Inner Plexiform Layer Thickness Research Articles

Differential Relationships Between Serum Xanthophylls and Macular Pigment and Retinal Morphology

Abstract Objectives Lutein and zeaxanthin are xanthophyll carotenoids that comprise macular pigment in the eye and disproportionately accumulate in brain tissue. While the link between serum xanthophylls and macular pigment has received considerable investigation, comparatively less is known regarding the relationship between circulating xanthophylls and retinal morphology. This knowledge gap is significant since deterioration of the morphometric measures of the retina (e.g., retinal nerve fiber layer, RNFL) is a feature of age-neurodegenerative diseases. This project aimed to understand the relationship between serum xanthophylls and retinal morphology. Methods Subjects included 84 individuals (30 males) with overweight and obesity (BMI ≥ 25 kg/m2) between 25–45 years. Macular pigment optical density (MPOD) was measured using heterochromatic flicker photometry. Optical coherence tomography (OCT) was used to assess RNFL, ganglion cell layer (GCL), and inner plexiform layer (IPL). Venous blood draws were used to assess serum lutein and zeaxanthin. Covariates assessed included demographic factors, adiposity (DXA), and dietary intake (7d food records). Results Serum lutein (r = 0.32, P < 0.01) and zeaxanthin (r = 0.23, P = 0.01) concentrations were associated with greater MPOD. There were no significant associations between serum xanthophyll concentrations and morphological values. Similarly, there was no influence of adiposity or dietary lutein and zeaxanthin on retinal morphological measures. However, overall diet quality, assessed using Healthy Eating Index (HEI) was positively associated with IPL (r = 0.35, P < 0.01) and GCL (r = 0.32, P < 0.01) thickness. Conclusions Although circulating carotenoids were associated with macular pigment, this relationship did not extend to morphological measures in the retina. However, overall dietary quality was significantly associated with retinal morphological measures. These findings suggest that macular pigment and retinal morphology may be influenced by nutritional factors. Funding Sources Hass Avocado Board.

Evaluation of neurodegenerative and inflammatory processes in temporomandibular joint disorders using optical coherence tomography

IntroductionTemporomandibular joint disorders (TMD) is a process with systemic effects rather than local effects. The purpose of this study is to examine the retinal layer structure using optical coherence tomography (OCT) method in order to detect possible degenerative and inflammatory process in patients with TMD. Material and methodsThirty-five healthy controls and 34TMD patients were evaluated bilaterally in this study. The retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL) and choroidal thickness were analyzed using OCT. ResultsWhen TMD patients were compared with healthy controls, GCL and IPL volumes and RNFL thickness decreased; while choroidal thickness increased. In the unilateral TMD patients, there was no statistically significant difference in GCL, IPL, RNFL and choroidal thickness between the affected and the unaffected regions. DiscussionOCT findings showed GCL and IPL volumes and RNFL thickness were decreased while choroidal thickness was increased in TMD patients. These findings suggest that TMD may cause neurodegeneration and inflammation.

An investigation of retinal layer thicknesses in unaffected first-degree relatives of schizophrenia patients

IntroductionA large number of studies using different neuroimaging methods showed various structural changes both in patients and their unaffected first-degree relatives (FDRs) over the past years. Optical coherence tomography (OCT) is a relatively new, non-invasive imaging method used to obtain high-resolution cross-sectional images of the retina. A growing body of evidence reports thinning of retinal layers in patients with schizophrenia which is considered as a proxy for CNS alterations. We hypothesized that retinal layer changes would be observed in FDRs, in parallel with those seen in patients, as a potential endophenotype candidate. MethodsThirty-eight schizophrenia patients, 38 FDRs of schizophrenia and 38 age and gender-matched healthy subjects with no family history (HCs) were recruited to this study. OCT measurements were performed and peripapillary retinal nerve fibre layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL) and macular thicknesses were measured. ResultsThe groups did not differ on RNFL, macular or GCL thickness. However, IPL thickness was significantly lower in both patients and FDRs than HCs (p = .025 and p = .041, respectively). The difference between groups remained significant after controlling for confounders such as age, gender, smoking status, comorbid medical diseases and BMI (p = .016 patients vs HCs and p = .014 FDRs vs HCs). ConclusionOur findings suggest that IPL thinning may hold promise as a useful endophenotype for genetic and early detection studies. The evaluation of this area could provide an important avenue for elucidating some of the neurodevelopmental aberrations in the disorder.

