jong Seo
- Department of Ophthalmology, College of Medicine, Chungbuk National University Hospital, Chungbuk National University, 776, Sunhwan-1-Ro, Seowon-Gu, Cheongju, 28644, Korea.
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Li H, Zhang C, Li H, Yang S, Liu Y, Wang F. Effects of disorganization of retinal inner layers for Idiopathic epiretinal membrane surgery: the surgical status and prognosis. BMC Ophthalmol 2023; 23:108. [PMID: 36932394 PMCID: PMC10022165 DOI: 10.1186/s12886-023-02856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND To compare the surgical status in idiopathic epiretinal membrane (IERM) patients with or without disorganization of retinal inner layers (DRIL) and to correlate with optical coherence tomography angiography (OCTA) and clinical data. METHODS In 74 eyes from 74 patients with IERM treated by surgery with 12-month follow-up. According to the superficial hemorrhage, the patients were divided into group A (no macular bleeding), group B (macular parafoveal bleeding) and group C (macular foveal bleeding). Optical coherence tomography (OCT) were evaluated for presence of DRIL,central retina thickness and integrity of the inner/outer segment layer recorded at baseline and at 1, 3, 6, and 12 months postoperatively and best-corrected visual acuity (BCVA) was recorded simultaneously. OCTA was conducted at 12 months postoperatively. Main outcome measures is correlation between DRIL and superficial hemorrhage in membrane peeling,and BCVA and OCTA outcomes postoperatively. RESULTS The rate of DRIL and BCVA had statistically significant differences between the three groups at the time points(baseline and 1, 3, 6, and 12 months after surgery), respectively (P < 0.001 for all). FD-300 value (P = 0.001)and DCP in all parafoveal regions (superior: P = 0.001; inferior: P = 0.002;Nasal: P = 0.014;Tempo: P = 0.004) in eyes with DRIL were lower than those without DRIL.There was a linear regression relationship between FD-300 and postoperative BCVA (P = 0.011). CONCLUSION IERM Patients with DRIL have more intraoperative adverse events and limited benefits from surgery which should be considered in the decision whether to perform mebrane peeling.OCT-A provides more detailed vascular information that extends our understanding of persistent DRIL.
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Affiliation(s)
- Huanhuan Li
- Department of Ophthalmology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Suzhou University, Chang Zhou, 213003, China
| | - Conghui Zhang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shang Hai, 200072, China
| | - Hui Li
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shang Hai, 200072, China
| | - Shuai Yang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shang Hai, 200072, China
| | - Yao Liu
- Department of Ophthalmology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Suzhou University, Chang Zhou, 213003, China.
| | - Fang Wang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shang Hai, 200072, China.
- Purui Eye Group, Shanghai Purui Eye Hospital, Shang Hai, 200336, China.
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Saeidian J, Mahmoudi T, Riazi-Esfahani H, Montazeriani Z, Khodabande A, Zarei M, Ebrahimiadib N, Jafari B, Afzal Aghaei A, Azimi H, Khalili Pour E. Automated assessment of the smoothness of retinal layers in optical coherence tomography images using a machine learning algorithm. BMC Med Imaging 2023; 23:21. [PMID: 36732684 PMCID: PMC9896782 DOI: 10.1186/s12880-023-00976-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 01/25/2023] [Indexed: 02/04/2023] Open
Abstract
Quantifying the smoothness of different layers of the retina can potentially be an important and practical biomarker in various pathologic conditions like diabetic retinopathy. The purpose of this study is to develop an automated machine learning algorithm which uses support vector regression method with wavelet kernel and automatically segments two hyperreflective retinal layers (inner plexiform layer (IPL) and outer plexiform layer (OPL)) in 50 optical coherence tomography (OCT) slabs and calculates the smoothness index (SI). The Bland-Altman plots, mean absolute error, root mean square error and signed error calculations revealed a modest discrepancy between the manual approach, used as the ground truth, and the corresponding automated segmentation of IPL/ OPL, as well as SI measurements in OCT slabs. It was concluded that the constructed algorithm may be employed as a reliable, rapid and convenient approach for segmenting IPL/OPL and calculating SI in the appropriate layers.
