Macular Area Research Articles

Dickkopf 1 and Neuregulin 1 as cutaneous biomarkers for dermal pigmentation activity in acquired dermal macular hyperpigmentation (ADMH): a case control study.

Lichen planus pigmentosus (LPP), ashy dermatosis, and Riehl's melanosis are all referred to by the general term acquired dermal macular hyperpigmentation (ADMH). These conditions are distinguished clinically by hyperpigmented macules and patches of unknown cause. Melanogenesisis regulated by multiple dermal factors secreted by fibroblasts and among them are neuregulin1 (NRG1) and dickkopf1 (DKK1). This study was designed to study NRG1 and DKK1 as cutaneous biomarkers for activity of dermal pigmentation in ADMH and to correlate their activity with acquired dermal macular hyperpigmentation area and severity index (DPASI) score. A total of 35 clinically diagnosed ADMH patients and 10 healthy controls along with 4 positive controls of melasma patients were included in the study and DPASI score was calculated using Dermlite (DL4) dermatoscope to assess the disease severity. Skin biopsy samples were taken and immunofluorescence and qPCR were performed to measure the expression of NRG1 and DKK1. A correlation of NRG1 expression, DKK1 expression with DPASI score was assessed. NRG1 expression had a linear positive correlation with DPASI score with a correlation coefficient (r = 0.97) (p < 0.001), while DKK1 showed an inverse correlation with a correlation coefficient (r=-0.69) (p < 0.001). NRG1 and DKK1 expression regulates pigmentation in ADMH and they can be used as an objective tool to assess the disease activity and probably guide therapy.

Real-world outcomes of Voretigene Neparvovec: a single-centre consecutive case series.

To present functional and anatomical outcomes of subretinal therapy with Voretigene Neparvovec (VN) in patients treated in one of the four specialist UK gene therapy centres. Single-centre, retrospective case series of patients affected by an inherited retinal dystrophy (IRD) caused by a pathogenic biallelic RPE65 mutation and treated with VN. Complete ophthalmic examination was planned preoperatively and 2, 4 and 8 weeks and 3, 6, 12, 18 and 24 months after surgery, and included visual acuity (VA) assessment (normal and low luminance), colour vision, contrast sensitivity, dark-adapted full-field stimulus threshold, macular optical coherence tomography (OCT) and fundus autofluorescence. Fourteen eyes of 8 patients were included with a mean follow-up of 26 months. Mean final VA improved by 2 lines, and improvements were noted in most other functional tests. Central retina thickness (CRT) remained fairly stable in the majority of patients, whereas 2 eyes experienced a reduction >30 μm. The status of ellipsoid band and external limiting membrane remained stable in all patients, except one. Peripapillary atrophy (PPA) was present in 5 eyes of 3 patients at the baseline; postoperative progression was noted in both eyes of one patient. No patient developed new PPA or chorioretinal atrophy (CRA) involving the macular area after treatment. Five eyes of 3 patients developed CRA at the retinotomy site, that progressed in 3 of them. Our study confirmed the effectiveness of subretinal VN therapy in terms of improvement of visual function. CRA was confirmed as a common postoperative complication, with limited functional impact.

Optical coherence tomography angiography in patients with focal epilepsy

PurposeThis study aims to compare optical coherence tomography angiography (OCTA) data in individuals with focal epilepsy and healthy individuals and to investigate the effect of antiseizure medications (ASM) on OCTA data.MethodsWe examined 48 consecutive patients with focal epilepsy and 46 healthy controls. Area and skeleton density of superficial and deep capillary plexuses in the macular area and peripapillary radial capillary plexus were measured.ResultsIn general, no differences in OCTA parameters were found between groups of individuals with epilepsy and healthy individuals. A comparison of individuals with epilepsy with and without comorbid major depressive disorder revealed no differences in OCTA data. However, the area and skeleton densities of the perfused capillary retinal vascular bed in the macular region showed a negative association with the use of valproates and modifiers of the presynaptic release machinery, whereas only the skeleton density of the deep capillary plexus showed a positive association with the use of modulators of voltage-gated sodium channels.ConclusionOCTA revealed different effects of various ASM groups on the perfused macular capillary bed. These findings suggest that OCTA parameters could serve as potential biomarkers for assessing ASM effects on small vessels and capillaries in the brain.