Segmented retinal layer analysis of chiasmal compressive optic neuropathy in pituitary adenoma patients.

To evaluate changes in the segmented retinal layers of pituitary adenoma (PA) patients and to identify the relationship between these changes and visual function. A total of 47 (PA patients) and 22 (healthy subjects) eyes were reviewed from the medical records. The PA patients performed a visual field (VF) test before surgery and 1month after surgery. By optical coherence tomography scanning, eight retinal layers were measured: retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer, outer nuclear layer, retinal pigment epithelium, and photoreceptor layer. The PA group showed reduced RNFL, GCL, and IPL thicknesses (p = 0.004,< 0.001,< 0.001) and thicker INL thickness (p = 0.012) than did the controls. The mean deviation of preoperative VF in the PA group was positively correlated with RNFL, GCL, and IPL thicknesses (R = 0.664, 0.720, 0.664; p < 0.001,< 0.001,< 0.001) and negatively correlated with the INL thickness (R = -0.400; p = 0.010). Among the 47 eyes, 32 eyes (68%) were included for subgroup analysis. Preoperative RNFL, GCL, and IPL thicknesses were thicker in the postoperatively improved VF group (p = 0.019, 0.009, 0.005). The preoperative cutoff values for visual recovery were 23.6μm for RNFL thickness, 30.6μm for GCL thickness, and 28.9μm for IPL thickness. During chiasmal compression, the thickening of the INL has presented in addition to thinning of the inner retinal layers. Also, changes in retinal anatomical structures are related to the extent of VF defect and can be used as a predictor of postoperative visual recovery.

The role and mechanism of retinal ganglion cell death in glaucomatous injury

AbstractPurposeGlaucoma refers to a group of diseases characterised by visual field damage and optic neuropathy. In glaucoma, retinal ganglion cell (RGC) death halts the progression of visual information from the eye to the brain, causing permanent visual loss. Due to their crucial role in the pathophysiology of glaucomatous injury, strategies delaying or preventing RGC death are being increasingly recognised as important to incorporate into novel approaches to glaucoma. However, the successful development of such therapies is reliant upon a comprehensive understanding of the mechanisms underlying RGC dysfunction. This study aims to help elucidate this by examining the difference between RGC layer nuclei counts, inner plexiform layer (IPL) thickness, and TrkB signalling in the retina between control and glaucoma human samples.MethodsNine healthy and eight glaucomatous retinas were obtained from the Mayo Clinic, US. 2‐3mm explants from peripheral and central regions were probed for p‐TrkB via immunohistochemistry. Six images per retinal section were quantified for TrkB signalling using ImageJ. RGC layer nuclei counts and IPL thickness measurements were taken as evidence of glaucomatous damage.ResultsThere was a loss of nuclei in the RGC layer, a decrease in IPL thickness, and loss of p‐TrkB signalling in the peripheral human glaucoma samples compared to controls. These changes correlated with a loss of visual field information. No significant changes were observed in the central retina.ConclusionsOur findings support the observation that patients lose peripheral vision early in glaucoma. This convincingly supports a picture of RGC death disrupting the transmission of visual information from the peripheral retina in glaucoma patients. Reduced TrkB signalling in glaucoma also demonstrates the importance of this signalling pathway in maintaining RGC survival. Investigating ways to restore, or preserve, TrkB phosphorylation may be beneficial in the treatment of glaucoma.

Relationship of the Macular Ganglion Cell and Inner Plexiform Layers in Healthy and Glaucoma Eyes.