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Affiliation(s)
- Jamshid Saeidian
- grid.412265.60000 0004 0406 5813Faculty of Mathematical Sciences and Computer, Kharazmi University, No. 50, Taleghani Ave, Tehran, Iran
| | - Tahereh Mahmoudi
- grid.411705.60000 0001 0166 0922Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences and Research Center for Science and Technology in Medicine, Tehran, Iran
| | - Hamid Riazi-Esfahani
- grid.411705.60000 0001 0166 0922Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Montazeriani
- grid.411705.60000 0001 0166 0922Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences and Research Center for Science and Technology in Medicine, Tehran, Iran
| | - Alireza Khodabande
- grid.411705.60000 0001 0166 0922Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Zarei
- grid.411705.60000 0001 0166 0922Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Ebrahimiadib
- grid.411705.60000 0001 0166 0922Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Behzad Jafari
- grid.411705.60000 0001 0166 0922Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Afzal Aghaei
- grid.412502.00000 0001 0686 4748Department of Computer Sciences, Faculty of Mathematical Sciences, Shahid Beheshti University, Tehran, Iran
| | - Hossein Azimi
- grid.412265.60000 0004 0406 5813Faculty of Mathematical Sciences and Computer, Kharazmi University, No. 50, Taleghani Ave, Tehran, Iran
| | - Elias Khalili Pour
- grid.411705.60000 0001 0166 0922Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Biswal S, Gondchawar A, Ravishankar HN, Sagar P, Shanmugam PM, Shah A, Tekade P, Mooss V. Predictors of visual outcome in post-fever retinitis: a retrospective analysis. Int Ophthalmol 2021; 41:4099-4109. [PMID: 34546494 DOI: 10.1007/s10792-021-01983-y] [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: 02/24/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To identify the predictors of final visual outcome in cases with post-fever retinitis (PFR). METHODS This is a retrospective study of cases with diagnosis of post-fever retinitis. Colour fundus photograph and optical coherence tomography (OCT) parameters at presentation and final visit were analysed. Various factors at presentation [age, systemic illness, best-corrected visual acuity (BCVA), area of retinitis and hard exudates, OCT parameters], at final visit (OCT parameters) and the treatment modalities used were correlated with BCVA at final visit. RESULTS Twenty-four eyes of 16 patients with PFR were included in the study. Median BCVA at presentation was 6/60 and at final visit was 6/9. By multiple linear regression after adjusting for other variables, for every 1 unit increase in height of subretinal fluid (SRF) at fovea at presentation, the value of final BCVA decreased by 0.001 unit. For every 1 unit increase in extent of ellipsoid zone (EZ) loss and subfoveal deposit height, the value of final BCVA decreased by 0.0001 unit and 0.004 unit, respectively. The baseline OCT parameters that had negative correlation with final BCVA included central macular thickness (r: - 0.5182, p: 0.02), maximum SRF height (r: - 0.5539, p < 0.01) and SRF height at fovea (r: - 0.582, p < 0.01). The OCT parameters at final visit which had a negative correlation with final BCVA included disorganisation of retinal inner layers (DRIL) within 1000 microns from centre of fovea (r: - 0.6494, p < 0.01), height of subfoveal deposit (r: - 0.7627, p < 0.01), horizontal extent of subfoveal deposit (r: - 0.6695, p < 0.01) and extent of EZ loss (r: - 0.8216, p < 0.01). CONCLUSION Height of SRF at presentation, extent of EZ loss and subfoveal deposit height at final visit were associated with poor final BCVA in PFR.
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Affiliation(s)
- Suchitra Biswal
- Department of Vitreo-Retina, Sankara Eye Hospital, Harakere, Shimoga, Karnataka, 577202, India
| | - Ankush Gondchawar
- Department of Vitreo-Retina, Sankara Eye Hospital, Harakere, Shimoga, Karnataka, 577202, India
| | - H N Ravishankar
- Department of Vitreo-Retina, Sankara Eye Hospital, Harakere, Shimoga, Karnataka, 577202, India
| | - Pradeep Sagar
- Department of Vitreo-Retina, Sankara Eye Hospital, Harakere, Shimoga, Karnataka, 577202, India.
| | - P Mahesh Shanmugam
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bangalore, India
| | - Aanal Shah
- Department of Vitreo-Retina, Sankara Eye Hospital, Harakere, Shimoga, Karnataka, 577202, India
| | - Pradeep Tekade
- Department of Vitreo-Retina, Sankara Eye Hospital, Harakere, Shimoga, Karnataka, 577202, India
| | - Vidya Mooss
- Department of Vitreo-Retina, Sankara Eye Hospital, Harakere, Shimoga, Karnataka, 577202, India
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Neuro-Ophthalmological Findings in Friedreich's Ataxia. J Pers Med 2021; 11:jpm11080708. [PMID: 34442352 PMCID: PMC8398238 DOI: 10.3390/jpm11080708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/08/2021] [Accepted: 07/21/2021] [Indexed: 12/17/2022] Open
Abstract
Friedreich ataxia (FRDA) is a progressive neurodegenerative disease caused by a severe autosomal recessive genetic disorder of the central nervous (CNS) and peripheral nervous system (PNS), affecting children and young adults. Its onset is before 25 years of age, with mean ages of onset and death between 11 and 38 years, respectively. The incidence is 1 in 30,000–50,000 persons. It is caused, in 97% of cases, by a homozygous guanine-adenine-adenine (GAA) trinucleotide mutation in the first intron of the frataxin (FXN) gene on chromosome 9 (9q13–q1.1). The mutation of this gene causes a deficiency of frataxin, which induces an altered inflow of iron into the mitochondria, increasing the nervous system’s vulnerability to oxidative stress. The main clinical signs include spinocerebellar ataxia with sensory loss and disappearance of deep tendon reflexes, cerebellar dysarthria, cardiomyopathy, and scoliosis. Diabetes, hearing loss, and pes cavus may also occur, and although most patients with FRDA do not present with symptomatic visual impairment, 73% present with clinical neuro-ophthalmological alterations such as optic atrophy and altered eye movement, among others. This review provides a brief overview of the main aspects of FRDA and then focuses on the ocular involvement of this pathology and the possible use of retinal biomarkers.
