Ganglion Cell-inner Plexiform Layer Thickness Research Articles

Effects of Cataract on Optic Nerve Head and Macular Analysis Using Optical Coherence Tomography

Purpose: To assess the impact of cataract on optic nerve head (ONH) parameters (disc area, rim area, average cup/disc ratio, vertical cup/disc ratio, cup volume), peripapillary retinal nerve fiber layer (pRNFL) thickness, and macular ganglion cell-inner plexiform layer (mGC-IPL) thickness in patients with glaucoma and in a control group.Methods: A retrospective analysis was conducted on medical records from January to December 2021 for individuals undergoing cataract surgery. This group included normal, glaucoma suspects, and glaucoma patients, totaling 44 individuals and 63 eyes. Measurements of ONH parameters, pRNFL thickness, and mGC-IPL thickness were taken using spectral-domain optical coherence tomography before and after surgery. We analyzed postoperative changes in these parameters and related factors to preoperative segmentation errors.Results: In glaucoma patients, a significant increase in the average thickness of the pRNFL (p = 0.002) was observed after surgery, while no significant changes were seen in ONH parameters and the average thickness of the mGC-IPL (all p > 0.05). Conversely, the control group showed an increase in some areas of mGC-IPL thickness after surgery (p < 0.05). Multivariate regression analysis indicated that in glaucoma patients, thinner preoperative pRNFL and mGC-IPL thickness were predictors of increased average thickness after surgery (p < 0.001 and p = 0.008, respectively).Conclusions: Cataract significantly impacts the pRNFL and mGC-IPL thickness in glaucoma patients, with less effect on ONH parameters. These findings suggest that ONH parameters can be more reliable for monitoring patients undergoing cataract surgery and assessing glaucoma progression simultaneously.

Prediction of the Cause of Glaucoma Disease Identified by Glaucoma Optical Coherence Tomography Test in Relation to Diabetes and Hypertension at a National Hospital in Seoul: A Retrospective Study.

Glaucoma remains the primary cause of long-term blindness. While diabetes mellitus (DM) and hypertension (HTN) are known to influence glaucoma, other factors such as age and sex may be involved. In this retrospective study, we aimed to investigate the associations between age, sex, DM, HTN, and glaucoma risk. We employed optical coherence tomography (OCT) conducted using a 200 × 200-pixel optic cube (Cirrus HD OCT 6000, version 10.0; Carl Zeiss Meditec, Dublin, CA, USA). Effects obscured by low-test signals were disregarded. Data were amassed from 1337 patients. Among them, 218 and 402 patients had DM and HTN, respectively, with 133 (10%) exhibiting both. A sex-based comparison revealed slightly greater retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness in females. Patients without DM and HTN were predominantly in their 50 s and 60 s, whereas DM and HTN were most prevalent in those in their 60 s and 70 s. Both RNFL and GCIPL thicknesses decreased with advancing age in most patients. The study revealed that older individuals were more prone to glaucoma than younger individuals, with a higher incidence among patients with DM and HTN and reduced RNFL and GCIPL thicknesses. Furthermore, early detection before advancing age could furnish valuable preventive insights.

Assessing Glaucoma Severity and Progression in Individuals with Asymmetric Axial Length: An Intrapatient Comparative Study

PurposeTo investigate whether there is a difference in inter-eye glaucoma severity and progression in patients with asymmetric axial length DesignLong-term observational study ParticipantsPatients over 20 years of age who had been diagnosed with glaucoma at Seoul National University Hospital, Seoul, Korea, between 2010 and 2020. MethodsPatients diagnosed with glaucoma in both eyes with an axial length difference of more than 1.0 mm were included. Each individual’s eyes were classified into “longer eye” and “shorter eye,” and the baseline and follow-up clinical data were analyzed using the paired test. Main Outcome MeasuresDifferences in clinical characteristics in patients with asymmetric axial length ResultsA total of 190 eyes of 95 glaucoma patients with asymmetric axial length were included in the study. The patients’ mean age was 51.2 ± 12.3 years, and the mean follow-up period was 10.1 ± 3.9 years. There was no difference in the baseline intraocular pressure (IOP) or central corneal thickness (CCT) between longer eyes and shorter eyes. Among the baseline disc parameters, ovality index, beta-zone and gamma-zone parapapillary atrophy (PPA) area were larger in the longer eyes. In the baseline OCT data, the retinal nerve fiber layer (RNFL) thickness and ganglion cell-inner plexiform layer (GCIPL) thickness were thinner in the longer eyes. According to a baseline visual field (VF) test, the mean deviation (MD) and visual field index (VFI) values were significantly lower in the longer eyes. Based on an analysis of glaucoma progression, the rate of change of superior GCIPL (longer eyes : -0.65 μm/yr, shorter eyes : -0.40 μm/yr) , MD (longer eyes : -0.40 dB/yr, shorter eyes : -0.21 dB/yr) , and VFI (longer eyes : -0.92 %/yr, shorter eyes : -0.46 %/yr) were larger in the longer eyes. The greater the difference between the mean IOP and beta-zone PPA area between inter-eyes, the greater the difference in the rate of change of RNFL and GCIPL. Additionally, the greater the difference in IOP fluctuation, the greater the difference in the rate of change between MD and VFI. ConclusionsWhen there was an axial length difference of more than 1.0 mm, glaucoma tended to be more severe and to progress faster in the longer eyes. The inter-eye difference in glaucoma progression rate is related to both mean IOP and IOP fluctuation.

