Macular Area Research Articles

Functional results of surgical treatment of macular holes fully preserving the internal limiting membrane as compared with the traditional method

Purpose: to assess the functional results of surgical treatment of macular holes (MH) using the authors’ developed technology preserving the internal limiting membrane (ILM) and compare them with the results of traditional surgery technology involving ILM peeling.Material and methods: 150 MH patients aged 50 to 82 were divided into 2 groups: the main group who underwent surgical MH treatment with ILM preservation and the control group, whose traditional surgical treatment involved ILM peeling. After vitrectomy, the main group patients’ macular areas were treated with a bacterial collagenase solution (1 kU) for three minutes, whereupon it was washed out, the vitreal cavity was dried and treated with platelet-rich plasma. In the control group, ILM was stained and removed, whereupon platelet-rich plasma was applied in the air medium. The anatomical result was assessed by optical coherence tomography data. To assess the functional results, the patients were tested for the best corrected visual acuity (BCVA) and subjected to microperimetry. The observation period was 24 months.Results: in all cases, a significant increase in BCVA was achieved after surgical treatment. After 6 months, the control group showed a tendency to a BCVA decrease, while in the main group BCVA remained stable. In the main group, not a single case showed a decrease in the total retinal photosensitivity below the threshold level of the norm of 24 dB, whilst in the control group, 35 cases (47 %) revealed a retinal sensitivity decrease below 24 dB. The total retinal sensitivity turned out to be significantly lower in the control group as compared to the main group over the entire observation period (p < 0.05). Postoperative scotomas were significantly more frequent after ILM peeling. Absolute scotomas were detected in 7 control group cases, whilst in the main group they were not noted in any case.Conclusion. The developed technology makes it possible to practically eliminate the formation of absolute scotomas and to significantly reduce the formation of relative scotomas in the postoperative period, as well as improve functional results against the traditional method of surgical treatment of MH with ILM peeling.

Results of treatment of optic disc pit maculopathy in children

Purpose: to analyze the anatomical and functional results of the differentiated treatment of optic disc pit maculopathy in children.Material and methods. We examined 23 children aged 5–17 years with an o ptic disc pit maculopathy. 10 children underwent retinal laser coagulation (LC) along the borders of the optic disc pit (1–3 sessions), 13 children underwent pars plana vitrectomy with gas tamponade (C2F6) in combination with retinal LC. In addition to the standard ophthalmological examination, all children underwent optical coherence tomography of the macular area of the retina before treatment and at different times after it.Results. In the group of children who underwent LC, the initial value of the maximum retina elevation averaged 525 ± 140 μm (from 346 to 882 μm). After laser treatment, all children showed a decrease in retinal elevation by 32 to 602 μm. 3 children had complete resorption of subretinal fluid during follow-up periods from 5 to 13 months. Best corrected visual acuity (BCVA) remained stable in 5 children, increased by 0.04–0.6 in 4 children, and decreased by 0.1 in one child. In the group of surgically treated children, the elevation of the retina before the intervention averaged 919 ± 143 μm (from 614 to 1420 μm) (p < 0.05). After the intervention, this parameter decreased in all children by 91 to 811 μm, complete resorption of subretinal fluid was observed in 4 children during follow-up periods from 4 to 6 months. BCVA remained stable in 5 children, increased in 7 children by 0.1–0.7, and decreased by 0.4 in one child due to the progression of the cataract.Conclusion. The differentiated approach to the treatment of optic disc pit maculopathy in children proved to be highly efficient, depending on the height of retinal elevation in the macular zone before the start of treatment.

Влияние исходных структурных нарушений и послеоперационного изменения перфузии на функциональное восстановление сетчатки после хирургического лечения сквозных макулярных разрывов

