Inner Segment/outer Segment Research Articles

OCT Biomarkers as Functional Outcome Predictors in Diabetic Macular Edema Treated with Dexamethasone Implant

Identification and characterization of patients with diabetic macular edema (DME) are important for individualizing treatment and optimizing outcome. We investigated OCT biomarkers for DME treated by intravitreal dexamethasone (DEX) implant. Multicenter, retrospective, observational cohort study. A total of 299 eyes from 284 patients treated with DEX implant for DME (naïve, n= 209; refractory, n= 90). Baseline best-corrected visual acuity (BCVA) was between 0.3 and 1.0 on a logarithm of minimum angle of resolution visual chart. The OCT scans previous to DEX implants were evaluated for submacular fluid, size and location of cystoid changes, inner segment-outer segment (IS-OS) continuity, quantity and location of hyperreflective foci (HRF), vitreomacular interface abnormalities, and epiretinal membrane. The BCVA and central macular thickness were recorded at baseline and at 1, 2, and 4 months after treatment with DEX implants. Correlations between OCT measures and visual outcome were analyzed using the generalized estimating equations procedure. The correlation between spectral-domain (SD) OCT measures at baseline and BCVA response (mean change from baseline; categorized improvement [<5, 5-9, or ≥10; Early Treatment Diabetic Retinopathy Study letters] in BCVA) after treatment with a DEX implant. The presence of subretinal fluid (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.23-3.20; P= 0.01), absence of HRF (OR, 3.66; 95% CI, 1.40-9.62; P= 0.01), and integrity of the IS-OS layer (OR, 2.09; 95% CI, 1.30-3.37; P= 0.003) were all predictive of better visual outcome after treatment with DEX implants. Although eyes with naïve DME gained more vision than refractory eyes (P < 0.001), the predictive value of OCT findings did not differ according to this classification. Spectral-domain OCT is useful in identifying various imaging findings in DME. Among eyes with DME, those with submacular fluid, no HRF, and a continuous IS-OS layer responded better to DEX implants than those without these features. These findings call for further study of combinations of OCT andmetabolic biomarkers.

Correlation between Postoperative Area of High Autofluorescence in Macula and Visual Acuity after Macular Hole Closure.

PurposeTo determine the correlation between the preoperative basal diameter of macular hole, the postoperative area of high autofluorescence (AF) in macula, and visual acuity in full-thickness macular hole.MethodsForty-nine patients with full-thickness macular hole who underwent vitrectomy and C3F8 filling were reviewed. The preoperative diameter of macular hole, the 6 months postoperative area of high AF in macula if it existed, the length of inner segment/outer segment (IS/OS) defect, and visual acuity were obtained. The correlation between them was determined.ResultsAt postoperative 6 months, the rate of high AF in macula was 63.3%. There were statistical differences between with and without high AF groups in postoperative best-corrected visual acuity (BCVA) (t = -2.751, p = 0.008), preoperative basal diameter of macular hole (t = -4.946, p = 0.00001), and postoperative length of IS/OS defect (t = -8.351, p<0.00001). Simple linear regression analysis showed high positive correlations between preoperative basal diameter of macular hole and area of high AF (p<0.00001, r = 0.893), postoperative length of IS/OS defect and area of high fundus AF (FAF) (p<0.00001, r = 0.779), and negative correlations between area of high AF and postoperative BCVA (p = 0.037, r = 0.375). There was low correlation between diameter of macular hole and postoperative BCVA (p = 0.112).ConclusionsThe preoperative basal diameter of macular hole and postoperative length of IS/OS defect decides the postoperative area of high AF in macula to some degree, and the postoperative area of high AF in macula can be an evaluating indicator for poor macular function recovery.

Gli1 Expression in Human Epiretinal Membranes.

