Linear Diameter Research Articles

Surgical classification for large macular hole: based on different surgical techniques results: the CLOSE study group

BackgroundThe CLOSE study group proposes an updated surgical classification for large macular holes based on a systematic review of new treatments. Recently, many new techniques have been introduced to treat large full-thickness macular holes (FTMH); although the indications are not clear. An updated surgical classification is needed to help surgical decision-making.MethodsWe gathered published series by the CLOSE Study Group members and from literature search until June 2021. Techniques included: internal limiting membrane peeling (ILM peeling), ILM flaps, macular hydrodissection (macular hydro), human amniotic membrane graft (hAM), and autologous retinal transplantation (ART). Within each technique, chi-square test assessed association between the minimal linear diameter (MLD) (in µm) and closure rate; the postoperative best-corrected visual acuity (BCVA) gains were compared among groups.ResultsData extraction included 31 published articles: total of 1135 eyes. Eyes were divided into the following groups: ILM peel (n: 683), ILM Flap (n: 233), macular hydrodissection (n: 64), hAM (n: 59), and ART (n: 96). The initial BCVA and size were heterogenous between the groups. ILM peel showed the best results in large FTMH ≤ 535 µm (closure rate 96.8%); adjusted mean BCVA: 0.49 (LogMAR) with a statistical difference among groups. Large FTMH between 535 and 799 µm: ILM flap technique showed better results (closure rate 99.0%); adjusted mean BCVA: 0.67(LogMAR); also with a statistical difference. For large FTMH ≥ 800 µm more invasive techniques are required. Use of hAM, macular hydrodissection and ART showed higher closure rates for this category (100%, 83.3% and 90.5% respectively), and adjusted mean BCVA varied from 0.76 to 0.89. Although there was no statistical difference between those techniques for this group due to the smaller number of cases.ConclusionsThe CLOSE study group demonstrated the potential usefulness of a new surgical classification for large FTMHs and propose OCT biomarkers for use in clinical practice and future research. This new classification demonstrated that Large (400–550 µm) and X-Large (550–800 µm) holes can be treated highly successfully with ILM peel and ILM flap techniques, respectively. Further studies are necessary for the larger FTMHs (XX-Large and Giant), using the CLOSE classification, in order to determine which technique is better suited for each hole size and characteristics.

Association Between Electrocardiographic Left Atrial Enlargement and Echocardiographic Left Atrial Indices Among Hypertensive Subjects in a Tertiary Hospital in South South Nigeria.

Left atrial (LA) enlargement poses a clinically significant risk of adverse cardiovascular outcomes for patients. To maximize the utility of LA size in diagnosis, its accurate measurement using electrocardiogram (ECG) and echocardiogram (ECHO) to assess LA linear diameter and LA volumes is expedient. The LA volumes correlate better than LA linear diameter with diastolic function variables. It is therefore expedient to use LA volumes routinely in assessing LA size as they may detect early and subtle changes in LA size and function. A descriptive cross-sectional study was conducted on 200 adult hypertensive patients attending the outpatient cardiology clinic at Delta State University Teaching Hospital, Oghara, Nigeria, irrespective of blood pressure control and duration of hypertension whether on antihypertensive medications or not. The SPSS version 22 (IBM Corp., Armonk, NY, USA) was used for data management and analysis. There was a significant association between electrocardiographic left atrial (ECG-LA) enlargement and echocardiographic left atrial (ECHO-LA) size (LA linear diameter and LA maximum volume) in the study. Logistic regression analysis showed a significant odds ratio for all associations. With LA linear diameter as standard for assessing LA enlargement, the ECG had a sensitivity of 19%, specificity of 92.4%, a positive predictive value of 51%, and a negative predictive value of 73% in detecting LA enlargement. Using ECHO-LA maximum volume as a standard for assessing LA enlargement, the ECG had a sensitivity of 57.3%, a specificity of 67.7%, a positive predictive value of 42.9%, and a negative predictive value of 79% in detecting LA enlargement. The LA maximum volume showed relatively higher sensitivity and negative predictive values while LA linear diameter showed relatively higher specificity and positive predictive values. A good association exists between ECG-LA enlargement and ECHO-LA enlargement. However, in ruling out LA enlargement on ECG, it is better to use LA maximum volume as a standardrather than the LA linear diameter.