Purpose. To evaluate effect of preoperative local structural retinal changes and capillary perfusion in idiopathic full-thickness macular holes (FTMH) on the recovery of functional activity of the retina after surgical treatment. Materials and methods. We used optical coherence tomography (OCT) and OCT-angiography (OCT-A), microperimetry, multifocal electroretinography. In 25 eyes with FTMH the density of capillaries in the superficial and deep capillary plexus (SCP and DCP), retinal sensitivity (RS), amplitude and implicit time of P1 were studied at 13 points located at different distances from the fixation point were evaluated. Data were analyzed in the projection of the hole, intraretinal cystic changes (ICC), neuroepithelial detachment (NED) and intact retina before surgical treatment, 7 days, and 3 months after. Results. In the area of hole, ICC, and NED, in comparison with intact areas of the retina, a significant decrease in RS, an increase in implicit time and a decrease in amplitude of P1, and a decrease in capillary density in the SCP and DCP were revealed. Functional restoration of the retina with an increase in its perfusion was noted 3 months after the surgery. The correlation was found between postoperative changes in RS and changes in capillary density in the SCP in the projection of NED (R=0.32, p=0.001) and ICC (R=0.19, p=0.001), as well as in the DCP in the projection of NED and ICC (R=0.31, p=0.001). The change in the amplitude P1 in the postoperative period significantly correlated with the change in perfusion in the SCP in the projection of the NED (R=0.38, p=0.001) and the hole area (R=0.31, p=0.001), as well as in the DCP in the projection of the ICC (R=0.31, p=0.01) and in the area of NED (R=0.28, p=0.001). Conclusion. Thus, when using a multimodal topographically oriented approach, a relationship was found in the postoperative period of changes in functional parameters at various points in the macular area with changes in local perfusion at the level of both SCP and DCP, while the relationship is most significant in the projection of NED along the tear edge and in the areas of ICC. Key words: full-thickness macular hole (FTMH), microperimetry, multifocal electroretinography, multimodal imaging, optical coherence tomography, optical coherence tomography-angiography

Влияние осевой миопии на течение неоваскулярной формы возрастной макулярной дегенерации на фоне анти-VEGF-терапии

Purpose. To determine the effect of increased axial length of the eyes on the course of choroidal neovascularization (CNV) in patients with neovascular age-related macular degeneration (AMD) during anti-VEGF therapy. Material and methods. The study included 29 people (34 eyes) with neovascular AMD occurring against the background of axial myopia, in comparison with control eyes. The length of the anterior-posterior axis (APA) was 25.42 (24.25; 27.55) mm. The influence of axial myopia on degenerative changes in the fundus such as myopic maculopathy and posterior staphyloma (PS) was analyzed. The type of CNV, parameters of the neovascular complex and retina, retinal microcirculation in the foveal area before treatment and at the end of the observation period, and correlations were assessed using optical coherence tomography (OCT) and OCT angiography (OCTA). Treatment was with intravitreal anti-VEGF. The follow-up period was 28.80 (15.18; 44.10) months. The number of intravitreal injections (IVI) was 7.75 (5.70; 9.85). Results. «Mild» categories of myopic maculopathy were detected by ophthalmoscopy – mosaic fundus (K1) in 20.60% and diffuse chorioretinal atrophy (K2) in 17.60% of cases. PS in eyes with CNV and fellow eyes was detected in 17.50 and 21.00% of eyes, respectively, types were identified exclusively without involvement of the macular area. CNV types 1 and 2 were detected in equal proportions – in 43.48 and 56.52% of eyes, respectively. Visual functions and OCT parameters of the retina and CNV reached the maximum positive values after 2 loading injections of anti-VEGF. A significant positive dynamics of retinal microcirculation in the foveal zone was established by the end of the observation period against the background of a decrease in exudative changes in the retina. Correlation analysis showed a direct relationship between the number of injections and the extent of CNV before treatment (rφ=0.743; p=0.009) and the height of the neuroepithelium above the CNV before treatment (r φ=0.378; p=0.027). Conclusion. The presence of axial myopia in patients with neovascular AMD contributes to the appearance of minimal degenerative changes in the posterior pole of the eyes, which has a positive effect on visual function and CNV during antiVEGF therapy. Key words: choroidal neovascularization, neovascular age-related macular degeneration, axial myopia, optical coherence tomography angiography, anti-VEGF therapy

Optimization of Platelet-Rich Plasma Fraction Selection for Surgical Treatment of Macular Holes

Objective: based on clinical and morpho — functional analysis of retinal restoration and assessment of the cellular composition of platelet-rich plasma, to determine its optimal fraction for surgical treatment of macular hole. Materials and methods. This study presents the results of 120 cases of surgical treatment of eyes with macular hole. The patients were divided into 2 groups. In the 1st group (60 eyes), the technology developed in our clinic was used without the use of postoperative tamponade of the vitreal cavity and the use of autologous platelet-rich plasma (PRP), in the 2nd — traditional technology for the treatment of macular hole s (60 eyes). The cellular composition of the PRP of 30 patients was analyzed. Results. 2 months after surgery, 119 patients had the restoration of all retinal layers in the macular hole area and positive dynamics of visual acuity was recorded in comparion with the preoperative period. After observation for 6 months after surgery, cases of recurrence of macular hole were not detected. Conclusion. The therapeutic value of BoTP lies in the tamponing and regenerative effect. According to the results of this study, for maculrupture surgery, it is rational to use plasma from a layer of pure platelet-rich plasma (P-PRP), which contains a sufficient number of platelets capable of having a positive therapeutic effect, and a minimum number of leukocytes capable of performing the functions of immune protion and repair of the retiand surrounding tissues.

