Cirrus HD-OCT Research Articles

A characterization study of the anterior segment morphology of patients with and without long-term silicone oil following vitrectomy

PurposeTo characterize the anterior segment (AS) morphology of patients with long-term silicone oil (SiO) in situ (> 12 months) following pars plana vitrectomy (PPV).MethodsThis prospective, comparative characterization study was conducted between January 2022 and July 2023. Patients were included and sorted based on if they had undergone PPV without long-term SiO or had SiO in situ for at least 12 months at the time of review and image collection. The Zeiss Cirrus HD-OCT (Carl Zeiss, Dublin, California, USA) was employed to image the ASs of study patients. Software within the OCT was used to collect the central corneal thickness (CCT), anterior chamber diameter (ACd), anterior chamber depth (ACD), chamber area, temporal irideocorneal angle and nasal irideocorneal angle.ResultsA total of 78 eyes from 42 total patients were included, their mean age was 63.74 ± 19.13 years and 64.29% (27/42) of participants were males. Patients who underwent PPV with and without long-term SiO were found to have no significant difference in CCT, ACd, ACD, chamber area and irideocorneal angles compared to their fellow unoperated eyes. The multivariate analysis of variance of the pooled data noted a statistically significant difference in the ACd of PPV with long-term SiO eyes compared to PPV without long-term SiO and unoperated eyes (p = < 0.001).ConclusionThese findings suggest PPV with long-term SiO may alter the AS morphology of patients, its influence on the development of OAG remains unclear and warrants further investigation.

Choroidal Thickness and Central Macular Thickness Measurements with Cirrus HD-OCT in Healthy Individuals in the Turkish Population

This research was conducted to determine the normal values of choroidal thickness in healthy individuals and to evaluate the relationship between this thickness and age, gender, refraction, axial length and average macular thickness using OCT. In the study, the right eyes of 400 healthy individuals (234 women, 166 men) between the ages of 4 and 70 years, who applied to the Department of Ophthalmology outpatient clinic for examination, were evaluated. Macular thickness, macular volume, and foveal thickness were found to be 249.12 ±21.32 µm, 9.98 ±0.5 µm3 and 280 ±13.45 µm, respectively. According to linear regression analysis, a negative correlation was detected between age and subfoveal choroidal thickness (p &lt; 0.05). It was determined that foveal thickness, retinal volume and average retinal thickness were higher in men, and foveal thickness increased with age (p &lt; 0.05). As a result of the research, it was determined that age is an important factor affecting choroidal thickness. It is thought that, in future, improving in vivo imaging of the choroid and measuring choroidal thickness using OCT will facilitate understanding of the pathophysiological basis of many ophthalmological diseases.

Retinal Nerve Fiber Layer Thickness(RNFL) Measurements in Nepalese Population of Eastern Region by Optical Coherence Tomography

Introduction: Glaucoma represents a group of disease defined by consistent remodeling of the connective tissue elements of the optic nerve head and with the loss of neural tissue of the retinal nerve fiber layer associated with the eventual development of distinctive patterns of visual function.1 OCT is used commonly to evaluate thinning of peripapillary retinal nerve fiber layer (RNFL) objectively and quantitatively, which is a hallmark for the diagnosis of glaucoma.2 As the OCT, normal database is commercially not available for Nepalese eyes. These measurements will provide a reference for the comparison and further evaluation of results of glaucoma and other patients with the help of OCT in the Nepalese Population. Methods: 384 eyes of normal population RNFL thickness measurements were done with peripapillary SD-OCT (Cirrus HD OCT Model 5000/500; Carl Zeiss Meditec, Dublin, USA). Multiple regression analyses were applied to assess the effect of age and mean refractive error on peripapillary RNFL thickness. Results: The average Retinal nerve fiber layer thickness (RNFLT) was highest in the age group 70-79 years (102.33 ±4.61µm) followed by age groups 50-59 years (93.89 ±5.89 µm) and 60-69 years (92.95 ±7.83 µm) respectively. The mean ± SD peripapillary RNFLT (µm) at the superior, inferior, nasal and temporal quadrants in the study population were 117.95±9.41µm, 120.71 ± 10.12 µm, 71.64 ±71.64 µm and 61.65±6.65µm respectively. Conclusion: This study may serve as a reference in comparing changes in RNFL thickness during glaucoma screening with SD-OCT in this population.

Inter-rater reliability in labeling quality and pathological features of retinal OCT scans: A customized annotation software approach.