Comparing structural and vascular parameters between advanced pseudoexfoliation glaucoma and primary open angle glaucoma using optical coherence tomography angiography

BackgroundTo compare structural and vascular parameters between advanced pseudoexfoliation glaucoma (PXG) and primary open-angle glaucoma (POAG).MethodsOne hundred and six eyes of 81 patients were enrolled in this cross-sectional study. All patients underwent complete ophthalmic examination and measurement of the thickness of the peripapillary retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC). The vessel densities (VD) in the peripapillary and macular area were also determined using optical coherence tomography angiography (OCTA). A linear mixed model was used for the comparison of the structural and vascular parameters between groups with adjustment for type of glaucoma, age, sex, intraocular pressure (IOP), and mean deviation (MD) of the visual field C24-2.ResultsThe patients in the PXG group were significantly older (68.06 ± 10.6 vs. 61.24 ± 15.23, p = 0.01) and had worse MD in the visual field C24-2 (-24.83 ± 6.18 vs. -22.37 ± 5.94, p = 0.04). Sex and IOP were comparable between groups (p > 0.05). Perippaillry RNFL and GCC thickness were not different between groups (p > 0.05). The PXG eyes showed lower VD in the average peripapillary area (32.67 ± 7.78 vs. 37.75 ± 8.87, p = 0.027) and nasal (37.45 ± 9.74 vs. 42.15 ± 7.36, p = 0.026) and inferior (38.09 ± 8.27 vs. 42.71 ± 9.13, p = 0.041) quadrants of parafovea.ConclusionThe advanced PXG and POAG eyes have comparable structural defects in the peripapillary and inner macula while the PXG eyes may have more vascular deterioration, especially in the macula.

Detection of macular and peripheral ocular microvascular changes after carotid artery revascularization using widefield SS-OCTA.

This study aims to investigate microvascular changes in the macular and peripheral regions, as well as alterations in the foveal avascular zone (FAZ) of the ipsilateral eye using widefield swept-source optical coherence tomography angiography (SS-OCTA) in patients with severe carotid artery stenosis (SCAS) after carotid artery revascularization (CAR). This study employed a prospective study design. SCAS patients were examined using widefield SS-OCTA, which covered an area of 16 × 16 mm centered on the fovea. These examinations were conducted both before and after CAR to assess changes in retinal and choroidal blood flow in the macular and peripheral regions, as well as alterations in the characteristics of the FAZ. A total of 56 patients and their corresponding 56 ipsilateral eyes were included in this study. In the macular area, a significant increase in the vessel density of the retinal superficial vascular complex (VDRSVC) was found, while a significant decrease was noted in the vessel density of the retinal deep vascular complex (VDRDVC) after CAR. Additionally, both the area and circumference of the FAZ decreased significantly after CAR. In the peripheral regions, significant increases were detected in both VDRSVC and the three-dimensional choroidal vascularity index (3D-CVI) post-CAR. The findings of this study demonstrated that CAR can improve perfusion in both the macular and peripheral fundus and lead to a decreased area and circumference of the FAZ in the ipsilateral eye. The observed decrease in the VDRDVC after CAR may be attributed to microvascular embolization and ischemia within the deep capillary plexus (DCP).

H syndrome with bilateral choroidal osteoma: Coincidence or association?

To report a case with bilateral corneal arcus and bilateral choroidal osteoma associated with H syndrome. Descriptive case report. A 16-year-old girl with H syndrome was followed up in the pediatric nephrology clinic for chronic renal failure and was consulted to the ophthalmology clinic. She had low vision for more than 5 years. Slit lamp examination revealed bilateral corneal arcus . Lens and iris were normal. Axial length was 19.99 mm in the right eye and 21.85 mm in the left eye. A bilateral orange-yellow plaque was noted in the posterior pole in the funduscopic examination. Fundus autofluorescence (FAF) showed a bilateral diffuse macular hipoautofluorescence area in correspondence with the decalcified portion of the mass. Optical coherence tomography (OCT) showed a bilateral choroidal mass with a dome-shaped pushing effect on the overlying retina and damage to the outer layers of the retina. Fluorescein angiography (FA) with bilateral patchy diffuse late hyperfluorescence and B scan ultrasonography showed a bilateral solid highly reflective choroidal mass with acoustic shadowing. Orbital computerized tomography (CT) scans showed bilateral hyperdense plaques in the posterior pole. A diagnosis of choroidal osteomas was made for both eyes. This report presents a case with bilateral corneal arcus and bilateral choroidal osteoma associated with H syndrome that has not been previously reported in the literature. Patients diagnosed with this syndrome should undergo routine eye examination, and due to the progressive nature of histiocytosis, they should also be followed closely ophthalmologically.