Evaluation of Central and Peripheral Retinal Vascular Changes in the Fellow Eyes of Patients with Unilateral Retinal Vein Occlusions

To evaluate the subtle peripheral retinal and macular vascular changes in the fellow eyes of patients with unilateral retinal vein occlusion (RVO). This retrospective study included 53 patients with unilateral RVO and 44 age-matched controls. The frequency of peripheral retinal vascular pathologies in both eyes was evaluated using high quality ultra-wide field fluorescein angiography (UWFFA). Macular vascular density, flow area, and foveal avascular zone measurements from optical coherence tomography angiography (OCTA) were analyzed together with laser flare photometry values in patients and controls. Peripheral retinal vascular pathologies were detected on UWFFA in the fellow eyes of 36 (67.9%) patients. No significant central vascular pathologies were detected on OCTA and there was no significant difference in OCTA parameters between the fellow eyes and the controls. Flare values did not differ significantly between the control and the fellow eyes. Two thirds of the fellow eyes of unilateral RVO patients had subtle peripheral retinal vascular changes, while there was no significant microvascular change detected with OCTA in the macula. This suggests that vascular changes caused by systemic vascular disorders probably first start in the peripheral retina of the fellow eyes of patients with RVO.

Topographic comparison of the retinal microvascular changes between patients with compressive and glaucomatous optic neuropathies

We investigated the difference in optical coherence tomography angiography characteristics between the patients with compressive optic neuropathy (CON, n = 26) and glaucomatous optic neuropathy (GON, n = 26), who were matched for the severity of visual field defect. The peripapillary retinal nerve fiber layer (pRNFL) thickness in the nasal and temporal sectors was thinner in the CON group, whereas the inferior pRNFL thickness was thinner in the GON group. Accordingly, the CON group had lower peripapillary vessel density (pVD) in the nasal and temporal sectors, and the GON group in the inferior sector. In the macular area, the CON group had a thinner macular ganglion cell-inner plexiform layer in the superior and nasal sectors, whereas the GON group in the inferior sector. However, the CON group did not have a lower macular VD than the GON group in any sector, whereas the GON group exhibited lower superficial capillary plexus VD in the superior, inferior, and temporal sectors. Comparison of the structure–vasculature correlation revealed a significant difference in the nasal and temporal peripapillary areas and superior and nasal macular sectors; a decrease in VD was greater in the GON group than in the CON group when the comparable structural change occurred.

Subfoveal and Parafoveal Choroidal Thickening in Patients with Keratoconus Using the ETDRS Grid on Swept-Source OCT.

There is growing evidence that confirms morphological changes in the posterior structures in patients with keratoconus (KC); however, isolated alterations could have been missed. This study assesses choroidal thickness (CT) in the fovea and beyond in KC eyes. This prospective case-control and non-randomized study enrolled 107 eyes, 62 eyes of 62 patients with KC, and 45 age-matched eyes of 45 control subjects with axial length in the range of 22-26mm. Swept-source optical coherence tomography (SS-OCT) was performed to manually measure the subfoveal choroidal thickness (SCT) using a single-line scan. CT was obtained automatically from the Early Treatment Diabetic Retinopathy Study (ETDRS) grid using the 12-lines radial scan pattern. A two-way repeated-measures analysis of variance (ANOVA) was conducted to evaluate CT variations among macular eccentricity, parafoveal area, and the interaction between both factors. CT was compared in all parafoveal areas between groups and subgroups of KC. SCT was significantly thicker in KC eyes (357 ± 57µm) than in healthy eyes (325 ± 63µm) (p < 0.001). Significant choroidal thickening was observed in the central ring and outer and inner rings of the temporal, superior, and inferior parafoveal macular areas (p < 0.001), except in the outer ring of the nasal macular zone (p > 0.05) of KC compared to healthy eyes. The CT significantly decreased from the center to the outer ring regardless of the presence of KC (p < 0.001). The choroid in the nasal macular zone was significantly thinner than that in the temporal, superior, and inferior parafoveal areas (p < 0.001). The choroidal structure increased its thickness not only in the subfoveal area, but also in eight parafoveal areas of the ETDRS grid encompassing a wider area of macular examination. These findings demonstrate and corroborate that keratoconus is not a purely corneal disease. Furthermore, it confirms the role that the choroidal structure has in the pathophysiology of keratoconus.