Various imaging features on optical coherence tomography (OCT) are crucial for identifying and defining disease progression. Establishing a consensus on these imaging features is essential, particularly for training deep learning models for disease classification. This study aims to analyze the inter-rater reliability in labeling the quality and common imaging signatures of retinal OCT scans. 500 OCT scans obtained from CIRRUS HD-OCT 5000 devices were displayed at 512x1024x128 resolution on a customizable, in-house annotation software. Each patient's eye was represented by 16 random scans. Two masked reviewers independently labeled the quality and specific pathological features of each scan. Evaluated features included overall image quality, presence of fovea, and disease signatures including subretinal fluid (SRF), intraretinal fluid (IRF), drusen, pigment epithelial detachment (PED), and hyperreflective material. The raw percentage agreement and Cohen's kappa (κ) coefficient were used to evaluate concurrence between the two sets of labels. Our analysis revealed κ = 0.60 for the inter-rater reliability of overall scan quality, indicating substantial agreement. In contrast, there was slight agreement in determining the cause of poor image quality (κ = 0.18). The binary determination of presence and absence of retinal disease signatures showed almost complete agreement between reviewers (κ = 0.85). Specific retinal pathologies, such as the foveal location of the scan (0.78), IRF (0.63), drusen (0.73), and PED (0.87), exhibited substantial concordance. However, less agreement was found in identifying SRF (0.52), hyperreflective dots (0.41), and hyperreflective foci (0.33). Our study demonstrates significant inter-rater reliability in labeling the quality and retinal pathologies on OCT scans. While some features show stronger agreement than others, these standardized labels can be utilized to create automated machine learning tools for diagnosing retinal diseases and capturing valuable pathological features in each scan. This standardization will aid in the consistency of medical diagnoses and enhance the accessibility of OCT diagnostic tools.

CNN-Based Device-Agnostic Feature Extraction From ONH OCT Scans.

Optical coherence tomography (OCT)-derived measurements of the optic nerve head (ONH) from different devices are not interchangeable. This poses challenges to patient follow-up and collaborative studies. Here, we present a device-agnostic method for the extraction of OCT biomarkers using artificial intelligence. ONH-centered OCT volumes from the Heidelberg SPECTRALIS, ZEISS CIRRUS HD-OCT 5000, and Topcon 3D OCT-1000 Mark I/II and 3D OCT-2000 devices were annotated by trained graders. A convolutional neural network (CNN) was trained on these segmented B-scans and utilized to obtain several ONH biomarkers, such as the retinal nerve fiber layer (RNFL) and the minimal rim width (MRW). The CNN results were compared between different devices and to the manufacturer-reported values using an independent test set. The intraclass correlation coefficient (ICC) for the circumpapillary retinal nerve fiber layer (cpRNFL) at 3.4 mm reported by the CIRRUS and 3D OCT-2000 was 0.590 (95% confidence interval [CI], -0.079 to 0.901), and our CNN resulted in a cpRNFL ICC of 0.667 (95% CI, -0.035 to 0.939). The cpRNFL at 3.5 mm on the CIRRUS, 3D OCT-2000, and SPECTRALIS generated by the CNN resulted in an ICC of 0.656 (95% CI, 0.055-0.922). Comparing the global mean MRWs from the SPECTRALIS between CNN and manufacturer yielded an ICC of 0.983 (95% CI, 0.917-0.997). The CNN ICC for the MRW among the CIRRUS, 3D OCT-2000, and SPECTRALIS was 0.917 (95% CI, 0.947-0.981). Our device-agnostic feature extraction from ONH OCT scans showed a higher reliability than the measures generated by the manufacturers for cpRNFL. MRW measurements compared very well among the manufacturers. This open-source software can robustly extract a wide range of biomarkers from any OCT device, removing the dependency on manufacturer-specific algorithms, which has significant implications for patient follow-up and collaborative research.

Features of Computer Static Perimetry in Primary Open-angle Glaucoma in Patients with Type 2 Diabetes Mellitus

Examined 110 eyes (55 patients) with POGC and type 2 diabetes mellitus; 40 eyes (20 patients) with POGC without diabetes mellitus and 60 eyes (30 patients) with diabetes without glaucoma. In addition to the generally accepted methods of research, the following were carried out: perimetry (static Octopus), ophthalmoscopy with Goldmann lens, binocular ophthalmoscope (Schepensa), and lens Volk-90,0D (USA), gonioscopy with lenses (Krasnova, Goldmana), tonometria by Maccov, NIidek (Japan) NT-2000 pneumometry, Tonography (Glau test-60). OCT disc optic nerve and yellow spot (Carl Zeiss Cirrus, HD OCT Model 4000/5000 Germany), OST retinal vessels with calibre meter (Cirrus HD-OCT Carl Zeiss), ultrasonic diagnosis (UZD) of central artery vessels and retinal vein (UZ-system of expert class Sono Scapesq), ultrasound of the eyes. Conducted studies of static perimetry in patients with POGC and type 2 diabetes suggest the influence of the severity of diabetic retinopathy on the course and progression of glaucoma.