Fundus Photography-Based Distribution of Retinal Hemorrhages in Newborns: Implications for Underlying Mechanisms.

Introduction: The aim of this study was to investigate the locational distribution and potential mechanisms of retinal hemorrhages in newborns using fundus photography. Methods: A retrospective analysis of 98 consecutive newborns with retinal hemorrhages in at least one eye and 30 control newborns without retinal hemorrhages after uneventful delivery was conducted. Retinal hemorrhages were diagnosed and characterized using fundus photography and indirect ophthalmoscopy. The location, grade, and features of the hemorrhages were analyzed, alongside their association with delivery mode. Visual function was assessed at a mean follow-up of 7.8 months to evaluate the long-term implications. Results: Retinal hemorrhages were significantly associated with normal spontaneous vaginal delivery (NSVD) compared to cesarean section (p = 0.004). Bilateral involvement was observed in 87.8% of cases, with hemorrhages predominantly located around the major vascular arcade (MVA) and near the optic disc. Higher grades of hemorrhages were linked to increased involvement of the macula and retinal capillary area (RCA) (p < 0.001). All hemorrhages resolved spontaneously within 45.6 ± 15.9 days. No significant differences in refractive errors or strabismus development were identified between the hemorrhage and control groups at follow-up. Conclusions: Neonatal retinal hemorrhages are commonly observed near the MVA and optic disc, with greater severity associated with macular and RCA involvement. These findings, along with the significant association with NSVD, support a mechanism related to elevated central venous pressure. Retinal hemorrhages resolve spontaneously without impacting refractive error or strabismus development in the short term follow-up.

Choroidal thickness and vascular density after rhegmatogenous retinal detachment.

To study choroidal thickness (CT) and luminal areas of choroidal vessels in the setting of fovea-off rhegmatogenous retinal detachment (RRD). Twenty-seven eyes with RRD were prospectively studied before and after pars plana vitrectomy and SF6 tamponade, using swept-source optical coherence tomography (SS-OCT). CT was measured pre- and postoperatively both subfoveally and in attached macular areas. Postoperatively, the CT in previously detached or attached Early Treatment Retinopathy Diabetic Study (ETRDS) macular areas and the choroidal luminal areas were assessed. The preoperative median subfoveal CT of 260 μm (interquartile range (IQR) = 151) was significantly reduced to 200 μm (IQR = 110) 1 month postoperatively (p < 0.001). Corresponding to attached macular areas, the preoperative median CT of 184 μm (IQR = 116) was significantly reduced to 155 μm (IQR = 103) 1 month postoperatively (p = 0.03). No significant changes in CT occurred from 1 to 12 months postoperatively, either in previously detached, median 163 μm (IQR = 74) to 173 μm (IQR = 127), (p = 0.484), or in attached, 148 μm (IQR = 110) to 159 μm (IQR = 142), (p = 0,766) EDTRS areas. Median luminal areas of inner choroidal microvasculature and large choroidal vessels were 58.5% (IQR = 1.4) and 61.4% (IQR = 2.2) at 1 month, respectively, and stayed unchanged until 12 months postoperatively. CT reduction 1 month after vitrectomy for fovea-off RRD was more pronounced subfoveally than beneath attached macular areas. This finding could represent a normalization of a subfoveal choroidal swelling due to increased fluid absorption during RRD. From 1 month and onwards, the CT and luminal areas remained unchanged.

Assessment of interocular symmetry of choroidal vascularity index and thickness in patients with systemic sclerosis: a prospective study.

