Macular Patients Research Articles

MACULAR CHANGES FOLLOWING PARSPLANA VITRECTOMY FOR RETINAL DETACHMENT USING OCT

Background: Retinal detachment is the separation of the neurosensory retina (NSR) from the underlying retinal pigment epithelium (RPE). These two layers are derived from neuroectoderm that lines the optic vesicle during embryogenesis. Objective: We compared spectral-domain optical coherence tomography imaging with postoperative visual acuity to evaluate the relationship between morphological changes in the macula and visual outcome after successful repair of RRD with macula off. Patients and methods: We enrolled 30 patients (30 eyes) 21 eyes were phakic (70%) and 9 eyes were pseudophakic (30%). with successful repair of RRD. the examination had been done 1,2,6-months and one year follow up after surgery in this prospective research. The mean age of the patients was 17 to 73 years with mean age value of 44 ± 13.4 years. The duration of retinal detachment (RD) ranged from 1 to 14 weeks with a mean of 6.8± 4.2 weeks. There was history of trauma in 3 cases (10%). The IS/OS line was evaluated considering its continuity and any disruption in the line was measured by manual caliber. The extent of disruption was evaluated in the 5-lines raster scan. In the scan that showed the largest defect, the extent of the IS/OS disruption was measured along a 1.8 mm-diameter area centered on the fovea. Results: SD-OCT was done to all patients post-operatively according to OCT findings, the 30 eyes were divided into three groups; A, B, and C. Group A included all cases with residual subretinal fluid, Group B included cases with other finding rather residual subretinal fluids. Group C included eyes with no detectable OCT findings. There were 8 (26.7%) eyes with retained subretinal fluids (Group A), 18 eyes (60%) with pathology other than Subretinal fluid (Group B), and 4 eyes (13.33%) with no detectable pathology after the operation (Group C) Conclusion: SD-OCT is an irreplaceable instrument for the postoperative assessment of macula in patients who have undergone surgery for macula-off RRD. It permits detection of the presence of foveal changes that are not visible with ophthalmoscope. Persistent sub-retinal fluid is responsible for the poor prognosis after surgery. Although there was a detectable improvement in vision with decrease of the amount of subretinal fluid, Visual prognosis related to other pathological finding as photoreceptors integrity, and presence or absence of Cystoid macular edema.

Assessing the Anatomical and Functional Efficacy of Aflibercept on Wet ARMD: An OCT and Mferg Recording

Objective: To investigate the therapeutic efficacy of aflibercept on sub-foveal choroidal neovascularization due to Age-Related Macular Degeneration (ARMD). Methods: Fifteen patients (15 eyes) with sub-foveal choroidal neovascularization due to ARMD were treated with intravitreal aflibercept. The doses were monthly for the first three months, being repeated every three months after for one year, using 2 mg of intravitreal aflibercept. A total of six aflibercept injections were, finally, performed during the 12-month study. All patients underwent a complete ophthalmic examination, including the measurement of bestcorrected visual acuity, fundus examination, intraocular pressure measurement, fluorescein angiography, optical coherence tomography (OCT) scan and multifocal electroretinography (mfERG) recording, at the baseline and at the first, second, third, sixth, ninth and 12th month after the first injection of aflibercept. Two masked examiners evaluated the visual acuity based on standard Snellen charts. Results: Fifteen patients (15 eyes), of mean age 69.2 ± 4.9 years old, with sub-foveal choroidal neovascularization due to ARMD were participated in this study. The mean BCVA was 0.12 ± 0.08, 0.20 ± 0.10, 0.25 ± 0.1, 0.28 ± 0.1, 0.34 ± 0.14, 0.36 ± 0.14 and 0.40 ± 0.14 decimal, at presentation, 1st, 2nd, 3rd, 6th, 9th and 12th month, respectively. Significant differences in amplitudes but not in latencies of three rings were observed over time. Significant reductions were noted among the central retinal thickness measurements before intravitreal aflibercept and at 1st, 2nd, 3rd, 6th, 9th and 12th month (465.0 ± 161.4, 374.9 ± 139.5, 323.3 ± 113.8, 290.3 ± 85, 263.3 ± 69, 243.0 ± 60.6 and 226.9 ± 63.5, respectively). Conclusion: This is the first time that anatomical and functional improvement of the macula in patients with subfoveal choroidal neovascularization due to ARMD was shown objectively, based on OCT and mfERG recordings. In addition, the improvement of visual acuity was noted over time. Our study supports the fact that intravitreal use of aflibercept is safe and effective in treating sub-foveal choroidal neovascularization observed in patients with ARMD

Retraction Note: Central macular thickness in patients with type 2 diabetes mellitus without clinical retinopathy.