Evaluation of retinal nerve fiber layer and choroidal structure in obese children and adolescents

Aim: Obesity-related vascular damage and endothelial dysfunction have deleterious effects on the ocular vasculature. It was aimed to examine optical coherence tomography (OCT) parameters in obese and overweight children and to define their relationship with metabolic markers in this study. Methods: The patient group consisted of 26 obese, 24 overweight patients aged between 8 and 18 years. The control group consisted of 25 healthy children with normal body mass index (BMI). This was a cross-sectional observational study. Serum glucose, lipid parameters, and homeostasis model assessment of insulin resistance (HOMA-IR) were investigated. Measurement of choroidal thickness was performed with Cirrus HD-OCT (Carl Zeiss Meditec Inc., Dublin, CA, USA). Retinal nerve fiber layer (RNFL) thickness was determined by an automatic computer algorithm without the need for user measurement. Results: There were no differences in subfoveal, nasal, temporal choroidal thickness, and RNFL between obese, overweight, and control groups (p&gt;0.05). A positive (linear) moderate relationship was found between RNFL and the HOMA-IR of 26 patients in the obese group (r=0.389) (p=0.049). A positively weak correlation was found between height and RNFL in obese patient group (r=0.264, p=0.028). Conclusion: In the study, RNFL thickness increased as HOMA-IR level increased in obese children and adolescents. RNFL decreased as the height increased in obese children and adolescents. We believe that more comprehensive data about the effect of obesity on RNFL and choroidal thickness will be obtained with prospective studies in which the obese patient group with insulin resistance is taken separately and disease durations are defined, and long-term patient follow-up is performed.

Progression of Capillary Hypoperfusion in Advanced Stages of Nonproliferative Diabetic Retinopathy: 6-month Analysis of RICHARD Study

To evaluate the 6-month progression of retinal capillary perfusion in eyes with advanced stages of nonproliferative diabetic retinopathy (NPDR). RICHARD (NCT05112445), 2-year prospective longitudinal study. Sixty eyes with Diabetic Retinopathy Severity Scale (DRSS) levels 43, 47, and 53 from 60 patients with type 2 diabetes. Fifty-one patients completed the 6-month evaluation. Eyes were evaluated on Optos California (Optos plc) ultrawidefield fundus fluorescein angiography (UWF-FFA), swept-source OCT angiography (SS-OCTA) (PLEX Elite 9000, ZEISS) and spectral-domain OCTA (SD-OCTA) (CIRRUS HD-OCT 5000 Angioplex, ZEISS). DRSS classification was performed based on 7-field color fundus photographs (CFPs) complemented with Optos California UWF-fundus imaging. Ischemic index was obtained from Optos. Vascular quantification metrics, namely foveal avascular zone, skeletonized vessel density (SVD), and perfusion density (PD) metrics, were acquired on OCTA in the superficial and deep capillary plexuses (SCP and DCP). Microaneurysm assessment was automatically performed based on CFP images using the RetmarkerDR (Retmarker SA, Meteda Group). Swept-source-OCTA metrics showed statistically significant differences between the advanced stages of NPDR. Differences between DRSS levels 47 and 53 were found at baseline in the inner ring (SVD, SCP: P= 0.005 and DCP: P= 0.042 and PD, SCP: P= 0.003) and outer ring (SVD, SCP: P= 0.007 and DCP: P= 0.030 and PD, SCP: P= 0.020 and DCP: P= 0.025). No significant differences were observed at baseline between DRSS levels 43 and 47. In SD-OCTA, the differences were similar but did not reach statistical significance. The total ischemic index showed an increase in association with diabetic retinopathy (DR) severity, but the differences between DRSS levels did not reach statistical significance. The number of microaneurysms also increased significantly with DR severity (P= 0.033). Statistically significant 6-month progression was detected with SS-OCTA in eyes with DRSS levels 47 and 53 but not in DRSS level 43. In eyes with DRSS level 53, 6-month progression was identified using a combination of metrics of capillary nonperfusion and microaneurysm counts. In a 6-month period, significant microvascular disease progression can be identified in eyes with DRSS levels 47 and 53 by performing OCTA examinations and microaneurysm counting using CFP. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Validity and Reliability of 2 Cirrus Optical Coherence Tomography Procedures for Measuring Objective Ocular Torsion

