Area Centralis Research Articles

Does Anti-Vascular Endothelial Growth Factor Treatment Delay Photoreceptor Maturation in Preterm Infants?

Purpose: To investigate the effects of intravitreal anti-vascular endothelial growth factor (VEGF) for treatment of type-1 or aggressive posterior retinopathy of prematurity (ROP) on photoreceptor maturation in preterm infants using spectral domain optical coherence tomography (SD-OCT). Methods: A study group of 36 patients with ROP treated with anti-VEGF therapy was compared to a control group of 80 patients with ROP. All patients had undergone SD-OCT imaging at least once between 40 and 44 weeks post-menstrual age (PMA). Two imaging specialists evaluated the images for ellipsoid zone (EZ) development, cystoid macular edema (CME), sub-retinal fluid (SRF) at the fovea, and cone outer segment tips (COST). The outer nuclear layer thickness and the distance from the EZ to the central fovea was measured. Results: EZ development was observed in 18 (50%) patients in the study group and 68 (85%) in the control group (p = 0.002). CME was observed in 17 (47.2%) patients in the study group and 17 (21.2%) in the control group. The distance between the EZ and central fovea was 868 ± 440 μm in the study group and 725 ± 380 μm in the control group (p = 0.02). COST was not observed in any patient. Regression analysis indicated that anti-VEGF treatment and CME affect EZ development. Conclusions: Early photoreceptor maturation is correlated with preterm birth week but not ROP stage. Anti-VEGF treatment delays photoreceptor maturation in preterm infants.

High-resolution in-vivo human retinal imaging using full-field OCT with optical stabilization of axial motion.

Time-domain full-field OCT (FF-OCT) represents an imaging modality capable of recording high-speed en-face sections of a sample at a given depth. One of the biggest challenges to transfer this technique to image in-vivo human retina is the presence of continuous involuntary head and eye axial motion during image acquisition. In this paper, we demonstrate a solution to this problem by implementing an optical stabilization in an FF-OCT system. This was made possible by combining an FF-OCT system, an SD-OCT system, and a high-speed voice-coil translation stage. B-scans generated by the SD-OCT were used to measure the retina axial position and to drive the position of the high-speed voice coil translation stage, where the FF-OCT reference arm is mounted. Closed-loop optical stabilization reduced the RMS error by a factor of 7, significantly increasing the FF-OCT image acquisition efficiency. By these means, we demonstrate the capacity of the FF-OCT to resolve cone mosaic as close as 1.5 o from the fovea center with high consistency and without using adaptive optics.

Distribution of rods and cones in the red-eared turtle retina (Trachemys scripta elegans).

We have identified the photoreceptors of Trachemys scripta elegans, an intensely studied species that is a model for color vision work. To recognize and count the different photoreceptor types, we labeled them with a combination of morphological and immunohistochemistry markers. The counts for the determination of the density of each photoreceptor type were made in wholemount retinas. The percentages found for each cone type were 29, 23, 21, 12, and 6%, respectively, for L (both types), double, M, S, and ultraviolet cones. The cones were found to be organized horizontally in a visual streak, a linear region with a higher density of photoreceptors that ends temporally in the periphery and more centrally in the nasal side. This region of high density of photoreceptors was not symmetrical along its extension; there was a region with conspicuous central density peaks in the temporal area, suggestive of an area centralis. We also observed a dorsoventral asymmetry in photoreceptor density, with greater density in the ventral region. This asymmetry was observed in cones and rods, but it was more pronounced in the rods. Our results corroborate and extend the findings of previous work in the literature describing the retinal photoreceptors of T. s. elegans and their spatial organization. The higher cone density within the visual streak reflects increased spatial resolution and its existence suggests the possibility of binocular vision. It is remarkable that within this region the entire potential for color vision is also present.

DEVELOPMENT OF MACULAR ATROPHY AFTER PARS PLANA VITRECTOMY FOR MYOPIC TRACTION MACULOPATHY AND MACULAR HOLE RETINAL DETACHMENT IN PATHOLOGIC MYOPIA.