An increase in macular thickness due to fluid accumulation in the macula in patients with diabetes mellitus. Optical coherence tomography (OCT) has been shown to be highly reproducible in measuring macular thickness in normal individuals and diabetic patients. OCT can detect subtle changes of macular thickness. The aim of this study is to compare central macular thickness (CMT) of diabetic patients with type 2 diabetes without clinical retinopathy and normal controls, in order to assess possible increased macular thickness associated with diabetes mellitus. Optical coherence tomography (OCT) measurements were performed in 124 eyes of 62 subjects with diabetes mellitus without clinically retinopathy (study group: 39 female, 23 male, mean age: 55.06 ± 9.77 years) and in 120 eyes of 60 healthy subjects (control group: 35 female, 25 male, mean age: 55.78 ± 10.34 years). Blood biochemistry parameters were analyzed in all cases. The data for central macular thickness (at 1 mm) and the levels of the fasting plasma glucose and glycosylated hemoglobin (HbA1c) were compared in both groups. The mean central macular thickness was 232.12 ±24.41 μm in the study group and 227.19 ± 29.94 μm in the control group. The mean HbA1c level was 8.92 ± 2.58% in the study group and 5.07 ± 0.70% in the control group (p=0.001). No statistically significant relationship was found between CMT, HbA1c, and fasting plasma glucose level in either group (p=0.05). Central macular thickness was not significantly thicker in patients with type 2 diabetes without clinical retinopathy than in healthy subjects.

Mineralocortycoid receptor's antagonists in treatment of central serous chorioretinopathy

PurposeTo evaluate the influence of eplerenon on the function and morphology of the macula in patients with central serous chorioretinopathy (CSC).MethodsThe study included 17 eyes in 16 patients with central serous chorioretinopathy treated in the Department of Ophthalmology at the University Hospital in Krakow. There were 13 males, 3 women at the age of 32 to 66 years, mean age 41.71 years. The duration of symptoms was ranging from 4 to 24 months, an average of 8 months. The patients were treated with eplerenone according to the scheme: 25 mg/day for a week, then 50 mg/day by 3 months. The baseline examination and two controls (after 1–1.5 month and after 3–4 months) included best corrected visual acuity, central retinal thickness in optical coherence tomography and visual central disturbances in Amsler test.ResultsThe values for CRT decreased from 367 (± 70) µm to 264 (± 50) µm (the first control) and to 248 (± 50) (the second control), the difference was an average of 112.71 microns (p = 0.00001). The average BCVA improved from 0.61 (± 0.25) to 0.67 (± 0.28) (the first control) and to 0.72 (± 0.28) (the second control). 10 patients (58.8%) reported improvement of Amsler test while in the 7 patients (41.2%) deterioration in central vision stayed unchanged during the first control. During the second control 7 patients (50%) reported improvement of Amsler test while in the 7 patients (50%) deterioration in central vision stayed unchanged.ConclusionsThe results of our observations indicate that eplerenone can provide an alternative treatment CSC especially in cases where there are contraindications for the use of other therapeutic methods such as laser photocoagulation of the retina. Further investigation is needed.

Correlation of structure and function of the macula in patients with retinitis pigmentosa.

To correlate the structure of the macula, as measured by spectral-domain optical coherence tomography (SD-OCT) and function, as measured by microperimetry (MAIA) in patients with retinitis pigmentosa (RP) and relatively good visual acuity. Prospective, cross-sectional, non-intervention study. Patients with RP. Thirty patients with RP and good central visual acuity were identified. Each patient underwent SD-OCT of the macula and microperimetry. The images were overlaid using the custom-designed software. The retinal sensitivity by microperimetry was correlated with corresponding retinal thickness, as measured by the SD-OCT. ELM, COST, and IS/OS junction were scored as intact, disrupted, or absent. Comparing the retinal sensitivity on the MAIA with various measurements on the SD-OCT. The retinal sensitivity on the MAIA showed a significant correlation with total retinal thickness and outer retinal thickness on the SD-OCT. There was no association with either the inner retinal thickness or the choroidal thickness. ORT showed a statistically significant correlation with the anatomical classification of ELM (r=-0.76, P<0.001), IS/OS (r=-0.800, P<0.001), and COST (r=-0.733, P<0.001). This study determined that there was a high correlation of the structure and function of the central macula in patients with RP. These studies are important to establish surrogate markers that can be used as end points for various tests in future therapeutic clinical trials.

