Fundus Pathology Research Articles

Anti-Angiogenic Effects of a Mutant Endostatin: A New Prospect for Treating Retinal and Choroidal Neovascularization

PurposePathological fundus angiogenesis is a major cause of vision loss in retina diseases. Endostatin, a C-terminal fragment of collagen XVIII, is an endogenous anti-angiogenic protein. The present study aimed to investigate the in vitro and in vivo anti-angiogenic properties of two proteins: an N-terminal H1D/H3D mutant endostatin (M-ES) and a polyethylene glycol propionaldehyde (PEG) covalent M-ES (PEG-M-ES).MethodsM-ES and PEG-M-ES properties were characterized in vitro using a zinc ion binding assay and a stability test. Activity assays, including migration, proliferation, and tube formation assays, were performed with human retinal microvascular endothelial cells (HRMECs) and human umbilical vein endothelial cells (HUVECs). Mouse oxygen-induced retinopathy (OIR) and choroidal neovascularization (CNV) models were used to evaluate in vivo anti-angiogenic effects. In addition, a rabbit model was used to study the retinal pharmacokinetic profile following an intravitreal injection.ResultsThe results indicated that the H1D/H3D mutations of endostatin reduced the zinc binding capacity of M-ES and facilitated PEG covalent binding. PEG-M-ES was more stable and persisted longer in the retina compared with M-ES. The in vitro studies demonstrated that M-ES and PEG-M-ES inhibited HRMEC and HUVEC proliferation, migration, and tube formation more efficiently than ES. In vivo, a single intravitreal injection of M-ES and PEG-M-ES significantly decreased neovascularization in both the OIR and CNV animal models.ConclusionThe present study demonstrated for the first time that PEG-M-ES exhibits a long-term inhibitory effect on neovascularization in vitro and in vivo. These data suggest that PEG-M-ES may represent an innovative therapeutic strategy to prevent fundus neovascularization.

Prevalence of ocular fundus pathology with type 2 diabetes in a Chinese urban community as assessed by telescreening

ObjectiveTo describe the telescreening model and assess the prevalence of ocular fundus pathology in patients with type 2 diabetes within a Chinese urban community.DesignCommunity-based cross-sectional study.SettingHealthcare centre of Fengyutan Community,...

Fundus Autofluorescence

Fundus Autofluorescence (FAF) is a unique in vivo method of fundus imaging. Although it has been an area of active research over the last half a century, its only in the past decade that major advances have been made in its clinical application. The imaging has its basis in the mapping of normal and abnormal fluorophores in various retinal conditions mainly lipofuschin. Recording of FAF is relatively easily accomplished, requires little time and is non-invasive. FAF signals are emitted across a broad wavelength spectrum. FAF imaging aids in identification and early detection of many retinal conditions often before changes can be picked up on other investigative modalities. FAF can assist in tracking temporal changes in fundus lipofuschin accumulation; detect pre clinical stage of fundus disorders related to lipofuschin, aid differential diagnoses based on different lipofuschin accumulation patterns and also in assessing risk factors that determine lipofuschin accumulation. FAF can also predict progression in various degenerative and age related retinal disorders before actual functional deficit occurs. In this review we shall discuss the principle and techniques of acquiring an FAF image. We shall describe a normal FAF picture with its basis and review various FAF features of various fundus pathologies. Many vitreo retinal diseases like age related macular degeneration, idiopathic macular telangiectasia, choroidal neovascular membranes, central serous chorioretinopathy among others have different autofluorescence patterns which will be discussed in this review.

Direct versus indirect ophthalmoscopy: Medical student assessment of retinal pathology

AbstractPurpose Fundoscopy by non Ophthalmic specialists is typically performed by direct ophthalmoscopy. This challenging skill gives a magnified, monocular image. In contrast, indirect ophthalmoscopy as regularly used by Ophthalmologists allows a wide field, binocular view. The aim of the study was to test the hypothesis that compared to direct ophthalmoscopy, indirect ophthalmoscopy is an easier technique to learn and that the correct diagnosis of fundus pathology is more readily achieved.Methods The design was a prospective cohort study, conducted on 50 third year medical students, at a large inner city hospital. Participants attended a practical teaching session on both techniques. Students were then randomly allocated to either ophthalmoscopy technique and scored on their ability to recognise common fundus pathology in a group of patients. Student perception of the technique was also ascertained.Results The number of surveys filled out for first and second session was 98% and 86% respectively. After the initial teaching session, the majority of students reported being ‘moderately’ confident in using both techniques (direct 52%; indirect 35%), but overall 59% preferred direct ophthalmoscopy. When asked to identify common retinal pathology, it was found that students allocated to direct ophthalmoscopy were more likely to correctly identify the pathology although not statistically significant (U value 9.5, p≤0.05).Conclusion Although indirect ophthalmoscopy provides better views of the retina, students are more confident using direct ophthalmoscopy. Furthermore, there is no significant difference in ability to diagnosis retinal pathology between either techniques.