To determine the incidence and long-term outcome of macular atrophy (MA) after pars plana vitrectomy (PPV) in pathologic myopia. Highly myopic patients who underwent PPV for myopic traction maculopathy and macular hole retinal detachment at Tokyo Medical and Dental University between 2012 and 2016 were studied. Fundus photographs and/or optical coherence tomography were examined before and after PPV at every visit. A total of 133 eyes were followed for 39 months with the mean age of 62.8 years and the mean axial length of 30.0 mm. Postoperatively, 14 eyes (10.5%) developed fovea-centered MA, observed initially as a small, isolated, whitish lesion at the center of fovea at 3.5 months after PPV. The appearance of the MA was distinctly different from the choroidal neovascularization-related MA or patchy atrophy-related MA. With time, the lesions enlarged circumferentially. In these 14 eyes, the final best-corrected visual acuity was worse than the baseline, although the difference was not significant. The occurrence of MA was significantly associated with the preoperative foveal status. The development of MA can occur in 11% of highly myopic eyes after PPV for myopic traction maculopathy and macular hole retinal detachment. This postoperative MA might be a new complication of pathologic myopia.

Analysis of Hyperreflective Dots Within the Central Fovea in Healthy Eyes Using En Face Optical Coherence Tomography.

The purpose of this retrospective study was to describe and quantify superficial hyperreflective dots within the central fovea and correlate them with age, using en face and cross-sectional B-scan optical coherence tomography (OCT). Healthy eyes, evaluated with a spectral domain instrument (primary cohort) at the Stein Eye Institute (UCLA) and with a swept source instrument (secondary cohort) at the Vitreous Retina Macula Consultants of New York, were included in this study. En face OCT images (3 × 3 mm) segmented at the level of the superior vascular plexus were acquired, and hyperreflective dots in the foveal avascular zone were quantified by two different methodologies. The threshold reflectivity methodology quantified these dots on a cropped en face OCT image using ellipsoid zone mean reflectivity as the threshold cutoff. The OCT B-scan methodology consisted of a manual count of elevated hyperreflective signals on B-scans that colocalized with the dots by en face OCT. Primary outcome was to quantify these dots and correlate them with age. A total of 44 healthy eyes were evaluated in the primary cohort, and 16 healthy eyes were evaluated in the secondary cohort. The hyperreflective dots steadily increased in number, especially in patients older than 50 years of age, with a strongly positive statistical significant correlation, using both quantitative strategies. Remarkable superficial hyperreflective dots in the central fovea of healthy subjects are novel anatomical findings that may be readily identified with both en face and cross-sectional OCT and steadily increase in number with age. We propose that these dots may represent a normal anatomical landmark, such as Müller cell end feet or inner limiting membrane basal lamina.

Macular thicknesses in patients with keratoconus: An optical coherence tomography study

Background: Keratoconus, a corneal ectasia associated with thickness and structural changes, has been reported to co-exist with posterior segment ocular conditions. However, very few studies have reported on macular thicknesses in individuals with keratoconus.Aim: The aim of this study was to investigate macular thicknesses in participants with keratoconus.Setting: This study was conducted at the University of KwaZulu-Natal (UKZN).Methods: A comparative cross-sectional research design was used. The sample consisted of 88 participants with 44 each in the control and keratoconus (15, 11 and 18 with mild, moderate and severe keratoconus, respectively) groups. Macular thicknesses were obtained with the Fourier-domain Optovue iVue100 optical coherence tomographer using the nine Early Treatment Diabetic Retinopathy Study sectors. Data were analysed using descriptive and inferential statistics.Results: Overall, the mean macular thicknesses were comparable among the control and three keratoconus groups (p ≥ 0.199). The mean central foveal thickness was greater in the severe keratoconus group (259 µm) than the other three study groups that showed similar measurements (247 µm – 248 µm). The central fovea was thinnest followed by the perifovea and parafovea in all four study groups. The mean thickness in the nasal and temporal quadrants of the parafovea and perifovea was thickest and thinnest, respectively, in all four study groups.Conclusion: Macular thicknesses via optical coherence tomography in individuals with keratoconus and controls are similar with thickness differences that are clinically insignificant. Consequently, macular thicknesses should be included in the preoperative assessment of individuals with keratoconus awaiting corneal transplantation to assess the integrity of the retina prior to surgery.

