Bruch's Membrane Research Articles

Intravitreal panitumumab for prevention of myopic axial elongation in highly myopic adult eyes with myopic macular degeneration: Phase 1 study on safety

AbstractPurpose: Recent histomorphometric and clinical studies suggested that axial myopic elongation occurs through an enlargement of Bruch's membrane (BM) in the retroequatorial and equatorial region, leading to a thinning of choroid and sclera at the posterior pole. Thickness of the retina and choriocapillaris and RPE‐density in the macular region and BM thickness in any region remain independent of axial length. The equatorial‐to‐retroequatorial BM enlargement may be caused by an epidermal growth factor (EGF)‐associated RPE activity. Experimental studies in guinea pigs and monkeys showed a reduction in axial elongation by intravitreally applied blockers of EGF family members and the EGF receptor, and an increase in axial elongation by intravitreally applied EGF family members. In a clinical study, the intraocular EGF amount correlated with longer axial length. It led to the hypothesis, that ocular axial elongation is associated with EGF, and that further axial elongation may be prevented by an EGF blockade. We examined here the safety of intravitreally applied panitumumab, an EGF receptor blocker, already in clinical systemic use in oncology for two decades.Methods: The phase‐1 study included highly myopic adult patients with myopic macular degeneration. The eyes received one to two intravitreal injections of 0.6 mg (60 μl), 1.2 mg (120 μl) or 1.8 mg (180 μl) panitumumab.Results: The study included 10 patients (age 57–72 years, axial length: 29.10 mm–32.67 mm). Examined at day 1, 7, and 28 and at 2 and 3 months after the injections, the injected eyes did not show any intraocular inflammation or morphologic or functional changes, assessed by retinal electroretinography, perimetry, optical coherence tomography, tonometry and visual acuity measurement.Conclusions: The preliminary observations of these 10 patients are in agreement with a notion of an intraocular tolerability of panitumumab repeatedly injected intravitreally in doses of 0.6, 1.2 or 1.8 mg.

Clinical features and multimodal imaging findings in primary vitreoretinal lymphoma

AbstractPurpose: To describe clinical features and multimodal imaging findings in primary vitreoretinal lymphoma (PVRL).Methods: Medical records and imaging findings of 4 patients (4 eyes) diagnosed with PVRL were retrospectively reviewed. Detailed ophthalmic examination, fundus photography, fundus autofluorescence (FAF), fluorescein angiography (FA), optical coherence tomography (OCT) and OCT angiography (OCTA) were analysed in all patients. All patients underwent vitreous biopsy for diagnosis confirmation. Brain magnetic resonance imaging (MRI) was performed in all cases.Results: There were 2 women and 2 male patients with a mean age of 68.75 years. Visual blurring was the presenting symptom in all patients (100%). Clinical findings at presentation included vitritis in 4 eyes (100%), vitreous clumps in 2 eyes (50%), subretinal deposits in 3 eyes (75%) and exudative retinal detachment in one eye (25%). FAF showed granular hyperautofluorescence and hypoautofluorescence lesions in 3 eyes (75%) and blockage by mass lesion was seen in 1 eye. The most common pattern on FA was hypofluorescent lesions with a “leopard spot” appearance (75%). OCT revealed hyperreflective sub retinal lesions between retinal pigment epithelium and Bruch's membrane with an undulating shape (seasick sign) in 3 eyes (75%) and epiretinal membrane in one eye. OCTA showed areas of decreased signal on choriocapillaris slab in 2 eyes (50%). MRI of the globes and brain showed no abnormality in all cases. Vitreous cytology revealed atypical mononuclear cells consisting with the diagnosis of PVRL in all cases. The patients were referred to oncology unit.Conclusions: The diagnosis of PVRL is challenging. Multimodal imaging provides novel insights into features of PVRL.