Цитокиновый профиль интраокулярных жидкостей в прогнозировании макулярного отека при хирургическом лечении регматогенной отслойки сетчатки

Purpose. Based on the study of cytokines content in the vitreous body and subsilicone fluid (SSF), to evaluate risk factors for the development of macular edema in patients with rhegmatogenous retinal detachment (RRD) after endovitreal surgery. Material and methods. An analysis of the treatment of 28 patients (28 eyes) with RRD complicated by PVR Sr type 1–4 involving the macular area was carried out. Patients underwent vitrectomy or vitrectomy combined with circumferential scleral indentation and silicone oil tamponade. During the initial intervention, the vitreous humor was collected, and upon completion of the silicone tamponade, the CVS was taken. In both obtained samples, the quantitative content of the following cytokines was determined by enzyme-linked immunosorbent assay (ELISA): GIF1α, interleukins (IL) – 4, 6, 17, TGF-β1, VEGF and TNF-α. Besides standard ophthalmological examination, all patients underwent optical coherence tomography in the postoperative period with assessment of the thickness and volume of the macular retinal area. Results. Connection between the quantitative content of cytokines in the vitreous body and preoperative indices showed significant negative correlation between TNF-a content and the number of detached quadrants as well as between the «visual field on the sum of 8 meridians» index and VEGF content. The values of TNF-αquantitative content had a pronounced negative correlation with the index «visual field on the sum of 8 meridians» after surgery, and positive correlation with the time of silicon oil finding in the vitreous cavity and the number of detached quadrants before treatment. We also found that IL-6 content had a significant positive correlation with the thickness of the central retinal zone and a negative correlation with the total visual field at the stage of treatment completion. The data obtained by comparing quantitative content of cytokines in CSF in patients with and without macular edema showed a statistically significant positive correlation between the risk of macular edema and content of IL-6, as well as TNF-α. Conclusion. Significant correlations were determined between the risks of macular edema and cytokines concentration in subsilicon-oil fluid that have proinflammatory properties (TNF-αand IL-6). Quantitative TNF-αcontent in sub-silicone fluid has a direct correlation with the time of silicone oil presence in the vitreous cavity, which may determine early completion of tamponade. Quantitative content of the cytokines studied in the vitreous body cannot be a predictor of macular edema development in the postoperative period. Key words: cytokine profile, regmatogenous retinal detachment, subsilicone fluid, intraocular fluid, macular edema

Incidental multiple myeloma in a patient with neuroretinitis: a case report

BackgroundNeuroretinitis is classically defined as a clinical triad of unilateral, painless vision loss, accompanied by optic disc edema and characteristic macular star formation. The causes of neuroretinitis can be categorized as infectious, non-infectious, and idiopathic, therefore differential diagnosis and careful evaluation are required, owing to the various etiologies and masqueraders.Case presentationA 54-year-old woman presented to the clinic with blurred vision in both eyes. A complete ophthalmic examination revealed optic disc edema with blurred margins and macular exudates, intraretinal edema in the temporal peripapillary area, and subretinal fluid with neurosensory retinal detachment in the macular area. Systemic laboratory investigations showed no signs of infection or inflammation. However, bone marrow suppression was suspected based on the results of the complete blood count test, and the patient was diagnosed with multiple myeloma.ConclusionAlthough neuroretinitis is rarely accompanied by hematological malignancy, it is important to be mindful of the latter because ophthalmic manifestations are a common feature of hematological malignancies and lesions occur in nearly every ocular structure.

Combined Internal Limiting Membrane Peeling and Subretinal Balanced Salt Solution Injection: A Novel Technique to Unfold Congenital Falciform Folds.

To describe a novel surgical technique to unfold congenital falciform folds. A retrospective, interventional case series was performed where a novel technique was applied to treat five cases of congenital falciform folds. Twenty-five-gauge vitrectomy was performed along with the removal of all vitreous adhesions. The internal limiting membrane was peeled from the macula and around the macular fold area. A Tano diamond-dusted membrane scraper was used to stretch the folded retina mechanically. Then, subretinal balanced salt solution was injected using a 38-gauge subretinal needle to create multiple blebs around the folded retina. Finally, 20% sulfur hexafluoride gas was used for tamponade. Follow-up was conducted for a minimum of 6 months. Vision improved from preoperative mean best-corrected visual acuity logMAR 1.44 (20/550) ± 0.32 to postoperative mean best-corrected visual acuity logMAR 0.75 (20/112) ± 0.17 ( P value = 0.0208) after intervention. There was a reduction in the macular fold. Postoperatively, a macular hole with retinal detachment developed in one of five (20%) eyes. The novel technique of vitrectomy with combined internal limiting membrane peeling and subretinal balanced salt solution injection is visually rewarding in treating congenital falciform folds.