Systemic sclerosis (SSc) affects blood vessels, internal organs, and skin. In ophthalmology, SSc impacts the choroid. The choroidal vascularity index (CVI) measures the vascular component of the choroid and may serve as a biomarker for the disease staging and prognosis. Studies have reported reduced choroidal thickness and altered CVI in SSc, which supports the theory of vascular damage. This study aimed to examine interocular symmetry in choroidal parameters among SSc patients. It has provided the insight into the disease symmetry and assessed the representativeness of examining one eye. This prospective single-center cross-sectional study included 33 patients with SSc and 40 healthy controls. The patients underwent ophthalmological examination (including refraction, visual acuity, IOP, biometry, slit-lamp biomicroscopy, dilated fundus examination, and spectral-domain optical coherence tomography) and rheumatological evaluation. Various parameters of the choroid in the macular and peripapillary regions were analyzed, including choroidal thickness, choroidal volume, and CVI. The interocular asymmetry in the choroidal parameters was quantified using signed and absolute differences. The correlation analysis between the left and right eyes was based on the intraclass correlation coefficient (ICC), Spearman's correlation coefficient, and paired Wilcoxon test. There were no significant differences in the macular and peripapillary choroidal parameters between fellow eyes in both SSc patients and controls (p > 0.05). The parameter that showed the lowest correlation among those examined was CVI-in both groups, as well as in both examined areas. The interocular correlation of choroidal parameters was stronger in the peripapillary area than in the macular area in both groups. In general, the results were confirmed in subgroup analyses stratified according to sex, SSc subtype, Scl70 antibody positivity and previous and/or active digital ulcers. There is interocular symmetry of the choroidal parameters in patients with SSc and controls included in our study. The parameters from one eye are representative of the fellow eye of a given patient. This conclusion may contribute to the design and interpretation of future studies. It also broadens our knowledge of SSc pathophysiology.

Ayurvedic management of age-related macular degeneration – A Case Report

Age-related macular degeneration (ARMD) is a progressive degenerative retinal disease in which there is a gradual progressive decrease in central vision. ARMD is the most common cause of blindness in developed countries mainly affecting the elderly, with a high prevalence among the age group more than 60 years. There are two forms of macular degeneration, dry/nonexudative and wet/exudative, and these differ in fundal findings and treatment options. Dry macular degeneration is due to accumulation of drusen between the retinal pigment epithelium and Bruch’s membrane and eventually progresses to geographic atrophy. The exudative or wet form represents the most severe form with rapid progression despite therapeutic progress. It is characterized by the development of choroidal neovascularization, crossing the retinal pigment epithelium and developing below the macular area. A diagnosed case of Dry ARMD with complaints of diminished vision in both eyes approached Salakyatantra department of Government Ayurveda Medical College, Tripunithura, and after in-patient treatment significant improvement in vision obtained. Ayurveda treatment seems to have contributed substantially to improved vision and it has an important role in the prevention and further progression of the disease. So, it is necessary to report this case for identification of treatment strategies for the prevention of progression of ARMD.

Genetic Characteristics of 63 Patients with Non-syndromic Retinitis Pigmentosa at a Single Korean Institution

Purpose: To investigate the genetic characteristics of patients with non-syndromic retinitis pigmentosa (RP) analyzed at a single institution.Methods: We conducted a retrospective analysis of 63 patients clinically diagnosed with non-syndromic RP who underwent genetic testing. The clinical features of patients exhibiting the most common mutations, &lt;i&gt;EYS&lt;/i&gt; and &lt;i&gt;USH2A&lt;/i&gt;, were further assessed through routine ophthalmic examinations.Results: Of the 63 patients, 22 (34.9%) exhibited significant mutations. Notably, &lt;i&gt;EYS&lt;/i&gt; and &lt;i&gt;USH2A&lt;/i&gt; mutations were each found in 5 patients (7.9%); &lt;i&gt;RP1&lt;/i&gt; mutations were found in 4 patients (6.3%). The average ages at diagnosis were 38.8 years for &lt;i&gt;EYS&lt;/i&gt; mutations and 41.8 years for &lt;i&gt;USH2A&lt;/i&gt; mutations. The average best-corrected visual acuities were logMAR 0.08 for &lt;i&gt;EYS&lt;/i&gt; mutations and logMAR 0.51 for &lt;i&gt;USH2A&lt;/i&gt; mutations. Both mutation types showed a decrease in the normal macular area in fundus photographs with increasing age. In &lt;i&gt;USH2A&lt;/i&gt; mutations, optical coherence tomography revealed a more pronounced reduction in central macular thickness and central foveal ellipsoid length compared with &lt;i&gt;EYS&lt;/i&gt; mutations. Visual field tests indicated a reduction within the central 10° in 40% of &lt;i&gt;EYS&lt;/i&gt; mutations and 60% of &lt;i&gt;USH2A&lt;/i&gt; mutations. Electroretinography showed non-detectable responses in 2 individuals with &lt;i&gt;EYS&lt;/i&gt; mutations and 4 individuals with &lt;i&gt;USH2A&lt;/i&gt; mutations (40% and 80%, respectively).Conclusions: &lt;i&gt;EYS&lt;/i&gt; and &lt;i&gt;USH2A&lt;/i&gt; mutations represented 45% of the genetically identified cases; affected patients typically were diagnosed in their 40s. &lt;i&gt;EYS&lt;/i&gt; mutations tended to preserve retinal function and central foveal structure better than &lt;i&gt;USH2A&lt;/i&gt; mutations.