We evaluate the expression of Gli1 in human epiretinal membranes (ERM) and correlate this with clinical data. We prospectively recruited patients with ERM. A total of 33 human ERM specimens were immunolabeled with anti-Gli1 antibody and the number of total cells/hyperfield (HF), Gli1(+) cells/HF, and the percentage of Gli1(+) cells/total cells were calculated. We evaluated the interrelationship of cellular properties and clinical findings, such as presence of diabetic retinopathy (DR), retinal breaks, intraocular inflammation, central foveal thickness, maximal retinal thickness, retinal contraction, lamellar holes, pseudoholes, the attenuation or absence of an inner segment/outer segment (IS/OS) junction/external limiting membrane (ELM), cystic changes, and paravascular inner retinal defects. Among 33 specimens, 25 specimens (75.8%) showed nuclear Gli1 expression. The mean Gli1(+) cells/total cells was 54.0 ± 36.7% (range, 0%-92.8%). There was significantly higher expression of Gli1(+) cells in ERM specimens from patients with DR (P = 0.014), and lower expression from patients with retinal breaks (P = 0.022). Epiretinal membrane specimens from patients with alteration of IS/OS junction/ELM or cystic changes on OCT showed higher percentage of Gli1(+) cells/total cells. Gli1 expression was detected in most ERM specimens. Patients who had DR or OCT findings indicating chronic retinal insults showed higher Gli1 expression. Gli1 may have a role in the pathogenesis of ERM after chronic retinal insults.

Restoration of photoreceptors in eyes with diabetic macular edema.

To show the prognostic value of foveal microstructures using optical coherence tomography (OCT) for the restoration of inner segment/outer segment (IS/OS) junction layer following resolution of diabetic macular edema (DME). Forty-one eyes of 39 patients with IS/OS damage at the time of DME that showed complete resolution of DME were included. Eyes were divided into 2 groups based on the IS/OS integrity at final visit, when edema was completely resolved: always damage group (damage at baseline and at final visit) and initial damage group (damage only at baseline). The OCT characteristics including the extent of the IS/OS damage, central subfield thickness (CST), maximum retinal thickness (MRT), presence or absence of subretinal fluid, duration of diabetic retinopathy, and duration of DME were studied. The integrity of IS/OS was evaluated at baseline and at last follow-up as percentage (0%-100%). Forty-four percent of eyes (18 eyes) achieved complete restoration of IS/OS after resolution of DME. There was no significant difference in CST or MRT during DME between the 2 groups. The always damage group had more IS/OS damage at baseline visit (23.6% ± 6.4% vs 10.7% ± 3.4%, p = 0.043) with a longer duration of DME (p = 0.025). Despite a borderline significance in visual acuity between the 2 groups at baseline (p = 0.05), the always damage group ended up with worse vision at last follow-up (p<0.001). Patients with shorter duration of DME and less baseline IS/OS damage were more likely to have intact (restored) IS/OS after resolution of DME.

The Distribution of the Photoreceptor Outer Segment Length in a Healthy Population.

Purpose To evaluate the effects of age and sex on the photoreceptor outer segment (PROS) length in healthy eyes, using spectral-domain optical coherence tomography (SD-OCT). Methods A total of 97 eyes of 97 healthy participants (spherical equivalent < ±1 diopters [D]) were scanned with SD-OCT. The patients were divided into 3 groups by age: group 1 (0–20 years), group 2 (21–40 years), and group 3 (41–60 years). The PROS length was defined as the distance from the inner surface of IS/OS (inner segment/outer segment) band to the inner surface of retinal pigment epithelium (RPE). Results The mean PROS length was 52.01 ± 3.79 μm in females and 53.41 ± 3.37 μm in males (p = 0.061). The mean PROS length of the different groups was 53.70 ± 3.18 μm (0–20 years), 52.14 ± 3.64 μm (21–40 years), and 52.20 ± 3.95 μm (41–60 years) (p = 0.155; ANOVA test). Multiple linear regression analysis revealed a −0.039 μm decline in PROS length per year (p = 0.074) and a −1.408 μm decline in females (p = 0.055). Conclusion The difference in PROS length was not statistically significant neither for age nor for gender; females tended to have a lower PROS length than males, and PROS length was slightly higher in the first two decades of life.

3D Curvelet-Based Segmentation and Quantification of Drusen in Optical Coherence Tomography Images