PurposeTo explore factors influencing the inner plexiform layer (IPL) in healthy subjects and to test the hypothesis that IPL thickness is preferentially decreased in glaucoma as compared with ganglion cell layer (GCL) thickness.MethodsNinety-nine glaucomatous eyes and 66 healthy eyes (165 subjects) underwent macular spectral-domain optical coherence tomography (SD-OCT) imaging and GCL and IPL were segmented creating 8 × 8 arrays of 3° × 3° superpixels. The central 24 superpixels were categorized into three levels of eccentricity (∼1.5°, 4.5°, and 7.5° from the foveal center). Linear mixed models were used to determine predictive parameters for IPL thickness in healthy subjects and to explore the influence of diagnosis of glaucoma on IPL thickness taking into account the effect of GCL thickness and other covariates.ResultsBeing located at 4.5° eccentricity predicted thicker IPL compared with 1.5° eccentricity (P < 0.001) in multivariable models in healthy subjects, whereas older age (P = 0.001) and Asian ethnicity (P = 0.021) were associated with thinner IPL. Diagnosis of glaucoma was not associated with thinner IPL regardless of eccentricity after accounting for age and ethnicity. The results were similar when only eyes with mean deviation greater than –6 dB were analyzed.ConclusionsEthnicity and distance from the fovea are the main determinants of IPL thickness in the central macula. Preferential thinning of the macular IPL, compared with GCL, could not be detected in this study regardless of glaucoma stage.Translational RelevanceThere is no evidence for preferential thinning of the macular IPL in glaucoma compared with GCL based on currently available SD-OCT–imaging technology.

Outer Retinal Dysfunction on Multifocal Electroretinography May Help Differentiating Multiple Sclerosis From Neuromyelitis Optica Spectrum Disorder.

Purpose: To evaluate the intermediate and outer retina of patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) using OCT and multifocal electroretinography (mf-ERG).Methods: Patients with MS (n = 30), NMOSD (n = 30), and healthy controls (n = 29) underwent visual field (VF), OCT, and mf-ERG testing. The eyes were distributed into 5 groups: MS with or without history of ON (MS+ON, MS–ON), NMOSD with or without ON (NMOSD+ON, NMOSD–ON), and controls. The thickness of the macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer, outer plexiform layer, outer nuclear layer, and photoreceptor layer was measured. mf-ERG P1 and N1 responses were registered and grouped in 3 sets of rings. The groups were compared using GEE models, and effect size (ES) calculated.Results: Compared to controls, GCL and IPL thickness was significantly smaller in MS+ON (both p < 0.01), MS–ON (p < 0.01 and p = 0.015, respectively), NMOSD+ON (both p < 0.01) and NMOSD–ON (p = 0.03 and p = 0.018, respectively). ES was >0.80. mRNFL was smaller in three of the above groups (p < 0.01, p < 0.001, and p = 0.028; ES > 0.80) but not in MS–ON eyes (p = 0.18). No significant difference was observed for the remaining layers. Compared to controls, P1 and N1 peak times were shorter in MS (p-values in the range 0.049–0.002, ES < 0.50; and 0.049–0.010; ES < 0.50, respectively) but not in NMOSD. These abnormalities were strongly correlated with intermediate and outer retinal layer thickness.Conclusions: mf-ERG data suggest outer retinal abnormalities in MS, but not in NMOSD. Our results may help understand how the two conditions differ regarding retinal damage.

Optical coherence tomography in myelin-oligodendrocyte-glycoprotein antibody-seropositive patients: a longitudinal study