Two Cases of Ischemic Optic Neuropathy after Extracorporeal Membrane Oxygenation (ECMO)

Purpose: We report two cases of non-arteritic ischemic optic neuropathy (NAION) following extracorporeal membrane oxygenation (ECMO) treatment.Case summary: (Case 1) A 36-year-old man underwent ECMO treatment. Upon regaining consciousness, he complained of a darkened peripheral visual field and was subsequently referred to an ophthalmologist. His best-corrected visual acuity was 0.9 in the right eye and 0.8 in the left eye. The intraocular pressure measured 12 mmHg in the right eye and 10 mmHg in the left eye; color vision was normal. A visual field test demonstrated concentric visual field defects in both eyes, and a fundus examination revealed a pale optic disc. Optical coherence tomography (OCT) indicated a decrease in retinal nerve fiber layer (RNFL) thickness. (Case 2) A 48-year-old woman underwent ECMO treatment. After regaining consciousness, she reported decreased vision in her right eye. Her best-corrected visual acuity was limited to hand motion in the right eye and was 1.2 in the left eye. A relative afferent pupillary defect in the right eye was observed. Color vision in the right eye was compromised, and a fundus examination revealed a pale optic disc. A visual field test demonstrated total visual field defect in the right eye, while OCT showed decreases in both the RNFL thickness and the ganglion cell-inner plexiform layer thickness of the right eye. Magnetic resonance imaging (MRI) revealed high signal intensity and abnormal enhancement in the right retrobulbar optic nerve.Conclusions: In cases where vision loss and visual field defects are observed following ECMO treatment, differential diagnoses for ischemic optic neuropathy are warranted.

COVID-19 and retinal layer thickness: A bidirectional Mendelian randomization study

BackgroundObservational studies have reported that COVID-19 is associated with alterations in retinal layer thickness, including changes in the ganglion cell inner plexiform layer (GCIPL) and retinal nerve fiber layer (RNFL). However, the causal relationships remain unknown. Therefore, we assessed the direction and strength of the causal relationship between COVID-19 and GCIPL and RNFL thicknesses using a bidirectional two-sample Mendelian randomization (MR) design. MethodsData were obtained from a large-scale COVID-19 Host Genetics Initiative (Nsample = 6,512,887), GCIPL dataset (Ncase = 31,434), and RNFL dataset (Ncase = 31,434). The inverse-variance weighted (IVW) method is the primary approach used to estimate causal effects. MR Egger, weighted median, weighted mode, MR Egger (bootstrap), and penalized weighted median methods were applied. Sensitivity analyses were implemented with RadialMR, MRPRESSO, MR-Egger regression, Cochran's Q statistic, leave-one-out analysis, and the funnel plot. ResultsForward MR analysis revealed that genetically identified COVID-19 susceptibility significantly increased the risk of GCIPL thickness (OR = 2.428, 95 % confidence interval [CI]:1.493–3.947, PIVW = 3.579 × 10−4) and RNFL thickness (OR = 1.735, 95 % CI:1.198–2.513, PIVW = 3.580 × 10−3) after Bonferroni correction. Reverse MR analysis did not indicate a significant causal association between GCIPL and RNFL thicknesses and COVID-19 phenotypes. No significant horizontal pleiotropy was found in the sensitivity analysis. ConclusionsThe host genetic liability to COVID-19 susceptibility was causally associated with increased GCIPL and RNFL thicknesses. Documenting this association increases our understanding of the pathophysiological mechanisms underlying COVID -19 susceptibility in retinopathy.