Accessory infraorbital foramen location using cone-beam computed tomography.

Accessory infraorbital foramen (AIOF) can change the normal course of emerging branches of the infraorbital nerve and blood vessels exiting the infraorbital foramen (IOF). This study aimed to examine the AIOF, number of foramina, and their position in relation to IOF using cone-beam computed tomography (CBCT). We performed a retrospective CBCT assessment of hospital records between January 2018 and August 2022. The CBCT of 507 patients were examined to extract information on the prevalence, number, position, linear distance from the IOF, and diameter of AIOF in relation to demographic factors. Descriptive statistics were used to evaluate the prevalence of AIOF. Mean and standard deviation were used to calculate the linear distance and diameter of the AIOF, respectively. The AIOFs, its distribution, and number were compared between sexes and sides using the chi-square test. The independent t-test and Mann-Mann-Whitney test were used to compare the mean difference between the sexes and sides. Statistical significance was set at P < 0.05. In this current study, the prevalence of AIOF was 7.1% (36 of the 507 patients). Additionally, the current study examined the number of foramina using a single foramen on each side and double foramina located bilaterally at a distance from the AIOF to the IOF. The mean AIOF diameter was also studied, and the AIOF position with respect to the IOF on CBCT was superomedial or inferomedial. There were no statistically significant associations between any of the parameters assessed in this study when comparing sex and sides. A greater number of patients with AIOF presented with a single foramen and unilateral occurrence, without a statistically significant difference. The AIOF was most commonly located superomedial to the IOF.

Internal Limiting Membrane Peeling or Inverted Flap Technique Combined with Air Tamponade in the Treatment of Macular Holes in High Myopia

Purpose: The aim of this study was to analyze the anatomical and visual outcomes after internal limiting membrane (ILM) peeling or ILM flap insertion in highly myopic macular holes (HMMHs) and try to compare these two surgical techniques in large HMMHs. Methods: This is a retrospective, consecutive series study of patients with HMMH undergone vitrectomy from September 2016 to January 2021. We observed the outcomes of the HMMHs with ILM peeling and ILM flap insertion, respectively. Binary logistic regression and receiver operating characteristic (ROC) curve were used to analyze the relationship between the minimum linear diameter (MLD) of macular hole and the initial closure rate in ILM peeling group. Finally, we compared the surgical outcomes between these two surgical techniques in large HMMHs. Results: There were 69 HMMHs using ILM peeling with a mean MLD of 423.55 ± 190.99 µm and 33 HMMHs using ILM flap insertion with a mean MLD of 600.79 ± 187.85 µm. The initial type I closure rate was 86.9% (60/69) and 81.8% (27/33), respectively. MLD had a good correlation with the initial closure rate in HMMHs with ILM peeling (p = 0.046). The large HMMH (MLD >461.5 μm obtained by ROC curve) was present in 26 eyes with each surgical technique, and there was no significant difference of baseline characteristics between them. In large HMMHs, the initial closure rate of ILM peeling was 73.0% and that of ILM flap insertion was 84.6% (p = 0.499). Postoperative best-corrected visual acuity (BCVA) improved significantly in both groups (p < 0.001), and the BCVA at last follow-up was better in closed large HMMHs with ILM peeling (p = 0.034). Conclusion: In HMMHs with ILM peeling, the initial closure rate was decreased when MLD >461.5 μm. ILM peeling may obtain better functional prognosis in eyes with closed large macular holes compared with ILM flap insertion.

