Optical Coherence Tomography Changes Research Articles

CHANGES IN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY MEASURES THROUGHOUT THE DAY: Diurnal Variation or Test-Retest Variability?

To evaluate the repeatability and diurnal variation of the retinal vessel density and foveal avascular zone parameters using optical coherence tomography angiography. Forty-one healthy individuals were measured twice in the morning and once in the evening. Foveal avascular zone area, perimetry, foveal density; superficial and deep capillary plexus (superficial capillary plexus, deep capillary plexus) vessel density, and central macular thickness were evaluated with the intraclass correlation coefficient, coefficient of repeatability, and Bland-Altman plots. Repeatability was evaluated with two consecutive scans taken in the morning. The coefficient of repeatabilities (%) was 5.4; 4.3, and 8.8 for the foveal avascular zone area, perimetry, and foveal density, respectively, with excellent intraclass correlation coefficients. Intraclass correlation coefficient was poor for parafovea (0.33), whereas excellent for fovea (0.97) in superficial capillary plexus-vessel density. Coefficient of repeatability for fovea and parafovea was 19.19% and 10.43%, respectively. Intraclass correlation coefficient values were poor (0.3-0.4) with 10% to 16% measurement differences in deep capillary plexus-vessel density parameters. Coefficient of repeatabilities for central macular thickness was between 1% and 2% with excellent intraclass correlation coefficient. The analysis on diurnal variation yielded comparable results. Except for the parafoveal vessel density, optical coherence tomography angiography is a highly reproducible device for measuring foveal avascular zone and vessel density using 6 × 6 scans with undilated pupils. However, variation in optical coherence tomography angiography parameters observed throughout the day could be attributed to test-retest variation rather than diurnal rhythm.

Predictive value of retinal atrophy for cognitive decline across disease duration in multiple sclerosis

BackgroundWe investigated the association between changes in retinal thickness and cognition in people with MS (PwMS), exploring the predictive value of optical coherence tomography (OCT) markers of neuroaxonal damage for...

'Structural OCT changes distinguishing between myopic macular haemorrhages due to choroidal neovascularization and spontaneous Bruch's membrane rupture: the "myopic 2 binary reflective sign".

To evaluate the sensitivity and specificity of structural optical coherence tomography (OCT) in comparison to fluorescein angiography (FA) and OCT angiography (OCTA) in discerning between macular haemorrhages (MH) due to myopic choroidal neovascularization (m-CNV) and idiopathic macular haemorrhage (IMH) in myopic patients and to suggest a new OCT biomarker to discern these two entities. In this longitudinal retrospective study, patients affected by MH and pathological myopia were included. All patients underwent OCTA and FA to discern bleeding from m-CNV or IMH. Furthermore, all patients underwent a structural OCT and 2 expert graders evaluated the presence of the myopic 2 binary reflective sign as a biomarker to discern between IMH and bleeding from m-CNV. Forty-seven eyes of 47 patients were enrolled. By means of angiographic examinations, 34 out of 47 eyes with MH (57%) were diagnosed as m-CNV, whereas 13 eyes (43%) as IMH. Using structural OCT, the graders identified the presence of the myopic 2 binary reflective sign in 13 out of 13 eyes with IMH. In 33 out of 34 cases with m-CNV, the 2 graders established the absence of the sign. This accounted for 100% of sensibility and 97% of specificity of structural OCT in discerning between MH from m-CNV and IMH. Structural OCT can discern with good reliability between IMH and bleeding from m-CNV based on the presence/ absence of the myopic 2 binary reflective sign. This could be of paramount relevance in the clinical setting for the diagnosis and treatment of HM patients.

THU162 Impact On Visual Function And Optic Nerve Morphology In Early Stages Of Growth Hormone Treatment