Changes in Retinal Ganglion Cell (RGC) and Retinal Nerve Fiber Layer (RNFL) Thickness in Children with Type 1 Diabetes Mellitus at Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Type 1 diabetes mellitus (DM) is a chronic metabolic disorder that causes hyperglycemia and increases the risk of morbidity and mortality. Diabetic retinopathy, a microvascular complication that often occurs in DM patients, can cause visual impairment and even blindness. Regular eye examinations are important for early detection of diabetic retinopathy. Optical coherence tomography (OCT) is a non-invasive method that can be used to measure the thickness of retinal layers, including RGC and RNFL. It is thought that thinning of the retinal layer can be a sensitive biomarker in detecting diabetic retinopathy in type 1 DM patients. This study aims to determine changes in RGC and RNFL thickness in children with type 1 DM. Methods: This cross-sectional design analytical observational study was conducted at the eye polyclinic of Dr. M. Djamil General Hospital Padang in November 2023-March 2024. A total of 46 eyes from 46 people, divided into two groups: the type 1 DM group and the control group, were recruited in this study. RGC thickness was measured using AS-OCT GC-IPL thickness analysis and RNFL with optic disc RNFL thickness analysis. Data analysis was carried out using the unpaired T-test. Results: The results showed RGC depletion in the type 1 DM group (RGC 83.48 ± 3.75) compared to the control group (RGC 86.70 ± 4.87) with a value of p = 0.016 (p < 0.05). There was no statistical difference in RNFL thickness between the type 1 DM group (RNFL 102 ± 11.80) and the control group (RNFL 100.96 ± 10.97) with a value of p = 0.581 (p> 0.05). Conclusion: This study found RGC thinning in type 1 DM patients, but did not find differences in RNFL thickness between the two groups. This RGC depletion is thought to be caused by apoptosis of retinal neuronal cells due to chronic hyperglycemia. Examination of RGC thickness with OCT can be developed as an early detection of diabetic retinopathy in children with type 1 DM.

Diagnostic ability of macular nerve fiber layer thickness measured by swept-source optical coherence tomography in preperimetric glaucoma.

We evaluated the diagnostic ability of macula retinal nerve fiber layer (mRNFL) thickness in preperimetric glaucoma (PPG) patients. This prospective study included 83 patients with PPG and 83 age- and refractive error-matched normal control subjects. PPG was defined as a localized RNFL defect corresponding to glaucomatous optic disc changes with a normal visual field test. We used spectral-domain (SD) optical coherence tomography (OCT) to measure the circumpapillary RNFL (cpRNFL) thickness and macular ganglion cell-inner plexiform layer (GCIPL) thickness. Swept-source (SS) OCT was used to measure cpRNFL thickness, macular ganglion cell layer + inner plexiform layer (IPL) thickness (GCL+), and macular ganglion cell layer + IPL+ mRNFL thickness (GCL++). The mRNFL thickness was defined as GCL++ minus GCL+. To evaluate the diagnostic power of each parameter, the area under the receiver operating characteristics curve (AUROC) was analyzed to differentiate PPG from the normal groups. Using SD-OCT, all GCIPL parameters and most cpRNFL parameters, except at the nasal and temporal quadrant, were significantly lower in PPG versus normal controls. PPG eyes had significantly smaller values than normal controls for all cpRNFL and GCL parameters measured by SS-OCT, except mRNFL at the superonasal area. The inferotemporal GCL++ had the largest AUROC value (0.904), followed by inferotemporal GCL+ (0.882), inferotemporal GCIPL thickness (0.871), inferior GCL++ (0.866), inferior cpRNFL thickness by SS-OCT (0.846), inferior cpRNFL thickness by SD-OCT (0.841), and inferotemporal mRNFL thickness (0.840). The diagnostic performance was comparable between inferotemporal mRNFL thickness and the best measures of GCL (inferotemporal GCL++, p = 0.098) and cpRNFL (inferior cpRNFL thickness by SS-OCT, p = 0.546). The diagnostic ability of mRNFL thickness was comparable to that of the best measures of cpRNFL and GCL analysis for eyes with PPG. Therefore, mRNFL thickness could be a new parameter to detect early structural changes in PPG.

Values of macular ganglion cell-inner plexiform layer and 10-2 visual field measurements in detecting and evaluating glaucoma.