Photoreceptor Outer Segment Loss at the Macular Hole Border: Clinical Characteristics and Surgical Prognosis

Introduction: During macular hole (MH) formation, the vitreofoveal traction may lead to foveal neural tissue avulsion and consequent photoreceptor loss. However, the clinical significance of the photoreceptor outer segment disruption at the MH border remains unclear. This study aims to investigate the clinical features and surgical outcomes of MHs with photoreceptor outer segment disruption at the MH border. Methods: This study retrospectively reviewed 86 eyes from 85 patients who underwent vitrectomy combined with internal limiting membrane peeling for idiopathic MHs. Baseline and postoperative best-corrected visual acuity (BCVA) and foveal microstructure on optical coherence tomography images were compared between eyes with smooth and bumpy morphology, the latter of which was defined as those with an uneven and irregular surface with evident lumps and indentations at the MH border. Results: The bumpy morphology was identified in 59 of 86 eyes (68.9%). At baseline, eyes with a bumpy MH morphology had a significantly larger minimum linear diameter (p = 0.043), a longer external limiting membrane defect (p = 0.013), and a worse baseline BCVA (p = 0.017) than those with a smooth morphology. Postoperatively, in a multivariate regression model adjusting preoperative confounding effects, eyes with bumpy borders were associated with a longer ellipsoid zone defect (p = 0.006) and a thinner central fovea (p = 0.002) at 1 month, and a thinner central fovea (p = 0.005) and a worse BCVA (p = 0.015) at 10 months. Conclusion: A severe photoreceptor outer segment loss is common at the MH border, which represents a chronic pathogenic process and may be an independent predictor for an incomplete photoreceptor recovery and worse long-term visual outcomes after surgery.

Comparison of air versus perfluoropropane intraocular tamponade combined with vitrectomy for the treatment of macular hole in high myopia.

To compare the efficacy of air and perfluoropropane (C3F8) with pars plana vitrectomy (PPV) in highly myopic macular holes (HMMH), and explore the factors related to surgical prognosis. A retrospective comparison of a consecutive series of HMMHs undergone PPV and internal limiting membrane (ILM) peeling. According to tamponade type, they were divided into air group and C3F8 group, which were further divided into subgroups based on hole diameter or axial length (AXL). Anatomical and functional outcome were compared between tamponades. Related factors of initial closure rate and postoperative best-corrected visual acuity (BCVA) were analyzed by logistic regression. The baseline characteristics in air group (n=63) and C3F8 group (n=37) were similar except the age of air was older (P=0.019). The mean follow-up period was 17.16 ± 17.97 months. After surgery, the initial closure rate of air group was 85.7% and that of C3F8 group was 83.7% (P=0.780). And the initial closure rate showed no difference between tamponades in the same subgroup classified by hole diameter or AXL (All P>0.05). Postoperative BCVA improved significantly in both groups (P<0.001), but no difference between them (P=0.793). Logistic regression showed age, MLD and AXL were risk factors of initial closure rate, and preoperative BCVA was the only factor associated with postoperative BCVA (all P<0.05). With a long-term follow-up of HMMH, we found air had a similar tamponade effect anatomically and functionally compared with C3F8. Air may also be a good choice for patients with HMMH.