Spectral-Domain Optical Coherence Tomography (SD-OCT) is a widely used interferometric diagnostic technique in ophthalmology that provides novel in vivo information of depth-resolved inner and outer retinal structures. This imaging modality can assist clinicians in monitoring the progression of Age-related Macular Degeneration (AMD) by providing high-resolution visualization of drusen. Quantitative tools for assessing drusen volume that are indicative of AMD progression may lead to appropriate metrics for selecting treatment protocols. To address this need, a fully automated algorithm was developed to segment drusen area and volume from SD-OCT images. The proposed algorithm consists of three parts: (1) preprocessing, which includes creating binary mask and removing possible highly reflective posterior hyaloid that is used in accurate detection of inner segment/outer segment (IS/OS) junction layer and Bruch’s membrane (BM) retinal layers; (2) coarse segmentation, in which 3D curvelet transform and graph theory are employed to get the possible candidate drusenoid regions; (3) fine segmentation, in which morphological operators are used to remove falsely extracted elongated structures and get the refined segmentation results. The proposed method was evaluated in 20 publically available volumetric scans acquired by using Bioptigen spectral-domain ophthalmic imaging system. The average true positive and false positive volume fractions (TPVF and FPVF) for the segmentation of drusenoid regions were found to be 89.15% ± 3.76 and 0.17% ± .18%, respectively.

Optical coherence tomographic features and correlation with visual acuity in adult-onset foveal vitelliform dystrophy

Purpose: The purpose of the study was to analyze the optical coherence tomographic (OCT) features of adult-onset foveal vitelliform dystrophy (AOFVD) using high-resolution spectral-domain (SD) OCT and to correlate each variable with visual acuity. Design: This was a retrospective, observational case series. Materials and Methods: Patients with a diagnosis of AOFVD based on clinical presentation, autofluorescence, and OCT were included in the study. SD-OCT images were analyzed. The vertical and horizontal basal dimensions of vitelliform material, the thickness of neurosensory retina (NSR) above the lesion, and the integrity of inner segment-outer segment (IS-OS) junction and external limiting membrane (ELM) were assessed, and each was correlated with best-corrected visual acuity. Results: Thirty-six eyes of 25 patients were included in the study. Mean age of patients was 65.39 ± 11.3 years. A weak positive correlation was noted between lesion dimensions and LogMAR visual acuity, but this was not statistically significant. A significant negative correlation was seen between thickness of NSR above the lesion and LogMAR visual acuity, indicating that as the overlying NSR became thinner, vision worsened. Although a worse visual acuity was noted in eyes with disrupted IS-OS junction and ELM, the result was not statistically significant. Conclusion: As the size of the vitelliform material increased, there was progressive thinning of overlying NSR which could lead to worsening of visual acuity.

Fundus Autofluorescence Patterns of Submacular Fluid Resolution Following Repair of Macula-Involving Rhegmatogenous Retinal Detachments.

Submacular fluid (SMF) can persist for months to years following rhegmatogenous retinal detachment (RD) repair. The authors' objective was to describe fundus autofluorescence (FAF) and optical coherence tomography (OCT) findings associated with the absorption of persistent submacular fluid (SMF) following RD repair. Retrospective review of clinical data and FAF and OCT imaging from sequential postoperative visits in a cohort of patients with persistent SMF following RD repair. In 11 of 13 eyes with persistent SMF, patches of decreased FAF signal corresponded to SMF on OCT. In eight eyes, there was a hypo- to hyperautofluorescence transition at the time of SMF resolution. These areas of increased FAF signal correlated with inner segment/outer segment (IS/OS) junction loss on OCT. FAF imaging can be informative when following SMF after RD repair; a hypo- to hyper-FAF signal transition correlates with SMF resolution and photoreceptor loss. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1020-1029.].

Why Poor Vision Despite an Attached Retina following Primary Vitrectomy in Egyptian Patients?

ABSTRACTObjective: To correlate findings on spectral domain optical coherence tomography (SD-OCT) and best-corrected visual acuity (BCVA) following primary vitrectomy for rhegmatogenous retinal detachment (RRD). Methods: In this prospective, interventional, non-randomized case series, 71 eyes with RRD of intermediate severity underwent primary vitrectomy followed by SD-OCT one month later. Main outcome measures were inner segment/outer segment (IS/OS) junction line and external limiting membrane (ELM) disruption. Results: All patients achieved reattachment with mean BCVA of 0.77 ± 0.36 logMAR. There was statistically significant correlation between each length of IS/OS and ELM defect on the one hand, and BCVA on the other hand. Conclusion: The extent of IS/OS and ELM disruption explains the poor visual outcome in successful RD surgery with an otherwise normal foveal contour.