To assess the performance of macular ganglion cell-inner plexiform layer thickness (mGCIPLT) and 10-2 visual field (VF) parameters in detecting early glaucoma and evaluating the severity of advanced glaucoma. Totally 127 eyes from 89 participants (36 eyes of 19 healthy participants, 45 eyes of 31 early glaucoma patients and 46 eyes of 39 advanced glaucoma patients) were included. The relationships between the optical coherence tomography (OCT)-derived parameters and VF sensitivity were determined. Patients with early glaucoma were divided into eyes with or without central 10° of the VF damages (CVFDs), and the diagnostic performances of OCT-derived parameters were assessed. In early glaucoma, the mGCIPLT was significantly correlated with 10-2 VF pattern standard deviation (PSD; with average mGCIPLT: β=-0.046, 95%CI, -0.067 to -0.024, P<0.001). In advanced glaucoma, the mGCIPLT was related to the 24-2 VF mean deviation (MD; with average mGCIPLT: β=0.397, 95%CI, 0.199 to 0.595, P<0.001), 10-2 VF MD (with average mGCIPLT: β=0.762, 95%CI, 0.485 to 1.038, P<0.001) and 24-2 VF PSD (with average mGCIPLT: β=0.244, 95%CI, 0.124 to 0.364, P<0.001). Except for the minimum and superotemporal mGCIPLT, the decrease of mGCIPLT in early glaucomatous eyes with CVFDs was more severe than that of early glaucomatous eyes without CVFDs. The area under the curve (AUC) of the average mGCIPLT (AUC=0.949, 95%CI, 0.868 to 0.982) was greater than that of the average circumpapillary retinal nerve fiber layer thickness (cpRNFLT; AUC=0.827, 95%CI, 0.674 to 0.918) and rim area (AUC=0.799, 95%CI, 0.610 to 0.907) in early glaucomatous eyes with CVFDs versus normal eyes. The 10-2 VF and mGCIPLT parameters are complementary to 24-2 VF, cpRNFLT and ONH parameters, especially in detecting early glaucoma with CVFDs and evaluating the severity of advanced glaucoma in group level.

Diagnostic Accuracy of Optic Nerve Head and Macula OCT Parameters for Detecting Glaucoma in Eyes With and Without High Axial Myopia

PurposeTo characterize structural differences and assess the diagnostic accuracy of optic nerve head (ONH) and macula optical coherence tomography (OCT) parameters to detect glaucoma in eyes with and without high axial myopia. DesignCross-sectional study Methods368 glaucoma and 411 healthy eyes with no axial myopia, 393 glaucoma and 271 healthy eyes with mild axial myopia and 124 glaucoma and 85 healthy eyes with high axial myopia were included. Global and sectoral peripapillary retinal nerve fiber layer thickness (pRNFLT), Bruch's membrane opening minimum rim width (BMO-MRW), ganglion cell inner plexiform layer thickness (GCIPLT), and macula RNFLT (mRNFLT) were compared and the diagnostic accuracy for glaucoma detection was evaluated using adjusted area under the receiver operating characteristic curve (AUC). ResultsDiagnostic accuracy for ONH and macula parameters to detect glaucoma was generally high and differed by myopia group. For ONH parameters the diagnostic accuracy was highest for global (AUC=0.95) and inferotemporal (AUC=0.91) pRNFLT for high myopes and global BMO-MRW for non-myopes (AUC=1.0) and mild myopes (AUC=0.97). For macula parameters, the diagnostic accuracy was higher in high myopes with 6 of the 11 GCIPLT global/sectors having adjusted AUCs > 0.90 compared to non-high myopes with no AUCs > 0.90. In all myopia groups, mRNFLT had lower AUCs than GCIPLT. ConclusionsThe diagnostic accuracy for pRNFL and GCIPL was high for high axial myopic eyes and shows promise for glaucoma detection in high myopes. Further analysis is needed to determine whether the high diagnostic accuracy can be confirmed in other populations.

Hybrid deep learning and optimal graph search method for optical coherence tomography layer segmentation in diseases affecting the optic nerve.

Accurate segmentation of retinal layers in optical coherence tomography (OCT) images is critical for assessing diseases that affect the optic nerve, but existing automated algorithms often fail when pathology causes irregular layer topology, such as extreme thinning of the ganglion cell-inner plexiform layer (GCIPL). Deep LOGISMOS, a hybrid approach that combines the strengths of deep learning and 3D graph search to overcome their limitations, was developed to improve the accuracy, robustness and generalizability of retinal layer segmentation. The method was trained on 124 OCT volumes from both eyes of 31 non-arteritic anterior ischemic optic neuropathy (NAION) patients and tested on three cross-sectional datasets with available reference tracings: Test-NAION (40 volumes from both eyes of 20 NAION subjects), Test-G (29 volumes from 29 glaucoma subjects/eyes), and Test-JHU (35 volumes from 21 multiple sclerosis and 14 control subjects/eyes) and one longitudinal dataset without reference tracings: Test-G-L (155 volumes from 15 glaucoma patients/eyes). In the three test datasets with reference tracings (Test-NAION, Test-G, and Test-JHU), Deep LOGISMOS achieved very high Dice similarity coefficients (%) on GCIPL: 89.97±3.59, 90.63±2.56, and 94.06±1.76, respectively. In the same context, Deep LOGISMOS outperformed the Iowa reference algorithms by improving the Dice score by 17.5, 5.4, and 7.5, and also surpassed the deep learning framework nnU-Net with improvements of 4.4, 3.7, and 1.0. For the 15 severe glaucoma eyes with marked GCIPL thinning (Test-G-L), it demonstrated reliable regional GCIPL thickness measurement over five years. The proposed Deep LOGISMOS approach has potential to enhance precise quantification of retinal structures, aiding diagnosis and treatment management of optic nerve diseases.