Novel En Face OCT-Based Closure Patterns in Idiopathic Macular Holes

To determine the postoperative en face OCT pattern of closure in idiopathic macular holes (MHs). Retrospective, multicentric, observational study. Patients aged > 18 years with a diagnosis of idiopathic MH, with well documented en face OCT images. Baseline characteristics and preoperative OCT and en face OCT parameters like horizontal and vertical minimum linear diameter (MLD), horizontal and vertical basal hole diameter (BHD), hole height, acircularity index, and hole orientation were measured. The type of hole closure on en face OCT, and a comparison of baseline parameters and final visual acuity among the en face closure types. A total of 64 eyes of 62 patients (24 men and 40 women) with a mean age of 63.8 ± 12.4 years. The median duration of symptoms was 3 months (interquartile range, 1.75-10.5). The eyes had a mean baseline visual acuity of 0.97 ± 0.46 logarithm of minimum angle of resolution (logMAR). The baseline horizontal MLD was 591.7 ± 219.4 μm and the vertical MLD was 552.9 ± 198.2 μm. Baseline horizontal and vertical BHD were 1240.3 ± 521.1 μm and 1142.1 ± 478.1 μm, respectively. The mean hole height was 394.8 ± 123.2 μm. Two different patterns were noted on en face OCT: round, or linear. A total of 38 eyes had a round/centripetal closure and 26 eyes had a linear closure (17 eyes had a horizontal closure, 7 eyes had an oblique closure, while 2 eyes had a vertical closure). The mean final visual acuity was 0.80 ± 0.43 logMAR (Snellen equivalent of 20/125). Eyes with linear closure (0.76 ± 0.23 logMAR) had a significantly (P= 0.03) better visual acuity than the round closure group (1.07 ± 0.28 logMAR), only in eyes with horizontal MLD of > 650 μm, but not when other MLD cut-offs were used. We describe 2 different patterns of hole closure (linear and round) on en face OCT. Further studies will be required to determine its functional significance. Proprietary or commercial disclosure may be found after the references.

Fovea sparing internal limiting membrane peeling for idiopathic macular holes-Report of unfavourable outcomes of a surgical technique.

To describe the outcomes of fovea-sparing internal limiting membrane peeling for idiopathic macular holes. This was a prospective, interventional case series in patients with idiopathic macular holes. Patients underwent fovea-sparing internal limiting membrane (ILM) peeling with the help of a finesse loop. The primary outcome measure was successful anatomical closure. Secondary outcome measures were postoperative improvement in best corrected visual acuity (BCVA) or any surgical complications. The study included 22 eyes of 22 patients (median age of 61 (IQR 58 to 66) years). The median basal diameter of the holes was 1054 (IQR 961.5 to 1278) microns, while the median minimal linear diameter was 697 (IQR 461.5 to 786) microns. Successful anatomic closure was achieved in nine cases out of 22 (40.9%). BCVA improved from 20/125 preoperatively to 20/80 at the end of the follow-up. There was no difference in baseline parameters between eyes with closure, versus eyes with an open hole. One eye had an iatrogenic break in an attempt to reinitiate peeling and create a fovea-sparing flap. One of the eyes had an ERM formation at end of 3 months. Our outcomes of fovea-sparing ILM peeling in idiopathic macular holes were unfavourable. The residual ILM could be causing tangential traction resulting in non-closure.

TREATMENT OF PERSISTENT MACULAR HOLES WITH HEAVY SILICONE OIL.

To determine anatomical success and best-corrected visual acuity after secondary surgery with heavy silicone oil tamponade in patients with persistent full-thickness macular holes. In this retrospective study, 63 eyes with persistent full-thickness macular holes after primary pars plana vitrectomy and internal limiting membrane peeling underwent secondary surgery with heavy silicone oil tamponade. Macular spectral domain optical coherence tomography and best-corrected visual acuity measurements were performed during the follow-up. Fifty of 63 eyes (79.4%) achieved anatomical success. In eyes achieving anatomical success, best-corrected visual acuity before primary vitreoretinal surgery was significantly better (0.77 [∼20/125 Snellen] ± 0.24 [1.3-0.3] logarithm of the minimum angle of resolution) compared with eyes not achieving anatomical success (0.88 [∼20/160 Snellen] ± 0.17 [1.1-0.6] logarithm of the minimum angle of resolution, P = 0.044). Minimum linear diameter of full-thickness macular holes was significantly smaller in eyes achieving anatomical success, both before primary (403.4 ± 128.7 [199.0-707.0] µ m vs. 568.1 ± 209.1 [307.0-953.0] µ m, P = 0.009) and secondary surgery (464.1 ± 215.0 [178.0-1,521.0] µ m vs. 663.3 ± 228.5 [451.0-1,301.0] µ m, P = 0.010). Patients remaining phakic during all three surgeries did not benefit from best-corrected visual acuity improvement, although anatomical success was achieved. Heavy silicone oil tamponade in secondary surgery for persistent full-thickness macular holes is a safe and efficient surgical method. Best-corrected visual acuity and minimum linear diameter before surgery may be indicators for anatomical success.