Abstract Disclosure: D.G. Braslavsky: None. A.C. Keselman: None. M.G. Ballerini: None. S. Rosenbrock: None. N. Cappa: None. G. Negrete: None. G. Dech: None. M.G. Ropelato: None. S. Gamio: None. I. Bergada: None. Background Current safety of recombinant human growth hormone (rhGH) treatment arises mainly from postmarketing surveillance. Headache is a relatively frequent symptom in children under rhGH. Secondary intracranial hypertension (SIH), is an adverse effect (AE), usually occurring within the first 12 weeks of treatment associated to headaches. Permanent visual defects are the most feared complication. Scarce information exists regarding incidence and natural history of visual impairment under rhGH. Aim To evaluate visual impairment and/or optic nerve affection in children throughout early rhGH treatment. Materials and Methods Prospective interventional study conducted from February 2018 to January 2020. Children ≥4 yr who received rhGH treatment for growth hormone deficiency (GHD), 0.16-0.25 mg/kg/w; Turner syndrome (TS), small for gestational age (SGA), 0.33 mg/kg/w and Prader Willy Syndrome (PWS) 1 mg/m2/d. Patients were assessed at basal, 1, 3, and 6 months of treatment. Each visit included clinical variables (adherence, auxology, AE, presence of headache), serum IGF1, IGFBP3, glucose, insulin, aldosterone, plasma renin activity, electrolytes and ophthalmologic evaluation [fundoscopy, optical coherence tomography (OCT), retinal nerve fiber layer (RNFL), ganglionic eye complex, ocular ultrasound, intraocular pressure (IOP), autorefractometry, biomicroscopy]. Results Sixty patients were enrolled, 12 GHD, 11 ST, 31 SGA, 3 PWS, 3 TBI (23 females), with a median age of 8.08 yrs (ranged 4.24-15). Median height was -2.25 ± 1.05 SDS. Baseline ophthalmologic evaluation was normal. Abnormal ophthalmological findings were observed in 15/60 (25%). Twelve patients showed changes in OCT, spontaneous recovery occurred in 8, whereas persistence or worsening of RNFL thickening lead to an MRI assessment and lumbar puncture (LP) in 4 patients (1 GHD, 2 SGA, 1 ST); only one referred headache. LP revealed opening pressure of 19, 21, 22 and 30 mmHg, respectively, the latter assumed as SIH at the 1st month of treatment. In these four patients, during the findings of ocular abnormalities, they presented a mean IGF1 1.12 ± 1.04 SDS and IGFBP3 -0.02 ± 2.34 SDS. ΔBMI -0.45 ± 0.71 SDS. Prevalence of SIH was 1.6%. All four patients received acetazolamide; median time for RNFL improvement took 4 months (range 4-8). One patient developed post-dural puncture headache. Three had elevated IOP. Along the protocol 19/60 referred headache (26 events). Three of these patients with headaches had abnormal ophthalmological findings (2 mild changes in OCT; 1 elevated IOP). Conclusion We have demonstrated a marked prevalence of abnormal ophthalmological findings upon early rhGH treatment. These observations occurred in the absence of suggestive clinical symptoms, and conversely, headache did not predict SIH. The prevalence of SIH due to rhGH is higher than previously reported. Presentation: Thursday, June 15, 2023

Swelling of Atrophic Optic Discs in Idiopathic Intracranial Hypertension.

Monitoring patients with idiopathic intracranial hypertension (IIH) and optic atrophy may be difficult as papilledema may not be appreciable on ophthalmoscopy. This retrospective chart review evaluated whether papilledema recurrence can be detected in this population using optical coherence tomography (OCT). Serial clinical assessments, ophthalmoscopy, and peripapillary OCT were reviewed in a cohort of patients with IIH and optic atrophy. Atrophy was defined as moderate if average peripapillary retinal nerve fiber layer (pRNFL) thickness was ≤80 μm and severe if average pRNFL thickness was ≤60 μm on at least 2 consecutive high-quality OCT scans. Based on the upper tolerance limit of test-retest variability, mean pRNFL elevation of ≥6 μm with subsequent decrease to baseline thickness was considered papilledema. In a cohort of 165 patients with IIH, 32 eyes of 20 patients and 22 eyes of 12 patients demonstrated moderate and severe optic atrophy, respectively. Over a median follow-up of 198.5 weeks (range, 14.0-428.9), 63.3% (19 of 30) of patients had at least 1 episode of relapse, and 50.0% (15 of 30) had at least 1 episode of papilledema. There was a total of 36 relapse episodes, of which 7 occurred in patients with clinical signs and symptoms but no OCT evidence of relapse, 12 occurred in patients with OCT changes but no clinical signs and symptoms of relapse, and 17 occurred in patients with both clinical and OCT evidence to support relapse. The median percent pRNFL increase in the latter 2 groups was 13.7% (range, 7.5-111.8), and 7 eyes (13.0%) of 5 patients (16.7%) showed thickening greater than 20.0% from baseline. The rate, magnitude, and concordance of pRNFL swelling were similar between moderately vs severely atrophic eyes. Papilledema recurrence can be detected in atrophic optic discs using OCT. All patients with atrophic IIH should be longitudinally monitored with pRNFL measurement. Concurrence of other relapse-suggestive features should prompt further evaluation.