BackgroundSerum antibodies against myelin-oligodendrocyte-glycoprotein (MOG-IgG) are detectable in a proportion of patients with acute or relapsing neuroinflammation. It is unclear, if neuro-axonal damage occurs only in an attack-dependent manner or also progressively. Therefore, this study aimed to investigate longitudinally intra-retinal layer changes in eyes without new optic neuritis (ON) in MOG-IgG-seropositive patients.MethodsWe included 38 eyes of 24 patients without ON during follow-up (F/U) [median years (IQR)] 1.9 (1.0–2.2) and 56 eyes of 28 age- and sex-matched healthy controls (HC). The patient group’s eyes included 18 eyes without (EyeON-) and 20 eyes with history of ON (EyeON+). Using spectral domain optical coherence tomography (OCT), we acquired peripapillary retinal nerve fiber layer thickness (pRNFL) and volumes of combined ganglion cell and inner plexiform layer (GCIP), inner nuclear layer (INL), and macular volume (MV). High-contrast visual acuity (VA) was assessed at baseline.ResultsAt baseline in EyeON-, pRNFL (94.3 ± 15.9 μm, p = 0.36), INL (0.26 ± 0.03 mm3, p = 0.11), and MV (2.34 ± 0.11 mm3, p = 0.29) were not reduced compared to HC; GCIP showed thinning (0.57 ± 0.07 mm3; p = 0.008), and VA was reduced (logMAR 0.05 ± 0.15 vs. − 0.09 ± 0.14, p = 0.008) in comparison to HC. Longitudinally, we observed pRNFL thinning in models including all patient eyes (annual reduction − 2.20 ± 4.29 μm vs. − 0.35 ± 1.17 μm, p = 0.009) in comparison to HC. Twelve EyeON- with other than ipsilateral ON attacks ≤ 6 months before baseline showed thicker pRNFL at baseline and more severe pRNFL thinning in comparison to 6 EyeON- without other clinical relapses.ConclusionsWe observed pRNFL thinning in patients with MOG-IgG during F/U, which was not accompanied by progressive GCIP reduction. This effect could be caused by a small number of EyeON- with other than ipsilateral ON attacks within 6 months before baseline. One possible interpretation could be a reduction of the swelling, which could mean that MOG-IgG patients show immune-related swelling in the CNS also outside of an attack’s target area.

Detailed Evaluation of Possible Ganglion Cell Loss in the Retina of Zucker Diabetic Fatty (ZDF) Rats

A thinning of the inner retina is one of the earliest potential markers of neuroretinal damage in diabetic subjects. The histological background is uncertain; retinal ganglion cell (RGC) loss and changes in the structure or thickness of the inner plexiform layer (IPL) have been suspected. Studies conducted on animal models on RGC pathology gave contradictory results. Hereby we present RGC numbers, distribution patterns and IPL thickness from Zucker Diabetic Fatty (ZDF) rats. After labelling RGCs on retinal whole mounts, isodensity maps were constructed, RGC numbers and distribution patterns analysed using a custom-built algorithm, enabling point-by-point comparison. There was no change in staining characteristics of the antibodies and no significant difference in average RGC densities was found compared to controls. The distribution patterns were also comparable and no significant difference was found in IPL thickness and stratification or in the number of apoptotic cells in the ganglion cell layer (GCL). Our results provide a detailed evaluation of the inner retina and exclude major RGC loss in ZDF rats and suggest that other factors could serve as a potential explanation for inner retinal thinning in clinical studies. Our custom-built method could be adopted for the assessment of other animal or human retinas.

Preventive and therapeutic effects of Keluoxin Capsules on early diabetic retinopathy in db/db mice

The aim of this paper was to investigate the preventive effects of Keluoxin Capsules(KLX) on diabetic retinopathy in db/db mice. One hundred male db/db diabetic mice(45-55 g, 8 weeks) were randomly divided into 5 groups(model, KLX low dose, KLX middle dose, KLX high dose, Dobesilate) and 20 male C57 BL/KsJdb~(+/+) were taken as control group. Body weight and fasting blood-glucose were detected every week. Mice were administrated with saline(control and model group), KLX(780, 1 560, 3 120 mg·kg~(-1)·d~(-1), ig), Dobesilate(195 mg·kg~(-1)·d~(-1), ig) for 20 weeks, respectively. At the end of the administration, optical coherence tomography, fundus fluorescein angiography and electroretinogram of the retina were measured. The eyeball was extirpated and retina was isolated to make paraffin section, followed by HE staining and glial fibrillary acidic protein(GFAP) immunohistochemistry. The results indicated that KLX has no obvious effect on body weight and fasting blood level in db/db mice. However, KLX could significantly regulate the thickness of retinal ganglion layer and inner plexiform layer. KLX was able to remarkably reduce the quantity of diabetic microvessel. Meanwhile, KLX could notably improve retinal function. Moreover, KLX could observably modulate the cell arrangement and edema in each layer. There was no markable difference in retina according to the immunochemistry assay. In the present study, KLX exert marked preventive effects on diabetic retinopathy in db/db mice, which provided an experimental evidence for clinical use.