Relationship of inferior oblique overaction to macular and subfoveal choroidal thickness

To evaluate the macular and subfoveal choroidal thickness of eyes with inferior oblique muscle overaction (IOOA) using enhanced depth imaging spectral domain optical coherence tomography (EDI SD-OCT). The measurements of macular and subfoveal choroidal thickness obtained by EDI SD-OCT of patients with IOOA (24 patients) were compared with those of age- and sex-matched controls (25 subjects). There were no morphological abnormalities of the macula in patients with IOOA or in control subjects. There were no statistically significant differences in macular and subfoveal choroidal thickness between the eyes with IOOA and the eyes of the control subjects (P > 0.05). When the patients with IOOA were assigned to two distinct groups according to the degree of IOOA, the macular thickness did not differ between groups (P = 0.66), whereas subfoveal choroidal thickness measures were significantly lower in eyes with severe IOOA compared to eyes of the controls (P = 0.01). IOOA has no effect on the morphology and the thickness of the macula. Severe IOOA seems to be related to thinning of subfoveal choroid due to possible external mechanical effect.

Состояние области макулы сетчатки у больных эндокринной офтальмопатией по данным оптической когерентной томографии

<p style="text-align: justify;"><span style="color: #800000;"><span style="font-size: 13.0080003738403px; line-height: 1.538em;"><span style="color: #800000;">https://doi.org/10.31288/oftalmolzh201423743</span></span></span> <p style="text-align: justify;"><span style="color: #800000;"><strong><span style="font-size: 13.0080003738403px; line-height: 1.538em;">Condition of the macula in patients with endocrine ophthalmopathology according to optical coherent tomography</span></strong></span> <p style="text-align: justify;"><strong>S. I. Polyakova, E. V. Ivanitskaya, A. Kajali</strong>

A morphological study of retinal changes in unilateral amblyopia using optical coherence tomography image segmentation.

ObjectiveThe purpose of this study was to evaluate the possible structural changes of the macula in patients with unilateral amblyopia using optical coherence tomography (OCT) image segmentation.Patients and Methods38 consecutive patients (16 male; mean age 32.4±17.6 years; range 6–67 years) with unilateral amblyopia were involved in this study. OCT examinations were performed with a time-domain OCT device, and a custom-built OCT image analysis software (OCTRIMA) was used for OCT image segmentation. The axial length (AL) was measured by a LenStar LS 900 device. Macular layer thickness, AL and manifest spherical equivalent refraction (MRSE) of the amblyopic eye were compared to that of the fellow eye. We studied if the type of amblyopia (strabismus without anisometropia, anisometropia without strabismus, strabismus with anisometropia) had any influence on macular layer thickness values.ResultsThere was significant difference between the amblyopic and fellow eyes in MRSE and AL in all subgroups. Comparing the amblyopic and fellow eyes, we found a statistically significant difference only in the thickness of the outer nuclear layer in the central region using linear mixed model analysis keeping AL and age under control (p = 0.032). There was no significant difference in interocular difference in the thickness of any macular layers between the subgroups with one-way between-groups ANCOVA while statistically controlling for interocular difference in AL and age.ConclusionsAccording to our results there are subtle changes in amblyopic eyes affecting the outer nuclear layer of the fovea suggesting the possible involvement of the photoreceptors. However, further studies are warranted to support this hypothesis.