Correlation of foveal bulge on SD‐OCT and visual acuity in resolved macular edema associated with branch retinal vein occlusion

PurposeTo investigate the correlation between the presence of a bulge in the photoreceptor inner segment/outer segment (IS/OS) line and the best corrected visual acuity (BCVA) in eyes with resolved macular edema associated with branch retinal vein occlusion (BRVO).MethodsA total of 17 eyes (17 patients) with macular edema associated with BRVO were evaluated. The medical records of patients who had a complete resolution of macular edema with intact IS/OS line in the central fovea on spectral‐domain optical coherence tomography (SD‐OCT) images were retrospectively reviewed. These eyes were classified into those with foveal bulge and those without foveal bulge and the characteristics of the 2 groups were compared.ResultsTwelve eyes (70.5%) had complete resolution of macular edema after a mean follow up of 24.1 months. A foveal bulge was present in 9 of 17 eyes with resolved macular edema. The BCVA was significantly better in eyes with a foveal bulge than in eyes without foveal bulge (p &lt; 0.001). All eyes with foveal bulge had a decimal BCVA less than 0.5 against only 28.6% in eyes without foveal bulge (p = 0.011).ConclusionsFoveal bulge seems to be frequent in resolved macular edema associated with BRVO. Visual acuity was significantly better in the subgroup with foveal bulge making it a potential good marker of the functional properties of the fovea.

RECOVERY OF FOVEAL PHOTORECEPTOR INTEGRITY AFTER VITRECTOMY IN EYES WITH AN IMPENDING MACULAR HOLE WITH VITREOMACULAR TRACTION SYNDROME.

To identify factors associated with the recovery of foveal photoreceptor disruption in eyes with an impending macular hole (MH) with vitreomacular traction syndrome after surgery. This study comprised 33 consecutive patients who underwent vitrectomy for Stage 1 impending macular hole with disrupted photoreceptor inner segment/outer segment (IS/OS) layer and were followed up for a minimum of 1 year after surgery. Preoperative optical coherence tomography (OCT) parameters were compared between eyes that achieved complete restoration of the IS/OS layer (Group A) and those that did not (Group B). Postoperative serial changes in best-corrected visual acuity (BCVA) and IS/OS disrupted length were also investigated. Smooth and symmetric foveolar contour was restored in 29 eyes (87.9%). Complete recovery of IS/OS disruption was observed in 11 of 33 cases (33.3%, Group A). Group A exhibited a larger percentage of foveal pseudocysts (54.5% vs. 13.6%, P = 0.033) and a smaller mean aperture size (102.1 ± 182.1 μm vs. 241.5 ± 163.8 μm, P = 0.031) than Group B. Postoperatively, Group A revealed a significantly better visual outcome than Group Be, which was the same as Group B, but with the four eyes that developed a full-thickness macular hole excluded. Restoration of the foveal photoreceptor layer was more likely to occur in eyes with a foveal pseudocyst and smaller aperture size.

The Photosensitivity of Rhodopsin Bleaching and Light-Induced Increases of Fundus Reflectance in Mice Measured In Vivo With Scanning Laser Ophthalmoscopy.

PurposeTo quantify bleaching-induced changes in fundus reflectance in the mouse retina.MethodsLight reflected from the fundus of albino (Balb/c) and pigmented (C57Bl/6J) mice was measured with a multichannel scanning laser ophthalmoscopy optical coherence tomography (SLO-OCT) optical system. Serial scanning of small retinal regions was used for bleaching rhodopsin and measuring reflectance changes.ResultsSerial scanning generated a saturating reflectance increase centered at 501 nm with a photosensitivity of 1.4 × 10−8 per molecule μm2 in both strains, 2-fold higher than expected were irradiance at the rod outer segment base equal to that at the retinal surface. The action spectrum of the reflectance increase corresponds to the absorption spectrum of mouse rhodopsin in situ. Spectra obtained before and after bleaching were fitted with a model of fundus reflectance, quantifying contributions from loss of rhodopsin absorption with bleaching, absorption by oxygenated hemoglobin (HbO2) in the choroid (Balb/c), and absorption by melanin (C57Bl/6J). Both mouse strains exhibited light-induced broadband reflectance changes explained as bleaching-induced reflectivity increases at photoreceptor inner segment/outer segment (IS/OS) junctions and OS tips.ConclusionsThe elevated photosensitivity of rhodopsin bleaching in vivo is explained by waveguide condensing of light in propagation from rod inner segment (RIS) to rod outer segment (ROS). The similar photosensitivity of rhodopsin in the two strains reveals that little light backscattered from the sclera can enter the ROS. The bleaching-induced increases in reflectance at the IS/OS junctions and OS tips resemble results previously reported in human cones, but are ascribed to rods due to their 30/1 predominance over cones in mice and to the relatively minor amount of cone M-opsin in the regions scanned.