Analysis of progression rate of idiopathic macular hole and optimal cut‐off for baseline minimum linear diameter and base diameter

AbstractPurpose: To determine the cut‐off points of minimum linear diameter (MLD) and base diameter (BD) at which the progression rate of idiopathic macular hole (MH) decreases before vitrectomy.Methods: This retrospective study compared optical coherence tomography (OCT) taken at baseline and on operation day for patients with stage 2, 3, and 4 idiopathic MH to determine the changes in MLD, BD, height, and MH index. The idiopathic MH progression rate was calculated by dividing each difference in OCT parameters by the time interval.Results: A total of 244 eyes of 235 patients were included. The average age of the patients was 64.12 ± 7.69 (40–85) years. The average time interval from baseline to operation was 36.65 ± 25.20 (7–197) days. Unclosed MHs were found in 14 eyes (5.7%). The progression rate obtained through simple linear regression decreased as the baseline MLD and BD increased (p = 0.044 and p = 0.002, respectively). The optimal cut‐off points obtained through piecewise regression were 295.0 μm for MLD and 414.0 μm for BD.Conclusions: In idiopathic MH with MLD &lt; 295.0 μm or BD &lt; 414.0 μm, the progression rates of MLD and BD were significantly faster. It would ultimately be beneficial for visual prognosis to perform vitrectomy without delay in patients with idiopathic MH with an MLD &lt; 295.0 μm or BD &lt; 414.0 μm.

Multi-layer internal limiting membrane plug technique for management of large full-thickness macular holes

BackgroundTo evaluate the efficacy of the multi-layer internal limiting membrane plug (MIP) technique in promoting the closure of large full-thickness macular holes (FTMH) and improvement of visual function.MethodsA prospective interventional non-comparative consecutive case series including patients with surgically naïve large FTMH whether primary or secondary. All macular holes were > 400 µm. All patients had 23-gauge pars plana vitrectomy (PPV), MIP technique, and sulfur hexafluoride (SF6) 20% gas tamponade. The main outcome measures were the closure of the hole, improvement of best-corrected visual acuity (BCVA), and detection of complications that might develop due to surgery.ResultsThe study included 15 eyes of 15 patients. The mean age was 44 years (range 10–68; SD 21.5). Primary FTMH constituted 53% of cases. The mean pre-operative minimum linear diameter (MLD) was 702 µm (range 401–1068 µm; SD 154). The mean duration of the macular hole was 6 months (range 1–24; SD 6). The mean pre-operative BCVA was 0.06 decimal units (range 0.01–0.1; SD 0.03). Post-operatively, the macular hole was closed in all patients. U- and V- type closure developed in 93% and 7% of patients, respectively. None of the patients developed W-type closure. Post-operatively, the mean post-operative BCVA was 0.2 decimal units (range 0.05–0.5; SD 0.1). The mean improvement was 5 lines of vision. The mean postoperative follow-up period was 4 months (range 1–10; SD 2.5). None of the patients developed complications attributed to the surgical technique described.ConclusionMIP technique is effective in promoting macular hole closure and improvement of visual function in large FTMH.

Clinical and Multimodal Imaging Features of Choroidal Nevi in the Korean Population.