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Drenser KA, Pieramici DJ, Gunn JM, Rosberger DF, Kozma P, Fineman MS, Duchateau L, Khanani AM. Retrospective Study of Ellipsoid Zone Integrity Following Treatment with Intravitreal Ocriplasmin (OZONE Study). Clin Ophthalmol 2021; 15:3109-3120. [PMID: 34295149 PMCID: PMC8291832 DOI: 10.2147/opth.s285464] [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: 11/03/2020] [Accepted: 06/28/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess generalized (GD) and focal ellipsoid zone disruption (FD) in patients with symptomatic vitreomacular adhesion (sVMA) using spectral domain optical coherence tomography (SD-OCT) following ocriplasmin. Patients and methods OZONE was a Phase 4, retrospective study of patients with sVMA treated with a single intravitreal injection of ocriplasmin (0.125 mg). Data from adult patients with at least 6-month follow-up after ocriplasmin were included. SD-OCT was performed at baseline (within 30 days before ocriplasmin), before Day 21 post-injection (early observation, EO), and by last observation (LO) which was maximally 6 months post-injection. The main outcome measure was the development of new and the evolution of existing FD/GD at EO and LO. Results The study enrolled 134 eyes/patients from 22 sites in the USA. At baseline, 87 eyes (64.9%) had FD, 21 eyes (15.7%) had GD and 26 eyes (19.4%) had no FD/GD. Among the eyes without FD/GD at baseline, 13 (50%) and 8 (30.8%) developed FD or GD, respectively, by EO. By LO, FD/GD improvement or resolution was seen in >80% of these eyes. Among the eyes with FD/GD at baseline, <40% had improving/resolving EZ integrity at LO. The absence of FD/GD at baseline was associated with less persistent FD/GD at LO (P<0.0005). The presence of FD with MH at baseline was associated with persistent FD at LO (P=0.027). Conclusion The fact that a large majority of eyes had FD/GD prior to ocriplasmin was unexpected and demonstrates that EZ disruptions are common in sVMA. This suggests that loss of EZ integrity may be part of the natural history of this disorder. It is hypothesized that the status of the EZ at baseline is a contributing, ocriplasmin independent modulator of subsequent EZ changes after ocriplasmin. Prospective analyses which include a sham control group would be required to test this hypothesis.
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Affiliation(s)
| | - Dante J Pieramici
- California Retina Consultants, Santa Barbara, CA, USA.,California Retina Research Foundation, Santa Barbara, CA, USA
| | | | | | - Petra Kozma
- Oxurion NV (formerly ThromboGenics NV), Leuven, Belgium
| | - Mitchell S Fineman
- Mid Atlantic Retina, Philadelphia, PA, USA.,Wills Eye Hospital, Philadelphia, PA, USA
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Alex D, Giridhar A, Gopalakrishnan M, Indurkhya S, Madan S. Subretinal hyperreflective material morphology in neovascular age-related macular degeneration: A case control study. Indian J Ophthalmol 2021; 69:1862-1866. [PMID: 34146045 PMCID: PMC8374782 DOI: 10.4103/ijo.ijo_3156_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: The aim of this study was to evaluate the association of morphological features of subretinal hyperreflective material (SHRM) with visual acuity (VA), geographic atrophy (GA) and scar formation in eyes with neovascular age-related macular degeneration (neovascular AMD) and to compare with controls of neovascular AMD without SHRM. Methods: Retrospective analysis of 157 wet AMD eyes with SHRM and 50 eyes without SHRM treated with Anti-VEGF. Baseline spectral domain-OCT characteristics (SHRM location, height, width, area, reflectivity, border definition) were collected and were correlated with VA at baseline, 3, 6, 12 months and looked for development of scar and geographical atrophy (GA) and were compared to the control group. Results: When compared to the control, baseline parameters with a significant predictive value of 12-VA were presence of SHRM, foveal involvement of SHRM, high reflective SHRM, well-defined SHRM borders and thick SHRM. VA was decreased with greater SHRM height, width and area (P < 0.001). Decreasing reflectivity of SHRM lesions and disappearance of SHRM correlated with better VA at 12 months (P < 0.05). At 12 months, scar and GA was present more often in eyes with persistent SHRM than in eyes with SHRM that resolved and those without SHRM in the control group. Conclusion: SHRM can be considered as a surrogate OCT biomarker in predicting final visual outcome in neovascular age-related macular degeneration. Baseline parameters predicting poorer vision at 12-follow-up were presence of SHRM involving the fovea, well-defined SHRM borders, greater SHRM height, width and area and persistence of SHRM with Anti-VEGF therapy.