Multimodal imaging in congenital simple hamartoma of retinal pigment epithelium (CSHRPE): optical coherence tomography (OCT), autofluorescence and oct angiography, a review of the literature and case presentation

Purpose: To report a case of congenital simple Hamartoma of retinal pigment epithelium (CSHRPE) with avulsion of RPE without visual impairment. Methods: A 11-years-old Caucasian male presented with full visual acuity in both eyes, and was made diagnosis of CSHRPE after a complete ophthalmological examination. Was also performed: fundus photographs, spectral domain optical coherence tomography (SD-OCT), fundus autofluorescence (FAF) and OCT angiography (OCT-A). Results: Hepresented with full visual acuity in both eyes; fundus examination showed a small, darkly pigmented, well-circumscribed lesion involving the central fovea in the right eye. Conclusion:This case shows a rare complication such as avulsion can be still associated with high visual acuity. Despite CSHRPE was storically defined as congenital pigment epithelial adenomas or primary pigment epithelial hyperplasia without vascular or glial components; the new sophisticated imaging techniques show the coexistence of a vascular and glial involvement. So CSHRPE can be defined as isolated RPE Hamartoma for the prevalence of the epithelial component, but this is not the only component. These new sofisticated techniques, especially OCT and OCT-A, should take us to consider Retinal Hamartomas like a broad spectrum.

THE ROLE OF CLUSTERIN IN THE DEVELOPMENT OF DIABETIC MACULAR EDEMA IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Relevance. One of the main causes of visual impairment in patients with type 2 diabetes mellitus (DMT2) is diabetic macular edema (DME). Complications associated with DME include microglial activation, dysfunc tion of neurons, their dystrophy and apoptosis. Purpose. To study the peculiarities of the content of anti-apoptotic factor clusterin in serum and to analyze the relationship of clusterin with the state of the macula in patients with DMT2 and DME. Material and research methods. 82 patients with DMT2 (145 eyes) were divided into 4 groups according to the form of DME. The criteria for inclusion in the open study was voluntary informed consent, age 18 years, the presence of DMT2. Non-inclusion criteria were the presence of endocrine diseases, which can lead to type 2 diabetes, DMT1, acute infectious diseases, cancer, decompensation of comorbid pathology, mental disorders, antipsychotics, antidepressants, neurodegenerative diseases of the central nervous system, proteinuria, damage to the optic nerve, glaucoma and mature cataracts. The following instrumental indices were used for the study: nerve fiber layer thickness — NFL, ganglion cell layer thickness — GCL, inner posterior layer thickness — IPL, central retinal thickness, the volume of the macula and central fovea, the minimum thickness of the central fovea (minimum in fovea), the average thickness of the retina in the macula (area thickness). Results. By en determined that in patients with T2DM and DME, chances of oc currence of low thickness (value > QI) of NFL + GCL + IPL (> 115 .m) and NFL (> 31 .m) are significantly in creased with increasing the blood clusterin levels on each 1 .g/ml (OR = 1.04 (95 % CI 1.01–1.08) and OR = 1.04 (95 % CI 1.01–1.08), respectively). It was shown that the optimal threshold value for serum clusterin is 77.0 .g/ml. With a selected clusterin content threshold for NFL + GCL + IPL thickness > 115 .m, the test sensitivity is 59.6 %, specificity is 75 %, and for NFL thickness > 31 .m — 56.7 % and 76.2 %, respectively. Conclusion. An increasing of the concentration of blood plasma clusterin over the optimal threshold (that we have identified) can be an indicator of the active inflammatory process and edema of the retina.