Torsional eye position by the disc-fovea angle (DFA) is a relevant objective parameter in vertical strabismus. DFA measurement with optical coherence tomography (OCT) has proven to be a good alternative to the gold standard measurement in fundus photography. Our study aims to analyze the validity and reliability of 2 undescribed Cirrus high-definition OCT (HD-OCT; Carl Zeiss Meditec) methods that offer clinical advantages for measuring objective cycloposition in normal patients compared with Spectralis spectral-domain OCT (Heidelberg Engineering) and the reference method. Prospective validity and reliability analysis. Objective cycloposition by means of the DFA was measured in the right eyes of 59 binocularly normal individuals attending the ophthalmology service of a medical institution. DFA was obtained by fundus photography (gold standard), FoDi software of Spectralis spectral-domain OCT, HD 1 line scan of Cirrus HD-OCT, and macular cube of Cirrus HD-OCT (fundus, FoDi, line, and cube methods, respectively). Measurements were performed 3 times for each method and the patient was repositioned and realigned between captures. Posterior manual quantification was made by 2 observers with external protractor software for the fundus and cube methods. The 3 OCT methods showed and excellent agreement with fundus photography (ICC 0.83-0.84) with no significant differences comparing mean values (P = .36 for fundus-FoDi, P = .09 for fundus-line, and P = .09 for fundus-cube). Absolute differences between methods were 1.5°. All methods showed excellent reliability (ICC 0.92 for FoDi, 0.91 for line, 0.92 for cube, and 0.91 for fundus). The minimal detectable change was lower than 3° and the absolute difference between repeated measurements was 1° for all methods. Interrater reliability was excellent for methods requiring manual quantification (ICC 0.98 for cube, ICC 0.94 for fundus). Measurement of the DFA by Cirrus HD-OCT methods in normal patients was a valid and reliable alternative for the cycloposition assessment. Among the methods, the Cirrus OCT HD 1 line improved clinical performance due to the simplicity and speed of measurement, with no need to export the image for quantification.

Early diagnosis of sickle cell retinopathy by using ocular coherence tomography in pediatric population (7-18 years) in central India.

Sickle cell disease (SCD) is the commonest inherited blood disorder leading to complications occurring due to vaso-occlusion including sight-threatening retinopathy. Retinopathy can be managed if diagnosed early and vision loss can be prevented. Since, very less data are available from India, hence, this study was conducted in children (7-18 years) with SCD to diagnose retinopathy by using ocular coherence tomography (OCT) in subclinical stages. This cross sectional single-center study was performed in 7-18 years age group children with SCD without any visual symptoms. Enrolled participants underwent complete ophthalmological examination including macula and optic disc thickness measurements using Cirrus HD-OCT and results were analyzed. Among 55 participants, none had visual impairment. Significant fundoscopy finding (nonproliferative sickle cell retinopathy/NPSR) was found in three patients (5.4%), thinning of central macula in four patients (7.27%), inner macula thinning in eight patients (14.5%), outer macula thinning in one patient (1.81%), retinal nerve fiber layer thinning in five patients (9%), ganglion cell layer to inner plexiform layer thinning in eight patients (14.54%). Overall NPSR was found in 5.4% patients detected with fundoscopy, whereas retinal layer thinning was found in 14 patients (25.4%) using OCT. Despite of the significant prevalence of SCR, it is still underdiagnosed complication, leading to thinning of the retina from early ages; thus, its early diagnosis by regular screening using newer diagnostic methods can prevent progression to sight-threatening complications and provide better quality of life for these patients.

The Impact of Social Vulnerability on Structural and Functional Glaucoma Severity, Worsening, and Variability