The Analysis of Intra-retinal Layers with Automatic Optical Coherence Tomography Segmentation in Healthy Subjects

Aims: To give normative databases of each retinal layers on OCT images in the healthy Caucasian population in Turkey and investigate the relevance of the data with factors such as age, gender, axial length and refraction.&#x0D; Study Design: Prospective, cross sectional, descriptive study.&#x0D; Place and Duration of Study: Department of Ophthalmology, Faculty of Medicine, Kirsehir Ahi Evran University, Kirsehir/TURKEY. Between September 2017 and March 2018.&#x0D; Methodology: 133 participants underwent full ophthalmologic examination and spectral domain OCT imaging (Spectralis, Heidelberg Engineering, Germany). After the automatic segmentation, central 1 mm and 1-3 mm superior, inferior, nasal and temporal thicknesses of retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), retina pigment epithelium (RPE), inner retinal layers (IRL), outer retinal layers (ORL) and total retina thickness (TRT) analyzed with respect to age, gender, axial length and refraction (spherical equivalent).&#x0D; Results: Central 1 mm INL, ONL, ORL, IRL and TRT and four quadrants of pericentral 1-3 mm thicknesses of RPE had positive correlation with the age. All the sections of total retina, RNFL, GCL, IPL, INL, ONL and IRL thicknesses were significantly thicker in males compared to females. The thicknesses of all RNFL sections and central 1 mm circle thicknesses of TRT, IPL, INL, OPL, RPE and IRL had positive correlation with the axial length.&#x0D; Conclusion: A normative database for thicknesses of intra-retinal layers in Turkish population was presented in the study and significant impacts of the age, gender and axial length were presented.

Comparison of optic coherence tomography results in patients with diagnosed epilepsy: Findings in favor of neurodegeneration

BackgroundEpilepsy is a chronic neurological disease characterized with recurrent seizures. Progressive neuronal degeneration is a common consequence of long-term and/or recurrent seizure activity in epilepsy. Optical coherence tomography (OCT) is a new medical imaging technique that displays biological tissue layers as high-resolution tomographic sections. The aim of our study was to evaluate OCT findings in patients with epilepsy and to compare OCT findings in terms of disease duration, presence of status, seizure frequency, and drug use. MethodsForty-three patients who had epilepsy according to the Commission on Classification and Terminology of the International League Against Epilepsy (ILAE) in 2010 and 40 healthy controls were recruited for the study. Disease duration, seizure frequency, status history, and multiple drug use were noted. Retinal nerve fiber layer (RNLF), ganglion cell layer (GCL), inner-plexiform layer (IPL), and choroid thinning were analyzed by using spectral OCT. ResultsThe mean RNFL values are 101.48 ± 11.33 in the patient group and 108.76 ± 8.37 in the control group (p = 0.001). The mean GCL thickness values in the patient and control groups are 1.14 ± 0.12 and 1.22 ± 0.05, (p < 0.001). The mean IPL thickness is 0.93 ± 0.09 in the patient group and 0.97 ± 0.05 in the control group (p = 0.02). Choroid thickness is significantly increased in the patient group (p < 0.001). ConclusionsDemonstration of RNFL, IPL, and GCL thinning might indicate neurodegeneration, and choroid thickening indicates neuroinflammation. We found no association between disease duration, seizure frequency, status history, and multiple drug use and OCT parameters. Further studies with larger patient groups should clarify the matter.

Inner retinal thickening in newly diagnosed choroidal neovascularization.

Automated segmentation of retinal layers by spectral-domain optical coherence tomography (SD-OCT) is usually erroneous in the presence of retinal diseases. The purpose of this study is to report the changes in ganglion cell complex (GCC) comprising retina nerve fiber layer (RNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) in neovascular age-related macular degeneration (AMD) patients by manually correcting the automated segmentation errors. Thirty eyes of 30 patients with new-onset choroidal neovascularization secondary to neovascular AMD and 30 eyes of 30 healthy subjects were included. The inner retinal thicknesses were measured using early treatment diabetic retinopathy circle in the central 1mm (fovea) and surrounding 3mm diameter (parafovea) after checking the accuracy of automated segmentation lines. Manual segmentation was done to ensure the accurate segmentation, when needed. Neovascular AMD patients had thicker mean RNFL, GCL, IPL, and GCC thicknesses within the fovea compared to healthy eyes (p = 0.04, p = 0.001, p = 0.032, and p = 0.005, respectively). In the parafoveal area, among the thickness-related measurements, the only significant difference was a thicker mean RNFL (p = 0.002). Diffuse thickening of inner retinal layers in neovascular AMD may overestimate actual GCC thickness within fovea. This pseudo-increase in GCC thickness and inner retinal layers in general likely does not reflect more cells or tissue, but rather diffuse edema which leads to a falsely increased reading of layer thickness. Such false readings may also make the assessment of other conditions that lead to reduced inner retinal layer thickness such as glaucoma, optic nerve disease, or retinovascular occlusions more difficult.