Peripapillary and Macular Microvasculature of the Retina in Primary Angle Closure Suspect

Purpose: To compare the macular and peripapillary vascular parameters between the primary angle closure suspect (PACS) eyes and normal control eyes using optical coherence tomography angiography (OCTA).Methods: In this retrospective study, 42 PACS subjects and 38 normal individuals are included. Vessel density (VD) and perfusion density (PD) of the macular area and peripapillary area, and fovea avascular zone parameter were analyzed using OCTA and compared between two groups after adjustment for the axial length.Results: There were no statistically significant differences in sex ratio, age, refractive errors and intraocular pressures between both groups. In the peripapillary area, inferior VD and PD in the outer zone were significantly lower in the PACS eyes, while the retinal nerve fiber layer thicknesses were similar between groups (&lt;i&gt;p&lt;/i&gt; = 0.032, 0.026). In the macular superficial capillary plexus, inferior VD and PD in the inner zone, inferior VD and PD, nasal VD and PD in the outer zone were significantly lower in the PACS eyes, whereas ganglion cell inner plexiform layer thickness were similar between both groups (all &lt;i&gt;p&lt;/i&gt; &lt; 0.005).Conclusions: The VDs and PDs of retinal capillaries in PACS eyes, which have no glaucomatous changes in the retinal nerve fiber layer and optic nerve disc, were significantly lower compared to normal eyes.

The Associations Between Myopia and Fundus Tessellation in School Children: A Comparative Analysis of Macular and Peripapillary Regions Using Deep Learning.

To evaluate the refractive differences among school-aged children with macular or peripapillary fundus tessellation (FT) distribution patterns, using fundus tessellation density (FTD) quantified by deep learning (DL) technology. The cross-sectional study included 1942 school children aged six to 15 years, undergoing ocular biometric parameters, cycloplegic refraction, and fundus photography. FTD was quantified for both the macular (6 mm) and peripapillary (4 mm) regions, using DL-based image processing applied to 45° color fundus photographs. Eyes exhibiting tessellation were classified into two groups: the macular distribution group had greater FTD in the macular area, while the peripapillary distribution group had higher FTD in the peripapillary area, allowing for a comparative analysis of axial length (AL), corneal radius, and refraction. Participants had a median age of 13years and a median spherical equivalent (SE) of -0.75 D. The macular distribution group exhibited significantly larger AL (24.13mm vs. 23.93mm, P < 0.001) and more myopic refraction (-1.13 D vs. -0.75 D, P < 0.001) compared to the peripapillary group. A higher prevalence of macular-distributed FT was noted in the myopic groups (χ2 = 131.675, P < 0.001). SE negatively correlated with macular (r = -0.238) and peripapillary FTD (r = -0.195), while AL positively correlated with FTD in both regions (r = 0.308; r = 0.265) (all P < 0.001). The macular FT distribution pattern is significantly associated with larger AL and greater myopic refraction in school-aged children, suggesting its potential as a marker for identifying children at risk of progressing myopia. DL analysis precisely identifies FT distribution patterns, potentially enhancing early detection of high-risk myopia in populations.