Clinical advances in hyper-reflective bands of outer retina in spectral-domain OCT image

With the widespread use of high-resolution spectral-domain OCT (SD-OCT) in clinical practice, one of the greatest progresses to the ophthalmologists is more detailed image analyses of outer retina in the macular region.There are four clear hyper-reflective bands of outer retina in the SD-OCT images, instead of three bands in the time-domain OCT (TD-OCT), the bands from inner to external are external limiting membrane (ELM), inner segment/outer segment (IS/OS) junction, cone outer segment tips (COST), and retinal pigment epithelium (RPE), respectively.From a perspective of corresponding retinal histological structure, all of the three bands of ELM, (IS/OS) and COST are within the photoreceptor cells.Therefore, the integrity of the three bands correlates well with the status and function of photoreceptor cells.It is one of the hot topics to study the status and function, as well as injury and repair of the photoreceptor cells using SD-OCT.This article reviewed the relevant clinical studies about the three bands of ELM, IS/OS and COST, including macular hole (MH), idiopathic epiretinal membrane (IERM), rhegmatogenous retinal detachment (RRD) and age-related macular degeneration (AMD). Key words: Optical coherence tomography; Outer retina; Hyper-reflective bands

Reliability of a Manual Procedure for Marking the EZ Endpoint Location in Patients with Retinitis Pigmentosa.

PurposeWe developed and evaluated a training procedure for marking the endpoints of the ellipsoid zone (EZ), also known as the inner segment/outer segment (IS/OS) border, on frequency domain optical coherence tomography (fdOCT) scans from patients with retinitis pigmentosa (RP).MethodsA manual for marking EZ endpoints was developed and used to train 2 inexperienced graders. After training, an experienced grader and the 2 trained graders marked the endpoints on fdOCT horizontal line scans through the macula from 45 patients with RP. They marked the endpoints on these same scans again 1 month later.ResultsIntragrader agreement was excellent. The intraclass correlation coefficient (ICC) was 0.99, the average difference of endpoint locations (19.6 μm) was close to 0 μm, and the 95% limits were between −284 and 323 μm, approximately ±1.1°. Intergrader agreement also was excellent. The ICC values were 0.98 (time 1) and 0.97 (time 2), the average difference among graders was close to zero, and the 95% limits of these differences was less than 350 μm, approximately 1.2°, for both test times.ConclusionsWhile automated algorithms are becoming increasingly accurate, EZ endpoints still have to be verified manually and corrected when necessary. With training, the inter- and intragrader agreement of manually marked endpoints is excellent.Translational RelevanceFor clinical studies, the EZ endpoints can be marked by hand if a training procedure, including a manual, is used. The endpoint confidence intervals, well under ±2.0°, are considerably smaller than the 6° spacing for the typically used static visual field.

Outer Retinal Layers Alterations in Chronic Central Serous Chorioretinopathy: Spectral Domain-OCT and Fundus Autofluorescence Findings

Purpose: To document alteration of the outer retinal layers and fundus autofluorescence (FAF) change in eyes with chronic central serous chorioretinopathy (CSCR). Methods: Seventeen eyes of fifteen patients diagnosed with chronic CSCR from January 2014 to March 2015 with at least 6 months of follow-up and no history of surgery were enrolled in this study. Morphologic alterations in the retinal pigment epithelium (RPE), the photoreceptor inner segment/outer segment (IS/OS) junction layer, and the outer retina were evaluated by Spectral domain optical coherence tomography (SD-OCT). The FAF images were obtained via Heidelberg Retina Angiogram using a view mode of 30° and were described using distribution patterns of retinal autofluorescence compared to background autofluorescence. After tomographic alignment of the FAF intensities with the OCT findings, we analyzed and assessed the alteration of the outer retinal layers and the characteristics of retinal autofluorescence. Results: RPE detachment lesions in SD-OCT showed little or no change in autofluorescence pattern. Five of seven eyes with RPE humps in SD-OCT showed hyper-fluorescence in FAF. All of the eyes with defects or changes of the reflective line representing the IS/OS junction in SD-OCT correlated with hyper-fluorescence in FAF. Seven of nine eyes with persistent subretinal detachment (SRD) showed specific ring-shaped hyper-fluorescence in FAF matching up with the border of the SRD, and five eyes with photoreceptor OS elongation within SRD showed a granular type of hyper-fluorescence within the ring-shaped hyper-fluorescence in FAF. Conclusions: In chronic CSCR, we found that RPE humps, the lesion IS/OS junction defect, the border of SRD, photoreceptor OS elongation in SD-OCT correlate with hyper-fluorescence lesions in FAF. The areas of the autofluorescence changes in the FAF images are associated with the extent of change in the RPE and outer retina. J Korean Ophthalmol Soc 2016;57(5):763-771