Correlation between inner retinal layer thickness and cognitive function in HIV: new insights from an exploratory study.

To compare retinal layer thickness in HIV-infected subjects with (CI-HIV) and without (NCI-HIV) cognitive impairment, with a control population and to correlate this with the cognitive status of the patient and other clinical parameters. Single-center cross-sectional study. Participants with controlled HIV infection aged between 40 and 70 years and sex-matched and age-matched controls were enrolled. Retinal nerve fiber layer (RNFL), ganglion cell layer (GCL) and inner plexiform layer (IPL) thickness were assessed using optical coherence tomography. These measurements in HIV patients were compared with those in controls. Age-related and sex-related changes were compared in both groups. Other variables studied in HIV patients included: duration of HIV infection, CD4 cell count nadir, antiretroviral therapy regimen and cognitive status using the Montreal Cognitive Assessment (MoCA) test. Sixty-nine individuals, 34 with and 35 without cognitive impairment, and 70 controls were enrolled. GCL was significantly thinner in CI-HIV patients compared with NCI-HIV patients and controls (P = 0.01 and P = 0.02, respectively). GCL and IPL thickness significantly decreased with age in patients with HIV (P = 0.0003, P = 0.02, respectively, for the entire cohort). This change was not seen in controls. MoCA test score significantly decreased with age in HIV patients and controls. GCL thickness positively correlated with cognitive function across the entire HIV cohort (P = 0.02). GCL was thinner in HIV patients with cognitive impairment. GCL thickness correlated positively with cognitive function and negatively with age in HIV patients. GCL thickness may reflect accelerated cognitive aging in HIV.

COMPARISON OF GANGLION CELL INNER PLEXIFORM LAYER THICKNESS BY CIRRUS AND SPECTRALIS OPTICAL COHERENCE TOMOGRAPHY IN DIABETIC MACULAR EDEMA.

Reduced thickness of the ganglion cell inner plexiform layer indicates diabetic neurodegeneration and can be assessed by spectral domain optical coherence tomography. The authors investigated the comparability of ganglion cell inner plexiform layer measurements from two spectral domain optical coherence tomography devices in patients with diabetic macular edema (DME). Analysis of optical coherence tomography data sets of eyes with and fellow eyes without DME. Macular cube scans of sufficient signal strength on Cirrus (Carl Zeiss Meditec) were compared with correlating scans on Spectralis (Heidelberg Engineering, Germany) being acquired within 1 hour. Eighty-one equivalent data sets for 20 eyes with DME (20 patients; 6 female) and 33 for 9 fellow eyes without DME (9 patients; 2 female) were included from each device. In DME eyes, mean ganglion cell inner plexiform layer thicknesses were 62.5 ± 20.4 μm on Cirrus and 91.2 ± 9.3 μm on Spectralis. Ganglion cell inner plexiform layer was significantly thicker on Spectralis analyzing eyes with and without signs of DME (P < 0.001). The ganglion cell inner plexiform layer variance (54.2%) related to device differences decreased to 34.8% in eyes without DME. Ganglion cell inner plexiform layer data from different devices vary considerably and cannot be used interchangeably. As spectral domain optical coherence tomography is indispensable for identifying ganglion cell loss associated with diabetic neurodegeneration, clinicians should be aware of the difference when monitoring patients.

New Normative Database of Inner Macular Layer Thickness Measured by Spectralis OCT Used as Reference Standard for Glaucoma Detection.

