Macular Changes Research Articles

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

PurposeThis 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).DesignThis study employed a prospective study design.MethodsSCAS 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.ResultsA 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.ConclusionThe 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).

Drusen Regression Following Macular Hole Surgery: A Case Report.

To report a case of drusen regression following pars plana vitrectomy with internal limiting membrane peel (ILMP) in a patient with a full-thickness macular hole and dry age-related macular degeneration (AMD). A 67-year-old gentleman presented in April 2024 with a full-thickness macular hole in OS and intermediate dry AMD OU. The patient underwent pars plana vitrectomy, ILMP, and an injection of sulfur hexafluoride gas for macular hole repair in OS. The patient's macular changes were monitored through visual acuity, fundus examination and optical coherence tomography (OCT) imaging at baseline and follow-up visits. The macular hole was closed and there was early stability of the macular drusen in OU. At a five-month follow-up in September 2024, he reported improved vision from 20/100 baseline to 20/40. Fundus examination as well as OCT imaging demonstrated a significant reduction of macular drusen in the operated eye, which was not observed in the fellow eye. This case demonstrates successful surgical management of a full-thickness macular hole in a patient with concomitant drusen regression. The regression of drusen was limited to the operated eye, which suggests that surgical interventions may influence the course of AMD in certain patients.

Analysis of macular retinal thickness in polyarteritis nodosa using spectral domain optical coherence tomography

PurposeTo identify the macular retinal layer thickness changes in polyarteritis nodosa (PAN) patients without pathological findings appearing in color fundus photography (CFP), and to investigate the correlations with disease durations.MethodsA total of 24 PAN patients who had been for 3 years or more and underwent SD-OCT were recruited from the UK Biobank, with exclusions for diabetes, eye disease, or abnormal CFP findings. Only the right eyes were included, with each PAN patient paired one-to-one with a control matched for age, sex, and ethnicity. Paired t-tests or Wilcoxon Signed-Rank tests were used to assess the differences in thickness of different retinal layers between groups, followed by linear regression analysis to evaluate the correlations with disease durations.ResultsPAN patients had significantly thinner retinal nerve fiber layer (RNFL) by 12.27% (mean ± standard deviation = 27.39 ± 8.94 μm for PAN patients and 31.22 ± 5.57 μm for controls, p = 0.048) and thinner outer plexiform and outer nuclear layers (OPL-ONL complex) by 10.67% (44.93 ± 6.59 μm for PAN patients and 50.31 ± 7.60 μm for controls, p = 0.032). Visual acuity and the whole macular thickness showed no statistical difference. The RNFL was thinned by 1.22 μm per year of disease progression (95% confidence interval: 0.12, 2.32, p = 0.042).ConclusionsPAN patients without visual impairments or abnormal CFP findings may exhibit significant thinning in RNFL and OPL-ONL complex. SD-OCT may serve as a useful tool for early screening of ophthalmic changes in PAN.

Macular Pigment Changes and Visual Recovery Following Successful Full-Thickness Macular Hole Closure Using the Inverted Flap Technique.

Objectives: This study aimed to assess the role of macular pigment optical density (MPOD) in patients with a full-thickness macular hole (FTMH) compared to healthy controls, evaluating postoperative changes in MPOD and exploring potential correlations with visual outcomes. Methods: This prospective, cross-sectional, comparative study included 16 eyes from FTMH patients who achieved anatomical hole closure following pars plana vitrectomy with the inverted ILM flap technique. Each eye underwent a comprehensive ophthalmologic examination, including BCVA and intraocular pressure measurements, anterior segment evaluation, fundus examination, and macular assessment with Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT, Spectralis, Heidelberg Engineering Inc., Heidelberg, Germany). Macular pigment optical density (MPOD) was measured using one-wavelength reflectometry (Visucam 200, Zeiss Meditec, Jena, Germany). These evaluations were conducted preoperatively and at 1, 3, and 6 months postoperatively to assess changes over time and correlate MPOD with visual outcomes. Results: Significant baseline differences were observed between FTMH patients and controls for BCVA, mean MPOD, maximum MPOD, and MPOD volume (p < 0.05). Postoperative BCVA improved significantly (p = 0.0011), with a notable increase in MPOD volume at 6 months (p = 0.01). A positive correlation was found between BCVA improvement and MPOD volume increase (r = 0.739; p = 0.002). Conclusions: In conclusion, MPOD measurement may serve as a valuable addition to the follow-up of FTMH surgery, providing insights into photoreceptor function and macular metabolic activity, potentially correlating with visual recovery. Further longitudinal studies are needed to clarify its relationship with clinical variables, such as metamorphopsia and OCT microstructural findings.