Percentage of Foveal vs Total Macular Geographic Atrophy as a Predictor of Visual Acuity in Age-Related Macular Degeneration.

This article investigates the relationship between visual acuity (VA), total area of geographic atrophy (GA), and percentage of foveal GA. A multicenter, retrospective, cross-sectional study was conducted of patients with GA due to age-related macular degeneration. Demographics, VA, fundus autofluorescence (FAF), and spectral-domain optical coherence tomography (SD-OCT) images were collected. Using FAF images aided by SD-OCT, fovea-sparing status, GA pattern, total GA size, and percentage of GA covering the foveal area-within a 1.5-mm-diameter circle centered on the fovea centralis-were assessed. Univariable and multiple linear regression analyses were performed. Fifty-four eyes (mean age, 78.7 ±7.7 years [SD], 60.0% female) were studied. Mean VA was 0.8 ± 0.6 logarithm of the minimum angle of resolution (Snellen equivalent 20/126 ± 20/80), mean total GA 8.8 ± 6.7 mm2, and mean percentage of foveal GA was 71.5 ± 30.9%. Of all assessed eyes, 48.2% (n = 26) presented with multifocal GA, and 18.5% (n =10) had foveal sparing. Multiple regression analysis revealed that, controlling for age and GA pattern, the percentage of foveal GA presented a statistically significant association with VA (ß =0.41, P = .004). No significant associations were observed with mean total GA size, while controlling for the same variables (ß=0.010, P = .440). Percentage of foveal GA was significantly associated with VA impairment, although the same was not verified for total GA area. These findings suggest that percentage of foveal GA may represent a more useful tool for assessing the impact of GA on VA. Further validation is needed in larger cohorts.

Lateral effects in pattern vision

There is a large literature on lateral effects in pattern vision but no consensus about them or comprehensive model of them. This paper reviews the literature with a focus on the effects of parallel context in the central fovea. It describes seven experiments that measure detection and discrimination thresholds in annular and Gabor-pattern contexts at different separations. It presents a model of these effects, which is an elaboration of Foley's (1994) model. The model describes the results well, and it shows that lateral context affects the response to the target by both multiplicative excitation and additive inhibition. Both lateral effects extend for several wavelengths beyond the target. They vary in relative strength, producing near suppression and far enhancement of the response to the target. The model describes the detection and discrimination results well, and it also describes the results of experiments on lateral effects on perceived contrast. The model is consistent with the physiology of V1 cells.

Measurement and analysis of choroidal vascularity index and subfoveal choroidal thickness in central serous chorioretinopathy

Objective To observe the choroidal vascularity index (CVI) and the subfoveal choroidal thickness (SFCT) of central serous chorioretinopathy (CSC), and to compare the stability and consistency of the two methods of measurement. Methods A retrospective study. Thirty-one patients with unilateral acute CSC who visited the Department of Ophthalmology of Beijing Friendship Hospital for the first time during the period from Nov 1st, 2016 to Mar 18th, 2018 were included in the study. Thirty-one healthy age-matched subjects were enrolled as controls. All CSC affected eyes and their fellow eyes and healthy eyes were scanned by single-line enhanced depth imaging of OCT through central fovea of macula to measure their SFCT. The image was binarized and then the CVI of a 1500 μm range below fovea was calculated, i.e. the ratio of vascular (or lumen) area to total choroidal area. CVI and SFCT were compared among CSC eyes, fellow eyes and healthy eyes by variance analysis. Intra-group correlation coefficient (ICC), Bland-Altman curve and coefficient of variation (CV) were used to analyze the repeatability, consistency and stability of CVI and SFCT; and Medcalc18.2.1 software was used to draw the Bland-Altman curve and observe the consistency of the two measurement methods. Results There were statistically significant differences in CVI and SFCT between CSC affected eyes and fellow eyes (t=3.470, 2.844; P=0.001, 0.006), CSC affected eyes and healthy eyes (t=6.977, 6.277; P<0.001,<0.001), fellow eyes and healthy eyes (t=3.508, 3.433; P=0.001, 0.001). Relative consistency analysis of CVI and SFCT showed that the ICC of single measurement and average measurement of CVI were 0.967 and 0.983 respectively, and that of single measurement and average measurement of SFCT were 0.937 and 0.967 respectively. The consistency of CVI and of SFCT was very good. The ICC value of CVI was slightly higher than that of SFCT. The results of repeatability analysis of CVI and SFCT showed that the difference between the two CVI measurements was smaller, and the difference between the two SFCT measurements was larger. And CVI and SFCT stability analysis results showed that the CV of CVI and SFCT were 10.5% and 25.3% respectively. CVI has smaller CV than SFCT. Conclusions Compared with healthy eyes, CVI and SFCT are increased in CSC affected eyes and fellow eyes. And compared with SFCT, CVI has better consistency, repeatability and stability. Key words: Central serous chorioretinopathy; Tomography, optical coherence; Choroidal vascularity index; Subfoveal choroidal thickness