Clinical and Genetic Findings in Korean Patients with Choroideremia.

We share and analyze the clinical presentations and genotypes of Korean male patients and female carriers who visited our clinic. Six male patients and three female carriers with comprehensive ophthalmic examinations and next-generation sequencing were included. Detailed clinical features were identified using visual field (VF) test and multimodal imaging including color fundus photography, fundus autofluorescence (FAF), optical coherence tomography (OCT). Six male patients were diagnosed with choroideremia at the median age of 25 years. Before genetic testing, three (50.0%) patients were clinically diagnosed with choroideremia, while the other three (50.0%) patients with retinitis pigmentosa (RP). Patients showed different types of hemizygous CHM mutation, including two nonsense mutations (c.715C>T, p.Arg239Ter; c.799C>T, p.Arg267Ter), two frameshift mutations (c.1584_1587del, p.Val529HisfsTer7; c.403_404delGA, p.Asp135PhefsTer9), one splicing mutation (c.1511-28_1511-2del), and one exon duplication (2-9). The latter three mutations are novel findings. Two female carriers showed exon duplication (2-9) and the other one female carrier showed nonsense mutations (c.715C>T, p.Arg239Ter) in heterozygote form. Fundus showed diffuse yellow-whitish scleral reflex and granular pigmented lesions. FAF showed multiple patchy hypofluorescence lesions, sparing macula. OCT showed thinning of outer nuclear layer, ellipsoid zone, RPE layer, choroid thickness, interlaminar bridges (ILBs), outer retinal tubulations (ORTs), and microcysts in the inner nuclear layer. VF showed ring scotoma pattern with small amount of remaining central field. Asymptomatic female carriers showed variable fundus findings and mild changes in OCT. A detailed description of the genotypes with three novel mutations and phenotypes of six choroideremia patients and three CHM mutation female carriers are presented.

Relation of interdigitation zone changes and right-angle vessels in Macular Telangiectasia Type-2 (MacTel).

To study the relation between interdigitation zone (IDZ) and right-angle vessel (RAV) in Macular Telangiectasia Type-2 (MacTel). A total of 43 eyes of 38 patients with presence of definite RAV on colour fundus photograph (Gass and Blodi-only stage-3) were confirmed on multimodal imaging. The relation of IDZ changes and associated ellipsoid zone (EZ) alterations on spectral-domain optical coherence tomography (OCT) with RAV were studied at baseline and these OCT changes were followed up in 15 eyes over a mean of 3.86 years. A total of 58 RAVs were found in the 43 eyes and 53/58 (91.3%) RAVs were associated with IDZ alterations in 39 eyes. On follow-up, IDZ attenuation progressed to IDZ loss and subsequent EZ attenuation and loss. A pre-existing IDZ loss was associated with subsequent EZ defect (P = 0.002). In 36 eyes that had OCT angiography, eyes with RAV showed deep capillary plexus telangiectasia in all 36 (100%) eyes and 32/36 (89%) eyes showed IDZ changes with or without EZ loss. IDZ attenuation and/or loss are associated with RAV and may serve as predictor of EZ loss in MacTel.

Efficacy assessment of oxygen flow assisted administration of topical methotrexate (OFA‐MTX5%) for superficial basal cell carcinoma assessed by optical coherence tomography