Choroidal nevus is a precursor of choroidal melanoma. Multimodal imaging has become vital in predicting the malignant transformation of choroidal nevi. This single-center, retrospective study analyzed clinical characteristics and multimodal imaging findings of 168 choroidal nevi (164 patients) of the Korean population. The mean age at presentation was 50 ± 15 (range, 13-85) (women, n = 88 [53.7%]). Choroidal nevi (melanotic, n = 164 [97.6%]; postequatorial, n = 160 [95.2%]) were densely located between the optic disc and foveola (65.5%). The mean maximum linear basal diameter on fundus photography and thickness on optical coherence tomography were 2.97 ± 1.51 mm and 521 ± 297 μm, respectively. On ultrasonography, the mean thickness was 0.87 ± 0.60 mm. Choroidal nevi in women were associated with a higher maximum linear basal diameter (3.23 ± 1.65 vs. 2.68 ± 1.21 mm; p = 0.033) and age at diagnosis (52 ± 14 vs. 47 ± 16 years; p = 0.046) than those in men. Choroidal nevi with associated subretinal fluid (23.2%) presented with larger basal diameter (p = 0.049) and thickness on B-scan and optical coherence tomography (p &lt; 0.001), but a younger age at diagnosis (p &lt; 0.001) than those of dry nevi. This multimodal imaging study of choroidal nevi revealed some distinct characteristics, including topographic distribution, sex-related differences, and a younger age at diagnosis of nevi with fluid.

Olive and green tea leaves extract in Pleurotus ostreatus var. florida culture media: Effect on mycelial linear growth rate, diameter and growth induction index

The exponential disposal of agro-industrial wastes onto the environment has endangered all forms of life. The implementation of these wastes in mushroom production is an eco-friendly and promising solution. The effect of olive and tea leaves extracts represented in culture media treatments: potato dextrose agar (PDA) 80% + tea extract (TE) 20% (T2), PDA 80% + olive extract (OE) 20% (T3), PDA 80% + OE 10% + TE 10% (T4), PDA 70% + OE 20% + TE 10% (T5) on mycelial growth diameter (MGD) and linear growth rate (MLGR) of Pleurotus ostreatus var. florida was compared to the one of PDA used as control (T1) at 22, 25 and 28°C inoculation temperatures. Optimum MGD was observed at 28°C in T1 (day 2), while it was significantly increased by 1.1–1.4 folds (days 4, 6, 8) in culture media containing plant extracts nevertheless the inoculation temperature. MLGR was improved by 102%–145% in olive/tea culture media compared to PDA nevertheless the inoculation temperature. Optimum growth induction index (GII) was observed in T3 (22.2%) at 22°C, T5 (21.9%) at 25°C and T4 (18.2%) at 28°C. These findings suggest the combination of olive and tea leaves extracts in the production of Pleurotus ostreatus.

Impact of Race and Ethnicity on Presentation and Surgical Outcomes of Idiopathic Macular Holes.

There is limited data on the presentation and surgical outcomes of idiopathic macular holes (IMH) for different ethnic and racial groups. Recognition of distinct, clinically-relevant patient subgroups may provide opportunities to identify specific unmet needs including possible barriers to optimal healthcare delivery. Medical records of patients who underwent surgery for IMH (between 2016 and 2022) at a large, urban retina practice were reviewed and self-reported ethnicity (Hispanic and non-Hispanic) and race (Asian, Black, White, and Other) were captured. The primary variables included (1) mean minimum linear diameter (MLD) at presentation and (2) surgical outcome (IMH closure status). Overall, mean MLD for all study eyes (515) was 366.1 μm, and surgical success was achieved in 489 (95.0%) eyes. Hispanic eyes presented with larger mean MLD (p = 0.002) compared to non-Hispanic eyes. Asian, Black, and Other eyes presented with larger mean MLD (p = 0.033, p < 0.001, p < 0.001) when compared to White eyes. The presentation of IMH varied in severity among different ethnic and racial groups. Hispanic patients were found to have worse preoperative visual acuity (VA), longer time to surgery, and larger mean MLD and BD compared to non-Hispanic participants. Black and Other patients were found to have worse VA, time to surgery, and larger mean MLD and BD when compared to White participants.

Commentary: To evaluate the functional and anatomical outcomes for autologous retinal autograft with Finesse™ Flex Loop for failed macular holes.

Commentary: To evaluate the functional and anatomical outcomes for autologous retinal autograft with Finesse™ Flex Loop for failed macular holes.

Observation of macular hole associated with retinoschisis in patients with high myopia.