Assessment of visual function and the neuroretina in subjects diagnosed with colour blindness

AbstractPurpose: To assess whether the existence of colour vision deficiency or colour blindness involves impairment of visual acuity, contrast sensitivity and colour vision and results in variations in retinal nerve fibre layer (RNFL) thickness, macular area, retinal ganglion cell complex and retinal layers that contain photoreceptors (bastons and cones) versus subjects with normal colour vision within the same age and gender distribution.Methods: Cross‐sectional and observational study including 50 eyes of subjects with colour blindness and 50 eyes of control subjects. Visual function (visual acuity, contrast sensitivity and colour vision) and neuroretinal structure were assessed in all subjects using optical coherence tomography (OCT).Results: Significant thinning of the retinal nerve fibre layer, ganglion cell layer and retina were observed in the colour blindness group. Significant thinning was also recorded in layers that involve photoreceptor nuclei (between the outer limiting layer and the Bruch membrane and between the outer plexiform layer and the outer limiting membrane).Conclusions: Significantly reduced thicknesses in the RNFL and several retinal layers (ganglion cell and photoreceptor layers) were found, demonstrating that colour blindness is associated with thinning in retinal and RNFL thickness, and in the retinal layers that involve photoreceptor nuclei. OCT study with retinal segmentation therefore seems to be a marker of colour blindness of utility in clinical practice in the case of doubt regarding diagnosis. This analysis could be useful in evaluating the effectiveness of potential therapies such as gene treatment.

Minimum Rim Width and Peripapillary Retinal Nerve Fiber Layer Thickness for Diagnosing Early to Moderate Glaucoma.

In a cross-sectional study from a Brazilian multiracial population, minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness measurements from OCT showed comparable diagnostic performance in discriminating early to moderate glaucoma from healthy eyes. The purpose of this study is to compare the ability of MRW and peripapillary retinal nerve fiber layer thickness (RNFLT) measurements in discriminating early to moderate glaucoma from healthy eyes in a Brazilian population. A total of 155 healthy controls and 118 patients with mild to moderate glaucoma (mean deviation >-12 dB) underwent MRW and RNFLT measurements with optical coherence tomography. Only 1 eye per patient was included in the analysis. A receiver operating characteristic (ROC) regression model was used to evaluate the diagnostic accuracy of MRW and RNFLT, whereas adjusting for age and Bruch membrane opening area. Sensitivities at fixed specificities of 95% were calculated for each parameter. Global RNFLT and MRW showed comparable area under the ROC curves [0.93 (0.91-0.96) and 0.93 (0.89-0.96), respectively; P =0.973]. Both parameters had similar sensitivities (75% vs. 74%, respectively; P =0.852) at a fixed specificity of 95%. The best sector for diagnosing glaucoma for both parameters was the temporal inferior sector, which showed an area under the ROC curve of 0.93 (0.87-0.96) for RNFLT and 0.91 (0.86-0.95) for MRW ( P =0.320). The temporal inferior sector showed similar sensitivities for RNFLT and MRW measurements (83% vs. 77%, respectively) at a fixed specificity of 95% (P =0.230). MRW and RNFLT measurements showed comparable diagnostic performance in discriminating early to moderate glaucoma from healthy eyes in a Brazilian multiracial population.

Arterial hypertension and retinal layer thickness: the Beijing Eye Study

PurposeTo investigate relationships between blood pressure and the thickness of single retinal layers in the macula.MethodsParticipants of the population-based Beijing Eye Study, free of retinal or optic nerve disease, underwent...

Outcomes of retinal pigment epithelial detachment in Vogt-Koyanagi-Harada disease: a longitudinal analysis

BackgroundThe aim of this study was to report the clinical profile and outcomes of retinal pigment epithelial detachment (PED) in Vogt-Koyanagi-Harada (VKH) disease, and to evaluate the correlation between PED and the subsequent development of central serous chorioretinopathy (CSC) throughout the whole corticosteroid treatment course.MethodsThe retrospective study enrolled a total of 470 eyes with VKH, and 12 eyes with VKH and PED were recruited. Patients were divided into two groups according to the CSC onset or not throughout the whole course (the CSC group and non-CSC group). Best-corrected visual acuity (BCVA) improvement, and PED angle (PEDA, the angle between the two lines of the vertex of the lifted retinal pigment epithelium to the two edge points of the Bruch membrane) were compared between the two groups.ResultsCSC developed at the site of the PED in 5 of the 12 eyes with PED, while in the remaining 7 eyes PED gradually resolved following therapy. The prevalence of PED and CSC in VKH was 2.55% (12/470) and 1.06% (5/470), respectively. BCVA improvement in the non-CSC group was greater than that in the CSC group, but without a statistical difference (P = 0.25). PEDA was significantly smaller in the CSC group than in the non-CSC group (P = 0.03).ConclusionPEDA is an ideal parameter to reflect hydrostatic pressure and stretches for RPE. As PED predisposes to the development of CSC in selected VKH eyes, PEDA may be a valuable predictive factor for the development of classic CSC in VKH cases.