AbstractBackgroundOxygen‐flow‐assisted topical administration of 5% methotrexate (OFAMTX5%) was recently described as a painless therapeutic option with good cosmetic results for superficial basal cell carcinoma (sBCC).ObjectivesTo assess the efficacy and cosmetic outcome of OFAMTX5% for small (<2 cm) and large (>2 cm) sBCCs of the trunk.MethodsPatients with a least two sBCCs, as diagnosed by clinical, dermatoscopic and optical coherence tomography (OCT) examination, were included. One target lesion was treated 2×/week for 2 weeks. Complete (CR), partial (PR) and no (NR) responses, respectively defined as a total absence, improvement or a similar OCT aspect compared to baseline, were evaluated by OCT at 3 and 12 months postprocedure. Cosmetic outcome was evaluated at 1 year.ResultsAt 3 months in a cohort of 32 patients (mean age: 54 years, min: 44 years, max: 89 years), the small sBCC lesion group presented a 94.4% (17/18) CR and a 5.5% PR (1/18), whereas the large lesion group revealed a CR of 64.3% (9/14) and PR of 35.7% (5/14). At 12 months, 3/14 large lesions presented recurrent sBCC at the border of the target lesion, but none in the small lesion group (0/18). No treatment‐related cutaneous nor systemic adverse events were observed. No OCT changes were noted at 3 and 12 months in control sBCC lesions. Cosmetic results were scored as good and excellent in 19.4% and 80.1%, respectively.ConclusionsOFAMTX5% represents an interesting therapeutic alternative for sBCC on the trunk, without pain sensations and treatment‐related adverse effects. The place of OFAMTX5% in the therapeutic armamentarium against sBCC remains to be determined in larger series.

Optical coherence tomography reflects clinically relevant gray matter damage in patients with multiple sclerosis

BackgroundRetinal degeneration leading to optical coherence tomography (OCT) changes is frequent in patients with multiple sclerosis (PwMS).ObjectiveTo investigate associations among OCT changes, MRI measurements of global and regional brain volume loss, and physical and cognitive impairment in PwMS.Methods95 PwMS and 52 healthy controls underwent OCT and MRI examinations. Mean peripapillary retinal nerve fiber layer (pRNFL) thickness and ganglion cell/inner plexiform layer (GCIPL) volume were measured. In PwMS disability was quantified with the Expanded Disability Status Scale (EDSS) and Symbol Digit Modalities Test (SDMT). Associations between OCT, MRI, and clinical measures were investigated with multivariable regression models.ResultsIn PwMS, pRNFL and GCIPL were associated with the volume of whole brain (p < 0.04), total gray matter (p < 0.002), thalamus (p ≤ 0.04), and cerebral cortex (p ≤ 0.003) –both globally and regionally–, but not white matter. pRNFL and GCIPL were also inversely associated with T2-lesion volume (T2LV), especially in the optic radiations (p < 0.0001). The brain volumes associated with EDSS and SDMT significantly overlapped with those correlating with pRNFL and GCIPL.ConclusionsIn PwMS, pRNFL and GCIPL reflect the integrity of clinically-relevant gray matter structures, underling the value of OCT measures as markers of neurodegeneration and disability in multiple sclerosis.

Changes in retinal nerve fiber layer, ganglion cell complex, and ganglion cell layer thickness in thyroid eye disease: A systematic review

Thyroid eye disease (TED) is characterized by progressive orbital inflammation. In severe cases, it can lead to dysthyroid optic neuropathy (DON), involving death of retinal ganglion cells and permanent vision loss. Imaging with optical coherence tomography (OCT) has enabled noninvasive examination of the structural impact of the disease, including of the retinal nerve fiber layer (RNFL), the ganglion cell layer (GCL), and the inner plexiform layer (IPL). In this study, we systematically review 20 studies (897 patients, 1430 eyes) to evaluate changes in retinal thickness in patients with TED, stratified by severity. Most studies found a decrease in thickness in peripapillary RNFL (pRNFL), non-pRNFL, combined RNFL/GCL/IPL, or combined GCL/IPL when comparing patients with DON to healthy controls or to patients without DON. However, results were equivocal regarding differences between non-DON TED patients and controls. In addition, several studies reported a postoperative decrease in pRNFL thickness after orbital decompression surgery. Future studies examining OCT changes of retinal thickness along with disease progression are needed to assess the potential of OCT in diagnosis and management of patients with TED.

Expression of poly(ADP-ribose) polymerase-1 gene and optical coherence tomography angiographic parameters among patients with multiple sclerosis

Back ground/aimsTo analyse different parameters of the macula, disc and their vascular affection using optical coherence tomography (OCT) and angiography (OCT-A) in patients with multiple sclerosis (MS) correlating these changes...