Baseline Retinal Nerve Fiber Layer Thickness and Macular Volume Quantified by OCT in the North American Phase 3 Fingolimod Trial for Relapsing–Remitting Multiple Sclerosis

Patients with multiple sclerosis (MS) demonstrate thinning of peripapillary retinal nerve fiber layer (RNFL) and decreased macular volume as measured by optical coherence tomography (OCT). To our knowledge, there are no previous reports from a large MS OCT database with strict quality control measures that quantitate RNFL and macula in patients with relapsing-remitting multiple sclerosis. The University of California Davis OCT Reading Center gathered OCT data at baseline as part of the North American phase 3 trial of fingolimod (Gilenya). Average RNFL thickness (RNFLT) and macular volume (TMV) were measured using time domain OCT (TD-OCT). RNFL quadrants, clock hours, and macular subfields were included. With strict quality control and accounting for signal strength differences, scans were categorized as "reduced" or "not reduced" for each field, based on being less than 5th percentile for age-matched controls derived from the normative database in the scanner software. Patients were deemed "abnormal" if at least 1 eye had reduced values for a given parameter. Patients with abnormalities in corresponding RNFL and macular subfields were compared by cross-tabulation. The TD-OCT data were prospectively collected from 939 of the 1,083 trial patients, 712 of whom met all final quality and data inclusion criteria. Of the final cohort, 242 (34.0%) demonstrated reduced (less than 5th percentile) average RNFLT in at least 1 eye. One hundred seventy-eight (25.0%) patients had reduced TMV. One hundred twenty-eight (18.0%) demonstrated both reduced TMV and RNFLT in the same eye, whereas 42 (5.8%) had reduced TMV and RNFLT in both eyes. Of the 242 patients with reduced average RNFL thickness, 128 (52.9%) also had reduced TMV. Fifty patients had reduced TMV in the absence of reduced RNFLT in at least 1 eye, a cohort prevalence of 7.0%. Quadrant and subfield analysis showed a predominance of temporal and inferior RNFL thinning, with inferior macular thinning corresponding best to RNFL thinning. RNFL and macular thinning/volume loss is common at baseline in relapsing-remitting multiple sclerosis, as measured by TD-OCT. When the RNFL is thin, the macular volume is reduced in more than half of the patients. There is a population of reduced TMV without any reduction in RNFLT. Documenting the prevalence and distribution of these structural abnormalities supports recent reports and suggests new retinal areas to probe for functional vision changes in MS.

Electroretinography combined with spectral domain optical coherence tomography to detect retinal damage in shaken baby syndrome

In order to correlate anatomical changes with visual function in shaken baby syndrome, we performed electroretinography and spectral domain optical coherence tomography on a 2-month-old girl and a 9-month-old girl after the retinal hemorrhages absorbed. Both patients had significant abnormalities in spectral domain optical coherence tomography images of the macular area. The amplitudes of the focal macular electroretinograms were more severely decreased than those of the full-field electroretinograms. Combining spectral domain coherence tomography with focal macular electroretinograms might better estimate the functional damage to the macula in patients with shaken baby syndrome.

Structural and Functional Assessment of Macula in Patients with High-Risk Proliferative Diabetic Retinopathy Submitted to Panretinal Photocoagulation and Associated Intravitreal Bevacizumab Injections: A Comparative, Randomised, Controlled Trial

Purpose: To compare the efficacy of therapy with panretinal photocoagulation (PRP) and intravitreal bevacizumab (IVB) injections versus PRP alone in patients with high-risk proliferative diabetic retinopathy (HR-PDR) with a 6-month follow-up. Methods: Forty-two patients with HR-PDR were prospectively studied in a randomised, masked, controlled trial. Both eyes of each patient were randomised either to the study group (SG) receiving PRP plus IVB injections or the control group (CG) receiving PRP alone. Mean change in visual acuity (VA), optical coherence tomography-measured foveal thickness (FT) and macular volume (MV) were compared. Results: Intergroup comparisons showed no significant difference in VA while FT exhibited a significant (p < 0.05) difference at 1 month of follow-up and MV was significantly reduced at the 1- and 3-month follow-up. Compared to baseline, VA was significantly worse at all follow-ups in the CG and was stable in the SG. FT increased significantly in the CG from baseline to the 1- and 6-month follow-ups and in the SG, no significant difference was observed. MV was significantly increased in the CG during all follow-up periods. Conclusion: In HR-PDR, using IVB injections as adjuvant treatment to PRP reduces the VA deterioration and results in decreased FT and MV measurements compared to PRP alone.