Diagnostic evaluation of optical coherence tomography parameters in normal, preperimetric and perimetric glaucoma patients.

To compare the diagnostic ability of glaucoma parameters measured by the optical coherence tomography (OCT) in normal, preperimetric glaucoma (PPG) and perimetric glaucoma (PG) patients. This cross-sectional observational study includes 127 eyes of 127 subjects. Patients were divided into PPG (51 eyes), PG (46 eyes), and normal controls (30 eyes) based on clinical optic disc assessment and Humphrey visual field changes. The Heidelberg Spectralis OCT machine using Glaucoma Module Premium Edition software was used to measure the retinal nerve fiber layer (RNFL) and Bruch's membrane opening-minimum rim width (BMO-MRW) to assess the optic nerve head and ganglion cell layer (GCL) thickness in the macula. RNFL, MRW, and GCL thickness were all significantly thinner in PG compared to PPG and the normal group. The BMO-MRW parameters showed better specificity (>70%) at 90% specificity compared to both RNFL and GCL parameters to discriminate normal, PPG, and PG patients. All BMO-MRW parameters showed higher area under curves (AUC) compared to RNFL and GCL parameters with the highest AUC observed in the superotemporal sector of the BMO-MRW (AUC=0.819 and and 0.897 between normal and PPG and PG groups respectively). While the BMO-MRW best discriminates PPG and PG against normal eyes, GCL parameters poorly differentiate the three groups.

Peripapillary hyperreflective ovoid mass-like structures: Multimodal imaging-A review.

Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are a laterally bulging herniation of distended axons into the peripapillary region above the level of Bruch's membrane opening. Increased use of enhanced depth imaging-optical coherence tomography (EDI-OCT) in our evaluation of the optic nerve head (ONH) and greater recognition of the vast range of optic nerve pathologies with which PHOMS is associated provides convincing evidence that PHOMS is not just buried optic disc drusen (ODD) as previously described. The frequent coexistence of PHOMS with ODD, papilloedema, anterior ischaemic optic neuropathy, tilted optic disc syndrome, inflammatory demyelinating disorders and other diseases associated with axoplasmic stasis provides insight into its underlying pathophysiology. The present review will discuss the role of key imaging modalities in the differential diagnosis of PHOMS, explore the current literature on the relationship between PHOMS and common neuro-ophthalmic conditions, and highlight the gaps in our knowledge, with respect to disease classification and prognosis, to pave the way for future directions of research.

Optical Coherence Tomography Can Predict Visual Acuity in Children with Optic Nerve Hypoplasia.

Optic nerve hypoplasia (ONH) is a common cause of visual impairment in children. Clinical complexity can cause diagnostic delay and difficulties predicting visual outcome. We evaluated whether optical coherence tomography (OCT) can improve the diagnosis and prediction of vision. Thirty-seven eyes with ONH from 12 girls and 8 boys, median age 10.5 years (range 2.8-18.9 years), were included in this cross-sectional cohort study. The majority, 17/20, had bilateral ONH. Ophthalmological assessments included best corrected visual acuity (BCVA), fundus photography, measurement of the peripapillary retinal nerve fibre layer (pRNFL), macular ganglion cell complex (GCC), Bruch's membrane opening (BMO) and visual fields. We compared OCT parameters with comparison data collected on 140 healthy individuals 5 to 25 years old. Pearson's correlation coefficient was used to determine the correlation of OCT parameters and BCVA. OCT demonstrated thinner mean pRNFL (p < 0.001) and mean GCC compared to the reference material (p < 0.001). BCVA displayed a strong or moderate correlation to pRNFL and to all sectors of the GCC except the inferotemporal. BCVA correlated strongly to Bruch's membrane opening (BMO) (0.71, p < 0.001), and moderately to the Zeki ratio (-0.52, p < 0.001). Multivariate analyses showed that BMO explained 48% of the variance in BCVA. Visual fields correlated strongly to pRNFL and GCC thickness. GCC thinning corresponded to visual field defects presence and location. OCT can facilitate the diagnosis of ONH. Parameters such as pRNFL, GCC and BMO can be predictors of visual acuity whereas GCC and pRNFL thinning can indicate location and severity of visual field defects.

