Foveal Contour Research Articles

Macular Morphology in Patients with Retinopathy of Prematurity

Purpose: To investigate macular morphology by spectral domain optical coherence tomography (SDOCT) in children with history of the retinopathy of prematurity (ROP). Materials and methods: In this cross-sectional study we included 35 eyes of 18 patients, aged 4 to 8 years, with history of ROP. Twenty-one eyes had received treatment for type 1 pre-threshold ROP. The others showed spontaneous regression of the disease. A 7 × 7-mm retinal area was sampled using a 3-dimensional scanning protocol with high-resolution spectral domain optical coherence tomography (SOCT Copernicus REVO). The central foveal thickness, mean macular thickness, macular volume and foveal depression were measured. The macular anatomy and the foveal contour were examined. Results: The mean birth weight was 1338.29 ± 324.05 grams. Mean gestational age at birth was 29.37 ± 2.07 weeks. Twenty-one eyes were treated with laser or cryotherapy. All of them showed regression of the disease. The mean best corrected visual acuity was 20/28. The average central foveal thickness was 262.26 ± 37.39, with 68.57% of preterm > 240 μm and 22.86% > 220 μm. In all eyes, the foveal contour is abnormal. A foveal depression was absent in 25 eyes (71%). Conclusion: In the majority of children with a history of ROP, we found changes in macular morphology, including retention of inner retinal layers and absent foveal depression. In our study foveal hypoplasia was associated with good functional outcome.

Defining Cystoid Macular Degeneration in Diabetic Macular Edema: An OCT-Based Single-center Study

Objectives:To describe cystoid macular degeneration (CMD), which has no clear definition in diabetic macular edema (DME), and examine its features in optical coherence tomography (OCT) and fundus fluorescein angiography (FFA).Materials and Methods:This study was conducted using OCT images of patients who were followed in Gazi University between November 2011 and March 2015. A total of 259 eyes (187 patients) found to have cystic changes on OCT were included. Macular ischemia, peripheral ischemia, and type of edema were identified on FFA. Vitreomacular interface abnormalities, foveal contour integrity, internal reflectivity of the cysts, and outer retinal layer defects were analyzed from OCT images. The horizontal and vertical diameters of the largest cyst within 1000 μm of the foveal center were measured for the definition of CMD. Cut-offs for these values were determined by receiver operating characteristic curve analysis. Cystoid macular edema (CME) and CMD groups were created and their characteristics were analyzed.Results:The horizontal and vertical diameters of the largest cyst were moderately positively correlated with visual acuity (rs=0.349, r=0.419, respectively). Eyes with horizontal diameter of the largest cyst ≥450 μm were classified as CMD; in this group, sensitivity in the prediction of visual acuity ≤20/60 was 58%. Eyes with horizontal diameter of the largest cyst <450 μm were classified as CME; in this group, specificity in the prediction of visual acuity >20/60 was 73%. For the threshold of 300 μm determined for vertical diameter of the largest cyst, sensitivity was 62% and specificity was 69%. The CME and CMD groups were formed according to these cut-off values. Compared to the CME group, the CMD group had greater central subfield thickness and higher prevalence of outer retinal damage, severe disruption of foveal contour, macular ischemia, and diffuse/mixed type edema.Conclusion:In eyes with DME, CMD can be defined as the largest cyst within 1000 μm of the foveal center having a horizontal diameter of ≥450 μm and vertical diameter ≥300 μm, especially if associated with macular ischemia, outer retinal damage, loss of foveal contour, and diffuse/mixed type edema.

Lamellar macular hole in diabetic retinopathy.

To describe the clinical features and surgical outcomes of diabetic retinopathy-associated lamellar macular hole and compare them with those of idiopathic lamellar macular hole. A total of 17 eyes with diabetic retinopathy-associated lamellar macular hole and 30 eyes with idiopathic lamellar macular hole undergoing surgery were retrospectively enrolled. Baseline best-corrected visual acuity, preoperative optical coherence tomography characteristics, and final best-corrected visual acuity were compared between two groups. Both the baseline and the final best-corrected visual acuity in the diabetic retinopathy group were significantly worse than those in the idiopathic group (p = 0.029 for baseline, p = 0.002 for final). Lamellar macular hole in diabetic retinopathy tended to have a wider opening (p < 0.001) and a thinner residual base (p = 0.023). The width and height of parafoveal schisis in diabetic retinopathy-associated lamellar macular hole were both larger than those in idiopathic lamellar macular hole (p < 0.001 for both). After operation, both groups achieved significant improvement in best-corrected visual acuity (p < 0.01 for both). Compared with idiopathic group, diabetic retinopathy-associated lamellar macular hole had worse baseline best-corrected visual acuity, wider defect, and more pronounced parafoveal schisis. However, significant visual improvement could be obtained after operation. All cases in both groups achieved good anatomical outcomes with normalization of foveal contour and reduction of parafoveal schisis.