The Cosine Law to Choose the Correct Forceps Shaft Length for Macular Surgery in Highly Myopic Eyes.

To demonstrate a mathematical analogy between the Pythagorean theorem using the axial a-scan measurement, i.e., the distance between the central cornea and the sclerotomy, and the lengths of the forceps in eyes of patients with all axial lengths. We used the Pythagorean equation (c 2 = a 2 + b 2 ) to calculate the adequate shaft length of the forceps to use in macular surgery, especially in highly myopic eyes, where c 2 represents the axial length (hypotenuse); b 2 the sum of the corneal ray and distance between the corneal limbus and the sclerotomy (base side); and a 2 the distance between the sclerotomy and the fovea (perpendicular side). We reproduced the cosine law to estimate the distance between the sclerotomy and the fovea. The distance between the sclerotomy and the foveal area is shorter than the axial length and can become smaller based on the distance from the sclerotomy to the corneal limbus. This simple mathematical formula is useful when performing surgery in highly myopic eyes, in which there can be difficulties reaching the macular area.

Intraretinal microvascular alterations in indirect traumatic optic neuropathy using optical coherence tomography angiography.

To quantitatively evaluate macular and peripapillary microvascular alterations in patients with indirect traumatic optic neuropathy (TON) compared to normal controls using optical coherence tomography angiography (OCT-A) and determine their associations with other ocular parameters. We enrolled 33 eyes of 33 patients with TON and 34 eyes of 34 healthy controls. OCT-A was used to generate microvascular structure images of the superficial retinal capillary plexus (SRCP), deep retinal capillary plexus (DRCP), and radial peripapillary capillary (RPC) segment in the macula and peripapillary area. Functional and structural parameters such as best-corrected visual acuity, visual field, peripapillary retinal nerve fibre layer (pRNFL) thickness, macular ganglion cell-inner plexiform layer (mGCIPL) thickness, OCT-A variables were compared between TON patients and controls. Age, gender, and spherical equivalent refractive errors were statistically adjusted for the analysis. OCT-A revealed a significant reduction of the average vessel density in the RPC segment in TON patients compared to controls (48.5% ± 6.28 vs. 57.88% ± 3.06%, P < 0.0001, corrected P < 0.0001). When comparing sectors, the vessel density of the RPC segment in TON patients was also significantly lower in all four quadrants compared to healthy controls. The inferior sector vessel density of the RPC segment was significantly associated with visual field defects (P = 0.0253) and visual acuity (P = 0.0369). The temporal sector vessel density of DRCP was also associated with visual field defects (P = 0.0377). The RPC segment in the superior and inferior sector vessel density displayed a significant association with the corresponding regional pRNFL thickness (P = 0.0248 and <0.0001, respectively). Patients with indirect TON exhibit significant microvascular alterations compared to controls. This study confirms that TON can induce intraretinal microvascular changes and suggests that OCT-A may serve as a useful biomarker for assessing visual functional and structural changes.

The effect of nondamaging subthreshold laser therapy in patients with chronic central serous chorioretinopathy.

To evaluate the efficacy of nondamaging subthreshold laser therapy in Korean patients with chronic central serous chorioretinopathy (cCSC). This retrospective interventional case series included 31 patients (31 eyes) with cCSC who underwent nondamaging laser therapy using Endpoint Management (EpM) software. Since a barely visible burn of the test spot was defined as 100% pulse energy, 30% pulse energy with a 200-μm spot was titrated to treat the macular area based on EpM settings. A 30% pulse laser with a spacing of 0.25-beam diameter was applied to cover the macular area where hyperfluorescent leaks were observed on fluorescein angiography. Changes in central macular thickness (CMT), subretinal fluid (SRF) height, subfoveal choroidal thickness (SCT), and logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) were measured at baseline and after 3 and 6months. If the subretinal fluid persisted for 3months, retreatment was performed. At 6months post-treatment, the complete SRF resolution rate was 48.39% (15/31 eyes), and the partial SRF resolution rate was 12.90% (4/31 eyes). The change in mean BCVA (logMAR) was not significant (0.31 ± 0.29 at the baseline and 0.31 ± 0.40 at month 6) (p = 0.943). At the baseline, the mean CMT (μm) decreased from 350.74 ± 112.76 at baseline to 239.71 ± 130.25 at month 6 (p < 0.001), and the mean SRF height (μm) decreased from 193.16 ± 90.69 at baseline to 70.58 ± 100.00 at month 6 (p < 0.001). However, the change in SCT was not statistically significant (p = 0.516). In 15 patients who were retreated at month 3, the mean SRF height (μm) decreased significantly from 144.67 ± 74.01 at month 3 to 77.13 ± 63.77 at month 6 (p = 0.002). No side effects associated with laser therapy were observed during the 6-month follow-up. Nondamaging laser therapy with a modified macular treatment was effective in reducing CMT and SRF and showed favorable visual and anatomical outcomes in patients with cCSC.