To observe the characteristics of highly myopic macular holes (HMMHs) with macular retinoschisis (MRS) by optical coherence tomography (OCT) and explore the possible relationship between HMMHs and different types of MRS. We consecutively reviewed the clinical data and OCT images of the patients with HMMHs from June 2015 to February 2021. Then we picked eyes with MRS from these HMMHs for analysis. The minimum linear diameter (MLD), basal diameter (BD), and height (H) of HMMHs were measured. HMMHs were grouped according to the extent or layer involvement of the concomitant MRS and the characteristics were compared among groups. The impact of MRS on the MLD of macular hole was analyzed with multivariable linear regression. We included 127 patients with MRS from 168 HMMHs (75.5%) for analysis. According to the different classification systems, the most frequent type of MRS in HMMHs was S3 (foveal but not entire macular area MRS) (62.2%) and both inner- and outer- (I/O-MRS) involved types. In our study, HMMHs with more extensive MRS had larger MLD, larger BD, larger H, and poorer best-corrected visual acuity (BCVA). Meanwhile, HMMHs with outer layer-involved MRS (outer MRS and I/O-MRS) had larger BD than HMMH with only inner layer-involved MRS. (All P < 0.05) Multivariable linear regression further illustrated only the extent of MRS was significantly associated with the MLD of HMMH, while there was no significant correlation between the involved retinal layers and the MLD of HMMH. HMMH with MRS presented as a predominant type in HMMHs. The MRS was always with a relatively large extent and involved both inner and outer layers. MLD of HMMH was mainly affected by the extent of MRS.

Prevalence and Area of Retinal Pigment Epithelium and Outer Retinal Atrophy in Eyes with Non-Exudative Macular Neovascularization

Purpose: The objective of this study wasto assess the prevalence of complete retinal pigment epithelium (RPE) and outer retinal atrophy (cRORA) in patients with unilateral exudative age-related macular degeneration (AMD) of the fellow eye and establish if the presence of non-exudative macular neovascularization (NE-MNV) influences the prevalence of RPE and outer retinal atrophy in eyes with AMD. Methods: This is an observational cross-sectional study of 68 patients with unilateral exudative AMD. Demographic and clinical data were collected, and multimodal retinal imaging was performed in all patients. Two groups of patients were defined according to the presence (NE-MNV) or absence (no NE-MNV) of NE-MNV in the study eye. We compared the prevalence of tomographic cRORA and fundus autofluorescence (FAF) geographic atrophy (GA) and differences in cRORA greatest linear diameter (GLD) and GA area between groups. Results: Globally, cRORA was present in 11 eyes (16.2%), FAF GA was present in 10 eyes (14.7%), and NE-MNV was present in 10 eyes (14.7%) of patients with unilateral exudative AMD of the fellow eye. The overall cRORA GLD was 1,950.64 ± 1,428.31 μm, and the mean area of GA was 9.25 ± 7.50 mm². Regarding comparisons between groups, cRORA was present in 9 eyes (15.5%) without NE-MNV and in 2 eyes (20%) with NE-MNV (p = 0.66). Tomographic signs of atrophy were more frequent in eyes with NE-MNV (50% vs. 24.1% in eyes without NE-MNV; p = 0.008). No significant differences were found in cRORA GLD (p = 0.30) between groups. Eyes with NE-MNV and eyes without NE-MNV had a similar prevalence of FAF GA (2 eyes out of 10 and 8 eyes out of 58, respectively; p = 0.64). Eyes with NE-MNV had a smaller mean area of GA (2.07 ± 0.24 mm² vs. 11.05 ± 7.34 mm²; p = 0.01). Conclusion: In our study, the presence of NE-MNV was not associated with the prevalence of cRORA and/or FAF GA. Nonetheless, eyes with NE-MNV presented smaller areas of GA, which suggests that this type of neovascularization may prevent the progression of RPE and outer retinal atrophy. Longitudinal studies are required to confirm these preliminary results.