Fundusscreening durch Assistenzpersonal

Ocular fundus photography allows detection of both ocular and systemic diseases. This study investigated the efficacy of a broad screening in a department of internal medicine using nonmydriatic digital fundus photography. For 8 weeks a medical technician was trained in using the camera as well as interpreting the photographs. The medical technician and an ophthalmologist evaluated the fundus photographs separately by using a self-developed questionnaire. The fundus camera was user-friendly and after several weeks of adjustment and practical application the medical technician was able to detect the majority of pathological fundus photographs. Out of 218 patients examined 148 (68%) were identified as pathological by the medical technician and 163 (75%) by the ophthalmologist (p = 0.0003). The medical technician missed 15 (7%) patients. Furthermore the diagnoses made by the medical technician were faulty. In summary an ophthalmological screening by a medical technician is feasible but the diagnosis still remains the responsibility of ophthalmologists. Such a compromise could facilitate the examination of a large number of patients and disclose previously unrecognized diseases.

Posterior segment causes of reduced visual acuity after phacoemulsification in eyes with cataract and obscured fundus view

PurposeTo determine posterior segment causes of reduced visual acuity after phacoemulsification in eyes with cataract and obscured fundus view.Patients and methodsRetrospective review of medical records of patients with cataract, obscured fundus view, and normal B-scan ultrasonography, undergoing phacoemulsification from May 2005 to March 2012 was conducted. Eyes with fundus pathology, previous trauma, surgery, glaucoma, amblyopia, or uveitic cataract were excluded. Ocular comorbid conditions, preoperative visual acuity (VA), intraoperative and early postoperative complications, and final best corrected visual acuity (BCVA) at 1 month were abstracted from the records.ResultsAll 201 eyes of 179 patients studied had a preoperative VA of ≤6/60. Preoperative ocular comorbidity was present in 31 eyes (15.5%). Intraoperative complications occurred in 20 eyes (10%). Postoperative complications developed in 34 eyes (17.0%). One month postoperatively, 175 eyes (87.1%) achieved a BCVA of ≥6/12; whereas 26 eyes (12.9%) achieved a BCVA of ≤6/18. The most common posterior segment causes of reduced VA in the 26 eyes were age-related macular disease in ten eyes (38.5%) and diabetic maculopathy in six eyes (23.1%). Similar fundus pathology was seen preoperatively in the fellow fundus in 10 of the 26 eyes (38.5%).ConclusionOne month after phacoemulsification in eyes with cataract and obscured fundus view, age-related macular disease and diabetic maculopathy were the most common posterior segment causes of reduced final BCVA. To avoid postsurgical dissatisfaction, patients with obscured fundus view in their preoperative eye should be counseled, especially if posterior segment pathology exists in their fellow eye.

Ocular fundus pathology and chronic kidney disease in a Chinese population

BackgroundPrevious study indicated a high prevalence of ocular fundus pathology among patients with chronic kidney disease (CKD), while the relationship between them has never been explored in a Chinese Population.MethodsThis cross-sectional study included 9 670 participants enrolled in a medical screening program. Ocular fundus examination was performed by ophthalmologists using ophthalmoscopes. The presence of eGFR less than 60 mL/min/1.73 m2 and/or proteinuria was defined as CKD.ResultsCompared to participants without CKD, participants with CKD had higher prevalence of retinopathy (28.5% vs. 16.3%, P < 0.001), glaucoma suspect (3.1% vs. 1.8%, P = 0.004), age-related macular degeneration (1.7% vs. 0.9%, P = 0.01) and overall eye pathology (32.0% vs. 19.4%, P < 0.001). After adjusting for potential confounders, the odds ratio of proteinuria for overall eye pathology and retinopathy was 1.29 (95% confidence interval [CI] 1.07-1.55) and 1.37 (95% CI 1.12-1.67), respectively. The results were robust after excluding participants with hypertension or with diabetes.ConclusionsOcular fundus pathology is common among Chinese patients with CKD. Regular eye exam among persons with proteinuria is warranted.