The Association of Urinary Sodium Excretion with Glaucoma and Related Traits in a Large United Kingdom Population

Excessive dietary sodium intake has known adverse effects on intravascular fluid volume and systemic blood pressure, which may influence intraocular pressure (IOP) and glaucoma risk. This study aimed to assess the association of urinary sodium excretion, a biomarker of dietary intake, with glaucoma and related traits, and determine whether this relationship is modified by genetic susceptibility to disease. Cross-sectional observational and gene-environment interaction analyses in the population-based UK Biobank study. Up to 103 634 individuals (mean age: 57 years; 51% women) with complete urinary, ocular, and covariable data. Urine sodium:creatinine ratio (UNa:Cr; mmol:mmol) was calculated from a midstream urine sample. Ocular parameters were measured as part of a comprehensive eye examination, and glaucoma case ascertainment was through a combination of self-report and linked national hospital records. Genetic susceptibility to glaucoma was calculated based on a glaucoma polygenic risk score comprising 2673 common genetic variants. Multivariable linear and logistic regression, adjusted for key sociodemographic, medical, anthropometric, and lifestyle factors, were used to model associations and gene-environment interactions. Corneal-compensated IOP, OCT derived macular retinal nerve fiber layer and ganglion cell-inner plexiform layer (GCIPL) thickness, and prevalent glaucoma. In maximally adjusted regression models, a 1 standard deviation increase in UNa:Cr was associated with higher IOP (0.14 mmHg; 95% confidence interval [CI], 0.12-0.17; P<0.001) and greater prevalence of glaucoma (odds ratio, 1.11; 95% CI, 1.07-1.14; P<0.001) but not macular retinal nerve fiber layer or ganglion cell-inner plexiform layer thickness. Compared with those with UNa:Cr in the lowest quintile, those in the highest quintile had significantly higher IOP (0.45 mmHg; 95% CI, 0.36-0.53, P<0.001) and prevalence of glaucoma (odds ratio, 1.30; 95% CI, 1.17-1.45; P<0.001). Stronger associations with glaucoma (P interaction=0.001) were noted in participants with a higher glaucoma polygenic risk score. Urinary sodium excretion, a biomarker of dietary intake, may represent an important modifiable risk factor for glaucoma, especially in individuals at high underlying genetic risk. These findings warrant further investigation because they may have important clinical and public health implications. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Analysis of retinal and choroidal microvascular changes using optical coherence tomography and optical coherence tomography angiography in patients with acute leukemia.

Although leukemic retinopathy accounts for 80% of ocular complications in acute leukemia, its pathogenesis remains unclear. To evaluate changes in retinal and choroicapillaris and structural parameters in patients with acute leukemia, we analyzed the correlation between vascular perfusion metrics and laboratory parameters and assessed the changes after hematopoietic stem cell transplantation (HSCT). Herein, 104 eyes of 52 patients aged 18 and above with acute leukemia were enrolled. 80 eyes of 40 healthy patients were recruited as control participants. All participants underwent optical coherence tomography (OCT) and OCT angiography (OCTA) at baseline. Patients with acute leukemia had a significantly thicker ganglion cell-inner plexiform layer (GCIPL) and lower circularity index than the control participants. Post-HSCT perfusion metrics did not differ significantly, but parafoveal thickness decreased significantly. During the active phase of acute leukemia, lower platelet levels were associated with significant GCIPL thickening and increased foveal avascular zone and perimeter. D-dimer levels positively correlated with GCIPL thickness. Patients with acute leukemia had subclinical retinal microvascular deficits on OCTA and GCIPL thickening on OCT, possibly associated with bone marrow function. GCIPL thickness may indicate acute ischemia in such patients. Further studies must elucidate their clinical and prognostic significance.

Trans-Synaptic Degeneration in the Visual Pathway in Patients With Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease.