Role of pattern and multifocal electroretinogram for macular evaluation in patients with multiple sclerosis treated with fingolimod

Objective To detect the role of pattern electroretinogram (PERG) and multifocal electroretinogram (MfERG) for macular function evaluation in patients with relapsing–remitting multiple sclerosis (RR-MS) treated by fingolimod. Patients and methods This prospective research was carried out on 25 patients with RR-MS (50 eyes), treated by fingolimod, with no ophthalmic disorders or complaints before the onset of the treatment, including no history of optic neuritis. PERG, MfERG, and spectral domain optical coherence tomography were performed before then 3 and 6 months after the treatment. Results Best-corrected visual acuity (BCVA) significantly decreased in third and sixth months compared to baseline (P&lt;0.001). Central macular thickness showed nonsignificant change. PERG waveform abnormalities were detected in 2.5% of patients at third month (P=0.9) and 27.5% in sixth month (P&lt;0.001). PERG P50 amplitude nonsignificantly decreased in third month (P=0.6), then significantly decreased at sixth month (P=0.021). PERG N95 amplitude showed no significant difference (P=0.345). MfERG revealed nonsignificant decrease of P1 amplitude of all five rings at third and sixth months. The duration of MS had significant negative correlations with BCVA, amplitude, and amplitude change of P1 of both ring 1 and ring 2. Conclusion Treatment with fingolimod for 6 months led to a significant reduction in BCVA and PERG responses and a slight decrease in P1 amplitude of MfERG before detection of any structural macular changes by optical coherence tomography. This indicates the role of PERG and MfERG as biomarkers for the early detection of macular function alteration in RR-MS fingolimod-treated cases.

Comparative analysis of optic disc and macular microvasculature in children with anisometropic amblyopia before and after treatment.

To evaluate optic disc and macular microvasculature changes in children with anisometropic amblyopia before and after treatment. In all, 60 children with unilateral anisometropic amblyopia between the ages of 6 and 12 were randomly selected from the ophthalmology clinic of Fuyang People's Hospital, while 60 children with non-amblyopia in the same age range were randomly selected as a normal control group. The right eye was uniformly taken in the control group with at least 6 months of follow-up. Optical coherence tomography angiography (OCTA) was used to evaluate the macular vessel density of superficial capillary plexus (SCP) and deep capillary plexus (DCP), optic disc vascular density (VD), foveal avascular zone (FAZ) area, macular thickness, and retinal nerve fiber layer thickness (RNFLT). Before treatment, the vessel density of the optic disc, macular SCP and DCP in the amblyopic group was significantly lower than those in the fellow eyes and the control group (P < 0.05), while there were no statistically significant differences in the vessel densities of the optic disc, macular SCP and DCP between the amblyopic eyes, the fellow eyes, and the control group after treatment (P>0.05). Statistically significant negative correlations were found between the alterations of BCVA in amblyopic eyes and the alterations of the vessel densities of the optic disc, macular SCP and DCP in amblyopia eyes (P<0.05) except for superior nasal (SN) and inferior nasal (IN) regions of the optic disc radial peripapillary capillary, temporal and nasal regions of macular parafoveal SCP, nasal regions of macular parafoveal DCP and inferior regions of macular perifoveal DCP(P>0.05). Macular and optic disc vessel density in OCTA are lower in children with anisometropic amblyopia and tend to return to normal levels to a certain extent following treatment for amblyopia.

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.