Optical Coherence Tomography Angiography Changes in Macular Area in Patients with Proliferative Diabetic Retinopathy Treated with Panretinal Photocoagulation.

The purpose of this study was to investigate the changes in macular microvasculature using optical coherence tomography angiography (OCTA) in association with functional changes in patients with proliferative diabetic retinopathy (PDR) treated with panretinal photocoagulation (PRP) with a follow up of 12 months. The participants in this study were 28 patients with PDR and no macular oedema, who were eligible for PRP. All participants underwent best-corrected visual acuity (BCVA) measurement, optical coherence tomography (OCT), and OCT angiography (OCTA) at baseline (before treatment) and at months 1, 6, and 12 after the completion of PRP treatment. The comparison of OCTA parameters and BCVA between baseline and months 1, 6, and 12 after PRP was performed. There was a statistically significant decrease in foveal avascular zone (FAZ) area at months 6 and 12 of the follow-up period compared to baseline (p = 0.014 and p = 0.011 for month 6 and 12, respectively). Of note is that FAZ became significantly more circular 6 months after PRP (p = 0.009), and remained so at month 12 (p = 0.015). There was a significant increase in the mean foveal and parafoveal vessel density (VD) at all quadrants at the superficial capillary plexus (SCP) at month 6 and month 12 after PRP compared to baseline. No difference was noticed in VD at the deep capillary plexus (DCP) at any time-point of the follow up. BCVA remained the same throughout the follow-up period. At months 6 and 12 after PRP, foveal and parafoveal VD at SCP significantly increased compared to baseline, while the FAZ area significantly decreased and FAZ became more circular.

Clinical Characteristics and Genetic Variants in Taiwanese Patients With PROM1-Related Inherited Retinal Disorders.

This study investigated the clinical characteristics of patients with PROM1-related inherited retinal diseases (IRDs). Patients diagnosed with IRDs who had mutations in PROM1 were identified at Linkou Chang Gung Memorial Hospital and Kaohsiung Medical University Hospital in Taiwan. Information on clinical characteristics and best-corrected visual acuity was recorded. Color fundus (CF) images, fundus autofluorescence photography (FAF), spectral-domain optical coherence tomography (SD-OCT), and electroretinograms (ERGs) were analyzed to examine patient phenotypes. PROM1 variants were detected using whole exome sequencing and verified by Sanger sequencing. Fourteen patients from nine families with PROM1-related IRDs were analyzed. Most patients exhibited chorioretinal atrophy in the macular area, with or without extramacular involvement on CF. Similarly, hypo-autofluorescence confined to the macular area, with or without extramacular involvement, was present for most patients on FAF. Furthermore, SD-OCT revealed outer retinal tubulations and focal or diffuse retinal thinning. ERGs showed variable findings, including maculopathy with normal ERG, subnormal cone response, and extinguished rod and cone responses. We detected five variants of the PROM1 gene, including c.139del, c.794del, c.1238T>A, c.2110C>T, and c.1117C>T. In this study, we evaluated 14 Taiwanese patients with five PROM1 variants. Additionally, incomplete penetrance of heterozygous PROM1 variants was observed. Furthermore, patients with autosomal dominant PROM1 variants had lesions in the macular area and the peripheral region of the retina. SD-OCT serves as a useful tool for early detection of PROM1-related IRDs, as it captures certain signs of such diseases.

Chronic Central Serous Chorioretinopathy in Elderly Subjects: Structure and Blood Flow Characteristics of Retina and Choroid.