POTENTIAL UTILITY OF FOVEAL MORPHOLOGY IN PRETERM INFANTS MEASURED USING HAND-HELD OPTICAL COHERENCE TOMOGRAPHY IN RETINOPATHY OF PREMATURITY SCREENING.

To investigate dynamic foveal morphology with postmenstrual age, in preterm infants with and without retinopathy of prematurity using hand-held optical coherence tomography, adjusting for gestational age (GA) and birthweight (BW). Prospective mixed cross-sectional/longitudinal observational study of 87 participants (23-36 weeks GA; n = 30 with, n = 57 without retinopathy of prematurity) using hand-held optical coherence tomography images (n = 278) acquired between 31 weeks and 44 weeks postmenstrual age excluding treated retinopathy of prematurity. Measurements included foveal width, area, depth, central foveal thickness, maximum slope, and parafoveal retinal thickness at 1,000 µm nasal and temporal to the central fovea. Retinopathy of prematurity was significantly correlated with only foveal width in either GA or BW adjusted statistical models. In contrast, severity of prematurity (GA, BW) correlated with foveal area (P < 0.005), depth (P ≤ 0.001), and slope (P < 0.01), although central foveal thickness (P = 0.007) and parafoveal retinal thickness (P < 0.001) correlated with GA, but not with BW. Foveal width is independent of GA and BW with potential in retinopathy of prematurity screening assessment using hand-held optical coherence tomography. Foveal morphology could be graded in prematurity during development, with possible implications for future management of preterm infants.

Multimodal imaging of torpedo maculopathy in a Chinese woman: a case report

BackgroundTorpedo maculopathy is a rare, benign, and congenital macular lesion that typically appears in a ‘torpedo-shape’ and is located at the temporal macula region. This study aimed to describe in detail regarding torpedo maculopathy in a Chinese woman using multimodal imaging.Case presentationA 30-year-old Chinese woman with occasional yellowish-white macular lesions in her right eye during a routine examination was presented to our hospital. She had no other symptoms, and the best-corrected visual acuity of both eyes was 6/6. Funduscopic examination revealed a torpedo-shaped and mild hypopigmented lesion in the temporal macular area of her right eye. Infrared fundal (IR) images showed visible lesion contour, transverse elliptical, and with a tip pointing towards the central fovea of the macula. Microperimetry visual field appeared normal. The spectral-domain optical coherence tomography (SD-OCT) showed a normal inner retina, with mild thinner outer retina and retinal pigment epithelium in the temporal macular area, and correspondingly increased choroidal reflectivity. Other OCT findings included outer retinal loss/attenuation with significant atrophy of an intact ellipsoid zone. OCT angiography (OCTA) of choroid capillary layer revealed increased density of choroidal vasculature in corresponding to the area of the lesion, while the superficial and deep layers revealed normal vasculature. Fundus autofluorescence (FAF) revealed normal signal with slight hyperautofluorescence at the nasal lesion margin. Fundus fluorescence angiography (FFA) of the lesion showed variegated fluorescence and no leakage and change in the morphology during the whole imaging process.ConclusionsThis is the first report to include a thorough and detailed description of torpedo maculopathy by using fundal photograph, IR, microperimetry visual field, OCT, OCTA, FAF, and FFA. Multimodal imaging provides precious and detailed information to further clarify the characteristics and development of this rare disease.