Relationship between Blood Pressure Variables (Systolic Blood Pressure, Diastolic Blood Pressure, Pulse Pressure, and Mean Arterial Pressure) and Left Atrial Measurements Among Hypertensive Subjects in a Tertiary Hospital in South-South Nigeria

Background: Hypertension is known to impact significant changes on the heart causing left ventricle diastolic dysfunction which precedes a sequel of anatomical and functional changes in the left atrium. Since hypertension remains the leading cause of diastolic dysfunction in the heart, it is expedient to determine how changes in the blood pressure of patients relate to measures of left atrial (LA) indices. Aims and Objectives: to determine how changes in blood pressure parameters relate to measures in LA indices. Materials and Methods: The study was a descriptive cross-sectional appraisal of 200 hypertensive patients and 100 normotensive controls (matched for age and sex in a 2:1 ratio) using electrocardiography and echocardiography. Participants were recruited from the cardiology clinics in Delta State University Teaching Hospital (DELSUTH), Oghara. Results: The mean age of the study population was 58.7 ± 13.96 (58.42 ± 13.29 for hypertensives and 59.26 ± 15.27 for controls) years, while the median age was 59 years. The female-to-male ratio was 1.06 among cases and 1.27 among the controls. The LA size (volumes and linear diameter) was significantly larger in the hypertensive group compared to the control arm. LA maximum volume correlated significantly with average systolic blood pressure, pulse pressure, and mean arterial pressure. LA pre A wave volume and LA minimum volume correlated significantly with average systolic blood pressure and pulse pressures. Conclusion: Hypertensive patients have larger LA volumes than normotensive controls. The size of the left atrium relates positively with blood pressure variables.

Influence of Race, Ethnicity, and Socioeconomic Factors in Idiopathic Macular Hole Presentation and Surgical Outcomes.

To characterize the influence of race, ethnicity, and socioeconomic factors on idiopathic macular hole (IMH) presentation and surgical outcomes. This retrospective cohort study of patients diagnosed with IMH who underwent surgical repair collected IMH data from optical coherence tomography scans as well as demographic information. Univariate and multivariate regression models interrogated relevant relationships. Of 292 eyes analyzed, 223 (76.4%) patients were White and 53 (18.2%) were Black. Mean income was $57,076.9 ± 17,794.7. Black patients presented with 0.05 mm2 larger IMH area (95% CI, 0.01 to 0.09; P = .01) and 69.07 µm wider minimum linear diameter (95% CI, 15.05 to 123.10; P = .01). Patients with higher income presented with 3.76 µm narrower base diameter (95% CI, -6.42 to -1.09; P = .006). Black patients were associated with larger IMH at presentation, and higher income patients were associated with smaller IMH. [Ophthalmic Surg Lasers Imaging Retina 2022;53(6): 333-344.].

Proof-of-Concept Analysis of a Deep Learning Model to Conduct Automated Segmentation of OCT Images for Macular Hole Volume

To determine whether an automated artificial intelligence (AI) model could assess macular hole (MH) volume on swept-source optical coherence tomography (OCT) images. This was a proof-of-concept consecutive case series. Patients with an idiopathic full-thickness MH undergoing pars plana vitrectomy surgery with 1 year of follow-up were considered for inclusion. MHs were manually graded by a vitreoretinal surgeon from preoperative OCT images to delineate MH volume. This information was used to train a fully three-dimensional convolutional neural network for automatic segmentation. The main outcome was the correlation of manual MH volume to automated volume segmentation. The correlation between manual and automated MH volume was R2 = 0.94 (n = 24). Automated MH volume demonstrated a higher correlation to change in visual acuity from preoperative to the postoperative 1-year time point compared with the minimum linear diameter (volume: R2 = 0.53; minimum linear diameter: R2 = 0.39). MH automated volume segmentation on OCT imaging demonstrated high correlation to manual MH volume measurements. [Ophthalmic Surg Lasers Imaging Retina. 2022;53(4):208-214.].