To determine the associations between social vulnerability index (SVI) and baseline severity, worsening, and variability of glaucoma, as assessed by visual field (VF) and OCT. Retrospective longitudinal cohort study. Adults with glaucoma or glaucoma suspect status in 1 or both eyes. Visual fields were derived from 7897 eyes from 4482 patients, while OCTs were derived from 6271 eyes from 3976 patients. All eyes had a minimum of 5 tests over follow-up using either the Humphrey Field Analyzer or the Cirrus HD-OCT. Social vulnerability index, which measures neighborhood-level environmental factors, was linked to patients' addresses at the census tract level. Rates of change in mean deviation (MD) and retinal nerve fiber layer (RNFL) thickness were computed using linear regression. The slope of the regression line was used to assess worsening, while the standard deviation of residuals was used as a measure of variability. Multivariable linear mixed-effects models were used to investigate the impact of SVI on baseline, worsening, and variability in both MD and RNFL. We further explored the interaction effect of mean intraocular pressure (IOP) and SVI on worsening in MD and RNFL. Glaucoma severity defined based on baseline MD and RNFL thickness. Worsening defined as MD and RNFL slope. Variability defined as the standard deviation of the residuals obtained from MD and RNFL slopes. Increased (worse) SVI was significantly associated with worse baseline MD (β=-1.07 dB, 95% confidence interval [CI]: [-1.54, -0.60]), thicker baseline RNFL (β=2.46 μm, 95% CI: [0.75, 4.17]), greater rates of RNFL loss (β=-0.12 μm, 95% CI: [-0.23, -0.02]), and greater VF variability (β=0.16 dB, 95% CI: [0.07, 0.24]). Having worse SVI was associated with worse RNFL loss with increases in IOP (βinteraction=-0.07, 95% CI: [-0.12, -0.02]). Increased SVI score is associated with worse functional (VF) loss at baseline, higher rates of structural (OCT) worsening over time, higher VF variability, and a greater effect of IOP on RNFL loss. Further studies are needed to enhance our understanding of these relationships and establish their cause. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

CORRELATION OF STRUCTURE AND FUNCTIONAL DEFECT WITH QUALITY OF LIFE IN PATIENT WITH GLAUCOMA

Introduction: Glaucoma damage generally produces a characteristic change in the morphology of the optic nerve, runs progressively and permanently that cause visual changes, decreased vision, and blindness. Blindness will affect one’s dependence to get help in their daily activities. This paper investigate the correlation between VFI, BCVA, MD and RNFL thickness with the quality of life of people with glaucoma using Glaucoma Quality of Life-15 (GQL-15). Methods: A cross-sectional study conducted at the Sardjito Eye Center in April 2021. Purposive sampling used to recruit glaucoma patients who had BCVA, Visual Field examination (Humphrey Field Analyzer (HFA) 3 Carl Zeiss Meditec Inc.), and OCT ONH (Cirrus HD-OCT 5000, Carl Zeiss). Glaucoma Quality of Life-15 (GQL-15) questionnaire were used to interview the patients. Results: Eight (32%) normotension glaucoma and 17 (68%) open angle glaucoma patients were included. Fifteen (60%) patients aged 17-40 y.o, 7 (28%) aged 41-60 y.o and 3 (12%) aged &gt; 60 y.o were included. Majority of the samples 6 of them were unemployed (24%), 5 entrepreneurs 5 (20%) and 5 students (20%). GQL-15 score was significantly correlated with respondent's BCVA r= -0.39 (p= 0.05). However, there was no correlation between GQL-15 with RNFL r= 0.01 (p=0.94), VFI r= -0.21 (p= 0.29) and MD with r=0.09 (p= 0.66) respectively. It showed that VFI and GQL-15 has negative correlation with a correlation coefficient of -0.21 (p=0.29). Subscale score related to central and near was significantly correlated with VFI (p= 0,05) and MD (p= 0,03). Conclusion: There was a significant correlation between GQL-15 subscale score of central and near vision with VFI and MD. Subjects with lower VFI and MD tend to have worse problem with central and near vision. Total GQL-15 score has a weak negative correlation with BCVA and MD. There was no correlation between GQL-15 with VFI and RNFL.

Alterations of the Ganglion Cell Complex in Age-Related Macular Degeneration: An Amish Eye Study Analysis