RETRACTED ARTICLE: Cental macular thickness in patients with type 2 diabetes mellitus without clinical retinopathy

BackgroundAn increase in macular thickness due to fluid accumulation in the macula in patients with diabetes mellitus. Optical coherence tomography (OCT) has been shown to be highly reproducible in measuring macular thickness in normal individuals and diabetic patients. OCT can detect subtle changes of macular thickness. The aim of this study is to compare central macular thickness (CMT) of diabetic patients with type 2 diabetes without clinical retinopathy and normal controls, in order to assess possible increased macular thickness associated with diabetes mellitus.MethodsOptical coherence tomography (OCT) measurements were performed in 124 eyes of 62 subjects with diabetes mellitus without clinically retinopathy (study group: 39 female, 23 male, mean age: 55.06 ± 9.77 years) and in 120 eyes of 60 healthy subjects (control group: 35 female, 25 male, mean age: 55.78 ± 10.34 years). Blood biochemistry parameters were analyzed in all cases. The data for central macular thickness (at 1 mm) and the levels of the fasting plasma glucose and glycosylated hemoglobin (HbA1c) were compared in both groups.ResultsThe mean central macular thickness was 232.12 ±24.41 μm in the study group and 227.19 ± 29.94 μm in the control group.The mean HbA1c level was 8.92 ± 2.58% in the study group and 5.07 ± 0.70% in the control group (p=0.001). No statistically significant relationship was found between CMT, HbA1c, and fasting plasma glucose level in either group (p=0.05).ConclusionsCentral macular thickness was not significantly thicker in patients with type 2 diabetes without clinical retinopathy than in healthy subjects.

Adaptive optics fundus images of cone photoreceptors in the macula of patients with retinitis pigmentosa

BackgroundThe purpose of this study was to examine cone photoreceptors in the macula of patients with retinitis pigmentosa using an adaptive optics fundus camera and to investigate any correlations between cone photoreceptor density and findings on optical coherence tomography and fundus autofluorescence.MethodsWe examined two patients with typical retinitis pigmentosa who underwent ophthalmological examination, including measurement of visual acuity, and gathering of electroretinographic, optical coherence tomographic, fundus autofluorescent, and adaptive optics fundus images. The cone photoreceptors in the adaptive optics images of the two patients with retinitis pigmentosa and five healthy subjects were analyzed.ResultsAn abnormal parafoveal ring of high-density fundus autofluorescence was observed in the macula in both patients. The border of the ring corresponded to the border of the external limiting membrane and the inner segment and outer segment line in the optical coherence tomographic images. Cone photoreceptors at the abnormal parafoveal ring were blurred and decreased in the adaptive optics images. The blurred area corresponded to the abnormal parafoveal ring in the fundus autofluorescence images. Cone densities were low at the blurred areas and at the nasal and temporal retina along a line from the fovea compared with those of healthy controls. The results for cone spacing and Voronoi domains in the macula corresponded with those for the cone densities.ConclusionCone densities were heavily decreased in the macula, especially at the parafoveal ring on high-density fundus autofluorescence in both patients with retinitis pigmentosa. Adaptive optics images enabled us to observe in vivo changes in the cone photoreceptors of patients with retinitis pigmentosa, which corresponded to changes in the optical coherence tomographic and fundus autofluorescence images.

Structural and Functional Impairment of the Retina and Optic Nerve in Alzheimer’s Disease

The purpose of this study was to evaluate the macular and retinal nerve fiber layer (RNFL) thickness, and the electrical activity of the macula in patients with Alzheimer's disease (AD). 30 patients with AD and 30 age and sex matched healthy controls were studied. The thickness and the electrical activity of the macula were evaluated by means of optical coherence tomography (OCT) and multifocal-electroretinogram (mf-ERG). Visual acuity, as well as visual fields and colour vision testing of all patients were normal. However, the mean foveal thickness was 148.50 μm (vs. 171.50 μm in the control group, p=0.001) and the RNFL thickness was 104.5 μm in the superior area (vs 123 μm in the control group, p < 0.0001) and 116.5 μm in the inferior area (vs. 138 μm in the control group, p < 0.0001) around the optic nerve. The mean P1 response density amplitude of the foveal area was 146.50 nV/deg2 (vs. 293 nV/deg2 in the control group, p < 0.0001) and the perifoveal area was 56.60 nV/deg2 (vs. 81.50 nv/deg2 in the control group, p < 0.001). Our study showed that in patients with AD, even without visual failure there was a decrease in macular and RNFL thickness, as well as a decrease of the electrical activity of the macula.