CLINICAL CHARACTERISTICS OF STREAKY MULTIFOCAL CHOROIDITIS: A Subtype of Multifocal Choroiditis.

To describe and analyze clinical characteristics of multifocal choroiditis with linear streaks (LSs). Eight cases of multifocal choroiditis with LSs were retrospectively studied. Multimodal imaging was performed. Demographic data and spherical equivalent were collected. Axial length was measured. All cases are young myopic women with a mean age of 17.13 ± 3.64 years (range, 13-23 years), presenting with vision loss and distortion. Nine eyes with LSs were high myopia of -8.97 ± 2.69 D (range, -6.00 to 12.5 D; growing by 1.88 ± 0.61 D annually since wearing glasses), with mean axial length of 26.36 ± 1.71 mm. Vitreous cells were noted in seven eyes. LSs were located in the equator (eight eyes), around the optic disk (three eyes), and at the edge of the posterior pole (one eye). Angio-optical coherence tomography showed choroidal neovascularization in eight eyes, especially 2 to 3 choroidal neovascularizations in three eyes. The location of choroidal neovascularization were in subfovea (three eyes), parafovea (six eyes), and perifovea (two eyes). Swept source optical coherence tomography showed punched-out disruption of retinal pigment epithelium‒Bruch's membrane‒choriocapillaris complex at the LSs' sites. LSs showed fluorescence staining on late FA but hypofluorescence throughout all phases on ICGA. Multifocal choroiditis with LSs mostly occurs in young women with high myopia, especially occurring in eyes with rapid progression of myopia. LSs are mainly located in the midperiphery near the equator, being prone to concur with choroidal neovascularization. Based on our findings, we propose a new term called "streaky multifocal choroiditis" as a subtype of multifocal choroiditis.

Racial Differences in Detection of Glaucoma Using Retinal Nerve Fiber Layer Thickness and Bruch Membrane Opening Minimum Rim Width

To compare the sensitivities and specificities of the retinal nerve fiber layer thickness (RNFLT) and Bruch membrane opening minimum rim width (BMO-MRW) reference database-based criteria for detection of glaucoma in individuals of European descent (ED) and individuals of African descent (AD). Comparative diagnostic analysis by race METHODS: 382 eyes of 255 glaucoma patients (ED=170, AD=85) and 94 eyes of 50 healthy individuals (ED=30, AD=20) with global and sectoral RNFLT and BMO-MRW measured with Spectralis optical coherence tomography (OCT) were included. Six diagnostic criteria were evaluated: global measurement below the 5th or 1st percentile, ≥1 of the 6 sector measurements below the 5th or 1st percentile, and superotemporal (ST) and/or inferotemporal (IT) measurement below the 5th or 1st percentile. The sensitivities and specificities of these measurements for detection of glaucoma were compared using bootstrapping methods. ST and/or IT RNFLT below the 5th percentile has the best performance for detection of glaucoma among RNFLT classifications with a sensitivity (95% CI) of 89.5% (86.1, 92.5) and specificity of 87.2% (77.8, 95.1). In AD individuals, sensitivities of ST and IT RNFLT and BMO-MRW measurements below the 5th percentile criteria were lower than in ED individuals (RNFLT: 83.7% vs 92.5%, and BMO-MRW: 72.1% vs 88.5%, respectively), as well as specificities (AD RNFLT: 73.7% and BMO-MRW: 89.5% vs ED RNFLT: 96.4% and BMO-MRW: 98.2%, respectively). RNFLT and BMO-MRW had consistently lower diagnostic performance in AD individuals compared with ED individuals. BMO-MRW criteria might fail to detect as many as one-third of eyes with glaucoma, specifically in AD individuals. With the current reference database, RNFLT, and especially BMO-MRW, criteria are not adequate for diagnosing glaucoma in AD individuals.