608-P: High er Level of Angiopoietin-Like Protein-2 Is Associated with Diabetic Macular Edema in Patients with Type 2 Diabetes Mellitus

Background: Diabetic macular edema (DME) is characterized by hyperpermeability of retinal blood vessels and subsequent formation of hard exudates and macular edema. ANGPTL2 is associated with microvascularization and angiopoiesis, so we investigate the relationship between ANGPTL2 and occurrence of DME. Methods: 222 patients with type 2 diabetic patients were enrolled and divided into 3 groups with matched gender, age and BMI: 1) DM group: patients without diabetic retinopathy (DR) and DME, 2) DR without DME group, and 3) DR with DME group. All subjects were performed optical coherence tomography scanning (OCT) and fundus photography. ANGPTL2 was measured by Elisa. We analyzed the OCT values of concentric circles of macular central fovea with average diameters of 1 mm (R1), 3 mm (R3) and 6 mm (R6) to diagnose DME. Multivariable regression analysis was performed to estimate association between ANGPTL2 and DME. Results: Values of duration of diabetes, fasting C-peptide, postprandial C-peptide 1h, CRP, history of cataract and Statins treatment showed significant differences among three groups (p&amp;lt;0.05). ANGPTL2 levels in DM, DR without DME, DR with DME groups were 3.55±1.56, 3.68±1.59, 4.45±1.8ng/ml, respectively (P=0.012). In multivariable linear regression, Angplt2 was significantly different among three groups after adjustment for age, gender, BMI, glycosylated hemoglobin, ALT, AST, GGT, and fasting C peptide (P=0.023). Conclusions: Our findings suggest that ANGPTL2 is higher in patients both with DR and DME. Increased level of ANGPTL2 may take part in the progression of diabetic macular edema in type 2 diabetes mellitus. Disclosure N. Zhang: None. Y. An: None. R. Yin: None. D. Zhao: None.

45‐4: Near‐eye Foveated Display for Achieving Human Visual Acuity

We demonstrate a multi‐resolution foveated display, to achieve retina‐level angular resolution while keeping wide field‐of‐view (FOV), with two display panels and an optical combiner. The first panel provides a wide FOV and the second one offers an ultra‐high resolution for the central fovea region, by an optical minifying system which enhances the effective resolution by up to 5×. Moreover, a switchable Pancharatnam‐Berry phase deflector is employed to actively shift the high‐resolution region to enable eye‐tracking. The proposed design can effectively suppress pixelation and screen‐door effect in near‐eye displays.

Quantitative analysis of macular retinal thickness and volume in patients with different degrees of Parkinson’s disease