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Affiliation(s)
- Divya Alex
- Department of Vitreoretinal Services, Giridhar Eye Institute, Cochin, Kerala, India
| | | | | | - Swati Indurkhya
- Department of Vitreoretinal Services, Giridhar Eye Institute, Cochin, Kerala, India
| | - Shivam Madan
- Department of Vitreoretinal Services, Giridhar Eye Institute, Cochin, Kerala, India
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Baseline Optical Coherence Tomography Parameters That May Influence 6 Months Treatment Outcome of Polypoidal Choroidal Vasculopathy Eyes with Combination Therapy: A Short-Term Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105378. [PMID: 34070071 PMCID: PMC8158141 DOI: 10.3390/ijerph18105378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 11/16/2022]
Abstract
Although optical coherence tomography (OCT) parameters have assisted in the diagnosis of polypoidal choroidal vasculopathy (PCV), its potential to evaluate treatment outcomes has not been established. The purpose of this pilot study was to evaluate baseline OCT parameters that may influence treatment outcome in PCV eyes with combination therapy. In this single-centered, prospective study, patients were recruited with at least one treatment-naïve PCV eye and treated with combination therapy of intravitreal anti-vascular endothelial growth factor and photodynamic therapy. Best-corrected distance and near visual acuity (DVA and NVA), and contrast sensitivity (CS) were recorded at baseline and six months after treatment. OCT parameters were determined. Twenty-six eyes of 26 patients aged between 51 to 83 years were evaluated. In eyes that had disrupted external limiting membrane (ELM), photoreceptors inner and outer segment (IS-OS) junction at 1000 micron of fovea at baseline showed low mean visual functions after 6 months of treatment. Eyes with foveal sub-retinal fluid (SRF) and polyp at central 1000 micron of fovea at baseline showed significantly worse DVA and CS after six months. Thus, the presence of foveal SRF, foveal polyp, disrupted ELM, and IS-OS junction at baseline significantly influenced the six months' visual outcome in PCV eyes treated with combination therapy.
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11
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Kim MS, Lee SG, Kim JY, Kang MY. Maculopathy from an accidental exposure to welding arc. BMJ Case Rep 2019; 12:12/2/bcr-2018-227677. [PMID: 30718265 DOI: 10.1136/bcr-2018-227677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Welding light can cause photic retinal injury. We report binocular maculopathy induced by a brief exposure to electric arc welding light in a patient who could not equipped with protective device because of narrow space. A 47-year-old man performed electric arc welding for approximately 10-15 min without wearing protective device because of narrow space and subsequently experienced eye discomfort and decreased visual acuity. At the initial visit, his best corrected visual acuity was 0.5. Fundus examination, optical coherence tomography (OCT) and multifocal electroretinogram (mfERG) were performed. OCT showed disruption in the ellipsoid zone, and mfERG amplitudes in the central 10° were markedly reduced in both eyes. The decrease in visual acuity had been noted for at least 18 months. Using the proper protective device is essential in welding, despite short time periods of work. For patients with welding-induced photokeratitis, doctors should also consider the possibility of photic retinal injury.
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Affiliation(s)
- Min-Seok Kim
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Sang-Gil Lee
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Ulsan, South Korea
| | - Jae Yun Kim
- Myungdong St. Mary's Eye Center, Seoul, South Korea
| | - Mo-Yeol Kang
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, South Korea.,Department of Occupational and Environmental Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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12
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Hyperglycemia potentiates the effect of ionic calcium in photoreceptor ellipsoid zone disruption in diabetic retinopathy. Int Ophthalmol 2019; 39:2237-2243. [PMID: 30628026 DOI: 10.1007/s10792-018-01063-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 12/21/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE To study the association of serum ionic calcium and glycated hemoglobin (HbA1c) with retinal photoreceptor ellipsoid zone (EZ) disruption in diabetic retinopathy (DR). METHODS This is a tertiary care center-based observational cross-sectional study. Sixty-three consecutive cases, divided into 21 cases each with no diabetic retinopathy, non-proliferative diabetic retinopathy and proliferative diabetic retinopathy were included. Twenty-one healthy controls were also included. Ellipsoid zone disruption was assessed using spectral-domain optical coherence tomography. Serum ionic calcium and HbA1c were measured using standard protocol. Patient data from cases were divided into two groups according to their HbA1c levels: group 1 (HbA1c < 7, n = 26) and group 2 (HbA1c > 7, n = 37). Data were analyzed statistically. RESULTS Mean ionic calcium levels in group 1 and group 2 were 1.131 ± 0.073 mmol/dL and 1.170 ± 0.070 mmol/dL, respectively. In group 1, 11 out of 26 had EZ disruption (42.3%). Similarly, in group 2, 29 out of 37 had EZ disruption (78.4%). On logistic regression analysis, as compared to group 1, ellipsoid zone disruption was found to be positively associated with serum ionic calcium (p = 0.01) in group 2 cases. CONCLUSION Increased levels of serum ionic calcium are associated with increased EZ disruption in patients with HbA1c > 7 in DR.