What gass did not say: how many ways to create a macular hole

Thanks to Dr. Gass' proposal for staging macular holes, we could have insights into the pathogenesis and progression of idiopathic macular holes back in the era without optical coherence tomography (OCT). This staging system is based on the foveal appearance, the size of the macular hole, and the presence or absence of vitreous separation as observed through biomicroscopy. According to the staging progression, anteroposterior traction from the posterior hyaloid plays a significant role in the development of a macular hole. Although most of Dr. Gass' descriptions remain relevant after the development of OCT, we have observed some cases of macular holes that do not fit into the Gass’ classification. The International Vitreomacular Traction Study (IVTS) Group has developed a new classification system based on OCT findings, such as macular hole size and the vitreomacular relationship. However, this system still considers partial or complete vitreomacular separation a necessary condition for the development of a macular hole. Interestingly, we have noticed that in some cases, there is no vitreomacular separation at the macular area, whereas in others, the macular hole develops only after posterior hyaloid detachment. These observations suggest that some macular holes might not develop through the classical route described by Dr. Gass. The traction force resulting in macular hole formation may be tangential, originating either from the undetached posterior hyaloid, the internal limiting membrane, or the epiretinal membrane. In this talk, we will explore aspects of the pathogenesis of idiopathic macular holes that Dr. Gass did not say.

Comparative analysis of methods in detecting glaucomatous progression

Aims/Purpose: Glaucoma is an optic neuropathy that, if left untreated, leads to irreversible blindness, making reliable methods for detecting progression essential. Functional damage is assessed by the reduction of the visual field (VF), and structural damage is evaluated by the thinning of retinal parameters. Since 50% of ganglion cells are located in the macular area, their study could be a good indicator of progression. The objective of this work is to evaluate the utility of ganglion cell layer (GCL) analysis using optical coherence tomography (OCT) in diagnosing glaucoma progression.Methods: This is a retrospective cross‐sectional study including 205 eyes with glaucoma followed for at least three years. The progression analysis values obtained from OCT of the GCL and the optic nerve fiber layer (NFL) are compared, taking the VF as a reference and stratifying by severity into mild and moderate‐advanced glaucoma.Results: In mild glaucoma, VF has limitations because functional damage does not occur until there is a 20‐40% loss of ganglion cells. Structural tests classify more cases as progression, and the concordance between them is higher than with VF. OCT of the GCL is the test that classifies progression the most. In moderate‐advanced glaucoma, VF classifies more cases than in mild glaucoma. However, VF is a variable test, influenced by the learning effect, and when damage is very advanced, results can be erroneous because the retina loses sensitivity. OCT of the NFL classifies fewer cases than in mild glaucoma because debris creates a floor effect that artifacts the measurement. OCT of the GCL is the test that classifies progression the most. The concordance is greater between OCT of the GCL and VF.Conclusions: In conclusion, OCT of the GCL may be a better indicator of progression than NFL in both mild and moderate‐advanced glaucoma. It could be a useful strategy in clinical practice for diagnosing glaucomatous progression.References Munuera I, Gándara‐Rodriguez de Campoamor E, Moreno‐Montañes J. Study of the ganglion cell complex of the macula by optical coherence tomography in the diagnosis of glaucoma progression. Arch Soc Esp Oftalmol (Engl Ed). 2024 Apr;99(4):145‐151.

Exploring retinal layer alterations in mild cognitive impairment: A pilot oct study

Aims/Purpose: In the last decades, retinal alterations have been shown by OCT in Alzheimer's disease (AD), initially affecting the macular region in early AD, and subsequently progressing to the peripapillary retina, pointing out this tissue to be considered for diagnosis and follow‐up in AD. This study aimed to investigate retinal changes in patients with mild cognitive impairment (MCI), an intermediate stage between normal aging and AD, to know if in this preclinical stage there are changes in the retina.Methods: Sixteen healthy subjects and 16 MCI patients were included. All participants underwent comprehensive ophthalmic evaluation and macular OCT (SD‐OCT, Heidelberg, Germany) to assess retinal structure. The thickness of each retinal layer in the macular area was measured using the OCT software, with manual verification and modification of segmentation if necessary. Thicknesses of retinal layers, including 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), and retinal pigment epithelium (RPE), were analyzed. The inner and outer macular rings were evaluated according to the standard macular grid of the Early Treatment Diabetic Retinopathy Study (ETDRS). Statistical analysis was performed using two‐way ANOVA with Tukey´s multiple comparison test.Results: Individuals with MCI exhibited significant thinning in the OPL in the inner ring of the superior sector (p &lt; 0.01), along with significant thickening in the ONL in the same area (p &lt; 0.05) compared to controls. Additionally, a trend towards thinning in the inner retinal layers was observed in the MCI group.Conclusions: While in the inner retinal layers it was shown a thinning, it is noteworthy that in the ONL it was shown a thickening. OCT holds promise as a non‐invasive tool for MCI screening. Further research with larger sample sizes is warranted to validate and expand upon these findings.

