Nerve Fiber Layer Research Articles

Monitoring of several morphometric parameters of the optic nerve and retina in persons without glaucoma and patients with primary open-angle glaucoma using various types of spectacle correction

Purpose: to perform long-term monitoring of the state of several morphometric parameters of the retina and optic nerve in persons without glaucoma and patients with primary open-angle glaucoma (POAG) in the conditions of achieving tolerant and target IOP against the background of the use of various types of spectacle correction. Material and methods: 139 patients aged 40–60 years with various types of clinical refraction were examined, 41 subjects (81 eyes) of them were without glaucoma, 98 patients (164 eyes) had POAG at stage I–II. In addition to standard methods, the scope of the examination included optical coherence tomography (OCT) of the optic nerve and the central area of the retina to determine the thickness of the retinal nerve fiber layer (RNFL), retinal ganglion cell complex (RGCC) and the area of the neuroretinal rim (NRR). The study was conducted in 4 observation groups. The first (21subjects) and the second (20 subjects) groups were represented by persons without glaucoma who used monofocal spectacle correction and progressive spectacle correction for near work, respectively. The third (50 subjects) and the fourth (48 subjects) groups were composed of patients with POAG who also used, respectively, monofocal spectacle correction for near vision or progressive spectacle correction against the background of topical hypotensive therapy with the achievement of tolerant and target IOP. The follow-up period was three years. Results: There were no significant changes in the area of NRR (p 0,5) and in the thickness of RNFL (p 0,2) and RGCC (p 0,3) over the three-year follow-up period in all patients without glaucoma. In patients with POAG who applied progressive correction, no negative dynamics was revealed in the NRR area (p 0,5) and in the thickness of RNFL (p 0,5) and RGCC (p 0,5) during the follow-up period. POAG patients with using monofocal correction had noticeable losses in RNFL and RGCC thickness (p 0,05) without a significant decrease in the area of NRR (p 0,3). Conclusion: The progressive spectacle correction using provides accommodative regulation of IOP in POAG and implements an indirect neuroprotective effect.

Sodium bicarbonate use in the treatment of idiopathic intracranial hypertension.

This retrospective case-control study from 2008 to 2022 aimed to determine the effect of adjunctive sodium bicarbonate (NaHCO3) on treatment outcomes of and side effects of acetazolamide (ACZ) for the treatment of idiopathic intracranial hypertension (IIH). Retrospective data was collected via chart review. 288 eyes of 144 patients with IIH, including those taking ACZ alone (control group, n = 89) vs. ACZ and NaHCO3 (treatment group, n = 56). The primary outcome measure was time to IIH resolution. Secondary outcomes included retinal nerve fibre layer thickness (RNFL), visual field mean deviation (VFMD), visual acuity (VA), discontinuation ACZ, and patient-reported side effects of ACZ. Cox proportional hazards model for the primary outcome yielded a hazard ratio of 0.800, which was statistically insignificant (95% CI, 0.57-1.13; p = 0.200). There was no significant difference between groups when comparing RNFL, VFMD, VA, surgical intervention, or discontinuation of ACZ. The treatment group was more likely to experience side effects from ACZ prior to starting sodium bicarbonate therapy (p < 0.001). Among the treatment group, 92.7% remained on NaHCO3 until IIH resolution, and 9 of 12 (75%) subjects reported significant improvement in ACZ-related side effects. Sodium bicarbonate does not appear to impact treatment outcomes in patients taking acetazolamide for IIH. Sodium bicarbonate may represent a reasonable adjunctive medication to help mitigate acetazolamide-related side effects in this group of patients.