Lamellar macular holes : Morphological characteristics and treatment success

In recent years the high resolution of optical coherence tomography (SD-OCT) has led to a more exact and detailed imaging of different morphological types of lamellar macular holes (LMH). This resulted in new knowledge on the pathogenesis, morphology and progression of the disease; however, this also resulted in alack of clarity in the terminology and in particular led to uncertainty in the treatment of these patients in clinical practice. This article gives an overview on the morphological characteristics and treatment indications for LMH with the aim of enabling a clear differentiation compared to other morphological alterations in traction macular pathologies. The evaluation is based on the current literature and own study data from the Department of Ophthalmology at the University of Munich, Germany. In eyes with LMH different morphological forms can be seen in SD-OCT. In addition to the known diagnostic criteria of irregular foveal contour, intraretinal splitting and defect of the inner foveal layers, the occurrence and characteristics of epiretinal tissue as well as the occurrence of photoreceptor layer defects can be evaluated. Further development of imaging techniques, such as SD-OCT led to improved visualization of different types of LMH. Decisions on treatment should be based on subjective complaints, best corrected visual acuity (BCVA), the clinical course, the presence of defects of the ellipsoid zone, occurrence and characteristics of epiretinal tissue. In cases of progression of symptoms and/or traction by the epiretinal tissue, an early surgical procedure has agood prognosis for functional and anatomical rehabilitation.

Foveal Abnormality associated with epiretinal Tissue of medium reflectivity and Increased blue-light fundus Autofluorescence Signal (FATIAS).

To describe a distinct vitreomacular interface disorder (VMID) termed Foveal Abnormality associated with epiretinal Tissue of medium reflectivity and Increased blue-light fundus Autofluorescence Signal (FATIAS). A case series including forty-seven eyes of 47 patients. The included eyes must present an irregular foveal contour on optical coherence tomography (OCT) and a pathologically increased autofluorescent signal at the fovea on blue-light fundus autofluorescence (B-FAF). Main outcome measures were morphologic characteristics of the lesions, logarithm of minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), and central foveal thickness (CFT). The following two types of FATIAS were identified: (1) the step type characterized by an asymmetric contour of the foveal pit and by a tissue of medium reflectivity on the foveal surface and (2) the rail type characterized by a shallow foveal pit and a rail of tissue of medium reflectivity on the foveal surface. The outer retinal bands were continuous in all cases. Both types presented with an area of increased B-FAF signal, usually bilobed in the step type and round and centered on the foveal pit in the rail type. LogMAR BCVA was 0.09 ± 0.1 and 0.1 ± 0.1 (P = 0.91), and CFT was 197.8 ± 9.7 and 202.2 ± 13.2 (P = 0.19) in the step and in the rail group, respectively. We describe a distinct VMID named FATIAS. Two types of FATIAS may be appreciated with SD-OCT and B-FAF analyses, the step and the rail type. Both are characterized by abnormal foveal contour and autofluorescence signal.

Optic disc pit maculopathy: tamponade of maculoschisis.