Identification of Factors Associated With the Development of Optic Disc Edema During Spaceflight

Approximately 70% of crew members who complete long-duration missions to the International Space Station develop signs of optic disc edema, a hallmark finding of spaceflight-associated neuro-ocular syndrome. The onset and magnitude of edema differ across individuals, and the reason for this variability remains unknown. Identifying risk factors for spaceflight-induced disc edema is important because this condition may become more severe during extended-duration missions to the moon and Mars and could be associated with irreversible vision loss. To assess whether preflight indicators of crowded optic nerve head morphology, other ocular measures (such as choroid thickness and axial length), body weight, body mass index, sex, age, and previous flight experience are associated with optic disc edema development. This cohort study analyzed ocular, body weight, and demographic data collected from 31 US and international crew members before, during, and after spaceflight at the NASA Johnson Space Center and International Space Station. Ocular factors assessed included preflight and in-flight peripapillary total retinal thickness, minimum rim width, optic cup volume, mean cup depth, mean cup width, cup-disc ratio, Bruch membrane opening area, retinal nerve fiber layer thickness, choroid thickness, axial length, and refractive error. In addition, body weight, body mass index, sex, age, and previous spaceflight experience were assessed for associations with optic disc edema development. The data were analyzed from August 2021 to June 2022. Approximately 6 to 12 months of spaceflight. In-flight increases in peripapillary total retinal thickness. Linear mixed models were used to assess for associations between a wide range of risk factors and in-flight increases in peripapillary total retinal thickness, which is a sensitive objective measure for detecting optic disc edema. This study included 31 International Space Station crew members with a mean (SD) age of 46.9 (6.0) years (25 men [80.6%]). During spaceflight, mean (SE) peripapillary total retinal thickness increased from 392.0 (5.8) μm to 430.2 (9.6) μm (P < .001), and greater individual changes were associated with smaller preflight cup volume (slope [SE], -62.8 [18.9]; P = .002), shallower preflight cup depth (slope [SE], -0.11 [0.03]; P < .001), and narrower preflight cup width (slope [SE], -0.03 [0.01]; P = .03). No associations were observed between changes in peripapillary total retinal thickness and any other variable evaluated. Findings of this cohort study suggest that smaller optic cup morphology may be associated with optic disc edema development during spaceflight. Crew members with this cup profile may benefit from enhanced ophthalmic monitoring during spaceflight and use of countermeasures against spaceflight-associated neuro-ocular syndrome.

Combined Model of OCT Angiography and Structural OCT Parameters to Predict Paracentral Visual Field Loss in Primary Open-Angle Glaucoma

To assess a model combining OCT angiography (OCTA) and OCT parameters to predict the severity of paracentral visual field (VF) loss in primary open-angle glaucoma (POAG). Cross-sectional study. Forty-four patients with POAG and 42 control subjects underwent OCTA and OCT imaging with a swept-source OCT device. The circumpapillary microvasculature was quantified for vessel density (cpVD) and flow (cpFlow) after delineation of Bruch's membrane opening and removal of large vessels. Retinal nerve fiber layer thickness (RNFLT) and Bruch's membrane opening-minimum rim width (BMO-MRW) were measured from structural OCT. Paracentral total deviation (PaTD) was defined as the average of the total deviation values within the central 10 degrees on Humphrey VF testing (24-2) for upper and lower hemifields. The OCT and OCTA parameters were measured in the affected hemisphere corresponding to the hemifield with lower PaTD for POAG patients. Models were created to predict affected PaTD based on RNFLT alone; RNFLT and BMO-MRW; OCTA alone; or RNFLT, BMO-MRW and OCTA parameters. The models were compared using coefficient of determination (r2) and Bayesian information criterion (BIC) score. Bayesian information criterion decrease of ≥6 indicates strong evidence for model improvement. Performance of models containing OCT and OCTA parameters in predicting PaTD. Patients with POAG and controls were similar in age and sex (65.9 ± 9.5 years and 38.4% male overall, P ≥ 0.56 for both). Average RNFLT, minimum RNFLT, average BMO-MRW, minimum BMO-MRW, cpVD, and cpFlow were all significantly lower (all P < 0.001) in the affected hemisphere in patients with POAG than in controls. In patients with POAG, the average mean deviation was -4.33 ± 3.25 dB; the PaTD of the affected hemifield averaged -4.55 ± 5.26 dB and correlated significantly with both OCTA and structural OCT parameters (r ≥ 0.43, P ≤ 0.004 for all). The model containing RNFLT, BMO-MRW, and OCTA parameters was superior in predicting affected PaTD (r2= 0.47, BIC= 290.7), with higher r2 and lower BIC compared with all 3 other models. A combined model of OCTA and structural OCT parameters can predict the severity of paracentral VF loss of the affected hemifield, supporting clinical utility of OCTA in patients with POAG with paracentral VF loss. Proprietary or commercial disclosure may be found after the references.