Retinal clinical and morphofunctional changes in high myopia in combination with age-related macular degeneration of different stages

Purpose: an analysis of clinical and morphofunctional changes of the retina in high myopia combined with age-related macular degeneration (AMD) of various stages.Materials and methods. We examined 45 patients (87 eyes, mean age 60 years) with high myopia (ave. spherical equivalent (SE) of refraction -11.0 D [-15.0; -7.125]) and the “dry” form of AMD, categories AREDS 1, 2, 3. Additionally, we formed three control groups of the same age range: group 1 consisted of 30 healthy subjects (58 eyes) with a SE between -0.25 D and +0.5 D and no retinal changes; group 2 included 20 patients (38 eyes) with isolated high myopia (SE +0.5 D and no retinal changes; group 2 included 20 patients (38 eyes) with isolated high myopia (SE ³ 6.5 D) and group 3 included another 20 patients (36 eyes) with the “dry” AMD form (AREDS 2, 3). We evaluated the best corrected visual acuity (BCVA), indicators of retinal photosensitivity (MD, PSD) according to computer perimetry data, and morphological characteristics: central retinal thickness (CRT), the anteroposterior axis of the eyeball, the condition of the macular region of the retina according to optical coherence tomography (OCT) in the β-scan mode and autofluorescence (AF).Results: in case of the combined pathology, we detected a reliable reduction of average BCVA to the level of 0.5 [0.3; 0.7] (p &lt; 0.001) and a reduced factor of retinal photosensitivity as compared to the control: MD to -4.36 dB (р&lt;0.001), PSD to 2.97 dB (р &lt; 0.001). CRT was 235 μm (p = 0.122), which showed no statistically significant differences to the control. Morphological changes of the retina corresponded to high myopia and AMD: a dome-shaped profile, lacquer cracks, paravascular retinal microcysts, paravascular lamellar ruptures; myopic maculopathy in the form of an epiretinal membrane, vitreomacular traction due to incomplete vitreoretinal cleavage, myopic foveoshisis; patchy chorioretinal atrophy, areas of diffuse RPE atrophy, damage of the junction line of the outer and inner segments of photoreceptors. The increase in the number and size of drusen depended on the stage of AMD. Normal autofluorescence of the fundus was absent. Pathological AF included minimal changes patterned as focal hypo- and hyperautofluorescence, reticular pattern, focal pattern, linear pattern, lace-like pattern, areas of geographic atrophy with pronounced hypoautofluorescence.Conclusion. Changes in OCT and visual field parameters (MD, PSD) in comorbid pathology (AMD combined with high myopia) were revealed. The morphofunctional indicators were compared for different AMD stages, and the diagnostic significance of AF was established.

Retinal Microvascular and Neuronal Changes Are Also Present, Even If Differently, in Adolescents with Type 1 Diabetes without Clinical Diabetic Retinopathy.

The purpose of this study was to evaluate retinal changes in adolescents with childhood-onset, long-lasting type 1 diabetes mellitus (T1D). Patients and healthy controls (HC) underwent optical coherence tomography (OCT) and OCT-angiography (OCTA). Individual macular layers, peripapillary retinal nerve fiber layer (pRNFL), and vascular parameters (vessel area density (VAD), vessel length fraction (VLF) and vessel diameter index (VDI)) of macular superficial vascular (SVP), intermediate (ICP), deep (DCP) and radial peripapillary capillary plexuses (RPCP) were quantified. Thirty-nine patients (5 with (DR group) and 34 without (noDR group) diabetic retinopathy) and 20 HC were enrolled. The pRNFL and ganglion cell layer (GCL) were thicker in noDR compared to HC and DR, reaching statistically significant values versus HC for some sectors. At the macular level, VAD and VLF were reduced in DR versus HC in all plexuses, and versus noDR in SVP (p < 0.005 for all). At the RPCP level, VAD and VDI were increased in noDR versus HC, significantly for VDI (p = 0.0067). Glycemic indices correlated to retinal parameters. In conclusion, in T1D adolescents, retinal capillary and neuronal changes are present after long-lasting disease, even in the absence of clinical DR. These changes modify when clinical retinopathy develops. The precocious identification of specific OCT and OCTA changes may be a hallmark of subsequent overt retinopathy.