Semi-automated quantification of retinal IS/OS damage in en-face OCT image

A variety of vision ailments are indicated by structural changes in the retinal substructures of the posterior segment of the eye. In particular, integrity of the inner-segment/outer-segment (IS/OS) junction directly relates to the visual acuity. In the en-face optical coherence tomography (OCT) image, IS/OS damage manifests as a dark spot in the foveal region, and its quantification, usually performed by experts, assumes diagnostic significance. In this context, in view of the general scarcity of experts, it becomes imperative to develop algorithmic methods to reduce expert time and effort. Accordingly, we propose a semi-automated method based on level sets. As the energy function, we adopt mutual information which exploits the difference in statistical properties of the lesion and its surroundings. On a dataset of 27 en-face OCT images, segmentation obtained by the proposed algorithm exhibits close visual agreement with that obtained manually. Importantly, our results also match manual results in various statistical criteria. In particular, we achieve a mean Dice coefficient of 85.69%, desirably close to the corresponding observer repeatability index of 89.45%. Finally, we quantify algorithmic accuracy in terms of two quotient measures, defined relative to observer repeatability, which could be used as bases for comparison with future algorithms, even if the latter are tested on disparate datasets.

Characteristic of optical coherence tomography image and choroidal thickness in patients with multiple evanescent white dot syndrome

Objective To observe the characteristic of optical coherence tomography (OCT) and subfoveal choroidal thickness(SFCT) in patients with multiple evanescent white dot syndrome (MEWDS). Methods The clinical data of 10 patients (10 eyes)with MEWDS were included in the study. 10 normal subjects with matched age, gender and ocular refractive status was selected as control. The patients including 9 females (9 eyes) and 1 male (1 eye), with the average age of (27±8) years. The onset time ranged from 5 to 14 days. The patients were in acute phase if it was in 2 weeks after onset, or convalescent phase if onset was 8 weeks ago. The corrected vision, slit lamp biomicroscopy, ophthalmoscope, fundus photography, fundus fluorescein angiography, indocyanine green angiography and optical coherence tomography (OCT) were performed alone or combined in all patients. The SFCT between the acute and convalescent phases were measured using enhanced depth imaging OCT. The average follow-up was 5 months. The OCT characteristics of affected eyes between acute and convalescent phase were compared. The SFCT of the affected eyes and fellow eye were compared. Results The foveal inner segment-outer segment (IS/OS) was disrupted, thin, irregular in the acute phase, and restored in the convalescent phase. The SFCT of patients in the acute phase was (239±140.7) μm, in the convalescent phase was (189.9±115.6) μm. The SFCT in the acute phase was more thicker than the convalescent phase (t=5.287, P<0.05). The SFCT of fellow eyes in the acute phase was (214.6±127.2) μm, in the convalescent phase was (186.5±108.6) μm, the difference was significant(t=3.553, P<0.05). The SFCT in the control subject was (155.5±83.5) μm. The SFCT in the acute phase was thicker than the control(Z=-2.117, P<0.05). Conclusions In the acute phase of MEWDS, the foveal IS/OS was disrupted, thin and irregular in OCT scan. The choroid is thicker in the acute phase than in the convalescent phase in both eyes, and thicker than controls. Key words: Retinal diseases/diagnosis; Choroid; Macula lutea; Tomography, optical coherence

Correlation between visual acuity changes and optical coherence tomography morphological findings in idiopathic epiretinal membranes.