Exposure of the retina to subthreshold micro- and nanosecond laser at early stages of age-related macular degeneration

At the moment, there are no effective methods of treatment for age-related macular degeneration at its early stages. The perspective of treatment for age-related macular degeneration may be a method using subthreshold laser radiation.&#x0D; In the present review of literature, analysis is represented of using both subthreshold micro- and nanosecond laser radiation on the retina in intermediate AMD stage. Subthreshold diode micro-pulse laser exposure of the retina in AMD has proven to be a safe procedure that allows for the regression of macular drusen.&#x0D; While some authors noted an improvement in visual functions and a decrease in the probability of developing choroidal neovascularization with such treatment, multicenter trials have not yet confirmed the effectiveness of micro-pulse therapy as a method to prevent the neovascular AMD development.&#x0D; Subthreshold nanosecond laser impact on the retina is safe for the structures of the eye fundus, theoretically more selective stimulates the natural biological and regenerative potential in the pigment epithelium and neuroepithelium due to remodeling of extracellular matrix, restores the thickness of the Bruchs membrane and metabolism between external retinal layers and choriocapillaris.&#x0D; Encouraging results have been achieved from the use of nanopulse therapy as a method of preventing the development of advanced stage AMD in the absence of reticular pseudodrusen, however, it seems premature to recommend this technology for widespread clinical use - further research is needed.&#x0D; The prospects of invading in wide clinical practice of subthreshold nanosecond laser impact on the intermediate stage of AMD on the basis of the obtained clinical research results are encouraging (regression of drusen, preventing of AMD progression in absence of reticular pseudodrusen), but there is currently no evidence base. It is required to conduct further researches.

Characterization and identification of measurable endpoints in a mouse model featuring age-related retinal pathologies: a platform to test therapies

AbstractApolipoprotein B100 (apoB100) is the structural protein of cholesterol carriers including low-density lipoproteins. It is a constituent of sub-retinal pigment epithelial (sub-RPE) deposits and pro-atherogenic plaques, hallmarks of early dry age-related macular degeneration (AMD), an ocular neurodegenerative blinding disease, and cardiovascular disease, respectively. Herein, we characterized the retinal pathology of transgenic mice expressing mouse apoB100 in order to catalog their functional and morphological ocular phenotypes as a function of age and establish measurable endpoints for their use as a mouse model to test potential therapies. ApoB100 mice were found to exhibit an age-related decline in retinal function, as measured by electroretinogram (ERG) recordings of their scotopic a-wave, scotopic b-wave; and c-wave amplitudes. ApoB100 mice also displayed a buildup of the cholesterol carrier, apolipoprotein E (apoE) within and below the supporting extracellular matrix, Bruch's membrane (BrM), along with BrM thickening, and accumulation of thin diffuse electron-dense sub-RPE deposits, the severity of which increased with age. Moreover, the combination of apoB100 and advanced age were found to be associated with RPE morphological changes and the presence of sub-retinal immune cells as visualized in RPE-choroid flatmounts. Finally, aged apoB100 mice showed higher levels of circulating and ocular pro-inflammatory cytokines, supporting a link between age and increased local and systemic inflammation. Collectively, the data support the use of aged apoB100 mice as a platform to evaluate potential therapies for retinal degeneration, specifically drugs intended to target removal of lipids from Bruch's membrane and/or alleviate ocular inflammation.