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Chandran V, Gao K, Swarup V, Versano R, Dong H, Jordan MC, Geschwind DH. Inducible and reversible phenotypes in a novel mouse model of Friedreich's Ataxia. eLife 2017; 6:e30054. [PMID: 29257745 PMCID: PMC5736353 DOI: 10.7554/elife.30054] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/20/2017] [Indexed: 12/13/2022] Open
Abstract
Friedreich's ataxia (FRDA), the most common inherited ataxia, is caused by recessive mutations that reduce the levels of frataxin (FXN), a mitochondrial iron binding protein. We developed an inducible mouse model of Fxn deficiency that enabled us to control the onset and progression of disease phenotypes by the modulation of Fxn levels. Systemic knockdown of Fxn in adult mice led to multiple phenotypes paralleling those observed in human patients across multiple organ systems. By reversing knockdown after clinical features appear, we were able to determine to what extent observed phenotypes represent reversible cellular dysfunction. Remarkably, upon restoration of near wild-type FXN levels, we observed significant recovery of function, associated pathology and transcriptomic dysregulation even after substantial motor dysfunction and pathology were observed. This model will be of broad utility in therapeutic development and in refining our understanding of the relative contribution of reversible cellular dysfunction at different stages in disease.
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Affiliation(s)
- Vijayendran Chandran
- Program in Neurogenetics, Department of Neurology, David Geffen School of MedicineUniversity of California, Los AngelesLos AngelesUnited States
| | - Kun Gao
- Program in Neurogenetics, Department of Neurology, David Geffen School of MedicineUniversity of California, Los AngelesLos AngelesUnited States
| | - Vivek Swarup
- Program in Neurogenetics, Department of Neurology, David Geffen School of MedicineUniversity of California, Los AngelesLos AngelesUnited States
| | - Revital Versano
- Program in Neurogenetics, Department of Neurology, David Geffen School of MedicineUniversity of California, Los AngelesLos AngelesUnited States
| | - Hongmei Dong
- Program in Neurogenetics, Department of Neurology, David Geffen School of MedicineUniversity of California, Los AngelesLos AngelesUnited States
| | - Maria C Jordan
- Department of Physiology, David Geffen School of MedicineUniversity of California, Los AngelesLos AngelesUnited States
| | - Daniel H Geschwind
- Program in Neurogenetics, Department of Neurology, David Geffen School of MedicineUniversity of California, Los AngelesLos AngelesUnited States
- Department of Human Genetics, David Geffen School of MedicineUniversity of California, Los AngelesLos AngelesUnited States
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14
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Wang Z, Camino A, Zhang M, Wang J, Hwang TS, Wilson DJ, Huang D, Li D, Jia Y. Automated detection of photoreceptor disruption in mild diabetic retinopathy on volumetric optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2017; 8:5384-5398. [PMID: 29296475 PMCID: PMC5745090 DOI: 10.1364/boe.8.005384] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 05/22/2023]
Abstract
Diabetic retinopathy is a pathology where microvascular circulation abnormalities ultimately result in photoreceptor disruption and, consequently, permanent loss of vision. Here, we developed a method that automatically detects photoreceptor disruption in mild diabetic retinopathy by mapping ellipsoid zone reflectance abnormalities from en face optical coherence tomography images. The algorithm uses a fuzzy c-means scheme with a redefined membership function to assign a defect severity level on each pixel and generate a probability map of defect category affiliation. A novel scheme of unsupervised clustering optimization allows accurate detection of the affected area. The achieved accuracy, sensitivity and specificity were about 90% on a population of thirteen diseased subjects. This method shows potential for accurate and fast detection of early biomarkers in diabetic retinopathy evolution.
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Affiliation(s)
- Zhuo Wang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, School of Physics and Electronics, Shandong Normal University, Jinan, 250014, China
- These authors contributed equally to this manuscript
| | - Acner Camino
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
- These authors contributed equally to this manuscript
| | - Miao Zhang
- Optovue, Inc. 2800 Bayview Dr., Fremont, CA 94538, USA
| | - Jie Wang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Thomas S Hwang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - David J Wilson
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Dengwang Li
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, School of Physics and Electronics, Shandong Normal University, Jinan, 250014, China
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
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15
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Correlation of Macular Focal Electroretinogram with Ellipsoid Zone Extension in Stargardt Disease. J Ophthalmol 2017; 2017:3643495. [PMID: 28912967 PMCID: PMC5585538 DOI: 10.1155/2017/3643495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 07/02/2017] [Accepted: 07/26/2017] [Indexed: 11/17/2022] Open
Abstract
Stargardt disease (STGD1) is the most common cause of inherited juvenile macular degeneration. This disease is characterized by a progressive accumulation of lipofuscin in the outer retina and subsequent loss of photoreceptors and retinal pigment epithelium. The aim of this study was to evaluate the relationship between cone photoreceptor function and structure in STGD1. Macular function was assessed by visual acuity measurement and focal electroretinogram (FERG) recording while spectral domain optical coherence tomography (SD-OCT) imaging was performed to evaluate the integrity of photoreceptors. FERG amplitude was significantly reduced in patients with Stargardt disease (p < 0.0001). The amplitude of FERG showed a negative relationship with interruption of ellipsoid zone (EZ) (R2 = 0.54, p < 0.0001) and a positive correlation with average macular thickness (AMT). Conversely, visual acuity was only weakly correlated with central macular thickness (CMT) (R2 = 0.12, p = 0.04). In conclusion, this study demonstrates that FERG amplitude is a reliable indicator of macular cone function while visual acuity reflects the activity of the foveal region. A precise assessment of macular cone function by FERG recording may be useful to monitor the progression of STGD1 and to select the optimal candidates to include in future clinical trials to treat this disease.