Retinal ganglion cell layer thickness and volume measured by OCT changes with age, sex, and axial length in a healthy population

BackgroundThe ganglion cell layer (GCL) measurements with Optical Coherence Tomography (OCT) are important for both ophthalmologists and neurologists because of their association with many ophthalmic and neurological diseases. Different factors can affect these measurements, such as brain pathologies, ocular axial length (AL) as well as age and sex. Studies conducted to measure the GCL have overlooked many of these factors. The purpose of this study is to examine the effect of age, sex, and AL on normal retinal GCL thickness and volume in a healthy population without any neurological diseases.MethodsA prospective cross-sectional study was designed to measure GCL thickness and total volume with OCT with automated segmentation and manual correction where needed. Visual acuity, AL, and autorefraction were also measured. A mixed linear model was used to determine the association of the effect of the various parameters on the GCL thickness and volume.ResultsOne hundred and sixteen eyes of 60 subjects (12–76 years of age, 55% female) were examined of which 77% had 0 ± 2 D of spherical equivalent, and mean axial length was 23.86 mm. About 25% of the OCT-automated GCL measurements required manual correction. GCL thickness did not differ in similar anatomic regions in right and left eyes (P > 0.05). GCL volume was greater in males relative to females after adjustment for age and axial length (1.13 ± 0.07 mm3 for males vs 1.09 ± 0.09 mm3 for females; P = 0.031). GCL thickness differed between males and females in the inner retinal ring (P = 0.025) but not in the outer ring (P = 0.66). GCL volume declined with age (P = 0.031) but not after adjustment for sex and axial length (P = 0.138). GCL volume declined with longer axial length after adjustment for age and sex (P = 0.048).ConclusionAge, sex and axial length should be taken into consideration when measuring the GCL thickness and volume with OCT. Automated OCT segmentation should be reviewed for manual adjustments.

The Effectiveness of Brolucizumab and Aflibercept in Patients with Neovascular Age-Related Macular Degeneration.

Age-related macular degeneration (AMD) is a progressive, chronic disease of the central area of the retina, which, if untreated, leads to blindness. This study aimed to compare the effectiveness of therapy using anti-VEGF drugs, namely brolucizumab and aflibercept, in patients with neovascular AMD (nAMD) during a monitoring period lasting around 20 weeks. The analysis consisted of 40 patients diagnosed with neovascular age-related macular degeneration, with 20 patients receiving aflibercept (Eylea, Bayer) at a dose of 2 mg/50 µL into the vitreous chamber at the following intervals—3 doses, 4 weeks apart, followed by a fourth dose after 8 weeks. The remaining 20 patients received brolucizumab (Beovu, Novartis) at a dose of 6 mg/50 µL, administered in the following schedule—3 initial doses, 4 weeks apart, with the administration of a fourth dose decided for each patient individually by the doctor, depending on disease activity, assessed through imaging tests. To evaluate treatment effectiveness, the following measurements were used: ‘read distance and near visual acuity’ for each eye separately using the Snellen chart; and non-invasive retinal imaging techniques—optical coherence tomography (OCT) and OCT angiography (OCTA). In patients treated using brolucizumab, during the observation period, statistically significant differences were found in the following parameters: flow area (p = 0.0277); select area (p = 0.0277); FOVEA (p = 0.0073); visus (p = 0.0064). In brolucizumab-treated patients, changes in OCT and OCTA, indicating an improvement, were already visible after the first injection of the drug, whereas in the aflibercept-treated group, changes were only visible after the fourth injection. We found a higher effectiveness of brolucizumab therapy compared to aflibercept in patients with nAMD during an observations period lasting 20 weeks. Our observations are significant, although they require further research.

The importance of monitoring wet age‐related macular degeneration patients during coronavirus disease 2019 pandemic: A retrospective study of assessment of functional and structural outcomes