Traumatic Maculopathies Associated with Closed-Globe Injury

Traumatic maculopathies due to closed-globe injury are commotio retinae (Berlin’s edema), choroidal rupture, traumatic macular hole, retinitis sclopetaria, shaken baby syndrome, Valsalva retinopathy, and Purtscher retinopathy. The main pathology in commotio retinae is in the outer retinal layers and usually resolves spontaneously. Blunt eye traumas coming from the anterior aspect can cause choroidal ruptures. These are mainly due to the rupture of inelastic Bruch membrane and adjacent structures. If they involve fovea, visual loss can occur. Late choroidal neovascularisation may develop in 1/10 of the cases. Traumatic macular holes develop in less than 2% of the blunt ocular traumas. Early macular holes result from tangential traction whereas late holes from anteroposterior vitreoretinal traction. They can be closed spontaneously within 4 months, especially in young patients. Retinitis sclopetaria is rare. It results from high-velocity pellets that hit but do not penetrate the globe. Shock waves can cause the rupture of the choroid and overlie the neurosensory retina. The shaken baby syndrome is a result of the violence in the family. It must be reported to the police. Retinal hemorrhages, cotton wool spots, and hemorrhagic retinoschisis areas are the prominent features. The sudden increase in intrathoracic or abdominal pressure may lead to the rupture of the retinal capillaries and usually a sub-internal limiting membrane hemorrhage in Valsalva retinopathy. If it is larger than 3-disc diameters and persists for more than 3 weeks; it may be drained into vitreous with an Nd-YAG laser. Purtscher retinopathy is an occlusive microvasculopathy resulting from severe head trauma or compression injuries of the thorax. Intraretinal hemorrhages, geometric white areas (Purtscher flecken), and cotton wool spots are typical features. Usually fades within 1-2 months. Medicolegal aspects as well as ocular and systemic associations are also important in closed globe injuries and should not be neglected.

Study of interactions between CFH gene polymorphism and retinal pigment epithelium phenotype in age-related macular degeneration

Annotation. AMD (age-related macular degeneration) is one of the leading causes of blindness in the world, associated with the formation of extracellular deposits called drusen in the macula, i.e. in the central part of the retina. These drusen contain cellular debris and proteins, including components of the complement system, such as the regulator CFH (complement factor H). Complement dysregulation is believed to play a major role in the development of AMD. CFH acts through its ability to recognize polyanionic structures (eg, sulfated GAGs (glycosaminoglycans)) found in host tissues, and thus CFH inactivates any complement system (C3b) that is deposited. Importantly, the common CFH (Y402H) polymorphism was strongly associated with an increased risk of AMD. Recent studies have shown that the disease-associated allotype 402H interacts more poorly (compared to 402Y) with binding sites in the macula (eg, Bruch's membrane), where GAGs (glycosaminoglycans), heparan sulfate, and dermatan sulfate play a major role in mediating the interaction with CFH. Decreased binding of the 402H allotype may lead to complement dysregulation, leading to chronic local inflammation that may contribute to drusen accumulation and thus the initiation, development, and progression of AMD. That is why the goal of our study was to highlight the effect of the rs1061170 polymorphism of the CFH gene on the occurrence and development of age-related macular degeneration and to clarify the intensity of this pathological effect. The study group consisted of 291 people suffering from AMD (89 – with the “dry” form, 97 – with the “wet” form), the comparison group – 105 people without a history of ophthalmic pathology of the corresponding age. Optical coherence tomography (SOCT Copernicus “Optopol”) of the macular area of the retina was used in the study. We used the parameter ILM-RPE (internal limiting membrane-retinal pigmented epithelium). DNA was isolated from the biological material obtained by the buccal scraping method using the Bio-Rad Chelex ® 100 kit. Polymerase chain reaction was used to detect the rs1061170 polymorphism of the CFH gene. Statistical processing of the obtained results was carried out using Statistica 10 (StatSoft, Inc., USA) and SPSS 23.0 programs. The following were used: Hardy-Weinberg equilibrium (Hardy–Weinberg); Kruskal-Wallis test ANOVA by Ranks and Friedman ANOVA and Kendall Coeff. of Concordance; H-criterion; indicators of the odds ratio (OR; Odds Ratio – OR) and 95% probable interval (±95% CI; Confidence limit for means Interval – CI); used the method of analysis of operating characteristic curves (ROC – Receiver Operating Characteristic curve analysis); used special formulas using 2x2 tables. Our results confirm the high prognostic significance of the rs1061170 polymorphism of the CFH gene on the development and progression of AMD in the Ukrainian population. Indicators of specificity and sensitivity of SNP genotypes are ambiguous.