Computer-Assisted Image Processing for a Simulated Stereo Effect of Ocular Fundus and Fluorescein Angiography Photographs

To report computer-assisted image processing for a simulated stereo effect of fundus and fluorescein angiography (FAG) digital photographs in patients with ocular fundus pathology. Fundus red-free and FAG photographs of patients with a variety of ocular fundus pathologies were digitized and then processed with the sketch bas relief filter of Adobe Photoshop software (Adobe Systems, San Jose, CA) to create a stereo-like carved image. The images were compared with indirect slit-lamp biomicroscopy and optical coherence tomography (OCT) for accuracy and reliability in showing ocular pathology. The bas relief filter could transform ocular fundus and FAG photographs into images carved in relief. Dark areas of the fundus image took on the background color, and light colors used the foreground color. A variety of ocular fundus pathologies with fluorescein dye leakage in the FAG were found to be elevated lesions after image processing with the bas relief filter. Image misinterpretations might occur and can be avoided with careful examination of the ocular fundus with indirect slit-lamp biomicroscopy and OCT. Computer-assisted image processing for a simulated stereo effect of fundus and FAG photographs is a simple and assessable method of image processing that decreases the complexity of ocular fundus and FAG photographs for patient interpretation. It might be a useful tool in assisting physician-patient communication by creating pseudo three-dimensional images and highlighting ocular fundus pathology.

Prevalence of Ocular Fundus Pathology in Patients with Chronic Kidney Disease

The objective of this study was to describe the prevalence of ocular fundus pathology in the Chronic Renal Insufficiency Cohort (CRIC) study, a multicenter, longitudinal study of individuals with varying stages of chronic kidney disease (CKD). In this cross-sectional study, 45 degree digital photos of the disc and macula in both eyes were obtained by nonophthalmologic personnel using a nonmydriatic Canon CR-DGI fundus camera in 1936 individuals who participated in the CRIC study. Photographs were assessed in a masked manner by graders and a retinal specialist at a central photograph reading center. The purpose of this review was to inform participants quickly of conditions that warranted a complete eye examination by an ophthalmologist. Among the 1936 participants who were photographed, 1904 (98%) had assessable photographs in at least one eye. Eye pathologies that required a follow-up examination by an ophthalmologist were identified in 864 (45%) of these 1904 participants. These eye pathologies included, among others, retinopathy (diabetic and/or hypertensive), a finding that was observed in 482 (25%) of these 1904 participants. Three percent (65 participants) of the 1904 participants had serious eye conditions that required urgent follow-up and treatment. Lower estimated GFR and cardiovascular disease were associated with greater eye pathology. Estimated GFR <30 ml/min per 1.73 m(2) was associated with a three times higher risk for retinopathy. We found a high prevalence of fundus pathology in participants with CKD. This finding supports recommendations for regular complete eye examinations in the CKD population.

Wirksamkeit und Sicherheit von Etofibrat bei Patienten mit nicht proliferativer diabetischer Retinopathie

Diabetic retinopathy is the leading cause of vision loss or blindeness in working-age adults in the developed and developing countries. No curative treatments are available for diabetic retinopathy and the most common symptomatic treatment, laser photocoagulation, provides only partial and temporary relief from the progressive vascular damage caused by this disease. Etofibrate (Lipo-Merz) is an orally-administered treatment for lipid disorders that combines fibrate and nicotinic acid in a slow-release formulation. This report describes the results of a double-blind, randomised, placebo-controlled study, performed to evaluate the efficacy and safety of etofibrat in patients with type 2 diabetes mellitus and concomitant diabetic retinopathy. They received either placebo or 1000 mg/day etofibrate for up to 12 months. Efficacy analyses were based on visual acuity assessment and blinded expert ratings of ocular fundus pathology, as well as laboratory analyses of serum lipid parameters. The evaluable population comprised 296 patients, 148 in each treatment group, of whom 89% completed the study and 73% completed according to protocol. After 12 months of treatment, a significantly larger population of etofibrate-treated patients than placebo-treated patients showed improvements in ocular pathology (46% versus 32%, respectively, p < 0.001); similar findings were already apparent after 6 months of treatment (43% versus 31%, respectively p < 0.001). Etofibrate treatment also produced significant improvements in total cholesterol, LDL-cholesterol and HDL-cholesterol in comparison to the placebo treatment group. Safety evaluations (adverse events, laboratory parameters) did not reveal any clinically significant adverse effects of etofibrate in comparison to placebo. Etofibrate provides a safe and effective treatment for ocular pathology resulting from type 2 diabetes mellitus.