PurposeThis study examines the capacity to detect glaucoma of inner macular layer thickness measured by spectral-domain optical coherence tomography (SD-OCT) using a new normative database as the reference standard.MethodsParticipants (N = 148) were recruited from Leuven (Belgium) and Zaragoza (Spain): 74 patients with early/moderate glaucoma and 74 age-matched healthy controls. One eye was randomly selected for a macular scan using the Spectralis SD-OCT. The variables measured with the instrument's segmentation software were: macular nerve fiber layer (mRNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) volume and thickness along with circumpapillary RNFL thickness (cpRNFL). The new normative database of macular variables was used to define the cutoff of normality as the fifth percentile by age group. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) of each macular measurement and of cpRNFL were used to distinguish between patients and controls.ResultsOverall sensitivity and specificity to detect early-moderate glaucoma were 42.2% and 88.9% for mRNFL, 42.4% and 95.6% for GCL, 42.2% and 94.5% for IPL, and 53% and 94.6% for RNFL, respectively. The best macular variable to discriminate between the two groups of subjects was outer temporal GCL thickness as indicated by an AUROC of 0.903. This variable performed similarly to mean cpRNFL thickness (AUROC = 0.845; P = 0.29).ConclusionsUsing our normative database as reference, the diagnostic power of inner macular layer thickness proved comparable to that of peripapillary RNFL thickness.Translational RelevanceSpectralis SD-OCT, cpRNFL thickness, and individual macular inner layer thicknesses show comparable diagnostic capacity for glaucoma and RNFL, GCL, and IPL thickness may be useful as an alternative diagnostic test when the measure of cpRNFL shows artifacts.

Cyclosporine A does not prevent second-eye involvement in Leber\u2019s hereditary optic neuropathy

BackrgroundEvaluation of the efficacy of oral cyclosporine A as a prophylactic agent in preventing second-eye involvement in Leber’s hereditary optic neuropathy (LHON) in a prospective, open-label, non-randomized, multicenter pilot study. Only LHON patients aged 18 years or more, with confirmed primary mitochondrial DNA mutations and strictly unilateral optic neuropathy occurring within 6 months prior to enrolment, were included in the study. All these patients, receiving treatment with oral cyclosporine (Neoral®, Novartis) at 2.5 mg/kg/day, were examined at three-month intervals for a year. The primary endpoint was the best corrected visual acuity in the unaffected eye; the secondary endpoints were the best corrected visual acuity in the first eye affected, the mean visual field defect on automated perimetry, the thickness of the perifoveal retinal ganglion cell inner plexiform layer, and the thickness of the peripapillary retinal nerve fiber layer in both eyes.ResultsAmong the 24 patients referred to our institution with genetically confirmed LHON, between July 2011 and April 2014, only five patients, four males and one female, fulfilled the inclusion criteria. Age at enrolment ranged from 19 to 42 years (mean: 27.2 years; median: 26 years), four patients harbored the m.11778G > A pathogenic variant, and one the m.14484 T > C pathogenic variant. The time-interval between the onset of symptoms and inclusion in the study ranged from 7 to 17 weeks (mean: 11.8 weeks; median: 9 weeks). Despite treatment with oral cyclosporine A, all patients eventually experienced bilateral eye involvement, occurring within 11–65 weeks after the initiation of treatment. Over the study time period, the average best corrected visual acuity worsened in the first eye affected; by the end of the study, both eyes were equally affected.ConclusionsOral cyclosporine, at 2.5 mg/kg/day, did not prevent second-eye involvement in patients with strictly unilateral Leber’s hereditary optic neuropathy.Trial registrationClinicalTrials.gov Identifier: NCT02176733. Registrated June 25, 2014.