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16
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Li Y, Fariss RN, Qian JW, Cohen ED, Qian H. Light-Induced Thickening of Photoreceptor Outer Segment Layer Detected by Ultra-High Resolution OCT Imaging. Invest Ophthalmol Vis Sci 2017; 57:OCT105-11. [PMID: 27409460 PMCID: PMC4968769 DOI: 10.1167/iovs.15-18539] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE We examined if light induces changes in the retinal structure that can be observed using optical coherence tomography (OCT). METHODS Normal C57BL/6J mice (age 3-6 months) adapted to either room light (15 minutes to ∼5 hours, 50-500 lux) or darkness (overnight) were imaged using a Bioptigen UHR-OCT system. Confocal histologic images were obtained from mice killed under light- or dark-adapted conditions. RESULTS The OCT image of eyes adapted to room light exhibited significant increases (6.1 ± 0.8 μm, n = 13) in total retina thickness compared to the same eyes after overnight dark adaptation. These light-adapted retinal thickness changes occurred mainly in the outer retina, with the development of a hyporeflective band between the RPE and photoreceptor-tip layers. Histologic analysis revealed a light-evoked elongation between the outer limiting membrane and Bruch's membrane from 45.8 ± 1.7 μm in the dark (n = 5) to 52.1 ± 3.7 μm (n = 5) in the light. Light-adapted retinas showed an increase of actin staining in RPE apical microvilli at the same location as the hyporeflective band observed in OCT images. Elongation of the outer retina could be detected even with brief light exposures, increasing 2.1 ± 0.3 μm after 15 minutes (n = 9), and 4.1 ± 1.0 μm after 2 hours (n = 6). Conversely, dark-adaptation caused outer retinal shortening of 1.4 ± 0.4 μm (n = 7) and 3.0 ± 0.5 μm (n = 8) after 15 minutes and 2 hours, respectively. CONCLUSIONS Light-adaption induces an increase in the thickness of the outer retina and the appearance of a hyporeflective band in the OCT image. This is consistent with previous reports of light-induced fluid accumulation in the subretinal space.
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Affiliation(s)
- Yichao Li
- Visual Function Core National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Robert N Fariss
- Biological Imaging Core, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Jennifer W Qian
- College of Arts & Sciences, University of Virginia, Charlottesville, Virginia, United States
| | - Ethan D Cohen
- Division of Biomedical Physics, Office of Science and Engineering Labs, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, United States
| | - Haohua Qian
- Visual Function Core National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
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17
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Lu X, Chen W, Xia H, Zheng K, Jin C, Ng DSC, Chen H. Atrophy of retinal inner layers is associated with poor vision after endophthalmitis: a spectral domain optical coherence tomography study. Eye (Lond) 2017; 31:1488-1495. [PMID: 28574491 DOI: 10.1038/eye.2017.100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 04/20/2017] [Indexed: 02/06/2023] Open
Abstract
PurposeTo investigate the retinal structural changes in endophthalmitis and their association with visual outcome.Patients and methodsForty-five eyes of 45 patients diagnosed with endophthalmitis were included. Spectral domain optical coherence tomography (SD-OCT) was performed after inflammation was controlled. The relationship between SD-OCT features and best-corrected visual acuity (BCVA) at the last follow-up was analyzed.ResultsThe structural changes included inner segment ellipsoid (ISe) disruption (49%), atrophy of retinal inner layers (24%), epimacular membrane (24%), and macular edema (24%). BCVA was worse in patients with ISe disruption (P=0.005) and retinal inner layers' atrophy (P=0.004) compared with those without. There was no significant difference of BCVA between the patients with and without epimacular membrane, or intraretinal cysts. Multivariate regression showed that atrophy of retinal inner layers (b=0.41±0.17, P=0.022) was the only independent factor associated with BCVA.ConclusionAtrophy of retinal inner layers is associated with visual impairment in endophthalmitis, despite successful management.