OCT angiography analysis of choriocapillaris vascular density in different stages of age-related macular degeneration.

To analyze the choriocapillaris vessel density (CVD) of eyes at different stages of Age-related Macular Degeneration (AMD) with Optical Coherence Tomography Angiography (OCTA). This is a prospective observational cross-sectional study on 21 age-matched healthy eyes and 84 eyes with AMD (i.e., early AMD, late AMD, Geographic Atrophy [GA], and disciform scar AMD). OCTA was used to automatically measure the CVD (%), on both the whole macula and the foveal area, in a layer going from 9 µm above to 30 µm below the Bruch's membrane. Furthermore, in the GA subgroup, the extension of the Ellipsoid Zone (EZ) interruption and the area of macular chorio-retinal atrophy was analyzed. Macular CVD was significantly lower in the GA, late AMD and disciform scar AMD-subgroups compared to controls (respectively, p=0.0052; p<0.0001; p=0.0003), whereas it did not significantly vary in the early AMD group (p=0.86). A significant difference between the early AMD and both the late AMD and the disciform scar AMD subgroups was also found (p=0.0009 and 0.0095, respectively). When comparing the foveal CVD of healthy and AMD eyes, a significant difference was found with every AMD subgroup (early AMD, p=0.011; GA, p<0.0001; late AMD, p<0.0001; disciform scar AMD, p<0.0001). Furthermore, in the GA subgroup, the CVD had an inverse correlation with both the extension of the EZ-interruption (p=0.012) and with the calculated chorio-retinal atrophic area (p=0.009). OCTA could play a crucial role in the categorization of AMD, allowing for the evaluation of gradual flow impairment at different stages of the disease. Moreover, the detection of a decreased macular and foveal CVD may shed light on the pathogenesis of AMD.

Hemisphere opposite to central retinal vascular trunk deviation is earlier affected by glaucomatous damage in primary angle-closure glaucoma.

The purpose of the study was to investigate whether the position of the central retinal vascular trunk (CRVT), as a surrogate for lamina cribrosa (LC) offset, is associated with the dominant hemisphere of visual field defect in primary angle-closure glaucoma (PACG) eyes. Central retinal vascular trunkdeviation was measured from Bruch's membrane opening (BMO) centre, which was delineated by OCT imaging, using the horizontal midline as a reference. The dominant hemisphere developing visual field defect was defined as three connected abnormal points (having a p-value < 5% probability of being normal) appearing in only one hemisphere or each point of the hemisphere having a statistically worse value compared with its mirrored point in the opposite hemisphere on pattern deviation plots. One hundred five (80%) of 132 eyes with PACG had dominant hemisphere of visual field defect initially: 70 eyes (67%) in the superior and 35 eyes (33%) in the inferior hemisphere. The CRVT was located superiorly in the dominant superior visual field defect group (p < 0.001). A logistic regression analysis revealed that superior deviation of the CRVT was the only factor associated with dominant superior visual field defect (p < 0.001). Externally oblique border (EOB) presence was associated with larger BMO (p=0.005) and angular deviation of CRVT (p=0.002). Central retinal vascular trunk deviation was associated with the dominant hemisphere of visual field defect in PACG eyes. This finding implies that the LC position relative to the BMO centre (LC/BMO offset) may incur structural vulnerability in the optic nerve head of PACG eyes.

Parapapillary gamma zone associated with increased peripapillary scleral bowing: the Beijing Eye Study 2011

AimsTo investigate the association between the backward configuration of the peripapillary sclera (PPS), measured as PPS angle (PPSA), and presence and extent of parapapillary gamma zone.MethodsOut of the population-based Beijing...