Rapid Campimetry in glaucoma – correspondence with standard perimetry and OCT

The Rapid Campimetry (RC), a kinetic visual field test proved to reliably detect visual field defects within the central 10° degrees, the most crucial part for visual acuity and quality of life, affected even at very early stages of glaucoma, within a short measurement epoch, ~ 1 min. This study aims to further investigate RC correspondence with standard tests in glaucoma, namely standard automated perimetry (SAP) and optical coherence tomography (OCT) within 10° of visual field (VF). For this purpose, we included 41 participants, [21 glaucoma (GLA, mean age: 65.9 ± 12.4; 12 preperimetric eyes and 11 with VF defects) and 20 healthy controls (HC; mean age: 65.0 ± 10.3); 20 eyes]. At first, we compared the rate of detection/exclusion of VF defects in RC vs. SAP. Then, for those with VF defects (11 eyes), we investigated the 68-pointwise correspondence of 10 − 2 layout of RC and SAP. For functional and structural (SF) correspondence, pointwise correspondence of RC, SAP vs. OCTmacula [ macular ganglion cell thickness (GCL)] was also performed. Further, we compared sector-based correspondence of RC, SAP vs. OCTmacula accounting for GCL displacement at the fovea as well as sector-based correspondence with OCTdisc [peripapillary retinal nerve fiber layer thickness (pRNFL)]. Agreement estimates were reported along with Cohen Kappa (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\kappa\\:$$\\end{document}) statistic. For overall performance, RC and SAP showed 100% agreement (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\kappa\\:=1$$\\end{document}) for the exclusion of VF defects (HC and preperimetric GLA) and for detection of VF defects [11 eyes of 9 GLA, (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\kappa\\:=1)$$\\end{document}]. Further, RC outperformed SAP in detection of arcuate scotomas, 7 vs. 5, respectively. Pointwise correspondence of VF defects (11 eyes), RC-SAP agreement reached 90% accuracy (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\kappa\\:=0.77,\\:substantial\\:agreement$$\\end{document}). For SF correspondence, RC [SAP] showed 62% [69%] pointwise agreement with OCTmacula, (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\kappa\\:=0.10\\:\\left[0.33\\right]$$\\end{document}). For macular sector-based correspondence, SF correspondence improved and reached 83% [83%] agreement, (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\kappa\\:=0.57\\:\\left[0.57\\right]$$\\end{document}). For OCTdisc sector-based analysis, SF correspondence was highest, 100% [100%] agreement, (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\kappa\\:=1\\:\\left[1\\right]$$\\end{document}). Rapid Campimetry gave reproducible results in comparison to SAP and OCT with high potential as a screening VF method given its short testing duration, ~ 1 min in screening mode, and compatibility with telemedicine technologies upon future optimization and automation.

Comparative evaluation of OCT with OCTA changes at the optic disc and macula in glaucoma suspect and early glaucoma.

To compare the diagnostic ability of macular ganglion cell inner plexiform layer (mGCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thickness on optical coherence tomography (OCT) and macular and peripapillary perfusion changes using OCT angiography (OCTA) in glaucoma suspect and early primary open angle glaucoma (POAG). Ninety patients (30 normal, 30 glaucoma suspects, and 30 early POAG) were recruited in this cross-sectional, prospective study. The average thickness of mGCIPL and pRNFL on spectral domain-OCT and macular vessel density (VD), optic nerve head (ONH) perfusion, and ONH flux index (FI) on OCTA were evaluated for early diagnosis of glaucoma. Macular VD, ONH perfusion, and ONH FI were significantly reduced in early POAG eyes compared to normal. The best correlation was observed between ONH FI and the average RNFL in both glaucoma suspects (r = 0.47, P < 0.01) and early POAG patients (r = 0.53, P < 0.01). Out of all the measured OCTA parameters, only ONH perfusion was significantly lower in glaucomatous eyes compared to glaucoma suspects (P < 0.001). Average GCIPL (0.82) and macular VD (0.76) had the highest area under the receiver operating characteristic (AUROC) curve value among all the OCT and OCTA parameters, respectively, for differentiating glaucoma suspects from controls. Rim area (0.92) and ONH FI (0.81) had the highest AUROC value among all the OCT and OCTA parameters for differentiating early POAG patients from controls. OCTA vascular parameters had a good correlation with structural damage both at the disc and the macula. OCT parameters were superior to OCTA parameters for diagnosis of glaucoma, although OCTA parameters are deranged very early in the disease.

Microvascular changes in eyes with non-proliferative diabetic retinopathy with or without macular microaneurysms: an OCT-angiography study.