PurposeTo present rapid and safe closure of the pit-macula communication (PMC) by core vitrectomy and adequate duration gas tamponade as our preferred method of resolving optic disc pit (ODP) maculopathy and to define the term “maculoschisis” in ODP maculopathy as an alternative to the term “schisis-like.”Patient and methodsA twenty-four-year-old female presented with an optical coherence tomography (OCT) confirmed ODP and a “giant” communicating maculoschisis cavity. Central macular thickness (CMT) measured 906 microns, and macular volume was twice normal, at 20.8 mm3. Snellen corrected visual acuity was 20/70. Two months after initial vitrectomy performed elsewhere with short-term gas tamponade (SF6 20%), CMT and visual acuity were not significantly improved. Combined lens extraction/intraocular lens placement and repeat vitrectomy with C3F8 15% gas tamponade were performed, with one supplemental (office) gas injection.ResultsOCT imaging six weeks postoperatively showed definitive closure of the PMC with CMT reduced by 405 microns. Sequestered from its ODP source, foveal schisis fluid then resolved by 12 weeks postoperatively. At final follow-up 3.4 years postoperatively, the macula remained dry with a CMT of 322 microns and a concave foveal contour. Macular volume was reduced to (a normal) 10.2 mm3 and visual acuity had improved to 20/25.ConclusionNo report heretofore has documented rapid, sustained closure of the PMC by gas tamponade as the preferred method of expeditiously resolving ODP maculopathy. However, tamponade PMC closure sequesters ODP fluid and uniquely provides early assurance of ultimate maculopathy resolution. In all other techniques, PMC closure is a trailing phenomenon and success remains uncertain during months to a year or more of (unsequestered) fluid resolution. We suggest that more invasive techniques (laser barrier application to the peripapillary choroid, vitreoretinal interface maneuvers, and pit-plugging) be withheld unless a recurrence is detected during subsequent examinations.

Lamellar macular holes: monitoring and management strategies.

Lamellar macular holes are a vitreoretinal condition characterized by abnormalities in foveal contour with splitting of the neuroepithelium and often an intact photoreceptor layer. Recent developments in high-resolution imaging have increased our ability to study the details of the vitreoretinal interface and to distinguish between different forms of lamellar holes. A new classification is needed to help clinicians in the management of lamellar macular holes. Some clinicians prefer to observe these clinical entities, especially when visual acuity is maintained or alterations of the photoreceptor layer are present. Nevertheless, lamellar holes may sometimes progress, and visual acuity can deteriorate. On the other hand, surgical treatment may lead to positive anatomical and functional outcomes, but not without risks. This review provides a critical overview of the available data on lamellar macular holes, focusing on diagnosis and managing options.

SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING OF THE MACULA AND VITREOMACULAR INTERFACE IN PERSISTENT FETAL VASCULATURE SYNDROME WITH POSTERIOR INVOLVEMENT.

To describe the microstructural features of the macula and vitreomacular interface in persistent fetal vasculature syndrome (PFVS) with posterior involvement managed with early vitrectomy or with observation, with functional correlation. We retrospectively identified 45 consecutive pediatric patients with PFVS with posterior involvement treated from 2005 to 2016. The eyes that could be imaged with spectral domain optical coherence tomography were included, and images were correlated with best-corrected visual acuity. Thirty-eight imaging sessions were performed on 10 eyes from 9 patients, including 7 that had been managed with vitrectomy for PFVS-related tractional retinal detachment, and 3 that had been observed. Mean age of the patients who were imaged was 9.1 years and their average length of follow-up was 5.9 years. Best-corrected visual acuities of the eyes imaged ranged from 20/30 to count fingers, with mean best-corrected visual acuity 20/163. All eyes imaged had microstructural anomalies identified. The main anomalous features included posterior hyaloidal organization, vitreoretinal traction, vitreopapillary traction, diminished foveal contour, foveal displacement, and disruption of the ellipsoid zone. Posterior hyaloidal organization (P = 0.043), diminished foveal contour (P = 0.019), and disruption of the ellipsoid zone (P = 0.014) were associated with worse best-corrected visual acuity. Macular and vitreomacular interface anomalies were identified in all pediatric patients with posterior PFVS imaged with spectral domain optical coherence tomography. These microstructural findings, together with functional measures, may inform the diagnosis and management of PFVS with posterior involvement.

Epiretinal membrane profile on spectral domain optical coherence tomography in patients with uveitis.