Ocular characteristics in 10 children with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency: a cross-sectional study with long-term follow-up

Ocular characteristics in 10 children with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency: a cross-sectional study with long-term follow-up

Management of large traumatic zonular dialysis with phacoemulsification and IOL implantation using the capsular tension ring

To report our results and to evaluate the longterm effect of capsular tension ring (CTR) insertion in eyes with large traumatic zonular dialysis that underwent phacoemulsification with posterior chamber (PC) intraocular lens (IOL) implantation. This prospective study included 17 eyes of 17 consecutive patients with cataract and large traumatic zonular dialysis (range 80-160 degrees determined pre-or intraoperatively). After insertion of a CTR, phacoemulsification with foldable acrylic PC IOL implantation was performed. Posterior capsule rupture, vitreous loss, best corrected visual acuity (BCVA), intraocular pressure (IOP) in the pre- and postoperative periods and postoperative IOL decentration were recorded. The mean follow-up period was 25.9 months (range 15-35 months). Capsule collapse did not occur in any eye with a CTR. Postoperatively, four eyes developed raised IOP that responded well to medical therapy. An improvement in BCVA was observed in all eyes except one because of co-existing fundus pathology. No IOL was found to be decentrated at the end of the follow-up period, apart from one eye in which the PC IOL was dislocated due to a postoperative trauma, in which an anterior chamber IOL was implanted. In cases of cataract associated with large traumatic zonular dialysis, implanting a CTR before or during phacoemulsification with an in-the-bag PC IOL is relatively safe technique with a high success rate. The CTR was found to be efficient in preventing IOL decentration in eyes with traumatic zonular deficiency.

Evaluation of Macular Changes After Uncomplicated Phacoemulsification Surgery by Optical Coherence Tomography

Purpose: To evaluate the effect of uncomplicated phacoemulsification surgery on macula by optical coherence tomography (OCT). Methods: A total of 110 eyes of 102 patients who underwent uncomplicated phacoemulsification and foldable intraocular lens implantation at Beyoglu Eye Research and Training Hospital between February and March 2005 and who were without any systemic disease, fundus or other ocular pathology were included. Postoperatively, topical prednisolone acetate (6× 1) and ofloxacine (5× 1) was started, and by decreasing the dosage progressively, treatment was continued for 6 weeks. Full ophthalmologic and OCT examinations were done preoperatively and at the postoperative 1st day, 1st week, 1st, 3rd, and 6th months. Mean retinal thicknesses, volumetric analyses at central fovea, superior, inferior, temporal, and nasal macular quadrants, and thinnest foveal retinal thicknesses were recorded. Preoperative and postoperative measurements were analyzed statistically by using ANOVA test, paired samples t-test with Bonferroni correction, and Pearson's correlation test. Results: The mean central foveal retinal thickness was preoperatively 202.4 ± 25.9 μ m, postoperatively 200.4 ± 26.1 μ m at 1st day (p = 0.29), 208.4 ± 27.6 μ m at 1st week (p = 0.29), 226.2 ± 54.9 μ m at 1st month, 215.2 ± 24.0 μ m at 3rd month, 213.5 ± 29.4 μ m at 6th month (p < 0.001). Perifoveal macular thicknesses at superior, inferior, temporal, and nasal quadrants were 264.9 ± 28.8 μ m, 266.1 ± 29.5 μ m, 255.0 ± 31.3 μ m, 260.3 ± 34.0 μ m, respectively, preoperatively; 287.9 ± 28.4 μ m, 288.0 ± 26.3 μ m, 286.8 ± 33.1 μ m, 272.0 ± 32.4 μ m, respectively, at postoperative 1st month (p < 0.001). The change in mean central foveal thickness, foveal thinnest retinal thickness, mean perifoveal retinal thickness and volumetric analyses was insignificant at postoperative 1st day (p > 0.05), and significant at 1st week, 1st, 3rd, and 6th months (p < 0.05 for all measurements). Conclusions: Statistically significant increase in macular thickness was detected at postoperative early periods, after the 1st week after uncomplicated cataract operation. The increase in macular thickness starts from parafoveal regions. Longer follow-up of patients is required for the macular consequences, and different treatment protocols should be studied in a randomized controlled fashion.