AbstractPurposeIntravitreal anti‐Vascular Endothelial Growth Factor (anti‐VEGF) injections are the gold standard treatment for wet Age‐related Macular Degeneration (wet AMD). Coronavirus disease 2019 (COVID‐19), and the resulting confinement, led to the cancellation of many programmed intravitreal anti‐VEGF injection visits. We compared the functional and structural visual outcomes of patients that did not respect their intravitreal anti‐VEGF injection intervals during the period of confinement due to COVID‐19 (group 1) and those who respected them (group 2).MethodsWet AMD patients of Swiss Visio Montchoisi and RétinElysée were included. Best Corrected Visual Acuity (BCVA) and Optical Coherence Tomography (OCT) changes between the first post‐ and last pre‐confinement visit were assessed, with favorable and unfavorable being the possible outcomes for each change.ResultsGroup 1 (n = 89, 109 eyes) had 13.41% greater rate of unfavorable BCVA outcome and 38.27% greater rate of unfavorable OCT outcome than Group 2 (n = 96, 122 eyes) (p = 0.04, p &lt; 0.0001, respectively). The multivariate analysis showed that the more the patients deviated from their programmed injections and the higher the BCVA pre‐confinement, the higher the rate of unfavorable BCVA outcome (p = 0.03, p = 0.02, respectively). The OCT changes were not a predictive factor for an unfavorable BCVA outcome. The rates of pigment epithelial detachment (PED) and intraretinal fluid (IRF) increase in the first post‐confinement visit were higher in group 1 than in group 2 (p = 0.0004, p = 0.0374, respectively), with a relative increase of unfavorable OCT outcome of 200% and 66.67%, respectively.ConclusionsCOVID‐19 pandemic led many patients to refrain from their routine intravitreal anti‐VEGF injection visits, allowing us to analyze the role of designated intervals in the treatment of patients with wet AMD. During a next confinement due to COVID‐19, or circumstances similar to it, ophthalmologists should ensure the continuity of injections for their patients.Bibliography Fung THM et al. Addressing COVID‐19 fear to improve clinic attendance for patients with wet age‐related macular degeneration. Acta Ophthalmol 99: e285 (2021). Colantuono D et al. AMD management during the COVID‐19 pandemic. Acta Ophthalmol 98, e925–e925 (2020).

A retrospective analysis on comparison of optical coherence tomography manifestations among AMD, CEC, PM and ICN and its relationship with vision.

Both macular choroidal neovascularization (MCN) and visual changes can occur in age-related macular degeneration (AMD), central exudative chorioretinopathy (CEC), pathological myopia (PM) and idiopathic choroidal neovascularization (ICN), but whether the optical coherence tomography (OCT) manifestations of the four diseases are different and their relationships with vision are not clear. This study clarifies this problem and can guide clinicians to prevent vision changes of patients according to OCT performance. 76 patients with MCN, included 25 AMD, 21 CEC, 18 PM and 12 ICN [refer to Chinese Ophthalmology (3rd Edition)], detected by OCT instrument, were enrolled in this study from June 2020 to June 2022. The OCT manifestations and indexes were observed. A comprehensive refractometer was used for detection of best corrected visual acuity (BCVA) and axial length (AL). Pearson chi squared and 1 way analysis of variance were used for enumeration data and continuous data test, and Pearson correlation coefficient was used for relationship analysis. (I) Macular edema proportions in the MCN eyes among AMD, CEC, PM and ICN groups were 96.00% and 94.12%, 14.29% and 14.29%, 44.44% and 32.00%, 33.33% and 28.57%, with statistical differences (both P<0.001). (II) Patients with macular edema had a significantly higher loose and thickened tissue reflex of the neuroepithelial layer (100.00% vs. 4.26%) and limited non-reflective dark area (100.00% vs. 4.26%) (both P<0.001). (III) PM had the lowest width, height and central fovea thickness (CFT) [(1,403.43±114.41), (210.74±21.22) and (250.70±41.36) μm], and the highest distance to the fovea, BCVA and AL [(234.44±288.69) μm, (0.30±0.08) Log minimal angle of resolution (MAR), (28.48±5.72) mm] (all P<0.001). (IV) The width and height of patients with macular edema were lower than those of patients without macular edema [(1,738.43±348.71) vs. (2,493.95±771.53) μm, P<0.001; (305.71±81.22) vs. (367.29±107.91) μm, P=0.002] (P<0.05). (V) The width and height, CFT were negatively correlated to BCVA (r=-0.635, -0.712, -0.724, all P<0.001), and height, CFT were negatively correlated to AL (r=-0.244, -0.275, P=0.018, 0.007). The distance to the fovea was positively correlated to BCVA and AL (r=0.241, P=0.019; r=0.267, P=0.007). Most of the OCT indexes were related to the BCVA and AL in MCN patients, and MCN patients with OCT changes should be reminded to protect their vision.