Macular and optic nerve microvascular changes in patients with type 1 diabetes mellitus

Macular and optic nerve microvascular changes in patients with type 1 diabetes mellitus

Predictors of Peripheral Retinal Non-Perfusion in Clinically Significant Diabetic Macular Edema

Background/Objectives: Diabetic macular edema (DME) is a significant cause of vision loss. The development of peripheral non-perfusion (PNP) might be associated with the natural course, severity, and treatment of DME. The present study seeks to understand the predictive power of central macular changes and clinico-demographic features for PNP in patients with clinically significant DME. Methods: A prospective study using contemporaneous multi-modal retinal imaging was performed. In total, 48 eyes with DME from 33 patients were enrolled. Demographic, clinical history, laboratory measures, ultrawide field photography, fluorescein angiography, optical coherence tomography (OCT), and OCT angiography results were acquired. Anatomic and vascular features of the central macula and peripheral retina were quantified from retinal images. Separate (generalized) linear mixed models were used to assess differences between PNP present and absent groups. Mixed effects logistic regression was used to assess which features have predictive power for PNP. Results: Variables with significant differences between eyes with and without PNP were insulin use (p = 0.0001), PRP treatment (p = 0.0003), and diffuse fluorescein leakage (p = 0.013). Importantly, there were no significant differences for any of the macular vascular metrics including vessel density (p = 0.15) and foveal avascular zone (FAZ) area (p = 0.58 and capillary tortuosity (p = 0.55). Features with significant predictive power (all p &lt; 0.001) were subretinal fluid, FAZ eccentricity, ellipsoid zone disruption, past anti-VEGF therapy, insulin use, and no ischemic heart disease. Conclusions: In the setting of DME, macular vascular changes did not predict the presence of PNP. Therefore, in order to detect peripheral non-perfusion in DME, our results implicate the importance of peripheral retinal vascular imaging.

A Novel Grid Strategy for Correlating Focal Macular Anatomic Changes With Focal Changes in Choriocapillaris Perfusion.

To establish the repeatability of choriocapillaris flow deficit (CCFD) measurements within a macular grid and then demonstrate the use of this registered grid strategy to follow CCFD measurements over time. Swept-source optical coherence tomography angiography scans were acquired (nominal size of 6 × 6mm). For each scan, masks of hyperreflective foci, calcified drusen, and persistent choroidal hypertransmission defects (hyperTDs) were generated. These masks were then used to exclude these prespecified regions when calculating the CCFD percentages (CCFD%). Scans were registered, and CCFD% measurements were performed within 3-mm and 5-mm fovea-centered circles and within a fovea-centered grid (one box: 74 × 74 pixels). The 95% minimal detectable changes (MDC95) for CCFD% were calculated for each of the regions. This longitudinal grid workflow was then used to study eyes before and after drusen resolved. Ninety eyes of 63 patients were identified: 30 normal eyes, 30 eyes with intermediate age-related macular degeneration (iAMD), and 30 eyes with hyperTDs. The MDC95 for the normal, iAMD, and hyperTD eyes within the 3-mm and 5-mm circles ranged from 0.85% to 1.96%. The MDC95 for an individual grid's box ranged from 3.35% to 4.67%, and for the total grid area, the MDC95 ranged from 0.91% to 1.40%. When tested longitudinally before and after the resolution of drusen using grid strategy, no significant differences in the CCFD% were observed. A grid strategy was developed to investigate targeted longitudinal changes in CCFD% associated with changes in optical coherence tomography biomarkers, and this strategy was validated using eyes in which drusen resolved.

Test-retest variability of mesopic microperimetry-associated parameters in patients with retinitis pigmentosa: REPEAT Study Report No. 2.