Parapapilläre Autofluoreszenz als Glaukomindikator

A pronounced fundus autofluorescence (lipofuscin) occurs in eyes with AMD. Parapapillary lipofuscin accumulation in the retinal pigment epithelial cells was observed in eyes with advanced glaucoma histologically. The aim of this study was to evaluate the parapapillary autofluorescence (PAF) in vivo in healthy eyes (controls), and in eyes with primary open angle glaucoma (POAG), pseudoexfoliation glaucoma (PSXG) or normal tension glaucoma (NTG). Controlled cross-sectional analysis was performed on 281 consecutive eyes (98 controls, 95 POAG, 32 PSXG, 56 NTG). Eyes with fundus pathologies were excluded. The confocal scanning laser ophthalmoscope HRA II (Heidelberg Retina Angiograph II) was used after lipofuscin-excitation with an argon blue laser (488 nm) to detect PAF in the spectrum above 500 nm. PAF area and PAF distance to the optic nerve head were analyzed using the HRA standard software. Two experienced ophthalmologists classified independently the stage of glaucomatous optic nerve head atrophy (GONHA) using 15 degrees fundus photographs. Vital optic nerve heads had smaller PAF areas (stage 0: 0.07 +/- 0.09 mm (2)) in contrast to advanced stages of GONHA (stages 1 to 4: 0.27 +/- 0.46 mm (2); p < 0.001; logistic regression Cox and Snell: r = 0.7; p = 0.015). The PAF distance to the optic nerve head was lower in controls (0.12 +/- 0.08 mm) than in eyes with POAG, PSXG, or NTG (0.25 +/- 0.21 mm, Bonferroni: p < 0,004). The PAF area correlated significantly with the stage of GONHA (stage 1: 0.23 +/- 0.23 mm (2), stage 2: 0.24 +/- 0.19 mm (2), stages 3 and 4: 0.34 +/- 0.73 mm (2), p < 0.01). No significant difference of PAF area was found between the glaucoma types. However, the distance between PAF and optic nerve head was higher in POAG (0.28 +/- 0.26 mm) than in NTG (0.24 +/- 0.07 mm) or in PSXG (0.18 +/- 0.07 mm, Bonferroni: p < 0.03). A pronounced fundus autofluorescence was detected as a sign of increased lipofuscin accumulation in the parapapillary atrophic zone of eyes with POAG, PSXG, and NTG in contrast to controls. The PAF analysis may provide an indicator for glaucomas in the future.

Evaluation of web-based annotation of ophthalmic images for multicentric clinical trials

An Internet browser-based annotation system can be used to identify and describe features in digitalized retinal images, in multicentric clinical trials, in real time. In this web-based annotation system, the user employs a mouse to draw and create annotations on a transparent layer, that encapsulates the observations and interpretations of a specific image. Multiple annotation layers may be overlaid on a single image. These layers may correspond to annotations by different users on the same image or annotations of a temporal sequence of images of a disease process, over a period of time. In addition, geometrical properties of annotated figures may be computed and measured. The annotations are stored in a central repository database on a server, which can be retrieved by multiple users in real time. This system facilitates objective evaluation of digital images and comparison of double-blind readings of digital photographs, with an identifiable audit trail. Annotation of ophthalmic images allowed clinically feasible and useful interpretation to track properties of an area of fundus pathology. This provided an objective method to monitor properties of pathologies over time, an essential component of multicentric clinical trials. The annotation system also allowed users to view stereoscopic images that are stereo pairs. This web-based annotation system is useful and valuable in monitoring patient care, in multicentric clinical trials, telemedicine, teaching and routine clinical settings.

Fundus-Quiz 2004

Six cases with characteristic fundus pathologies are presented and discussed using multiple choice questions.

The incidence of irreversible retinal toxicity in patients treated with hydroxychloroquine: A reappraisal