To evaluate different quantitative non-invasive retinal biomarkers of microvascular impairment and neurodegeneration in patients affected by mild and moderate non proliferative diabetic retinopathy (NPDR) with or without macular microaneurysms (MAs). A cross-sectional case-control study. Ninety-seven eyes with NPDR, 49 with no central MAs and 48 with central MAs, underwent color fundus photography and optical coherence tomography (OCT)/OCT-angiography (OCT-A). Thickness of central macula, retinal nerve fiber layer (NFL), ganglion cell layer (GCL+) and NFL + GCL + was evaluated on OCT. FAZ metrics (ImageJ), perfusion and vessel density (PD/VD), and fractal dimension (FD) (MATLAB) were evaluated on 3 × 3 OCT-A slabs of both superficial and deep capillary plexuses (SCP/DCP). All evaluations were performed on the full image and after subdivision in 4 quadrants. In the MA group, 77 MAs were detected (45.5% in the DCP). The MA group showed: increased FAZ area and perimeter in the SCP (p < 0.01) and DCP (p = 0.02), and reduced circularity index in the SCP (p = 0.03); reduced VD in the SCP (p < 0.01) and reduced PD, VD (p < 0.01) and FD (p = 0.02) in the DCP; decreased VD and FD in the SCP (p = 0.02 and p = 0.05), and in VD and FD in the DCP in the inferior quadrant (p = 0.04 and p = 0.03); a decrease in VD in the SCP in the nasal quadrant (p = 0.05). No differences have been detected in OCT parameters. Our results suggest that the presence of central MAs in patients with NPDR may correlate with more pronounced macular microvascular impairment, particularly during the mild and moderate stages of the disease.

Lifestyle modifications and environmental risk factors for glaucoma

Purpose of review To summarize recent evidence about the association between different lifestyle modifications and environmental risk factors and glaucoma. Recent findings Incorporating moderate exercise into the routine of glaucoma patients may help slow the progression of the condition. However, caution should be taken when using swim goggles, and it may be advisable to avoid certain yoga positions and heavy weight-lifting exercises, as they have been linked to intraocular pressure (IOP) spikes and potential risks for glaucoma patients. Various relaxation techniques may lower IOP. The evidence remains inconclusive about the association between vitamins intake and glaucoma. Dietary nitric oxide has been associated with a lower risk of glaucoma. Higher smoking intensity has been linked to faster visual field decline and retinal nerve fiber layer thinning. Additionally, there is currently insufficient evidence to support the use of marijuana in managing glaucoma, with side effects outweighing the proposed benefits. A significant association has been found between air pollutants and ganglion cell layer thinning, as well as a greater burden of glaucoma. Summary Lifestyle and environmental factors are increasingly recognized as significant contributors to glaucoma development and progression. These modifications should be integrated into a comprehensive treatment approach alongside medications or surgical interventions.

Evaluation of retinal nerve fiber layer and choroidal structure in obese children and adolescents

Aim: Obesity-related vascular damage and endothelial dysfunction have deleterious effects on the ocular vasculature. It was aimed to examine optical coherence tomography (OCT) parameters in obese and overweight children and to define their relationship with metabolic markers in this study. Methods: The patient group consisted of 26 obese, 24 overweight patients aged between 8 and 18 years. The control group consisted of 25 healthy children with normal body mass index (BMI). This was a cross-sectional observational study. Serum glucose, lipid parameters, and homeostasis model assessment of insulin resistance (HOMA-IR) were investigated. Measurement of choroidal thickness was performed with Cirrus HD-OCT (Carl Zeiss Meditec Inc., Dublin, CA, USA). Retinal nerve fiber layer (RNFL) thickness was determined by an automatic computer algorithm without the need for user measurement. Results: There were no differences in subfoveal, nasal, temporal choroidal thickness, and RNFL between obese, overweight, and control groups (p&gt;0.05). A positive (linear) moderate relationship was found between RNFL and the HOMA-IR of 26 patients in the obese group (r=0.389) (p=0.049). A positively weak correlation was found between height and RNFL in obese patient group (r=0.264, p=0.028). Conclusion: In the study, RNFL thickness increased as HOMA-IR level increased in obese children and adolescents. RNFL decreased as the height increased in obese children and adolescents. We believe that more comprehensive data about the effect of obesity on RNFL and choroidal thickness will be obtained with prospective studies in which the obese patient group with insulin resistance is taken separately and disease durations are defined, and long-term patient follow-up is performed.