Understanding test-retest variability (TRV) of mesopic microperimetry is critical for defining meaningful treatment effects in retinitis pigmentosa (RP) trials. This study uniquely evaluates intra- and intervisit TRV and coefficients of repeatability (CoRs) for microperimetry parameters in RP patients with varying best-corrected visual acuity (BCVA) levels. In this single-centre prospective cohort study, RP patients were assessed on two visits, 14.0 days apart. Patients were grouped by BCVA: low (≤20/50 Snellen; ≥0.4 logMAR) or moderate (>20/50 Snellen; <0.4 logMAR). Using Bland-Altman analyses, the CoRs for intra- and intervisit variability were determined for pointwise (dB), mean (dB), and volume sensitivity (dB*deg2) on mesopic microperimetry. Intravisit CoRs for mean, volume, and pointwise sensitivity were 1.7 dB, 353.2 dB*deg2, and 8.6 dB, respectively, in the low-BCVA group (n = 32), and 0.9 dB, 254.5 dB*deg2, and 7.3 dB in the moderate-BCVA group (n = 15). Intervisit CoRs for mean, volume, and pointwise sensitivity were 2.4 dB, 355.2 dB*deg2, and 10.2 dB in the low-BCVA group (n = 31). The moderate-BCVA group (n = 16) showed smaller CoRs of 1.6 dB, 386.8 dB*deg2, and 7.7 dB for mean, volume, and pointwise sensitivity. BCVA and mean sensitivity, but not fixation stability, are predictors of TRV for volume sensitivity. Due to significant TRV, pointwise sensitivity is an unreliable endpoint for RP patients, irrespective of BCVA. Mean sensitivity is suitable as an endpoint when BCVA is relatively preserved. Volume sensitivity provides additional spatial information, and shows promise as a clinical endpoint for assessing macular sensitivity changes on mesopic microperimetry in patients with RP.

Homonymous hemi-macular atrophy in multiple sclerosis

Background: Retrograde trans-synaptic degeneration (TSD) following retro-chiasmal pathology, typically retro-geniculate in multiple sclerosis (MS), may manifest as homonymous hemi-macular atrophy (HHMA) of the ganglion cell/inner plexiform layer (GCIPL). Objective: To determine the frequency, association with clinical outcomes, and retinal and radiological features of HHMA in people with MS (PwMS). Methods: In this cross-sectional study, healthy controls (HC) and PwMS underwent retinal optical coherence tomography scanning. For quantitative identification of HHMA, a normalized asymmetry ratio was used, and its normative cutoffs were established from the HC. HHMA PwMS were propensity score matched 1:2 to non-HHMA PwMS. Mixed-effects linear regression models were used in analyses. Results: Based on normative data from 238 HC (466 eyes), 79 out of 942 PwMS exhibited HHMA (8.4%; 143 eyes). Compared to non-HHMA eyes from matched PwMS (158 PwMS; 308 eyes), HHMA eyes had lower average GCIPL (diff: −5.7 μm (95% CI −7.6 to −3.8); p < 0.001) but also inner nuclear layer (diff: −0.9 μm (95% CI −1.6 to −0.1); p = 0.02), and outer nuclear layer (diff: −1.9 μm (95% CI −3.4 to −0.4); p = 0.02) thicknesses; in further analyses, these differences were exclusive to the homonymous side of HHMA. HHMA participants also exhibited higher expanded disability status scale scores (diff: 0.5 (95% CI 0.1 to 0.9); p = 0.02), worse 100% and 2.5% visual acuity scores (diff: −3.2 (95% CI −4.1 to −1.0); p = 0.002, −5.4 (95% CI −7.5 to −3.5); p < 0.001), and higher frequency of microcystoid macular changes (10.1% vs. 3.2%; p = 0.03) compared to non-HHMA participants. Conclusions: HHMA, possibly as a marker of TSD, may signify higher disability in MS.

The macular microvascular changes in children with a history of retinopathy of prematurity treated with intravitreal Bevacizumab injection using optical coherence tomography angiography: a retrospective cohort.