Objective To observe the macular retinal thickness and volume in patients with different degrees of Parkinson's disease (PD). Methods Thirty eyes of 30 patients with primary PD and 20 eyes of 20 healthy subjects (control group) in Xuanwu Hospital of Capital Medical University from October 2016 to October 2017 were enrolled in this study. There were 17 males and 13 females, with the mean age of 63.2±6.4 years and disease course of 3.9±2.4 years. The patients were divided into mild to moderate PD group (15 eyes of 15 patients) and severe PD group (15 eyes of 15 patients). The macular area was automatically divided into 3 concentric circles by software, which were foveal area with a diameter of 1 mm (inner ring), middle ring of 1 to 3 mm, and outer ring of 3 to 6 mm. The middle and outer ring were divided into 4 quadrants by 2 radiations, respectively. The changes of retinal thickness and macular volume of the macular center and its surrounding quadrants were analyzed. SPSS 16.0 software was used for statistical analysis. One-way ANOVA were used to analyze all data. Results Compared with the control group, the retinal thickness and volume in macular center and each quadrant of the mild to moderate PD group and severe PD group were reduced. Compared with the mild to moderate PD group, the retinal thickness and volume in macular center and each quadrant of the severe PD group were reduced. The differences of retinal thickness and macular volume among 3 groups were significant(F=5.794, 5.221, 5.586, 5.302, 5.926, 5.319, 5.404, 5.261, 5.603; P=0.001, 0.007, 0.003, 0.005, 0.000, 0.004,0.004, 0.006, 0.002). In inner ring of the mild to moderate PD group and the severe PD group, the retinal thickness and macular volume in the upper and the nasal were the largest, the inferior was followed, and the temporal was the smallest. In outer ring of the mild to moderate PD group and the severe PD group, the retinal thickness and macular volume in the nasal was the largest, the upper was the second, the temporal and the inferior were the smallest. Conclusions The retinal thickness and volume of the macular central fovea and its surrounding areas in PD patients are significantly thinner than that in the healthy subjects. And with the increase of the severity of PD, the macular structure changes obviously, showing macular center and its surrounding macular degeneration thin, macular volume reduced. Key words: Parkinson disease; Macula lutea/pathology; Retina/physiopathology; Tomography, optical coherence/utilization

Optical coherence tomography findings in chronic progressive external ophthalmoplegia.

Background:Chronic progressive external ophthalmoplegia (CPEO) is a mitochondrial encephalomyopathy caused by multiple mtDNA abnormalities. There is little information about the changes of ocular fundus with CPEO. The aim of this work was to measure and evaluate changes in the macular retinal thickness and optic nerve head in patients with CPEO using spectral-domain optical coherence tomography and to compare the findings with those of healthy individuals.Methods:Totally, 18 CPEO patients were enrolled in this study. Healthy volunteers matched for gender, age, and diopter settings were included as a control group. The retinal thickness of macular central fovea, inner and outer retinal layer thickness of perifoveal macular, optic nerve head parameters, and peripapillay retinal nerve fiber layer thickness (pRNFLT) for all included cases were measured using spectral-domain optical coherence tomography. A paired t test was used to compare the differences in the studied parameters between the two groups. The correlations between macular retinal thickness, pRNFLT, disease duration, and age of onset were also analyzed.Results:Among the macular parameters, retinal thickness of macular central fovea (t = −2.135, P < 0.05) and outer retinal layer thickness (t = −1.994, P < 0.05) of patients in the CPEO group were statistically significant lower than those of patients in the normal control group. For the optic nerve head parameters, the patients in the CPEO group showed a larger rim volume (t = −2.499, P < 0.05) and nerve head volume (t = −2.103, P < 0.05). The overall pRNFLT of patients in the CPEO group was statistically significant lower than that of patients in the control group (t = −4.125, P < 0.05). The comparison of pRNFLT in eight sectors showed that the pRNFLT of patients in the CPEO group was statistically significant lower than that of the control group mainly in the inferior and temporal sectors. The degree of pRNFL defect negatively correlated with the disease duration (r = −0.583, P < 0.05).Conclusions:The retinal thickness of patients with CPEO was significantly thinner, which was mostly the outer retina. The patients’ optic discs had a low volume and the loss of the retinal nerve fiber layer was obvious. With the extension of the disease duration, the retinal nerve fiber layer defect was even more significant.

Anatomical configurations of vitreomacular traction syndrome: influence on clinical course and surgical outcomes.