Structural and vascular density affection of macular and peripapillary areas in patients having multiple sclerosis versus neuromyelitis optica with previous optic neuritis

Purpose The aim of this study was to compare the peripapillary and macular vascular density changes in neuromyelitis optica spectrum disorders (NMOSD) patients to multiple sclerosis (MS) patients with previous history of optic neuritis and to correlate the loss in the retinal nerve fiber layer (RNFL) and the ganglion cell complex (GCC) with the vascular density. Patients and methods This observational cross-sectional retrospective study was carried out on 25 patients divided into two equal groups of eyes (20 eyes of 13 MS patients and 20 eyes of 12 NMOSD patients), aged 18–50 years of both sexes and 11 age-matched and sex-matched healthy individuals as a control group. The patients were evaluated by history taking, neurological examination, Symbol Digit Modalities Test, and ophthalmic examination including best-corrected visual acuity, Goldmann applanation tonometry (adjusted for central corneal thickness), and slit-lamp biomicroscopy, followed by spectral-domain optical coherence tomography, and optical coherence tomography angiography. Results The NMOSD patients were significantly older, with lower Symbol Digit Modalities Test score, more prevalence of temporal disc pallor, larger foveal avascular zone, and with higher Expanded Disability Status Scale compared to the MS patients and the control group (P&lt;0.05). In the deep vascular plexus, the foveal density and the central macular thickness were significantly less in the NMOSD patients (P&lt;0.05), while in the superficial vascular plexus (SVP), the whole image density, foveal density, parafoveal density, parafoveal superior hemi, parafoveal inferior hemi, and perifoveal density were significantly less in the NMOSD patients (P&lt;0.05). In addition, in the radial peripapillary capillary density (RPCD %), the whole image, total peripapillary, peripapillary superior hemi, and peripapillary inferior hemi were significantly less in the NMOSD patients (P&lt;0.05). The average, superior, and inferior RNFL and GCC were significantly thinner in the NMOSD patients compared to the other two groups (P&lt;0.05). In the MS group, there were strong positive correlations between the RNFL thickness and the choriocapillaris flow area, most of the SVP density, and the RPCD parameters, and between the GCC thickness and most of the SVP density parameters and the whole image of RPCD %, while in the NMOSD group, the best-corrected visual acuity was correlated with duration, number of eye attacks, central macular thickness of the deep vascular plexus, most of the RPCD %, all RNFL and GCC parameters. Conclusion Subclinical primary retinal vasculopathy was detected more frequently in the NMOSD than in the MS disease. It has an essential impact on this disease and the Expanded Disability Status Scale may be a useful adjunct for differentiation between NMOSD and MS individuals who developed previous optic neuritis.

Vascular density and metamorphopsia after successful repair of rhegmatogenous retinal detachment. comparison between macula‐on and macula‐off eyes

Purpose: To analyze vascular changes such as the postoperative foveal avascular zone (FAZ) area, the superficial vessel density (sVD) and deep vessel density (dVD) and their correlation with functional (best‐corrected visual acuity, metamorphopsia) and anatomical variables (foveal macular thickness, FMT) after successful repair of a rhegmatogenous retinal detachment (RRD) repair.Methods: Patients with RRD eyes, successfully treated with a single pars plana vitrectomy (PPV) with gas or silicone oil tamponade and a minimum 6 months follow‐up, were re‐examined. For patients where silicone oil was applied, measures were taken after its removal. Foveal avascular zone (FAZ) area, sVD, dVD and FAZ area were evaluated by using optical coherence tomography angiography (OCTA) and compared to fellow eye. Moreover, anatomical association was tested between areas of reported metamorphopsias and vascular changes in the corresponding area.Results: Twenty‐one patients with macula‐on and 24 with macula‐off RRD were included in the study. In both groups, no significant difference in macular thickness and FAZ area was found compared to fellow eyes. In macula‐on RRD eyes, a lower total dVD (p &lt; 0.05) was detected; FAZ area was not related to FMT, and the postoperative BCVA was correlated with FAZ area and dDV (p &lt; 0.05). In macula‐off RRD eyes, lower sDV (p = 0.05), and dVD (p &lt; 0.05, respectively) were observed when compared to fellow eyes. The prevalence of metamorphopsia in macula‐on group was 42.86% (9/21), whereas in macula ‐off this number increased to 62.5% (15/24). For both of these groups we found significant association between sDV and presence of metamorphopsia but only in the inferior paramacular area (p = 0.01).Conclusions: Rhegmatogenous retinal detachment eyes successfully treated with PPV had lower vessel density in the superficial and deep retinal plexus compared to fellow healthy eyes; final BCVA was related to vessel density and FAZ area. Metamorphopsias were also related to superficial vessel density inferiorly of the macula.