Purpose:To study the epiretinal membrane (ERM) profile on the spectral-domain optical coherence tomography (SDOCT) in eyes with uveitis.Methods:In this prospective observational study, macula of uveitic eyes were evaluated by SDOCT (Cirrus, model 5000) for ERM. ERM was quantified (in microns) and were followed up along with the best-corrected visual acuity (BCVA) and treatment profile for 1 year. ERM morphology (focal, global, or mixed) and characteristics (thickness at fovea, maximum thickness, and location of maximum thickness in relation to fovea) were documented. Changes in altered foveal contour, cystoid macular edema (CME), and central foveal thickness were also noted. BCVA was noted when the inflammation subsided and it was correlated to specific ERM characteristics. SDOCT characteristics were compared in three treatment groups (no oral steroids, oral steroids with, and without immunomodulators).Results:Thirty-four eyes of 25 patients were evaluated. Mean logMAR BCVA decreased from 0.25 to 0.35 (P = 0.005). Foveal involvement with ERM (P = 0.011), lost foveal contour (P = 0.043), and ellipsoid layer disruption (P = 0.017) were associated significantly with reduced BCVA. Focal attachment of ERM was more commonly associated with CME (P = 0.03). Median ERM thickness showed significant increase (P < 0.001). Significant ERM progression from parafoveal to foveal (P = 0.02), significant progression of the thickest area of ERM closer to fovea (P = 0.0006) indicated a strong tendency of foveal involvement and this was correlated with worse BCVA (P = 0.009, r = −0.44) Oral steroids/immunomodulators showed no significant benefit on ERM progression.Conclusion:ERM progression in uveitis has a tendency to involve the fovea and is associated with significant vision loss, particularly in foveal ERM, focal attachment, and IS-OS disruption. Oral steroids and immunomodulators have no role in halting progression.

DEVELOPMENT AND PROGRESSION OF A LAMELLAR MACULAR HOLE WITH LAMELLAR HOLE–ASSOCIATED EPIRETINAL PROLIFERATION

To describe evolution and progression of a lamellar macular hole (LMH) with "lamellar hole-associated epiretinal proliferation (LHEP)" using spectral-domain optical coherence tomography and fundus autofluorescence. Observational case report. We report on a 63-year-old male patient demonstrating a complete history of LMH development with LHEP occurring during a follow-up period of 8 years. Presenting with a normal foveal contour and attached posterior vitreous at first visit, an LMH developed shortly after incomplete posterior vitreous detachment with vitreopapillary adhesion. On spectral-domain optical coherence tomography images, progression of the LMH including enlargement of the intraretinal cavitation and decrease in the retinal thickness were documented. An increase of LHEP was first documented 6 months after LMH evolution. One month after cataract surgery and 6 years after the first visit, a full-thickness macular hole developed that closed spontaneously after 4 weeks. Localization of LHEP had moved into the foveal defect toward the outer retinal layers. Thereafter, the LMH was stable, and the patient presented with a visual acuity of 20/25. Proper follow-up time is important for studying eyes with an LMH. Epimacular cell proliferation shows progression over time that appears to be associated with morphologic changes of the LMH including shape of the lamellar defect, amount of LHEP, and contractive properties of epiretinal tissue. The presence of LHEP was documented shortly after posterior vitreous detachment.

PNEUMATIC DISPLACEMENT OF LIMITED TRAUMATIC SUBMACULAR HEMORRHAGE WITHOUT TISSUE PLASMINOGEN ACTIVATOR: A CASE SERIES

To evaluate the efficacy of intravitreal gas (perfluoropropane, C3F8)-assisted displacement of submacular hemorrhage (SMH) secondary to recent or old blunt trauma. An interventional case series of three patients who presented with SMH after blunt trauma, ranging from 2 days to 2 weeks back. All three patients were treated with an intravitreal injection of 0.3 cc of 100% C3F8 with anterior chamber paracentesis. Strict prone position was advised for 2 weeks with a minimum of 6 to 8 hours per day. Documentation was done with serial recording of corrected distance visual acuity, fundus photographs, and spectral domain optical coherence tomography both before and after intervention. The follow-up period ranged from 2 weeks to 3 months. All patients showed a significant displacement of SMH with recovery of the normal foveal contour; foveal thinning was noted in 2 cases. Best spectacle-corrected visual acuity improved from counting finger at 1 m to 20/30 in Case 1 and counting finger 3 m to 20/40 in Case 2. In Case 3, the visual acuity remained unchanged from the preoperative 20/60 which could be attributed to the presence of a choroidal rupture in the foveal area that became evident after the displacement of SMH. Pneumatic displacement is an effective technique in the management of SMH due to recent or old blunt trauma.

Efficacy of intravitreal aflibercept monotherapy in retinopathy of prematurity evaluated by periodic fluorescence angiography and optical coherence tomography.