Posterior short ciliary arteries ischemia following embolization of anterior ethmoid artery to treat dural arteriovenous fistulas: a case report

BackgroundThe Onyx™ Liquid Embolic System is a non-adhesive liquid embolic agent, which has been proved by the US FDA for embolization of lesions in the peripheral and neurovasculature since 2005. We reported a case of ischemic optic neuropathy after using Onyx-18 to embolize the anterior ethmoid arteries that feeding dural arteriovenous fistulas (DAVF).Case presentationA 57-year-old Asian male presented with anterior cranial fossa DAVF underwent embolotherapy by delivering Onyx-18 through a microcatheter into the anterior ethmoid arteries under angiography guidance. The interventional procedure was successful and no clear evidence was found pointing to untargeted occlusive embolus. But after the surgery the patient experienced delayed painless vision loss in the right eye (RE). The fundoscopy showed unilateral papilledema with pale optic disc in RE, accompanied by significant edema and thickening in the retinal nerve fiber layer (RNFL) of macula. The fundus fluorescence angiography showed that most of the optic disc in RE had postponed or absent fluorescence filling. Visual evoked potential (VEP) confirmed that the amplitude of the P100 component was decreased in RE without significant prolongation of the latency. The patient was diagnosed with anterior ischemic optic neuropathy, but immediate pulse steroid therapy failed to rescue his vision.ConclusionPreoperative evaluation of the patient’s hemodynamic status and fundus examination are essential for assessing the risk of ischemic ocular complications, and the non-adhesive liquid embolic agent Onyx-18 should be used cautiously during endovascular embolization of intracranial artery.

Application of optical coherence tomography in neurodegenerative diseases: a focus on Parkinson’s, Alzheimer’s, and Schizophrenia in Bulgarian patients

This study investigates retinal alterations in patients with Alzheimer’s disease (AD), Parkinson’s disease (PD), and schizophrenia (SZ) using Optical Coherence Tomography (OCT). The primary objective was to determine whether these neurodegenerative diseases manifest in measurable retinal changes and to assess the impact of disease duration, medication use, and cognitive decline on these alterations. A cross-sectional observational design was employed, including 132 patients and age- and gender-matched controls. OCT imaging was performed using the Topcon 3D OCT-1 Maestro 2, focusing on the retinal nerve fibre layer (RNFL), ganglion cell complex (GCC), and macular thickness. Significant retinal thinning was observed in the AD and PD groups, correlating with disease severity and cognitive decline, and was more pronounced with longer disease duration. In contrast, no significant retinal changes were identified in the SZ group. The study also explored the effects of different drug classes, revealing correlations between specific medications and retinal parameters, particularly in the AD and PD cohorts. To our knowledge, this is the first study of its kind conducted with Bulgarian patients. These findings suggest that OCT may serve as a non-invasive biomarker for neurodegeneration in AD and PD, though its utility in SZ remains limited. Future research should aim to standardize OCT protocols, further investigate the potential of retinal imaging in tracking neurodegenerative disease progression, and explore its integration with other neuroimaging techniques for a more comprehensive diagnostic and monitoring approach.