Changes of retinal ganglion cell–inner plexiform layer thickness and visual acuity in patients with diabetic macular edema treated with Aflibercept

Background Anti-vascular endothelial growth factor agents have now become the first line of treatment for diabetic macular edema (DME). Changes in the thickness of the individual retinal layers including the ganglion cell–inner plexiform layer (GC–IPL) might serve as a biomarker for the response to treatment. Aim The aim of this study was to evaluate the effect of intravitreal injections of Aflibercept on the average thicknesses of the GC–IPL in naïve eyes and on the visual acuity in patients with DME. Patients and methods This is a retrospective observational study that included 224 naïve eyes of 224 patients having DME. It compared the changes in the GC–IPL thickness at baseline and after receiving three loading doses of Aflibercept followed by as needed protocol for 12 months. All patients had optical coherence tomography imaging at baseline (with GC–IPL thickness measurement) and at the 12-month visit. The change in GC–IPL thickness was measured and was correlated with best-corrected visual acuity. Results During the study duration, a median of five injections of Aflibercept were given. There was a statistically significant decrease in the posttreatment values of the GC–IPL thickness from 89±13 to 84±14.7 µm (P=0.029). Moreover, a statistically significant association was found between the thickness reduction of the GC–IPL in the central macular area and the best-corrected visual acuity (r=0.9, P=0.005, Pearson coefficient=0.26). Conclusion The results of this study suggest that the reduction in the GC–IPL thickness can be used as a prognostic tool for the response to Aflibercept as it was associated with improved visual acuity.

Retinal capillary density in metabolic syndrome and its association with main risk factors of cardiovascular disease

Aims/Purpose: To describe retinal capillary density of normal eyes from patients with metabolic syndrome and to investigate possible associations with main risk factors of cardiovascular disease (smoking, arterial hypertension, dyslipidemia).Methods: This was a prospective cross‐sectional study. We included 214 eyes (clear media, no ocular diseases, no prior surgery or ocular trauma) of 114 patients with metabolic syndrome (median age 54 (49.25, 59.0), male 51 (44.74%), female 63 (55.26%)). Data on ambulatory blood pressure (BP), triglycerides (TG), lipid profile and smoking status were collected. Retinal capillary density at the superficial vascular plexus (SVP) at 6 × 6 mm square of central macular area was measured with a commercial optical coherence tomography angiography OCT‐A (AngioVue®, OptoVue, Framont, CA, USA) system. Linear regression was used to investigate the association of risk factors with capillary density.Results: In the multivariable analysis, older age was associated with sparser retinal vascular density in whole image (β = ‐0.198, p &lt; 0.001), foveal (β = ‐0.264, p = 0.021), perifoveal (β = ‐0.226, p &lt; 0.001) and parafoveal (β = ‐0.153, p = 0.007) areas. Lower capillary density in whole image (β = ‐0.149, p = 0.025) and perifoveal area (β = ‐0.162, p = 0.018) was also associated with higher body mass index in the multivariable analysis. Higher HDL and TG levels were associated with denser retinal capillaries in SVP in whole image (β = 2.064, p = 0.028 and β = 0.847, p = 0.001), perifoveal (β = 2.246, p = 0.023 and β = 0.899, p &lt; 0.001) and parafoveal (β = 2.346, p = 0.047 and β = 0.865, p = 0.024) areas. Systolic and diastolic BP and smoking were not associated with capillary density (p &gt; 0.05).Conclusions: In adults with metabolic syndrome retinal capillary density in SVP was found to be reduced with older age and higher body mass index. Higher HDL and TG concentrations were associated with denser SVP capillaries. The latter results may be the consequence of vasodilatation due to sub‐clinical inflammation.