With advancements in imaging technology, researchers have been able to identify more distinctive imaging features of central serous chorioretinopathy (CSC). However, existing research primarily concentrates on young patients aged 50years and below, leaving a dearth of studies on elderly CSC patients. Previous studies indicate that elderly CSC patients may exhibit unique imaging characteristics and have a clinical prognosis that significantly differs from younger patients. This study aimed to evaluatethe characteristics of retina, choroid structure, and blood flow in elderly patients with chronic CSC (cCSC) examined multimode imaging and try to find new pathogenesis information of it. Using a cut-off age of 50years, patients with chronic central serous chorioretinopathy were divided into two groups: older and younger. The control group consisted of 40 healthy individuals, with their right eyes assigned. Various clinical features were recorded, including the incidence of ellipsoid zone rupture (EZ-), fibrin in the subretinal fluid (SRF), pachydrusen, subretinal drusenoid deposits (SDD), pigment epithelial detachment (PED), double-layer sign (DLS), and choroidal lipid globule cavern. Measurements were taken for the thickness of the outer nuclear layer (ONL), the length of the extended outer photoreceptor segment (POS), the height and width of SRF, the vascular density of each layer of the retinal capillary plexus, the central macular thickness (CMT), and the subfoveal choroidal thickness (SFCT). The proportion of females in the elderly group (43.75%) was significantly higher than that in the youth group (22.41%) (p = 0.034). The degree of hyperopia in the elderly group (1.03 ± 0.73) was higher than that in the youth group (0.26 ± 1.06), with a significant difference in BCVA (p = 0.05). The thickness of SFCT, CMT, ONL in the elderly group, and the length of photoreceptor outer segment in the elderly group were thinner than those in the youth group (p < 0.05). Choroidal capillary perfusion area (CCPA), macular area, and paramacular area were lower in the elderly group than those in the youth group in the full scan range (p < 0.05). The blood flow densities of deep capillary plexus (DCP), intermediate capillary plexus (ICP), and superficial capillary plexus (SCP) in the whole scan range, macular area, and paramacular area were lower in the elderly group than in the youth group, but the differences were not statistically significant. In conclusion, our data suggest that elderly patients with cCSC may experience different disease outcomes. Elderly cCSC patients exhibit less gender bias, poorer vision, more severe structural damage and ischemia in the choroid and retina, and have a higher risk of developing choroidal neovascularization.

Attenuation of irradiated choroid and its regional vortex veins in central serous chorioretinopathy after photodynamic therapy

We retrospectively studied 12 eyes of 12 patients with central serous chorioretinopathy (CSC) to investigate choroidal thickness changes following half-fluence photodynamic therapy (PDT) using widefield choroidal thickness maps obtained by optical coherence tomography (OCT). Additionally, we assessed the relationship between choroidal thickness changes and the regional vortex veins as visualized on widefield en face OCT of the choroid. Pre-treatment en face images of the choroidal vasculature were superimposed on subtracted choroidal thickness maps before and 3 months after half-fluence PDT. The choroidal thickness decreased mainly in the irradiated macular area and in the region of vortex veins which function as drainage for the macula in all eyes. Eleven eyes (91.7%) showed choroidal thinning in the nasal area which overlapped with the nasal vortex vein distribution. Moreover, in 10 (90.9%) of those eyes, we observed intervortex venous anastomosis across the vertical watershed zone. Quantitative analysis revealed that the reduction in choroidal thickness was most pronounced in the macular area. Furthermore, the choroidal thickness reduction in the area with macular drainage vortex veins was significantly greater than that in the area without such vortex veins. These results suggest that half-fluence PDT might decrease choroidal thickness due to choriocapillaris occlusion in the irradiated macula, possibly leading to diminished venous drainage from the macula to regional vortex veins. Moreover, venous blood flow through the anastomotic vessels from the macular drainage vortex veins into the nasal vortex veins might be reduced post-treatment.

Influencing factors of visual prognosis in patients with persistent submacular fluid after successful scleral buckle surgery for macula-off retinal detachment