To compare the ganglion cell complex (GCC) thickness in eyes with age-related macular degeneration (AMD) vs healthy controls in an elderly Amish population. Prospective cross-sectional study. This is a post hoc analysis of the family-based prospective study of Amish subjects. Study subjects underwent imaging with the Cirrus HD-OCT (Carl Zeiss Meditec Inc) using a macular cube protocol of 512 × 128 scans (128 horizontal B-scans, each comprising 512 A-scans) over a 6 mm × 6 mm region centered on the fovea. The ganglion cell analysis algorithm calculated the GCC thickness by segmenting the outer boundaries of the retinal nerve fiber layer (RNFL) and inner plexiform layer (IPL) in all B-scans of the volume, with the region between these boundaries representing the combined thickness of the ganglion cell layer (GCL) and the IPL. A number of parameters were used to evaluate the GCC thickness: the average GCC thickness, minimum (lowest GCC thickness at a single meridian crossing the elliptical annulus), and sectoral (within each of 6 sectoral areas: superior, superotemporal, superonasal, inferior, inferonasal, and inferotemporal). The stage of AMD was graded on color fundus photographs in accordance with the Beckman Initiative for Macular Research classification system. Of 1339 subjects enrolled in the Amish eye study, a total of 1294 eyes of 1294 subjects had all required imaging studies of sufficient quality and were included in the final analysis. Of these, 798 (62%) were female. Following age adjustment, the average GCC thickness was significantly (P < .001) thinner in AMD subjects (73.71 ± SD; 13.77 µm) compared to normals (77.97 ± 10.42 µm). An independent t test showed that the early AMD (75.03 ± 12.45 µm) and late AMD (61.64 ± 21.18 µm) groups (among which eyes with geographic atrophy [GA] had the lowest thickness, of 58.10 ± 20.27 µm) had a statistically significant lower GCC thickness compared to eyes without AMD. There was no significant differences in average GCC thickness between early AMD and intermediate AMD (76.36 ± 9.25 µm) eyes. The GCC thickness in AMD eyes is reduced compared to normal eyes; however, the relationship is complex, with the greatest reduction in late AMD eyes (particularly eyes with GA) but no difference between early and intermediate AMD eyes.

Bone Marrow-derived Mesenchymal Stem Cell Therapy in Retinitis Pigmentosa.

To determine the effectiveness of bone marrow-derived mesenchymal stem cell therapy on visual acuity and visual field in patients with retinitis pigmentosa. Stem cell treatment in retinitis pigmentosa provides improvement in visual acuity and visual field. Forty-seven eyes of 27 patients diagnosed with retinitis pigmentosa were included in our study. Allogeneic bone marrow-derived mesenchymal stem cells were administered by deep subtenon injection. Complete routine ophthalmological examinations, optical coherence tomography (Zeiss, Cirrus HD-OCT) measurements, and visual field (Humphrey perimetry, 30-2) tests were performed on all patients before the treatment and on the 1st, 3rd, and 6th month after treatment. The best corrected visual acuities of the patients were determined by the Snellen chart and converted to logMAR. Visual evoked potential (VEP) and electroretinogram (ERG) examinations of the patients before the treatment and on the 6th month after the treatment were performed (Metrovision) data were compared. Visual acuities were 0.74 ± 0.49 logMAR before treatment and 0.61 ± 0.46 logMAR after treatment. Visual acuity had a statistically significant increase (p < 0.001). The visual field deviation was found to be -27.16 ± 5.77 dB before treatment and -26.59 ± 5.96 dB after treatment (p = 0.005). The ganglion cell layer was 46.26 ± 12.87 μm before treatment and 52.47 ± 12.26 μm after treatment (p = 0.003). There was a significant improvement in Pattern VEP 120º P100 amplitude compared to that before the treatment (4.43 ± 2.42 μV) and that after the treatment (5.09 ± 2.86 μV) (p = 0.013). ERG latency measurements were 18.33 ± 15.39 μV before treatment and 20.87 ± 18.64 μV after treatment for scotopic 0.01 (p = 0.02). ERG latency measurements for scotopic 3.0 were 20.75 ± 26.31 μV before treatment and 23.10 ± 28.60 μV after treatment (p = 0.014). Retinitis pigmentosa is a progressive, inherited disease that can result in severe vision loss. In retinitis pigmentosa, the application of bone marrow-derived mesenchymal stem cells by deep subtenon injection has positive effects on visual function. No systemic or ophthalmic side effects were detected in the patients during the 6-month follow-up period.

Longitudinal Changes in Choroidal Thickness Varied With Refractive Progression in Myopic and Non-Myopic Children: A Two-Year Cohort Study.