Abnormal Fundus Autofluorescence Results of Patients in Long-term Treatment with Deferoxamine

To describe and classify patterns of abnormal fundus autofluorescence (FAF) of patients with β-thalassemia receiving long-term treatment with deferoxamine (DFO). Prospective, cross-sectional, case-control study. A total of 197 consecutive patients with β-thalassemia major or intermedia with at least 10 years of treatment with DFO were recruited in a tertiary referral center in Milan, Italy, and were investigated. Seventy-nine thalassemic patients without a history of chelation therapy were included as a control group. All of the patients were investigated using best-corrected visual acuity (BCVA), fundus photography, and FAF imaging by confocal scanning laser ophthalmoscopy (cSLO) and were compared with the control group. Identification of abnormal FAF patterns in thalassemic patients treated with long-term DFO and their progression and relationship with visual function. Abnormal FAF not related to other diseases was observed in 18 of the 197 patients (9%) and was classified into 4 phenotypic patterns: minimal change, focal, patchy, and speckled. The abnormal increased or decreased FAF was bilateral in all the cases, and only in some cases did it correspond to funduscopically visible alterations. There were no FAF abnormalities in the control group. During the follow-up, progressive FAF changes related to retinal pigment epithelium (RPE) damage occurred in the patchy pattern, associated with decreasing BCVA. Patients with speckled and focal patterns showed limited or no changes in FAF during the follow-up. No changes in FAF were found in patients with a minimal change pattern. No treated patient with a normal baseline examination demonstrated FAF changes. Patients with patterns other than the minimal change showed significant BCVA deterioration (P<0.001). Various phenotypic patterns of abnormal FAF can be identified with cSLO imaging. Fundus autofluorescence is a helpful, fast, and noninvasive tool for monitoring the status of the macula in patients at risk of DFO toxicity. It may be useful in the decision to discontinue or switch the therapy in cases of particular high risk for disease progression. The progressive alteration of the RPE suggests an important role of pathologic RPE changes in the evolution of visual loss during long-term treatment with DFO.

Application of Color-Based Segmentation Approach to Detect Berlin's Edema

Berlin's edema is an initial condition to macular hole. This may progress to blindness as well, especially during acute traumatic maculopathy. In this paper an attempt has been made to locate Berlin's edema in a patient with acute traumatic maculopathy. Initially the fundus image has been pre-processed to sharpen the image. The processed image is then been used to locate the central macula for the diagnosis using color-based segmentation approach. This method is to help the ophthalmologists to detect any anatomical changes to the macula in patients with commotion ratinae or Berlin's edema directly from fundus camera images, rather than going for fluorescein angiography. The processing algorithms are developed on MATLAB 7.6.0 (R2008a) programming platform.

Retinal Ganglion Cell Layer Thickness and Local Visual Field Sensitivity in Glaucoma

To compare loss in sensitivity measured using standard automated perimetry (SAP) with local retinal ganglion cell layer (RGC) thickness measured using frequency-domain optical coherence tomography in the macula of patients with glaucoma. To compare corresponding locations of RGC thickness with total deviation (TD) of 10-2 SAP for 14 patients with glaucoma and 19 controls, an experienced operator hand-corrected automatic segmentation of the combined RGC and inner plexiform layer (RGC+IPL) of 128 horizontal B-scans. To account for displacement of the RGC bodies around the fovea, the location of the SAP test points was adjusted to correspond to the location of the RGC bodies rather than to the photoreceptors, based on published histological findings. For analysis, RGC+IPL thickness vs SAP (TD) data were grouped into 5 eccentricities, from 3.4° to 9.7° radius on the retina with respect to the fovea. The RGC+IPL thickness correlated well with SAP loss within approximately 7.2° of the fovea (Spearman ρ = 0.71-0.74). Agreement was worse (0.53-0.65) beyond 7.2°, where the normal RGC layer is relatively thin. A linear model relating RGC+IPL thickness to linear SAP loss provided a reasonable fit for eccentricities within 7.2°. In the central 7.2°, local RGC+IPL thickness correlated well with local sensitivity loss in glaucoma when the data were adjusted for RGC displacement.