To evaluate the efficacy of intravitreal aflibercept (IVA) in vascular and macular maturation in neonates with type 1 retinopathy of prematurity (ROP) and aggressive posterior retinopathy of prematurity (APROP). Thirty-six eyes of 18 patients with type 1 ROP or APROP in zone I or posterior zone II were enrolled in our study. At baseline, only fluorescein angiography (FA) was performed. After IVA injection, both FA and optical coherence tomography (OCT) were performed after 6.8 ± 0.8 (range 6-8) and 19 ± 0.9 (range 18-20) weeks to follow vascular and macular changes. Both diffuse flat neovascularization with leakage and abnormal vascular branching at the small arteriolar level were detected in all eyes (100%) at baseline FA. Regression of the disease was observed in 34 eyes (94.4%) in the first week with binocular indirect ophthalmoscopy. Early unresponsiveness in remaining two eyes of an infant required an IVA re-treatment. Late reactivation was detected only in 19.4% of eyes, none of which required treatment during 12months of follow-up. The most common feature after IVA injection was abnormal branching at capillary level, which was noted in 100% in the first post-injection FA and 50.0% of all eyes in the second FA. Meanwhile, the end limit of vascularization was observed in zone III in 83.3% of eyes. No vascular abnormality was also detected in 27.3% of eyes. The OCT examination at a mean postmenstrual age of 43.4weeks revealed cystoid macular changes in four eyes of two infants (11.1%), normal foveal contour in 30 eyes of 15 infants (83.3%) and matured ellipsoid zone at the foveal center in 28 eyes of 14 infants (77.8%). Macular maturation was complete in all eyes in the last OCT analyses. Intravitreal aflibercept monotherapy has been an effective treatment in type I ROP and APROP with much lower early and late re-treatment rates because of early unresponsiveness and late reactivation, respectively. In most of the eyes, rapid vascular outgrowth beyond zone III together with normal macular maturation was observed more precisely by periodic FA and OCT.

The outcomes of epiretinal membrane peeling in patients with foveal herniation

BackgroundTo evaluate the surgical outcomes of vitrectomy in patients with foveal herniation associated with epiretinal membrane (ERM).MethodsThis was a retrospective case series. The patients who had a foveal herniation associated with ERM, underwent vitrectomy, and had a minimum follow-up period of 12 months were included. The visual and anatomical outcomes were assessed during the first 12 months of follow-up and at the last follow-up visit. The main outcome measure was the reorganization pattern of foveal pit at month 12.ResultsEleven eyes of 11 patients were included. The mean postoperative follow-up period was 14.8 ± 2.6 months. The foveal contour was completely restored in 5 eyes (45.5%), partially restored in 5 eyes (45.5%), and was not restored in 1 eye (9.1%) at postoperative month 12 follow-up visit. The mean preoperative best corrected visual acuity was 0.61 ± 0.16 LogMAR and increased to 0.49 ± 0.16 LogMAR at month 12 (p < 0.0001). The mean preoperative central retinal thickness was 476 ± 128 micrometers and decreased to 302 ± 70 micrometers at month 12 (p < 0.0001).ConclusionThe foveal contour was restored in 45.5% of the eyes and visual acuity was significantly increased by a mean of 1.2 LogMAR lines at month 12 in patients with foveal herniation associated with ERM.

Progression to Surgery for Patients With Idiopathic Epiretinal Membranes and Good Vision.

Patients with idiopathic epiretinal membranes (ERMs) and visual acuity of 20/40 or better are often monitored until vision or associated symptoms worsen to affect everyday living. This study looks at the rate of progression to surgery and the characteristics associated with progression. This study was a retrospective, consecutive case series of patients with newly diagnosed idiopathic ERMs who were referred to the Retina Service at the Ophthalmic Consultants of Boston between January 2009 and May 2015 with 20/40 or better visual acuity. Surgical membrane peel was typically offered when vision worsened to 20/50 or beyond and/or when patients could not tolerate symptoms attributable to the ERM. All eligible eyes were categorized by baseline optical coherence tomography (OCT) morphology into normal, mild or incomplete, or complete loss of foveal contour. Visual acuities were averaged through conversion to logMAR. Kaplan-Meier survival curves for progression to surgical membrane peel were calculated. The main outcome measure was progression to surgical intervention. The study included 201 eyes from 170 patients; 29.8% had normal, 18.9% had mild loss, and 51.2% had complete loss of foveal contour on baseline OCT. Overall, 13% of eyes progressed to surgery at 7 years. However, only 5% of eyes with normal foveal contour progressed to surgery by 5.5 years, whereas 17% with incomplete and 16% with complete loss of foveal contour progressed to surgery at 6 and 7 years, respectively. Eyes with worse foveal contours progressed to surgery more rapidly. A minority of patients with newly diagnosed ERMs who did not need surgical intervention progressed to needing surgery at 7 years with the rate and speed of progression dependent on baseline OCT morphology. These statistics can be useful in counseling patients who are deciding between watchful waiting and surgical intervention. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:S18-S22.].