To evaluate the longitudinal changes in subfoveal choroidal thickness (SFCT) in children with different refractive status. A total of 2290 children 3 to 14years old who attended the first year of kindergarten (G0), first year of primary school (G1), fourth year of primary school (G4), or first year of junior high school (G7) in Guangzhou, China, were recruited and followed up for 2years. All participants received cycloplegic autorefraction, axial length measurement and SFCT measurement using a CIRRUS HD-OCT device. Children were divided into groups of persistent non-myopia (PNM), persistent myopia (PM), or newly developed myopia (NDM). Children in the PNM and PM groups were further divided into subgroups of stable refraction (absolute mean annual spherical equivalent refraction [SER] change < 0.5D) and refractive progression (absolute mean annual SER change ≥ 0.5D). The mean ± SD ages for the G1 to G7 cohorts were 3.89 ± 0.30, 6.79 ± 0.47, 9.71 ± 0.34, and 12.54 ± 0.38, years, respectively. SFCT consistently decreased in the NDM group across the G1 to G7 cohorts (all P<0.001) and exhibited variability across different age cohorts in the PNM and PM groups. Further subgroup analysis revealed significant thickening of SFCT in the PNM-stable group among the G0, G1, and G7 cohorts (all P<0.05), whereas it remained stable among all cohorts in the PM-stable group (all P>0.05). Conversely, SFCT exhibited thinning in the G4 and G7 cohorts in the PM-progressive group (both P<0.01) and for the entire cohort of children in the PNM-progressive group (P=0.012). SFCT increased in nonmyopic children with stable refraction, remained stable in myopic children maintained stable refraction, and decreased in those with refractive progression, whether they were myopic or not.

Five-year changes in macular thickness in the elderly population: A cohort study.

The aim of this study is to determine the 5-year changes in macular thickness and related factors. Data were from the second (2014) and third (2019) phases of the Shahroud Eye Cohort Study. Examinations included measurement of uncorrected and best-corrected visual acuity, non-cycloplegic autorefraction, slit-lamp biomicroscopy, and funduscopy. Participants underwent Cirrus HD-OCT 4000 (Carl Zeiss Meditec, Dublin, CA). The 5-year changes (95% confidence interval) of central and overall macular thicknesses were - 3.48 ± 8.16 μ (-3.92, -3.03) and - 0.79 ± 4.06 μ (-1.03, -0.54), respectively. The median and IQR of 5-year changes in the central subfield thickness were -3 and 10, although they were 0 and 5 in the overall macular thickness, respectively. Multiple regression model showed the central macular thickness (CMT) decreased with a U-shape pattern with increasing age. The 5-year changes in CMT were significantly lower in females compared to males β = -1.55; (-2.78, -0.32) and in smokers compared to non-smokers β = -1.92; (-3.55, -0.28). Moreover, higher body mass index β = -0.12; (-0.22, -0.02) and CMT at baseline β = -0.08; (-0.10, -0.06) were significantly associated with lower CMT changes. The average 5-year changes in overall macular thickness showed a non-linear decrease with age and was significantly higher in females β = 0.93; (0.4, 1.43). These changes were directly related to the anterior chamber depth β = 0.87; (0.10, 1.64) in the baseline. The macular thickness decreased slightly after 5 years; however, this change is not clinically significant. Demographic factors such as age and sex and refractive errors were significantly related to macular thickness changes.

Decreased retinal vascular density is associated with cognitive impairment in CADASIL: an optical coherence tomography angiography study.

This study aimed to assess alterations in retinal vascular density in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) patients using optical coherence tomography angiography (OCTA) and investigate their association with MRI and cognitive features. Twenty-five patients with CADASIL and forty healthy controls were evaluated by Cirrus HD-OCT 5000 with AngioPlex OCTA to determine changes in macular retinal vasculature. Retinal vasculature parameters between two groups were compared. The MRI lesion burden and neuropsychological scales were also examined in patients. The association between OCTA parameters and MRI/cognitive features was evaluated using partial Spearman rank correlation. The vessel density and perfusion density of whole image in macular region (vessel density: t = - 2.834, p = 0.005; perfusion density: t = - 2.691, p = 0.007) were significantly decreased in patients with CADASIL. Moreover, vessel density of whole image in macular region was negatively associated with Fazekas scores (ρ = - 0.457; p = 0.025) and the number of lacunar infractions (ρ = - 0.425, p = 0.038) after adjustment for age. Decreased macular vessel density and perfusion density of whole image were also associated with MoCA scores (vessel density: ρ = 0.542, p = 0.006; perfusion density: ρ = 0.478, p = 0.018) and other domain-specific neuropsychological tests (p < 0.05) after adjustment for age. Decreased retinal vascular density was associated with increased MRI lesion burden and cognitive impairment in patients with CADASIL. Our findings suggest that the degree of retinal vascular involvement, as demonstrated by OCTA, may be consistent with the severity of MRI lesions and the degree of cognitive impairment in patients.

A Cohort Study to Evaluate the Evolution of the Optic Nerve Head Parameters and Inner Retinal Thickness During Childhood.