Comparison of optic coherence tomography results in patients diagnosed with OCD: findings in favor of neurodegeneration

Objective: Optic coherence tomography (OCT) is a contactless and fast neuroimaging method. Previous studies have observed thinning of the ganglion cell layer (GCL) and inner plexiform layer (IPL) in many neurodegenerative diseases. The aim of this study was to compare the GCL volume, retinal nerve fiber layer (RNFL), and IPL thickness in obsessive compulsive patients and controls using OCT to demonstrate neurodegeneration in obsessive compul-sive disorder (OCD). Methods: This study involved 50 OCD patients who were being followed by the Psychiatry Department of Adiyaman University Medical School and 50 healthy volunteers as control. OCT measurements were performed for both groups. The RNFL, IPL thickness, and GCL volumes were measured and recorded automatically by a spectral OCT device. Results: The RNFL thickness was lower in patients compared with controls at all mea-sured regions, and this decrease statistically significant in a few regions (left temporo-superior, left mean). The left and right choroid layer thickness acquired from three regions of choroid layer was higher in patients compared with controls. The GCL and IPL volumes were also significantly lower in the patient group. There was a significant negative correlation between the disease duration and OCT results. Discussion: These findings suggest that neurode-generation occurs during the course of OCD. This degeneration may be demonstrated by decreased GCL at early stages, and as the disease progresses, involvement of other retinal layers, such as the RNFL and IPL, may be observed.

Morphological and Functional Inner and Outer Retinal Layer Abnormalities in Eyes with Permanent Temporal Hemianopia from Chiasmal Compression.

The aims of this study are to compare optical coherence tomography (OCT)-measured macular retinal layers in eyes with permanent temporal hemianopia from chiasmal compression and control eyes; to compare regular and slow-flash multifocal electroretinography (mfERG) in patients and controls; and to assess the correlation between OCT, mfERG, and central visual field (SAP) data. Forty-three eyes of 30 patients with permanent temporal hemianopia due to pituitary tumors who were previously submitted to chiasm decompression and 37 healthy eyes of 19 controls were submitted to macular spectral domain OCT, mfERG, and 10-2 SAP testing. After segmentation, the thickness of the macular retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer, and photoreceptor layer (PRL) was measured. Amplitudes and oscillatory potentials (OPs) were measured on regular and slow-flash mfERG, respectively, and expressed as the mean values per quadrant and hemifield. RNFL, GCL, and IPL thickness measurements were significantly reduced in all quadrants, whereas INL, OPL, and PRL thicknesses were significantly increased in the nasal quadrants in patients compared to those in controls. Significant correlations between OCT and 10-2 SAP measurements were positive for the RNFL, GCL, and IPL and negative for the INL, OPL, and PRL. OPs and mfERG N1 amplitudes were significantly reduced in the nasal hemiretina of patients. Significant correlations were found between OP and mfERG amplitudes for inner and outer nasal hemiretina OCT measurements, respectively. Patients with permanent temporal hemianopia from previously treated chiasmal compression demonstrated significant thinning of the RNFL, GCL, IPL, and thickening of the INL, OPL, and PRL associated with reduced OP and mfERG N1 amplitudes, suggesting that axonal injury to the inner retina leads to secondary damage to the outer retina in this condition.

Melanopsin-expressing retinal ganglion cells are relatively resistant to excitotoxicity induced by N-methyl-d-aspartate.

Excitotoxicity plays an important role in neuronal loss in glaucoma. Previous studies indicate melanopsin-expressing intrinsically photosensitive retinal ganglion cells (ipRGCs) are more injury-resistant. However, whether melanopsin-expressing ipRGCs are resistant to N-methyl-d-aspartate (NMDA) induced excitotoxicity is not well understood. In the present study, we investigated the effects of NMDA-induced excitotoxicity in conventional retinal ganglion cells (RGCs) and melanopsin-expressing ipRGCs in adult mice. The loss of RGCs and the reduction of the thickness of inner plexiform layer (IPL) were studied by histology, immunofluorescence, TUNEL assay and optical coherence tomography (OCT). The remaining conventional RGCs and ipRGCs were quantified on the 1st, 3rd, 7th, and 21st day after NMDA injection using immunofluorescence. NMDA mediated acute and severe damage of conventional RGCs damage in a time-dependent manner, and approximately 85% of the conventional RGCs were lost on the 21st days. Furthermore, a significant reduction of the IPL thickness was observed. Moreover, compared to the PBS-injected eyes, the density of total melanopsin-positive RGCs decreased by 25% on the 1st day after NMDA injection, and then the density was constant at other time points. Our results suggest that melanopsin-expressing ipRGCs are relatively resistant to excitotoxicity induced by NMDA.