Our study aims to evaluate and compare the macular microvascular condition of the intravitreal Bevacizumab (IVB)-treated retinopathy of prematurity (ROP) cases to the preterm cases without ROP and spontaneously regressed ROPs. It is a retrospective cohort of 50 premature neonates visited from 2016 to 2017 for ROP screening in Nikookari Eye Hospital and recalled for re-evaluation in 2022. These patients were classified into three groups based on their medical documents: 1. Preterm cases without ROP (PT), 2. Spontaneously regressed ROPs (SR), and 3. IVB-treated ROPs (IVB). All the included cases underwent a thorough ophthalmic exam, cyclo-refraction, Best-corrected visual acuity (BCVA) assessment, and macular optical coherence tomography angiography (OCTA). The foveal thickness, foveal avascular zone (FAZ) area, foveal, parafoveal, and perifoveal vascular density (VD) were evaluated as the quantitative variables. Twenty-five male and 25 female cases with a median age of 5.0 entered the study. Twenty-six eyes were evaluated in the PT group, 50 in the SR group, and 24 in the IVB group. The SR group consisted of 25 zone-2 and 25 zone-3 ROPs. In comparison, the IVB group consisted of 9 zone-1 and 15 zone-2 ROPs (p: < 001). Also, zone-2 cases were more advanced in the IVB group. The IVB-treated eyes demonstrated a significantly higher foveal superficial capillary plexus (SCP) VD than the others (28.5% vs. 23.1 and 22.9, respectively, in PT and SR, p:0.008). However, the parafoveal deep capillary plexus (DCP) VD was lower than the PT cases (48.5% vs. 53.4, p:0.034). The FAZ area was also smaller than the PT cases (0.113 vs.0.219 mm2, p:0.032). The FAZ area was significantly positively correlated with the foveal SCP and DCP VD and negatively correlated with parafoveal DCP VD (CC: -0.770, -0.719, 0.377, respectively, p: < 0.001). In the long term, although the IVB-treated ROP cases experience an excellent visual outcome comparable to those without ROP, they may show some macular microvascular changes. These changes might be related to the effect of IVB or the nature of more advanced stages of ROP.

Severity of Vessel Color Changes and Macular and Peripheral Whitening in Malarial Retinopathy Are Associated with Higher Total Body and Sequestered Parasite Burdens.

Two-thirds of children with cerebral malaria (CM) exhibit retinopathy characterized by whitening, vessel color changes, and/or hemorrhages. The pathogenesis of malarial retinopathy is not fully understood. This study aimed to assess the relationship between malarial retinopathy and the severity of its components (macular whitening, retinal hemorrhages, and vessel color changes) with the total, circulating, or sequestered parasite load in children with CM. Total parasite burden was estimated by measuring plasma levels of Plasmodium falciparum histidine-rich protein 2 (PfHRP2), while the sequestered load was calculated as the difference between the total burden and circulating parasitemia. Children with retinopathy-positive CM (n = 172) had higher total and sequestered parasite burdens compared to retinopathy-negative children (n = 42) (both p = 0.049). In a subgroup with detailed retinopathy grading (n = 52), more extensive vessel color changes correlated with higher total, sequestered, and circulating parasite loads (p = 0.0057, p = 0.0068, and p = 0.0433, respectively). Peripheral retinal whitening was also associated with increased total and sequestered loads (p = 0.0017 and p = 0.0012). No association was found between retinal hemorrhages and parasite burden, indicating that other factors may influence their pathogenesis.

Investigating Microperimetric Features in Bietti Crystalline Dystrophy Patients: A Cross-Sectional Longitudinal Study in a Large Cohort.

To assess the clinical and genetic characteristics of patients with Bietti crystalline dystrophy (BCD) with a focus on potential of microperimetry in monitoring macular function. A total of 208 genetically-confirmed BCD patients were enrolled in this retrospective study. The patients were categorized into subgroups based on their fundus characteristics (fovea sparing and fovea involved), optical coherence tomography (OCT) findings (presence/absence of retinal pigment epithelium [RPE] or ellipsoid zone [EZ] line at the fovea/parafovea), and genetic profiles (Mis/Mis, Tru/Mis, Tru/Tru). Fixation patterns were analyzed, and macular sensitivity (MS) parameters were compared among different groups. Longitudinal analysis was performed to calculate the annual changes in MS parameters. Correlation between genotype and phenotype were further investigated by analyzing cumulative incidence of vision impairment among different genotypic groups. Patients with well-preserved RPE or EZ at the foveal/parafoveal region exhibited higher MS. Notably, there was a decline in sensitivity parameters, with a decrease of -2.193dB/year (95% confidence interval [CI] -4.292 to -0.095, P = 0.041) at the fovea and -1.353dB/year (95% CI -2.047 to -0.659, P < 0.001) in average sensitivity. An age-adjusted comparison of sensitivity among genotypic groups and cumulative incidence analyses showed no association between genotypic groups and vision loss. Microperimetry proves to be one of a credible tool for detecting macular functional changes in BCD patients. BCD patients with different genotypes may have similar disease progression.

Optic disc pit maculopathy: Covering or filling technique with human amniotic membrane patch to treat the optic disc pit maculopathy?