To develop a new classification system for vitreomacular traction (VMT) syndrome according to spectral-domain optical coherence tomography (SD-OCT) imaging and to investigate the clinical course of VMT patients. This study included 68 eyes of 68 consecutive patients who were followed with observation or treated with vitrectomy for idiopathic VMT. Eyes were classified into one of three groups according to SD-OCT findings: group A (foveal pseudocyst, which was defined as the formation of cystoid cavity located in the inner part of the central fovea along with foveal thickening), group B (parafoveal retinoschisis, which was defined as intraretinal cysts or clefts along with no apparent foveal thickening), and group C (outer retinal dehiscence at the fovea, which is sometimes accompanied by foveal thinning). The minimum required follow-up period was 1year. Clinical course and anatomical and functional outcomes were compared among the groups. Twenty-seven eyes (39.7%) were included in group A, 22 eyes (32.4%) were included in group B, and 19 eyes (27.9%) were included in group C. Among the 24 eyes that were managed by observation, a significantly larger percentage of patients in group A (6/10 [60%]) exhibited more spontaneous resolution of VMT compared with those in groups B (9.1%) or C (0%) (P = 0.010). In the 44 eyes that were managed with vitrectomy, a significantly larger percentage of patients in group C (4/16 [25%]) experienced subsequent full-thickness macular hole development following vitrectomy compared with those in groups B (0%) or C (0%) (P = 0.014). The percentage of patients with photoreceptor inner segment/outer segment disruption was significantly reduced in group A after vitrectomy, with group C exhibiting the lowest recovery rate. Postoperatively, group A experienced a significantly better visual outcome than group C (P = 0.021). A novel configuration system offering insight into the clinical course of VMT is proposed. According to this system, anatomical and functional outcomes were favorable in group A and worse in group C.

Intravitreal Fluocinolone Acetonide May Decelerate Diabetic Retinal Neurodegeneration

PurposeThere is no prevention or treatment for diabetic retinal neurodegeneration (DRN), which is a complication of diabetes that can occur independently of diabetic retinopathy (DR). We hypothesized that an intravitreal fluocinolone acetonide (FAc) implant may affect the rate of DRN when used in patients with diabetic macular edema (DME).MethodsIn this retrospective analysis, optical coherence tomography with neuroretinal analysis was obtained at 3-month intervals from 130 patients in the USER study both before (mean duration 903 days, range 35–4005 days) and after administration of FAc (mean 408 days, range 7 to 756 days). The rate of DRN was defined as the change over time on inner neuroretinal thickness using logistic regression. A DRN rate was calculated independently for two areas: region 1 located within 1.5 mm of the fovea, and region 2 from 1.5 mm to 3.0 mm from the fovea.ResultsIn regions of the macula more than 1.5 mm from the central fovea, there was a statistically significant decrease in the rate of DRN in the post-FAc period. The pre-FAc neuroretinal loss in this area occurred at 4.0 μm/y, compared with a post-FAc loss rate of 1.1 μm/y (P = 0.001).ConclusionsThis retrospective study suggests that FAc may decelerate the rate of inner retinal thinning in patients with persistent DME. Further prospective studies are necessary to determine the effects of FAc on the rate of DRN in patients with DME.

Foveal Avascular Zone Distortion in Epiretinal Membrane by Optical Coherence Tomography Angiography.

To show the morphologic changes on the foveal avascular zone (FAZ) in patients with epiretinal membrane (ERM) using optical coherence tomography angiography (OCTA) and to demonstrate the correlation between distortion of FAZ and features of the ERM. FAZ eccentricity index (longest diameter of FAZ/shortest diameter of FAZ) was measured in 52 patients with ERM and compared with 27 healthy subjects' values. The density of the ERM was quantified using a grading scale (0-3) on multicolor scanning laser images, and spectral-domain OCT characteristics of the eyes were assessed. Of the 52 eyes with ERM, 31 eyes (59.61%) showed some foveal remodeling, including full (13.46%) or partial (30.76%) apparent vascularization of FAZ, presence of a vessel crossing the fovea (9.61%), and horizontal or vertical elongation of FAZ (5.76%). The mean FAZ eccentricity index was 0.84 ± 0.46 (range: 0.0-1.86) in eyes with ERM and 0.98 ± 0.07 (range: 0.96-1.02) in the control subjects, respectively (P = .02). There was a negative significant correlation between FAZ eccentricity index and central macular thickness (P = .04). Thickening of the central fovea leads to foveal remodeling in ERM eyes, and OCTA enables the visualization of architectural FAZ changes. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:295-301.].