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Affiliation(s)
- X Lu
- Joint Shantou International Eye Center, Shantou University, Chinese University of Hong Kong, Shantou, China
| | - W Chen
- Joint Shantou International Eye Center, Shantou University, Chinese University of Hong Kong, Shantou, China
| | - H Xia
- Joint Shantou International Eye Center, Shantou University, Chinese University of Hong Kong, Shantou, China
| | - K Zheng
- Joint Shantou International Eye Center, Shantou University, Chinese University of Hong Kong, Shantou, China
| | - C Jin
- Joint Shantou International Eye Center, Shantou University, Chinese University of Hong Kong, Shantou, China
| | - D S C Ng
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - H Chen
- Joint Shantou International Eye Center, Shantou University, Chinese University of Hong Kong, Shantou, China
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18
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Willoughby AS, Chiu SJ, Silverman RK, Farsiu S, Bailey C, Wiley HE, Ferris FL, Jaffe GJ. Platform-Independent Cirrus and Spectralis Thickness Measurements in Eyes with Diabetic Macular Edema Using Fully Automated Software. Transl Vis Sci Technol 2017; 6:9. [PMID: 28180033 PMCID: PMC5295813 DOI: 10.1167/tvst.6.1.9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/17/2016] [Indexed: 12/18/2022] Open
Abstract
PURPOSE We determine whether the automated segmentation software, Duke Optical Coherence Tomography Retinal Analysis Program (DOCTRAP), can measure, in a platform-independent manner, retinal thickness on Cirrus and Spectralis spectral domain optical coherence tomography (SD-OCT) images in eyes with diabetic macular edema (DME) under treatment in a clinical trial. METHODS Automatic segmentation software was used to segment the internal limiting membrane (ILM), inner retinal pigment epithelium (RPE), and Bruch's membrane (BM) in SD-OCT images acquired by Cirrus and Spectralis commercial systems, from the same eye, on the same day during a clinical interventional DME trial. Mean retinal thickness differences were compared across commercial and DOCTRAP platforms using intraclass correlation (ICC) and Bland-Altman plots. RESULTS The mean 1 mm central subfield thickness difference (standard error [SE]) comparing segmentation of Spectralis images with DOCTRAP versus HEYEX was 0.7 (0.3) μm (0.2 pixels). The corresponding values comparing segmentation of Cirrus images with DOCTRAP versus Cirrus software was 2.2 (0.7) μm. The mean 1 mm central subfield thickness difference (SE) comparing segmentation of Cirrus and Spectralis scan pairs with DOCTRAP using BM as the outer retinal boundary was -2.3 (0.9) μm compared to 2.8 (0.9) μm with inner RPE as the outer boundary. CONCLUSIONS DOCTRAP segmentation of Cirrus and Spectralis images produces validated thickness measurements that are very similar to each other, and very similar to the values generated by the corresponding commercial software in eyes with treated DME. TRANSLATIONAL RELEVANCE This software enables automatic total retinal thickness measurements across two OCT platforms, a process that is impractical to perform manually.
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Affiliation(s)
| | | | | | - Sina Farsiu
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Clare Bailey
- University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK
| | - Henry E Wiley
- National Eye Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, NC, USA
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19
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Zhu W, Chen H, Zhao H, Tian B, Wang L, Shi F, Xiang D, Luo X, Gao E, Zhang L, Yin Y, Chen X. Automatic Three-dimensional Detection of Photoreceptor Ellipsoid Zone Disruption Caused by Trauma in the OCT. Sci Rep 2016; 6:25433. [PMID: 27157473 PMCID: PMC4860566 DOI: 10.1038/srep25433] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 04/18/2016] [Indexed: 12/03/2022] Open
Abstract
Detection and assessment of the integrity of the photoreceptor ellipsoid zone (EZ) are important because it is critical for visual acuity in retina trauma and other diseases. We have proposed and validated a framework that can automatically analyse the 3D integrity of the EZ in optical coherence tomography (OCT) images. The images are first filtered and automatically segmented into 10 layers, of which EZ is located in the 7th layer. For each voxel of the EZ, 57 features are extracted and a principle component analysis is performed to optimize the features. An Adaboost classifier is trained to classify each voxel of the EZ as disrupted or non-disrupted. Finally, blood vessel silhouettes and isolated points are excluded. To demonstrate its effectiveness, the proposed framework was tested on 15 eyes with retinal trauma and 15 normal eyes. For the eyes with retinal trauma, the sensitivity (SEN) was 85.69% ± 9.59%, the specificity (SPE) was 85.91% ± 5.48%, and the balanced accuracy rate (BAR) was 85.80% ± 6.16%. For the normal eyes, the SPE was 99.03% ± 0.73%, and the SEN and BAR levels were not relevant. Our framework has the potential to become a useful tool for studying retina trauma and other conditions involving EZ integrity.