We aimed to assess the presence of retinal neurodegeneration independent of optic neuritis (ON) in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and to investigate the development of trans-synaptic anterograde degeneration in these patients after ON. Cross-sectional, retrospective study of 34 adult patients with MOGAD and 23 healthy controls (HC). Clinical, optical coherence tomography (OCT), and MRI data were collected. Peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell inner plexiform layer (GCIPL) were obtained using Heidelberg Spectralis. FreeSurfer7 was used to obtain the lateral geniculate nucleus (LGN), occipital volume fractions (to total estimated intracranial volume), and occipital cortical thickness. For the anterior visual pathway, the analysis was conducted using eyes, classified based on the history of ON (Eye-ON and Eye-NON) and compared with Eye-HC. The analysis of OCT and brain volumetric measures was conducted comparing MOGAD-ON, MOGAD-NON, and HC groups. The analysis of covariance with a Bonferroni-adjusted post hoc test was used to test differences between groups and linear regression analysis to evaluate OCT/MRI associations; age and sex were considered as covariates. 24 (70.5%) patients had a prior ON. Median pRNFL and GCIPL thickness (um) was significantly reduced in Eye-ON vs EyeNON and HC (pRNFL: 69.4 (17.3), 89.6 (13.7), 98.2 (11.7), p < 0.001; GCIPL: 55.8 (8.7), 67.39 (8.7), 72.6 (4.5), p < 0.001). pRNFL and GCIPL thickness had a negative correlation with the number of ON episodes (p = 0.025 and p = 0.031, respectively). LGN volume fraction was significantly lower in patients with MOGAD-ON than in HC (0.33 (0.05) vs 0.39 (0.04), p = 0.002). The occipital cortical thickness was lower in MOGAD-ON compared with MOGAD-NON and HC (p = 0.010). In patients with MOGAD-ON, pRNFL correlated with LGN volume (p = 0.006), occipital thickness (p = 0.002), and the medial occipital cortex (p = 0.002), but not the lateral occipital lobe. Compared with HC, MOGAD-ON exhibits reduced retinal thickness, primarily influenced by the presence and the number of prior ON episodes. Moreover, MOGAD-ON demonstrates significant atrophy in the retinal, subcortical, and cortical regions of the visual pathway, distinguishing them from MOGAD-NON and HC. These findings suggest that in patients with MOGAD neurodegeneration is tightly correlated with damage to the involved pathway.

Risk factors of internal carotid artery stenosis in patients with proliferative diabetic retinopathy: an analysis using optical coherence tomography and optical coherence tomography angiography

BackgroundThis research investigates the correlation between the severity of internal carotid artery (ICA) stenosis and retinal parameters in patients with proliferative diabetic retinopathy (PDR), aiming to uncover potential risk factors.MethodsA retrospective analysis of 68 patients (136 eyes) diagnosed with bilateral PDR from January 1, 2017, to December 31, 2021, was conducted. Carotid artery stenosis (CAS) was assessed using neck computed tomography angiography (CTA) and carotid duplex ultrasound (CDUS), with stenosis classified into two groups: normal (group 1) and mild or above (group 2), based on the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Optical coherence tomography (OCT) and OCT angiography (OCTA) measured several retinal parameters, including sub foveal choroidal thickness (SFCT), retinal nerve fiber layer (RNFL) thickness, ganglion cell-inner plexiform layer (GCIPL) thickness, vessel density (VD), and foveal avascular zone (FAZ) area. Statistical analyses determined correlations between ICA degrees and retinal parameters.ResultsThis study showed significant differences between groups in total VD, FAZ area, total RNFL thickness, and temporal RNFL thickness, indicating that patients with more severe ICA stenosis had noticeable retinal changes. Other parameters such as hyperlipidemia, total cholesterol levels, and intraocular pressure (IOP) also differed significantly, while no notable differences were observed in SFCT, central VD, average GCIPL, and superior, nasal, and inferior RNFL thickness.ConclusionThe study findings highlight retinal changes, such as an increased FAZ area, decreased total VD, and a total and thinner temporal RNFL, which suggest the need for carotid artery evaluation in patients. These findings have important clinical implications for the need for carotid work up in patients with PDR.

Degradation of Photopic and Mesopic Contrast Sensitivity Function in High Myopes With Partial Posterior Vitreous Detachment.