Correlations between cognitive assessment and RNFL changes in OCT in healthy aging subjects

AbstractBackgroundThe retinal nerve fibre layer (RNFL) comprises retinal ganglion cell axons and link the outer neuroretina to the higher visual cortex. The retina is the only part of the central nervous system that can be visualised directly and non‐invasively by optical coherence tomography (OCT). The study aimed to examine whether changes in the visual pathway are correlated with various domains of cognitive function assessment. We evaluated correlation between retinal structural (OCT) and neuropsychological (trail making test, TMT; Boston naming test, BNT) measures in healthy aging subjects.MethodIn the present cross‐sectional clinical study, 74 healthy aging subjects were recruited from the Optic Nerve Decline and Cognitive Changes (ONDCC) study. All participants underwent OCT peripapillary ring scan protocol for RNFL analysis, TMT testing for attention and executive function and BNT neuropsychological examination for the detection of word‐retrieval or naming difficulties. Averaged RNFL thickness measures were used to analyse the relationship with TMT and BNT. Correlations between TMT, BNT and OCT parameters were analysed using partial correlation and controlled for age and gender (P &lt; 0.05).ResultThe mean (SD) age of the current cohort is 67.5 (± 9.0 years). At baseline, significant correlation was observed between TMT‐test A and nasal RNFL thickness (r = ‐0.33, P = 0.009). The BNT also demonstrated mild but significant positive correlations with global (r = 0.32, P = 0.01), nasal (r = 0.27, P = 0.03) and nasal inferior (r = 0.33, P = 0.01) sectoral RNFL thicknesses respectively.ConclusionThe results indicated a significant correlation between RNFL thickness and executive function domain of cognitive assessment. Sectoral RNFL was also significantly correlated with naming ability (BNT) across the cohort of healthy elderly. These findings suggest that the RNFL measures may parallel cognitive decline in the aging population. Further studies are planned in confirmed cognitively impaired subjects.

Recent advances in diagnosis and management of sympathetic ophthalmia.

Sympathetic ophthalmia is a bilateral granulomatous uveitis that occurs following unilateral trauma or surgery and is sight-threatening in the contralateral eye. Despite significant potential morbidity, disease remains poorly understood. Variable presentations and clinical courses, as well as a lack of definitive diagnostic laboratory tests can complicate the diagnosis and result in delayed treatment, which can beget permanent vision loss. This review focuses on recent advances in areas of pathophysiology, classification, diagnosis and treatment. Sympathetic ophthalmia is thought to involve a cell-mediated immune response to retinal and uveal antigens exposed through trauma or surgery. Multiple mechanisms have been implicated, including activation of the interleukin-23/IL-17 pathway. Ongoing emphasis is placed on early disease recognition and prompt treatment with multimodal imaging. Multiple authors advocate for the routine use of optical coherence tomography (OCT) for screening and disease monitoring. Systemic steroids and steroids sparing-immunosuppressive agents remain the mainstay of treatment. Understanding pathophysiology may provide useful targets for drug development, as well as allow for identification of patients at risk. OCT is a useful tool in early diagnosis and management of sympathetic ophthalmia, as OCT changes may precede clinical symptoms and signs, allowing for early disease detection and better visual outcomes.

Optical Coherence Tomography Angiography in Type 1 Diabetes Mellitus. Report 4: Glycated Haemoglobin.

The purpose of this study was to evaluate specifically the relationship between glycated haemoglobin (HbA1c) levels and retinal optical coherence tomography (OCT) and OCT angiography (OCTA) parameters in type 1 Diabetes Mellitus (DM). A total of 478 type 1 DM patients and 115 controls were included in a prospective OCTA trial (ClinicalTrials.gov NCT03422965). Subgroup analysis was performed for controls, no diabetic retinopathy (DM-no DR) and DR patients (DM-DR), and HbA1c levels. OCT and OCTA measurements were compared with HbA1c levels (current and previous 5 years). DM-no DR patients with HbA1c levels >7.5% showed lower VD than DM-DR and controls (20.16 vs. 20.22 vs. 20.71, p < 0.05), and showed a significant correlation between HbA1c levels and FAZc (p = 0.04), after adjusting for age, gender, signal strength index, axial length, and DM disease duration. DM-DR patients with HbA1c > 7.5% presented greater CRT than DM-no DR and controls (270.8 vs. 260 vs. 251.1, p < 0.05) and showed a significant correlation between HbA1c and CRT (p = 0.03). In conclusion, greater levels of HbA1c are associated with OCTA changes in DM-no DR patients, and with structural OCT changes in DM-DR patients. The combination of OCTA and OCT measurements and HbA1c levels may be helpful to identify patients at risk of progression to greater stages of the diabetic microvascular disease.