Purpose To define the risk of hydroxychloroquine (HCQ)-related retinal toxicity in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) who are receiving recommended dosages of the drug (≤6.5 mg/kg/day). Design Prospective cohort study, from 1985 to 2000. Participants Greek patients with RA (n = 335) and SLE (n = 191) treated with HCQ, 400 of whom had completed at least 6 years of treatment. Methods Ophthalmologic evaluation was performed every 6 months from 1985 to 1995, and yearly thereafter. This consisted of best-corrected visual acuity, color vision testing, static central visual field testing, fundoscopy, electroretinography, and fluorescein angiography, when indicated. Main outcome measures Fundus lesions attributed to HCQ. Results No HCQ retinal toxicity was noted in any of the 526 patients during the first 6 years of treatment. Two (3.4%) of the first 58 long-term (>6 years) treated patients developed HCQ-related maculopathy at 8 and 6.5 years of treatment, despite regular ophthalmologic evaluation. On follow-up 7 and 9 years after cessation of HCQ treatment, both patients had stable eye disease. No HCQ retinal toxicity was observed in the subsequent 342 patients who were treated for >6 years. Overall, the incidence of HCQ-related retinopathy in 400 patients who were treated with recommended dosages of the drug for a mean of 8.7 years was reduced to 0.5%. Conclusions After a baseline ophthalmic examination to confirm the absence of preexisting fundus pathology, patients with normal renal function may receive HCQ at a maximal daily dosage of 6.5 mg/kg and continue safely for 6 years. However, annual screening is recommended in patients who have taken the drug, even in recommended doses, for >6 years.

Efficacy of a capsular tension ring for phacoemulsification in eyes with zonular dialysis

Purpose To determine the safety and efficacy of capsular tension ring (CTR) insertion in eyes with zonular dialysis of less than 150 degrees having phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation. Setting Dr. Agarwal’s Eye Hospital, Chennai, India. Methods This prospective study comprised 21 eyes of 19 patients with zonular dialysis of less than approximately 150 degrees determined preoperatively or intraoperatively. After insertion of a CTR, phacoemulsification with PC IOL implantation was performed. The mean follow-up was 242.33 days. Results Capsule collapse did not occur in any eye with a CTR. Intraoperative extension of the dialysis occurred in 2 eyes (9.52%). The IOL was placed in the bag in all the eyes except 1 that had traumatic cataract and received a scleral-fixated IOL during a subsequent surgery. Postoperatively, there was minimal corneal edema in 2 eyes (9.52%) and mild iritis in 5 eyes (23.80%). Three eyes (14.28%) developed raised intraocular pressure that responded well to medical therapy. The symptoms resolved in the 3 patients with preoperative diplopia. Fifteen eyes (71.42%) had a final visual acuity of 6/12 or better. Six eyes had a final best corrected visual acuity of worse than 6/12 because of coexisting fundus pathology. A dilated pupil examination at 6 months showed a well-centered IOL in all eyes. Conclusions Phacoemulsification with in-the-bag PC IOL and CTR implantation in eyes with zonular dialysis of up to approximately 150 degrees had a success rate of 90.47%. Visual recovery was not as good as in normal eyes because of the problems associated with zonular dialysis.

Uveal effusion and ultrasonic imaging: a clinical series

To establish the diagnostic role of imaging by ultrasound for the diagnosis of uveal effusion syndrome. Using ultrasonic imaging features as the main criteria for evaluation, the recorded data from 16 patients with presumed uveal effusion seen between 1994 and 2000 were reviewed and analysed for clinical manifestations and current diagnostic suggestions. Eventually, as cumulating experience suggested that ultrasound is capable of indicating uveal effusion, the study set-up became in part more prospective. The two main ultrasonic features found were: (1) extended multi-layered detachment patterns by B-scan, often kinetically mobile; (2) a spongy oedematous ciliary body region, often with interstitial lacunae, as demonstrated by high-resolution ultrasound biomicroscopy (50 Mhz). In patients with visual loss and ambiguous detachment-like fundus pathology, ultrasonic features are often of practical guidance for diagnosing uveal effusion syndrome.

Relation Between Retinal Thickening and Clinically Visible Fundus Pathologies in Mild Nonproliferative Diabetic Retinopathy

To determine the association of retinal thickening (RT) with clinically observable retinal pathologies in eyes with mild nonproliferative diabetic retinopathy. Using an objective quantitative imaging method (Retinal Thickness Analyzer), the ratio relative to normal RT (RTI) was measured in 23 eyes with and 35 eyes without clinically observable diabetic fundus pathology. RTI was analyzed in relation to presence of mild diabetic retinal lesions in the +/-0.5 mm vicinity. The percent of eyes with RTI significantly above normal values did not differ significantly between eyes with and without retinopathy (30% vs 34%). Mean RTI was not associated with local presence of microaneurysms (P=0.92), soft exudates (P=0.55), or retinal hemorrhages (P=0.31). Areas without hard exudates had significantly greater mean RTI (1.10) than areas with exudates (0.97, P=0.009). In diabetic patients with mild retinopathy, areas with and without clinically observable retinal pathologies had similar retinal thickness. We conclude that clinical strategies for detection of retinal thickening should not be limited to areas with visible fundus pathologies.