Three-dimensional Distribution of the Vitelliform Lesion, Photoreceptors, and Retinal Pigment Epithelium in the Macula of Patients With Best Vitelliform Macular Dystrophy

To describe the anatomical phenotypes of Best vitelliform macular dystrophy (BVMD) with spectral-domain optical coherence tomography (SD-OCT) in a large series of patients with confirmed mutations in the BEST1 gene. In our retrospective observational case series, we assessed 15 patients (30 eyes) with a clinical diagnosis of vitelliform macular dystrophy who were found to have mutations in the BEST1 gene. Color fundus photographs and SD-OCT images were evaluated and compared with those of 15 age-matched controls (30 eyes). Using a validated 3-dimensional SD-OCT segmentation algorithm, we calculated the equivalent thickness of photoreceptors and the equivalent thickness of the retinal pigment epithelium for each patient. The photoreceptor equivalent thickness and the retinal pigment epithelium (RPE) equivalent thickness were compared in all patients, in a region of the macula outside the central lesion for patients with BVMD and outside the fovea in control patients. Paired t tests were used for statistical analysis. The SD-OCT findings revealed that the vitelliform lesion consists of material above the RPE and below the outer segment tips. Additionally, drusen-like deposition of sub-RPE material was notable, and several patients exhibited a sub-RPE fibrotic nodule. Patients with BVMD had a mean photoreceptor equivalent thickness of 28.3 μm, and control patients had a mean photoreceptor equivalent thickness of 21.8 μm, a mean difference of 6.5 μm (P < .01), whereas the mean RPE equivalent thickness was not statistically different between patients with BVMD and control patients (P = .53). The SD-OCT findings suggest that vitelliform material is located in the subretinal space and that BVMD is associated with diffuse photoreceptor outer segment abnormalities overlying a structurally normal RPE. These findings provide new insight into the pathophysiology of BVMD and thus have implications for the development of therapeutic interventions.

The structure and function of the macula in patients with advanced retinitis pigmentosa.

To assess the structure and function of the macula in advanced retinitis pigmentosa (RP). Twenty-nine eyes of 22 patients with RP were compared against 17 control eyes. Time-domain optical coherence tomography (OCT) data were processed using OCTRIMA (optical coherence tomography retinal image analysis) as a means of quantifying commercial OCT system images. The thickness of the retinal nerve fiber layer (RNFL), ganglion cell layer and inner plexiform layer complex (GCL+IPL), inner nuclear layer and outer plexiform layer complex (INL+OPL), and the outer nuclear layer (ONL) were measured. Multifocal electroretinography (mfERG) was performed; two groups were formed based on the mfERG findings. Fourteen eyes had no detectable central retinal function (NCRF) on mfERG; detectable but abnormal retinal function (DRF) was present in the mfERG of the other 15 eyes. The thickness of the ONL in the central macular region was significantly less in the NCRF eyes compared with that in both DRF eyes and controls. The ONL was significantly thinner in the pericentral region in both patient groups compared with that in controls, whereas the thickness of the GCL+IPL and INL+OPL was significantly decreased only in the NCRF eyes. The RNFL in the peripheral region was significantly thicker, whereas the thickness of the GCL+IPL and ONL was significantly thinner in both patient groups compared with that in controls. The results are consistent with degeneration of the outer retina preceding inner retinal changes in RP. OCT image segmentation enables objective evaluation of retinal structural changes in RP, with potential use in the planning of therapeutic interventions and conceivably as an outcome measure.

OCT assessment of morphological changes of the optic nerve head and macula in idiopathic intracranial hypertension

Objective To assess the morphologic changes of the optic nerve head and macula in patients with idiopathic intracranial hypertension (IIH) with optical coherence tomography (OCT). Methods Data was extracted from the medical records and Stratus OCT images of IIH patients. Results Ninety-one eyes of 48 IIH patients were divided into 3 groups according to their clinical optic disc appearance. Average retinal nerve fiber layer (RNFL) thickness was statistically different between the groups: normal optic disc/mild elevation group ( N = 20) – 89 μm (95% CI, 80–98 μm), mild elevation group ( N = 51) – 109 μm (95% CI, 101–117 μm), and papilledema group ( N = 20) 124 μm (95% CI, 100–153 μm) ( P = 0.004). Fast macular thickness map did not demonstrate a significant difference between the groups for most measured macular areas ( N = 49 eyes). Conclusions Peripapillary RNFL measurements correlated with the clinical appearance of the optic discs, suggesting that OCT may assist in the follow up of IIH patients.