Embedding of lamellar hole-associated epiretinal proliferation combined with internal limiting membrane inversion for the treatment of lamellar macular hole: a case report

BackgroundWe recently reported that lamellar macular hole (LMH) with lamellar hole-associated epiretinal proliferation (LHEP) can be effectively treated by embedding the LHEP into the retinal cleavage to improve foveal contour and visual acuity. Here, we report a case of LMH with LHEP for which we performed embedding of the LHEP combined with internal limiting membrane (ILM) inversion. We then evaluated the effects of this surgery on macular morphology and visual functions.Case presentationA 62-year-old man presented with visual disturbance (20/29) and metamorphopsia in his right eye. B-scan optical coherence tomography (OCT) imaging revealed the presence of both partial-thickness defect of the macula with degenerative retinal cleavage and LHEP at the surface of the retina. En face OCT imaging showed the absence of retinal fold. We performed phacoemulsification with intraocular lens implantation, vitrectomy, embedding of LHEP into the retinal cleavage, and ILM inversion. Three months after the surgery, both foveal contour and visual acuity (20/20) were improved and metamorphopsia was reduced.ConclusionEmbedding of the LHEP combined with ILM inversion may be an effective treatment for LMH with LHEP.

Macular Changes on Optical Coherence Tomography Before, During, and After Silicone Oil Tamponade for Macula-On Retinal Detachment: A Case Series

Purpose: Assess changes on spectral domain optical coherence tomography (OCT) before, during, and after removal of silicone oil (SO). Methods: Retrospective series of patients who underwent SO tamponade for macula-on rhegmatogenous retinal detachment. OCT scans of the affected eye were taken before, during, and 3 months after SO tamponade. Qualitative assessment of foveal contour and quantitative comparison of OCT parameters (central macular, cube, ganglion cell layer [GCL], and outer retinal thicknesses) were done between 3 time points. Results: Ten eyes of 9 patients were included. Flattening of the foveal contour during SO tamponade was completely reversed after SO removal. Average cube and GCL thicknesses decreased with SO tamponade and increased after SO removal ( P = .01 and P = .02, respectively). Outer retinal thicknesses did not vary among 3 time points ( P = .09). Conclusions: SO tamponade causes foveal flattening and thinning of the inner retinal layers, which is reversible on removal.

Lamellar Macular Holes; Pathophysiology, Classification, Clinic, Diagnosis, and Treatment

Lamellar macular hole (LMH), first described as a macular lesion developing after the opening of the central cyst in an eye with cystoid macular edema, has been used to define an aborted stage in full-thickness macular hole (MH) development. Abnormal posterior vitreous detachment associated with contraction of vitreous cortex plays a role in its pathophysiology. As a result of foveal traction of the attached and contracted macular vitreous cortex, splitting of the inner and outer retinal layers is observed. Contraction of the frequently accompanying epiretinal membrane also has an effect on the development of LMHs. Classified as tractional, degenerative, and mixed types, LMHs are seen as reddish, round, oval or lobulated lamellar defects at the fovea with the fundoscopic examination. In the differential diagnosis, it can be mistaken with MHs, and pseudoholes. Its diagnosis is best made with optic coherence tomography (OCT) examination. The diagnostic criteria with OCT are, defects in inner retinal layers with irregular foveal contour, thinning of the base of the fovea, partial-thickness MH with preservation of photoreceptors, and intraretinal splitting. Epiretinal proliferation is seen in most of the eyes. A thick, homogenous layer consisting of unusual material on the epiretinal surface has been defined as LMH-associated epiretinal proliferation by OCT. Persistent vitreopapillary adhesion is demonstrated in one-third of eyes. Patients with LMHs stay stable with minimal complaints about a long time, and surgery is not needed in most of them. When the patients have serious visual complaints, or a decrease in visual acuity (VA) is noted, surgery is indicated. The anatomical and functional success rate is high with pars plana vitrectomy, peeling of ERM, and ILM, air/gas endotamponade. Patient selection is important. Low preoperative VA, disruption at the junction of inner-outer photoreceptor layers, and foveal thinning are poor prognostic indicators. Further studies are warranted to determine which patients will benefit from surgery.