To analyze the influence of spectral-domain optical coherence tomography (SD-OCT) features on visual acuity changes in patients with idiopathic epiretinal membranes (ERMs). Seventy-nine eyes of 71 patients were included in this study. SD-OCT was performed for all patients; data were collected upon ERM diagnosis and at the final visit. The patients were divided into subgroups based on their SD-OCT features. The initial best corrected visual acuity (BCVA) and changes in BCVA for each subgroup were compared. A multivariate analysis was performed to assess the factors associated with changes in BCVA. During a mean follow-up period of 20.78 months, the mean change in logMAR visual acuity was 0.052 ± 0.089. Eyes with inner segment/outer segment (IS/OS) junction disruption and cystoid macular edema (CME) had a significantly lower mean initial BCVA than those without disruption and CME (P = 0.036 and P = 0.012, respectively). However, only eyes with CME had significant changes in BCVA (P = .034). Multivariate analysis revealed the presence of CME as the only factor that had a significant correlation with VA changes. In patients with idiopathic ERMs, the presence of CME and IS/OS disruption detected by OCT correlated with a poorer initial BCVA. Most patients' visual acuity remained stable during follow-up. The presence of CME with OCT represented a predictor of the progression of visual acuity. These results may provide valuable clinical information regarding the management of patients with idiopathic ERMs. We demonstrated that the presence of CME and IS/OS disruption detected with OCT correlated with a poorer BCVA in idiopathic ERMs. The visual acuity of most patients was stable during the follow-up period. The presence of CME in OCT represented a predictor of vision deterioration for patients with idiopathic ERMs.

Predictors of 1-year visual outcome in OCT analysis comparing ranibizumab monotherapy versus combination therapy with PDT in exsudative age-related macular degeneration.

The aim of this study was to find predictive factors of 1-year visual outcome, analyzing novel optical coherence tomography (OCT) biomarkers in exsudative age-related macular degeneration (choroidal neovascularization (CNV)) in two groups of different treatment modalities. In all, 34 consecutive patients with new-onset CNV were randomized 1:1 to receive either ranibizumab monotherapy or ranibizumab combined with photodynamic therapy (PDT) with verteporfin. After three initial injections with ranibizumab, re-treatment was performed according to an as-needed scheme; PDT was performed once at baseline. Best-corrected visual acuity (BCVA) and OCT parameters like central macular volume (CMV), central macular thickness (or central retinal thickness (CRT)), subretinal and intraretinal fluid, fibrovascular lesion thickness, or inner segment/outer segment (IS/OS) junction were analyzed. After 12 months, a visual gain of 6.1 letters was found in the monotherapy group, whereas patients in the combination therapy group lost - 4.8 letters from baseline to the 12-month visit. CMV and CRT decreased considerably between baseline and month 2-3 in both groups, with a following slight increase until month 12. Additional application of PDT had negative effect to 12-month BCVA, whereas higher baseline BCVA and integrity of the IS/OS junction at month 12 had positive effect to 12-month BCVA. Better baseline BCVA and the integrity of IS/OS junction at 12-month visit were the most important predictive factors for final BCVA. Combination therapy caused worse final BCVA and a higher degree of IS/OS disruption.

Correlation between Retinal Changes and Visual Function in Late-Stage Vogt-Koyanagi-Harada Disease: An Optical Coherence Tomography Study.

Purpose. To characterize the optical coherence tomography (OCT) findings in late-stage Vogt-Koyanagi-Harada (VKH) disease and its correlation with visual function. Methods. The records of patients with late-stage VKH disease (defined as ≥12 months from disease onset) were retrospectively reviewed. The analysis focused on the OCT findings and microperimetry, in addition to the possible correlation between morphology and functional findings. Results. Twenty-nine patients (58 eyes) were included. Mean age at onset was 34.24 ± 10.67 years. The OCT revealed that the outer retina and retinal pigment epithelium (RPE) were mainly affected. These effects included RPE thickening and breakage or disappearance of the cone outer segment tip (COST) line and/or inner segment/outer segment (IS/OS) junction. The COST line and IS/OS results were related to macular function and the interval between symptom onset and initiation of high-dose corticosteroid treatment (all P < 0.01). Eyes with intact COST lines demonstrated intact IS/OS and normal RPE layers as well as better visual function and normal retinal sensitivity. Conclusions. The OCT findings are strongly correlated with macular function, as well as other clinical findings in late-stage VKH. With respect to the COST line and retinal sensitivity especially, the OCT and microperimetry findings may be useful for evaluating later-stage VKH.