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Affiliation(s)
- Weifang Zhu
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Haoyu Chen
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, 515041, China.,Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Shatin N.T., Hong Kong, 999077, China
| | - Heming Zhao
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Bei Tian
- Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Lirong Wang
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Fei Shi
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Dehui Xiang
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Xiaohong Luo
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, 515041, China
| | - Enting Gao
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Li Zhang
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Yilong Yin
- School of Computer Science and Technology, Shandong University, Jinan, Shandong, 250100, China
| | - Xinjian Chen
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu, 215006, China
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20
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Li XJ, Yang XP, Li QM, Wang YY, Wang J, Lyu XB, Jia H. Posterior scleral reinforcement combined with vitrectomy for myopic foveoschisis. Int J Ophthalmol 2016; 9:258-61. [PMID: 26949646 DOI: 10.18240/ijo.2016.02.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/04/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the effects of posterior scleral reinforcement (PSR) combined with vitrectomy for myopic foveoschisis. METHODS Thirty-nine highly myopic eyes of 39 patients with myopic foveoschisis underwent PSR combined with vitrectomy. Best corrected visual acuity (BCVA), refraction error, and the foveal thickness by optical coherence tomography (OCT) were recorded before and after the surgery, and complications were noted. RESULTS The follow-up period was 12mo, and the main focus was on the results of the 12-month follow-up visit. The mean preoperative BCVA was 0.96±0.43 logMAR. At the final follow-up visit, the mean BCVA was 0.46±0.28 logMAR, which significantly improved compared with the preoperative one (P=0.003). The BCVA improved in 33 eyes (84.62%), and unchanged in 6 eyes (15.38%). At the end of follow-up, the mean refractive error was -15.13±2.55 D, and the improvement was significantly compared with the preoperative one (-17.53±4.51 D) (P=0.002). Twelve months after surgery, OCT showed complete resolution of the myopic foveoschisis and a reat-tachment of the fovea in 37 eyes (94.87%) and partial resolution in the remained two eyes (5.13%). The foveal thickness was obviously reduced at 12-month follow-up visit (196.45±36.35 µm) compared with the preoperative one (389.32±75.56 µm) (P=0.002). There were no serious complications during the 12mo follow-up period. CONCLUSION PSR combined with vitrectomy is a safe and effective procedure for myopic foveoschisis with both visual and anatomic improvement.
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Affiliation(s)
- Xiu-Juan Li
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Xiao-Peng Yang
- Department of Medical Equipment, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Qiu-Ming Li
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Yu-Ying Wang
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Jing Wang
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Xiao-Bei Lyu
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Heng Jia
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
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21
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Willoughby AS, Ying GS, Toth CA, Maguire MG, Burns RE, Grunwald JE, Daniel E, Jaffe GJ. Subretinal Hyperreflective Material in the Comparison of Age-Related Macular Degeneration Treatments Trials. Ophthalmology 2015; 122:1846-53.e5. [PMID: 26143666 DOI: 10.1016/j.ophtha.2015.05.042] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the association of subretinal hyperreflective material (SHRM) with visual acuity (VA), geographic atrophy (GA), and scar in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT). DESIGN Prospective cohort study within a randomized clinical trial. PARTICIPANTS The 1185 CATT participants. METHODS Masked readers graded scar and GA on fundus photography and fluorescein angiography and graded SHRM on time-domain and spectral-domain (SD) optical coherence tomography (OCT) throughout 104 weeks. Measurements of SHRM height and width in the fovea, within the center 1 mm(2), or outside the center 1mm(2) were obtained on SD OCT images at 56 (n = 76) and 104 (n = 66) weeks. MAIN OUTCOME MEASURES Presence of SHRM, as well as location and size, and associations with VA, scar, and GA. RESULTS Among CATT participants, the percentage with SHRM at enrollment was 77%, decreasing to 68% at 4 weeks after treatment and to 54% at 104 weeks. At 104 weeks, scar was present more often in eyes with persistent SHRM than in eyes with SHRM that resolved (64% vs. 31%; P < 0.0001). Among eyes with detailed evaluation of SHRM at weeks 56 (n = 76) and 104 (n = 66), mean VA letter score was 73.5 (standard error [SE], 2.8), 73.1 (SE, 3.4), 65.3 (SE, 3.5), and 63.9 (SE, 3.7) when SHRM was absent, present outside the central 1 mm(2), present within the central 1 mm(2) but not the foveal center, or present at the foveal center (P = 0.02), respectively. When SHRM was present, the median maximum height under the fovea, within the central 1 mm(2) including the fovea and anywhere within the scan, was 86 μm, 120 μm, and 122 μm, respectively. Visual acuity was decreased with greater SHRM height and width (P < 0.05). CONCLUSIONS In eyes with neovascular age-related macular degeneration (AMD), SHRM is common and often persists after anti-vascular endothelial growth factor treatment. At 2 years, eyes with scar were more likely to have SHRM than other eyes. Greater SHRM dimensions were associated with worse VA. In eyes with neovascular AMD, SHRM is an important morphologic biomarker.
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Affiliation(s)
- Alex S Willoughby
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Gui-Shuang Ying
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cynthia A Toth
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Maureen G Maguire
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Juan E Grunwald
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ebenezer Daniel
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina.
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