Contour interaction under photopic and scotopic conditions.

In the present study, we asked whether contour interaction undergoes significant changes for different luminance levels in the central and peripheral visual field. This study included nine normal observers at two laboratories (five at Palacky University Olomouc, Czech Republic and four at the University of Houston, USA). Observers viewed a randomly selected Sloan letter surrounded by four equally spaced bars for several separations measured edge-to-edge in min arc. Stimuli were viewed foveally under photopic and mesopic luminances and between 5° and 12° peripherally for four different background luminances of the display monitors, corresponding to photopic, mesopic, scotopic, and dim scotopic levels. The extent of the contour interaction in the fovea is approximately 20 times smaller than in the periphery. Whereas the magnitude of foveal contour interaction markedly decreases with decreasing luminance, no consistent luminance-induced change occurs in peripheral contour interaction. The extent of contour interaction does not scale with the size of the target letter, either in the fovea or peripherally. The results support a neural origin of contour interaction consistent with the properties of center-surround antagonism.

Foveal Crowding Resolved

Crowding is the substantial interference of neighboring items on target identification. Crowding with letter stimuli has been studied primarily in the visual periphery, with conflicting results for foveal stimuli. While a cortical locus for peripheral crowding is well established (with a large spatial extent up to half of the target eccentricity), disentangling the contributing factors in the fovea is more challenging due to optical limitations. Here, we used adaptive optics (AO) to overcome ocular aberrations and employed high-resolution stimuli to precisely characterize foveal lateral interactions with high-contrast letters flanked by letters. Crowding was present, with a maximal edge-to-edge interference zone of 0.75-1.3 minutes at typical unflanked performance levels. In agreement with earlier foveal contour interaction studies, performance was non-monotonic, revealing a recovery effect with proximal flankers. Modeling revealed that the deleterious effects of flankers can be described by a single function across stimulus sizes when the degradation is expressed as a reduction in sensitivity (expressed in Z-score units). The recovery, however, did not follow this pattern, likely reflecting a separate mechanism. Additional analysis reconciles multiple results from the literature, including the observed scale invariance of center-to-center spacing, as well as the size independence of edge-to-edge spacing.

PARAFOVEAL MICROVASCULAR FEATURES ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN EYES WITH CIRCUMSCRIBED CHOROIDAL HEMANGIOMA.

To evaluate parafoveal microvasculature in eyes with circumscribed choroidal hemangioma using optical coherence tomography angiography. Fourteen eyes with unilateral circumscribed choroidal hemangioma were imaged using OCT for central macular thickness and optical coherence tomography angiography for superficial and deep foveal avascular zone area, and superficial and deep capillary density (CD), comparing affected and paired fellow eyes. Mean patient age was 53 years, and mean visual acuity was 20/60 in the involved eye and 20/25 in the fellow eye. In the affected eye, clinical findings included cystoid macular edema (CME) in 1, parafoveal/subfoveal subretinal fluid (SRF) in three, and both CME and SRF in two eyes. OCT revealed current CME/SRF in six eyes, and normal foveal contour in eight eyes, among which five never demonstrated OCT evidence of CME or SRF. By OCT (affected vs. fellow eye), mean central macular thickness was greater in affected eyes (312 vs. 264 μm, P = 0.042). By optical coherence tomography angiography, there was no difference in superficial foveal avascular zone (P = 0.327), deep foveal avascular zone (P = 0.563), and superficial CD (P = 0.159), but mean deep plexus CD was reduced in affected eyes (50% vs. 54%, P = 0.010). Subgroup analysis showed that eyes with previous or current CME and/or SRF had reduced deep plexus CD (53% vs. 57%, P = 0.005), while eyes without previous/current CME/SRF had similar deep plexus CD (P = 0.399) compared with fellow eyes. Circumscribed choroidal hemangioma generally does not affect parafoveal inner retinal microvasculature. However, a reduction in deep plexus CD can be expected in eyes with previous or current CME/SRF.