The purpose of this study was to evaluate the effects of posterior vitreous detachment (PVD) on visual quality in patients with high myopia, as well as investigate the associated factors of photopic and mesopic contrast sensitivity function (CSF) in high myopia. Visual quality was comprehensively assessed in patients with high myopia. Visual acuity, contrast sensitivity (CS) at four spatial frequencies (3, 6, 12, and 18 cycles per degree [c.p.d.]) under photopic and mesopic conditions, as well as the modulation transfer function cutoff value (MTFcutoff), the objective scatter index (OSI), the Strehl ratio (SR), and internal aberrations, were measured in this cross-sectional study. This study included 94 eyes from 47 subjects with bilateral high myopia, including 23 eyes with complete PVD (cPVD), 21 eyes with partial PVD (pPVD), and 50 eyes without PVD (nPVD). There was no significant difference in visual quality between the cPVD group and the nPVD group. Whereas in eyes with pPVD, there was a degradation of overall photopic CSF (versus nPVD, P = 0.048), photopic CS at 3 c.p.d. (versus cPVD, P = 0.009 and versus nPVD, P = 0.032), photopic CS at 18 c.p.d. (versus nPVD, P = 0.033), overall mesopic CSF (versus nPVD, P = 0.033), and secondary astigmatism (versus cPVD, P = 0.044). Under photopic conditions, the factors affecting CSF were pPVD and SR, whereas the factors affecting mesopic CSF were pPVD, OSI, and ganglion cell-inner plexiform layer thickness. The pPVD impaired visual quality in patients with high myopia compared to nPVD or cPVD, and pPVD could be a factor explaining CSF at both photopic and mesopic illumination. Clinicians need to closely monitor patients with high myopia with pPVD due to the potential decline in visual quality and the development of vitreoretinal disorders.

Optical coherence tomography angiography value for detection of early retinal microvascular changes in systemic hypertension

Purpose The aim of this study was to assess the macula and optic disc vessel density (VD) and perfusion and the anatomical alterations at the fovea and optic nerve in chronic treated hypertension (HTN) patients who exhibited no signs of hypertensive retinopathy using optical coherence tomography angiography (OCTA). Patients and methods This is a prospective case–control study that included 37 participants. They were subdivided into two groups: the hypertensive group that included 22 patients (mean age=51.9±5.9 years), with no clinically evident signs of hypertensive retinopathy, and the control group that included 15 individuals (mean age=48.8±3.7 years) with no known history of HTN or other chronic systemic diseases. OCTA scans covering a 6.0×6.0 mm area for the macula and a 4.5×4.5 mm region for the optic nerve head were performed to evaluate the VD, the foveal avascular zone area, macular thickness, and retinal nerve fiber layer (RNFL) thickness. The correlation of the VD measurements with the RNFL thickness was evaluated. Results The hypertensive patients exhibited a significantly lower overall mean macular VD (45.8±6.0) compared to the control group (48.5±2.9, P=0.017). In addition, they exhibited a significantly lower superficial VD in the superior hemifield (46.4±5.3 and 48.6±2.9, respectively, P=0.030). On the other hand, the deep vascular density in the superior hemifield showed no significant difference between the two groups. In addition, the hypertensive patients were found to have a significantly lower average RNFL thickness (103.2±17.8 μm) compared to the control group (117.1±14.1 μm, P=0.001), with specific statistically significant reductions in the superior (P=0.002) and inferior (P=0.004) sectors. Although the central ganglion cell-inner plexiform layer thickness did not reach statistically significant difference between the two groups (HTN: 50.7±12.0 μm vs. control: 55.7±8.8 μm, P=0.055), the hypertensive group exhibited statistically significant reductions in the ganglion cell-inner plexiform layer thickness in the superior (P&lt;0.001), inferior (P=0.002), nasal (P=0.003), and temporal (P=0.001) sectors compared to the controls. There was no statistically significant difference in the size of the foveal avascular zone between the two groups. Conclusion OCTA revealed subclinical alterations in the retinal microvasculature parameters among the hypertensive patients without clinical signs of hypertensive retinopathy, in comparison to normotensive individuals.

Retinal Vascular Changes in Heart Failure with Preserved Ejection Fraction Using Optical Coherence Tomography Angiography.

Background: Systemic microvascular regression and dysfunction are considered important underlying mechanisms in heart failure with preserved ejection fraction (HFpEF), but retinal changes are unknown. Methods: This prospective study aimed to investigate whether retinal microvascular and structural parameters assessed using optical coherence tomography angiography (OCT-A) differ between patients with HFpEF and control individuals (i.e., capillary vessel density, thickness of retina layers). We also aimed to assess the associations of retinal parameters with clinical and echocardiographic parameters in HFpEF. HFpEF patients, but not controls, underwent echocardiography. Macula-centered 6 × 6 mm volume scans were computed of both eyes. Results: Twenty-two HFpEF patients and 24 controls without known HFpEF were evaluated, with an age of 74 [68-80] vs. 68 [58-77] years (p = 0.027), and 73% vs. 42% females (p = 0.034), respectively. HFpEF patients showed vascular degeneration compared to controls, depicted by lower macular vessel density (p < 0.001) and macular ganglion cell-inner plexiform layer thickness (p = 0.025), and a trend towards lower total retinal volume (p = 0.050) on OCT-A. In HFpEF, a lower total retinal volume was associated with markers of diastolic dysfunction (septal e', septal and average E/e': R2 = 0.38, 0.36, 0.25, respectively; all p < 0.05), even after adjustment for age, sex, diabetes mellitus, or atrial fibrillation. Conclusions: Patients with HFpEF showed clear levels of retinal vascular changes compared to control individuals, and retinal alterations appeared to be associated with markers of more severe diastolic dysfunction in HFpEF. OCT-A may therefore be a promising technique for monitoring systemic microvascular regression and cardiac diastolic dysfunction.