To describe two patients affected by optic disk pit-maculopathy ODP-M surgically treated with pars-plana vitrectomy (PPV) and the apposition of a human Amniotic Membrane (hAM) patch. Patients underwent a PPV with the apposition of a hAM patch to cover the ODP. In case 1, a 2nd surgery was necessary to push the hAM patch inside the pit, whereas in case 2 the patch was pulled inside the pit following the pressure gradient when infusion was turned on. After surgery the hAM patch filled the ODP and in both cases, during follow-up, there was a progressive reduction of macular OCT changes and a concomitant BCVA improvement. Our experience seems to support the idea that the dynamic fluctuation of pressure between intra-ocular and intra-cranial spaces can direct the movement of fluid through the anomalous communication created by the ODP. In this perspective, our cases seem to support the idea that the primary goal of any surgery should be to create a permanent barrier to fluid migration through the ODP to the intra-ocular space, and that hAM can be successfully used to fill the OPD and to create that permanent barrier to achieve the resolution of ODP-M.

Insights Into Cataract Surgery Outcomes In Age-Related Macular Degeneration: Real-World Perspectives Across Severity Grades

PurposeCataract and age-related macular degeneration (AMD) share age as a main risk factor and thus have a high coincidence. Both conditions substantially reduce visual acuity. This study aimed to assess the impact of cataract surgery on visual acuity, retinal morphology, and vascular-endothelial-growth-factor (VEGF) inhibitor therapy in patients with AMD. DesignThis study was designed as a retrospective, monocentric, real-world study. SubjectsPatients diagnosed with either dry AMD or neovascular AMD undergoing cataract surgery at Charité Campus Benjamin Franklin. MethodsTreatment data were extracted from the Berlin Macular Registry. Best-corrected visual acuity (BCVA) and macular optical coherence tomography (OCT) parameters, including central retinal thickness (CRT), macular volume (MV), presence of macular edema, intraretinal or subretinal fluid and pigment epithelial detachment were assessed. Main Outcome MeasuresPrimary outcome measure was the postoperative BCVA. Secondary outcomes included postoperative CRT, MV, changes in qualitative OCT parameters, alterations in anti-VEGF-therapy interval and postoperative complications. ResultsA total of 418 eyes of 418 patients were included in the analysis with a mean follow-up time of 18.8 (2-62) months. They were classified into a neovascular AMD (n=85) and a dry AMD (n=333) cohort. Mean BCVA improved significantly in the neovascular AMD cohort from 0.69 ±0.45 logMAR to 0.47 ±0.42 (p= <0.001) and in the dry AMD cohort from 0.53 ±0.47 logMAR to 0.27 ±0.32 (p= <0.001) at the two-month follow-up. Improvements in BCVA were sustained to the final visit (18.9 ±19.5 months post-surgery) with BCVA at 0.46 ± 0.38 logMAR (p= <0.001) and 0.26 ± 0.34 logMAR (p= <0.001), respectively. Temporary postoperative increases in CRT and MV were observed, reverting to preoperative levels by six months post-surgery. The need for anti-VEGF therapy did not change postoperatively in patients with neovascular AMD. ConclusionsWithin this retrospective analysis, on average patients with coincident AMD of all severity grades meeting the inclusion criteria benefited from cataract surgery. Transient increases in retinal thickness and macular volume returned to baseline within six months post-surgery. The need for intravitreal injections in neovascular AMD subjects was unchanged post-surgery. Overall, the study suggests no adverse long-term macular changes attributable to cataract surgery.

Retinal and Macular Changes in Pregnant Women of Advanced Maternal Age: A Retrospective Study.