To compare children's stereometric optic disc parameters and inner retinal thickness measured by optical coherence tomography (OCT) in two different moments in life in the same children and to establish a correlation between the optic nerve head (ONH) area and the difference of these parameters in the two observations. In this observational cohort, children were evaluated on two occasions: at 6.7 ± 1.6 and 13.2 ± 0.7 years of age. Cup volume, neuroretinal rim (NRR) area, average cup-to-disc ratio, peripapillary retinal nerve fiber layer (pRNFL), and ganglion cell inner plexiform layer (GCIPL) were measured by the Cirrus HD-OCT (Carl Zeiss Meditec AG). A total of 175 children were included, 89 boys (50.9%) and 86 girls (49.1%). There was a significant decrease of the NRR area (P < .001) and increase of the cup volume (P < .001) on the second observation. The pRNFL thickness and GCIPL thickness also decreased (P < .001 and P = .002, respectively). There was a positive correlation between the ONH area and the difference of the cup volume (P = .047; r = 0.102) and a negative correlation with the difference of the NRR area (P < .001; r = 0.237). During childhood, there is an increase of the cup volume, a decrease of the NRR area, and a decrease of inner retinal layer thickness (more significant in the superior and inferior quadrants) measured by OCT. This study demonstrates that in children with large discs the enlargement of the cup and decrease of the NRR is more evident. Considering these changes, the physiological enlargement of the cup in a child with a large disc can be misinterpreted as the development of a glaucomatous lesion. [J Pediatr Ophthalmol Strabismus. 2024;61(6):410-415.].

Comparison of Patterns of Structural Progression in Primary Open Angle Glaucoma and Pseudoexfoliation Glaucoma.

Primary open angle glaucoma and pseudoexfoliation glaucoma showed different progression patterns of the retinal nerve fiber layer and ganglion cell-inner plexiform layer thinning in OCT-guided progression analysis. To compare the patterns of progression of retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) thinning by guided progression analysis (GPA) of optical coherence tomography (OCT) in primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). The progression of RNFL and GCIPL thinning was assessed by the GPA of Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA). By overlaying the acquired images of the RNFL and GCIPL thickness-change maps, the topographic patterns of progressive RNFL and GCIPL thinning were evaluated. The rates of progression of RNFL and GCIPL thinning were analyzed and compared between patients with POAG and those with PXG. Of the 248 eyes of 248 patients with POAG (175 eyes of 175 patients) or PXG (73 eyes of 73 patients) enrolled, 156 POAG eyes and 48 PXG eyes were included. Progressive RNFL thinning was significantly more common in PXG than in POAG ( P =0.005). According to the RNFL progression-frequency maps, progression appeared mainly in the superotemporal and inferotemporal areas in POAG, whereas it had invaded more into the temporal area in PXG. According to the GCIPL maps, progression was most common in the inferotemporal area in both POAG and PXG. The average progression rate of GCIPL thinning was faster in PXG than in POAG ( P =0.013), and when analyzed in 2 halves (superior/inferior), the progression rate of the inferior half was faster in PXG than in POAG ( P =0.011). OCT GPA showed progression patterns of RNFL and GCIPL thinning in POAG and PXG. Understanding the specific patterns of progressive RNFL and GCIPL thinning according to glaucoma type may prove helpful to glaucoma-patient treatment and monitoring.

Normative optical coherence tomography reference ranges of the optic nerve head, nerve fiber layer, and macula in healthy Saudi children.

To use the Cirrus high-definition (HD)-OCT to establish normative data for the macula and optic disc in healthy Saudi children and to examine the effect of age and gender on these parameters. This retrospective study was carried out at King Abdulaziz University Hospital (KAUH), Saudi Arabia from November 2022 to April 2023. The study involved 135 full-term and healthy Saudi children aged 4-18 years who were evaluated at the KAUH ophthalmology clinic. Detailed demographic and ocular disease history data were obtained from the patients' medical records. The main outcome measures of the study included measurements of retinal nerve fiber layer (RNFL) thickness, macular thickness, and optic nerve head (ONH). The mean macular volume was 9.9mm3, the mean macular thickness was 275.9 μm, and the mean central subfield thickness was 240.6 μm. There was no significant association between age and the macular values, except for the superior inner macula. Boys had significantly thicker central macula than girls, while the RNFL quadrants were not different between age groups and genders. The mean values for RNFL thickness, disc area, rim area, and cup volume were 93.9 μm, 2mm2, 1.6mm2, and 0.3mm3, respectively. The vertical ratio of cup to disc was 0.4. Normative values for macular and optic nerve measures among Saudi children were established using the Cirrus HD-OCT device to serve as a reference.