One year monitoring of retinal morphologic and functional changes in traumatic optic neuropathy patients

BackgroundTo analyze the morphologic and functional change in traumatic optic neuropathy (TON) divided by the mechanism of optic nerve injury.MethodsA retrospective analysis of 58 patients who were diagnosed as monocular TON from February 2015 to August 2021 was conducted at in CHA Bundang Medical Center in Seongnam, South Korea. The patients visited the clinic of the department of ophthalmology for more than 6 months and at least 4 times during this period.Results44 patients were classified as blunt TON patients, and 14 patients were surgical TON patients. The visual acuity showed significant decrease in traumatic eyes at the first visit after injury compared to fellow eyes and maintained the injured status during the 1-year follow-up period in blunt TON. In surgical TON, the visual acuity slightly improved during 1 month follow-up period. RNFL thickness tended to be decreased at 1 month after first visit blunt TON patients, which was earlier than surgical TON patients. GCIPL thickness showed earlier decreased than RNFL thickness in both blunt and surgical TON patients.ConclusionsIn both blunt and surgical TON eyes, there was a notable thinning in both RNFL and GCIPL, with particularly remarkable reduction in GCIPL in early phase. Therefore, analyzing each retinal layer thickness using OCT in conjunction with assessing visual function would be necessary. This combined approach is not only crucial for understanding clinical courses of each TON, but also predicting the morphological and functional deteriorations in TON.

Hemifield-based analysis of pattern electroretinography in normal subjects and patients with preperimetric glaucoma

This prospective cross-sectional study investigated the visual function of preperimetric glaucoma (PPG) patients based on hemifield (HF) pattern electroretinogram (PERG) amplitudes. Thirty-two (32) normal subjects and 33 PPG patients were enrolled in control and PPG groups, respectively. All of the participants had undergone full ophthalmic examinations, including spectral-domain optical coherence tomography (SD-OCT), visual field (VF) examination and pattern electroretinography (PERG). The PERG parameters along with the HF ratios of SD-OCT and PERG were compared between the control and PPG groups. Pairwise Pearson's correlation coefficients and linear regression models were fitted to investigate the correlations. The PERG N95 amplitudes were significantly lower in the PPG group (P < 0.001). The smaller/larger HF N95 amplitude ratio of the PPG group was found to be smaller than that of the control group (0.73 ± 0.20 vs. 0.86 ± 0.12; P = 0.003) and showed positive correlations with affected HF average ganglion cell-inner plexiform layer (GCIPL) thickness (r = 0.377, P = 0.034) and with average GCIPL thickness (r = 0.341, P = 0.005). The smaller/larger HF N95 amplitude ratio did not significantly change with age (β = − 0.005, P = 0.195), whereas the full-field N95 amplitude showed a negative correlation with age (β = − 0.081, P < 0.001). HF analysis of PERG N95 amplitudes might be particularly useful for patients with early glaucoma.

Peran Citicoline Oral Sebagai Terapi Tambahan dalam Pengobatan Glaukoma

Glaucoma is the second-leading global cause of blindness. Lowering intraocular pressure can prevent the worsening of open-angle glaucoma, but alternative neuroprotective therapies are needed; citicoline is supposed to have neuroprotective potential. This evidence-based case report was to review the effectiveness of oral citicoline as an adjunct therapy for glaucoma. From 22 studies identified through PubMed, Scopus, Cochrane, EBSCO Host, and Google Scholar, three articles were selected for critical review. Lanza M. found the RNFL and GCC of the citicoline group 500 mg were significantly higher, 70.39 and 71.19 Pm, p&lt;0,01 compared to controls, after 12 months. Sahin A, et al, showed that the RNFL was significantly higher in the third month than baseline in the oral citicoline 250 mg group, p = 0.038. Putri VC, et al, found that after 60 days, based on sub-group analysis, there was a significant difference in RNFL and GCIPL thickness changes after citicoline 500 mg intervention in the mild glaucoma group and after citicoline 1,000 mg in the moderate-severe glaucoma group. Oral citicoline supplementation prevents significant worsening of glaucoma, it can be given as an adjunct therapy.