Aims/Background Pregnancy may cause physiological and pathological changes in multiple organs in a woman's body, including the heart, liver, and eyes. With rapid advances in societies and economies, the proportion of advanced maternal age (AMA) women has significantly increased. Here, we aimed to investigate the changes in arteriole retinal diameter, venule diameter, macular layer thickness, and arteriole to venule ratio (AVR) in this population. Methods This retrospective case-control study included 523 pregnant women (1046 eyes) and was performed on both eyes. In total, 318 subjects were included in the AMA group, and 205 subjects were included in the non-AMA group. Nonmydriatic fundus photography and optical coherence tomography (OCT) were performed on the same day, and the results were analyzed for the central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), AVR, and macular thickness (9 subfields) by integrative vessel analysis and automatic OCT software. Results In both eyes, the CRAE was significantly lower in the AMA group than that in the non-AMA group (p < 0.05; respectively). The CRVE in the AMA group was higher than that in the non-AMA group (p < 0.001; respectively). Compared to the non-AMA group, the AMA group exhibited a significant reduction in macular thickness within the inner nasal, outer nasal, and inner temporal subfields of both eyes (p < 0.05; respectively). Age was significantly correlated with CRVE and AVR in both eyes of pregnant women (CRVE: p < 0.0001; AVR: p < 0.01). Conclusion This study reports variations in the diameter of the retinal vasculature and the thickness of the macula in women of AMA. It is important to consider these changes when interpreting the adverse eye outcomes experienced by women of AMA.

Macular Alterations in a Cohort of Caucasian Patients Affected by Retinitis Pigmentosa.

Our objective was to investigate the prevalence of macular complications detected by spectral-domain optical coherence tomography (SD-OCT) in a large Caucasian cohort of RP patients, highlight the major alterations in chorioretinal structure, and compare the macular structural changes in eyes affected by retinal dystrophies with those in healthy controls. This was an observational, retrospective, and cross-sectional study. Three hundred and seven patients with RP were consecutively enrolled and underwent clinical assessment. In particular, SD-OCT images were used to ascertain the morphology of the posterior pole of patients with RP by evaluating the residual ellipsoid zone (EZ), the volume and thickness of the outer nuclear layer (ONLT), and subfoveal choroid thickness (SCT). At the same time, the pathological finding that the patients' vision was reduced under treatment was analyzed. A total of 436 eyes of 218 patients with RP were studied. Considering all of the eyes studied, 103 had cystoid macular edema (CME) (23.62%), 123 (28.21%) had vitreomacular traction (VMT), and 199 (45.75%) had epiretinal membranes (ERMs). There were also 12 (2.75%) cases of lamellar macular holes (LMHs), of which 3 (1.38% of all patients) cases were bilateral. Only 137 eyes (31.42%) did not have the above-mentioned alterations. SCT was significantly reduced compared to that of the control group (193.03 µm ± 67.90 SD vs. 295 µm ± 69.04 SD), while the foveal central macular thickness (FCMT) was greater (270.91 μm ± 74.04 SD vs. 221 µm ± 37.25 SD). This research highlights the high incidence of macular complications. The results of our study indicate the importance of regular monitoring of RP patients and early intervention to avoid further complications in this group of subjects with severe visual field impairment to avoid further central vision loss.

MACULAR CHANGES IN ADULTS WITH HISTORY OF PREMATURE BIRTH.

To characterize changes in the macular structure and vascularity seen in premature-birth adults. Retrospective review of adult patients seen in the clinic from July 2018 to November 2020 with history of premature birth not requiring treatment for retinopathy of prematurity, as well as healthy controls. Swept-source ocular coherence tomography-angiography scans were analyzed for various parameters related to the macular structure and vascularity. Statistical analysis was performed using univariate linear regression. Thirty-four eyes were included (17 eyes from 10 premature-birth adults, 17 eyes from 11 control patients). Prematurity was associated with vascular changes on ocular coherence tomography-angiography: decreased foveal avascular zone area ( P = 0.001), decreased foveal avascular zone circularity index ( P < 0.001), decreased superficial capillary plexus vessel density ( P = 0.02), and decreased deep capillary plexus vessel density ( P < 0.001). Prematurity was also associated with structural changes: shallower foveal pit depth ( P < 0.001), decreased cube average thickness ( P = 0.005), and increased central subfield thickness-to-cube average thickness ratio ( P = 0.002). This is the largest published series of ocular coherence tomography-angiography data for premature-birth adults. Even without a history of retinopathy of prematurity treatment, premature birth is associated with multiple changes to the macular structure and vascularity that persist into adulthood. These include a smaller, more irregularly shaped foveal avascular zone, decreased juxtafoveal vascular density, and a shallower foveal pit.