Objective: To investigate the factors influencing visual outcomes in patients with rhegmatogenous retinal detachment (RRD) who developed persistent submacular fluid (PSF) after scleral buckling surgery. Methods: A retrospective case series analysis was conducted. Clinical data were collected from patients who underwent successful scleral buckling surgery for RRD at Beijing Tongren Hospital from June 2020 to December 2022 and were followed up. Patients with RRD involving the macular area preoperatively and graded as C1 or below in proliferative vitreoretinopathy (PVR) were included. Surgical procedures followed a minimally invasive scleral buckling approach. PSF was defined as subretinal fluid persisting for more than 1 month postoperatively. Regular follow-up visits were scheduled at postoperative days 1, 3, 7, 2 weeks, and 1 month, followed by monthly visits until complete PSF absorption. Best-corrected visual acuity (BCVA), intraocular pressure, refractive error, slit-lamp biomicroscopy, binocular indirect ophthalmoscopy, and optical coherence tomography (OCT) were performed at each follow-up time point. Eyes were divided into two groups based on whether the final follow-up BCVA was≥0.5 and whether the absorption time of PSF was>6 months, and statistical analysis was performed using the Wilcoxon signed-rank test, chi-squared test, and Mann-Whitney U test. Results: A total of 46 patients (46 eyes) were included in this study, comprising 25 males and 21 females, with a median age of 32.5 (21.0, 57.3) years. The preoperative equivalent spherical refractive error was (-5.27±4.05) D, and the preoperative duration of illness was 30 (14, 92) days. The preoperative BCVA (logarithm of the minimum angle of resolution,logMAR) was 2.00 (1.00, 2.50). Scleral buckle surgery was performed in 28 eyes (60.9%), and 18 eyes (39.1%) underwent scleral buckle surgery combined with encircling. External drainage was performed in 15 eyes (32.6%), while 31 eyes (67.4%) had no external drainage. BCVA (logMAR) at 1 month, 3 months, and the final follow-up postoperatively was 0.60 (0.50, 1.00), 0.40 (0.28, 0.53), and 0.15 (0.00, 0.50), respectively. In the final follow-up, 31 eyes (67.4%) achieved BCVA≥0.5, and 26 eyes (56.5%) had continuous ellipsoid zone on OCT. The differences in BCVA (logMAR) between preoperative, 1 month, 3 months, and the final follow-up were statistically significant (Z=-5.85, -5.63, -4.73;all P<0.001). The absorption time of PSF postoperatively was 6.50 (3.00, 9.00) months, ranging from 2 to 19 months. The eyes with PSF duration<3 months, 3-6 months, and>6 months were 12 eyes (26.1%), 11 eyes (23.9%), and 23 eyes (50.0%), respectively. There were statistically significant differences between the two groups in preoperative BCVA≥0.05, preoperative duration of illness within 1 month, PVR grading, surgical method, and continuous ellipsoid zone on OCT (all P<0.05), while there were no statistically significant differences between the two groups in PSF absorption time, different types of PSF, and intraoperative drainage (all P>0.05). The PSF absorption time in the two groups was 7 (3, 10) months and 6 (4, 8) months, with no statistically significant difference (P>0.05). Conclusions: Preoperative visual acuity, duration of illness, and PVR grading are factors influencing visual outcomes in patients with RRD who have undergone scleral buckling surgery and develop PSF. In contrast, intraoperative drainage, PSF absorption time, and different PSF types are not factors affecting visual prognosis. Although PSF may persist for a long time after scleral buckling surgery, it does not significantly impact long-term visual outcomes.

Evaluations of microvascular density by optical coherence tomography, angiography, and function by multifocal electroretinography of the macular area in eyes with branch retinal artery occlusion.

It is reported that eyes with a branch retinal artery occlusion (BRAO) had normal full-field electroretinography (ERG) but the response of the multifocal electroretinography (mfERG) was reduced in the area of the arterial occlusion. Optical coherence tomography angiography (OCTA) is a recently appeared modality that can evaluate microvascularizations in different retinal layers and in different regions of the retina. The purpose of this study was to determine the density of the microcirculation and the function of the macular area of eyes with BRAO, and to determine whether they are significantly correlated. The OCTA and mfERG findings of 7 eyes of 6 patients (3 men, 3 women) were studied. The mean age of the patients was 71.7±10.6 years. The OCTA examinations were made with volume scans of 3 × 3 and 6 × 6mm squares centered on the fovea. The macular vessel densities (mVD) in the superficial retinal layer (SRL) and deep retinal layer (DRL) were measured for the superior and inferior halves of 3 × 3 and 6 × 6mm diameter concentric circles. The mfERGs were recorded with targets set to stimulate the focal areas of the retina corresponding to the areas examined by OCTA. The OCTA examinations showed that the mVD of the 3 mm concentric circle in the SRL was significantly lower on the affected side than on the unaffected side (P = 0.022). No such difference was observed in the DRL. The N1 amplitude of the 20.2° concentric circle and the N1-P1 amplitude of the 10.1° concentric circle of the mfERGs were significantly smaller on the affected side than on the unaffected side (P = 0.047 and 0.031). A significant positive correlation was found between the mVD of the 6 mm concentric circle in the DRL and the P1-N2 amplitude of the 20.2° concentric circle (ρ = -0.929 and p = 0.003). These findings indicate that OCTA images may be able to show changes in the density of the retinal macular microcirculation, and the mfERGs may be able to show alterations in the function of the macular area of the eyes with BRAO. A layer-by-layer analysis of the local retinal microcirculation and function should help in determining the pathogenesis of BRAO.