Differential diagnosis of optic neuritis and anterior ischemic optic neuropathy

Background. Acute anterior ischemic neuropathy and optic neuritis are among the most common diseases that are the most frequent cause of both reversible and persistent visual acuity reduction. There is a sudden loss of vision, the clinical picture is often similar, and the restoration of visual functions and the prevention of complications in the form of optic nerve atrophy and disease relapses depend on a correct diagnosis and timely prescribed therapy. A significant level of medico-social and economic losses for society in all regions of the world is related to complications, namely the occurrence of optic nerve atrophy due to both optic nerve inflammation (neuritis) and ischemic optic neuropathy. The purpose was to determine the differential signs of optic neuritis and anterior ischemic optic neuropathy. Materials and methods. Eighty-five patients were examined, 52 (61.2 %) women and 33 (38.8 %) men. Seventy-one (83.5 %) participants were employed. The patients were divided into two groups: the first one — 38 patients with optic neuritis (papillitis); the second one — 47 people with ischemic optic neuropathy. General ophthalmological examinations were carried out. Results. Computed perimetry showed the presence of scotoma and quadrantanopia, both in anterior optic neuropathy (typical altitudinal scotomas) and optic neuritis (peripheral and central scotomas). The difference in the indicators of the electrical activity of the visual analyzer according to phosphene between the groups was 15.8 % (p &lt; 0.05), which indicates a more significant increase in the functional activity of the visual analyzer in the group with anterior optic vascular neuropathy. Thinning of the peripapillar nerve fiber layer and partial atrophy of the optic nerve were noted 2 times less often in patients with anterior vascular ischemic neuropathy — 7 (16.3 %) vs. 14 (33.3 %) in those with partial atrophy of the optic nerve (Pearson’s χ2 = 22.59, p = 0.00001). Conclusions. The issue of early differential diagnosis of anterior optic ischemic neuropathy and optic neuritis is relevant, which determines the prognosis of the disease, allows increasing the effectiveness of treatment and preventing irreversible consequences. The therapeutic effect of treating the consequences of damage to the optic nerve is not stable and is weak, and success is not always achieved. First of all, the treatment of the underlying disease is indicated. Computed perimetry showed the presence of scotoma and quadrantanopia in both anterior optic neuropathy (typical altitudinal scotomas) and optic neuritis (peripheral and central scotomas).

Imprint of preterm birth with very low birth weight on optic disc OCT in adulthood-A two-country birth cohort study.

To determine the pattern, degree and prevalence of optic disc optical coherence tomography (OCT) alterations in adults born preterm with very low birth weight (VLBW; birth weight < 1500 g). Optic disc OCT was assessed in 98 VLBW participants and 139 term-born controls from birth cohorts in Finland and Norway at the mean age of 36 years. The participants had not been treated for retinopathy of prematurity and had no diagnosed brain abnormality. OCT assessment included parameters for optic disc size, neural rim and peripapillary retinal nerve fibre layer thickness (pRNFLT), and for the foveal developmental stage. Background data, visual acuity, refractive error and intraocular pressure were recorded. In the VLBW group, optic disc neural rim and pRNFLT were significantly decreased, most frequently in the nasal and inferior sectors. In 40% (95% CI: 33-47) of the VLBW eyes, nerve fibre thickness of at least one optic disc sector was below the fifth percentile of the control group, including 9% (95% CI: 6-14) subgroup falling below the first percentile, that is, clinically below normal limits. VLBW participants with nerve fibre thickness below the fifth percentile did not differ by perinatal data or foveal developmental stage from the other VLBW participants. All participants had normal visual acuity. A moderate decrease of the optic disc neural rim and pRNFLT is frequently seen in clinically healthy adults born preterm with VLBW. Awareness of the VLBW-related optic disc nerve fibre shallowness especially in the inferior and nasal sectors is important while evaluating acquired optic disc pathology in adulthood.

Long-term efficacy and safety of ab externo canaloplasty in the Polish Caucasian population with open-angle glaucoma: A 3-year retrospective study.

This study aimed to assess the effectiveness and safety of ab externo canaloplasty over a 3-year follow-up period in Polish Caucasian patients with glaucoma. This retrospective study of a cases series was conducted at the Department of Ophthalmology Medical University of Bialystok, Poland. Primary outcome measures were intraocular pressure and medication burden. Secondary outcome measures were best corrected visual acuity, retinal nerve fiber layer thickness, visual field test results, endothelial cell density, intraoperative and postoperative complications, and additional glaucoma surgery. The study group consisted of 160 eyes diagnosed with early to-moderate primary open-angle glaucoma and treated with ab externo canaloplasty from 2014 to 2020. The criteria for qualified and complete success were intraocular pressure < 18 mmHg or ≥ 20% reduction in intraocular pressure from baseline with or without antiglaucoma medications, respectively. After surgery, the mean intraocular pressure decreased from 19.23 ± 4.33 to 14.52 ± 3.79 mmHg, which constituted a 36.7 ± 7.8% reduction compared to the baseline value. The number of medications decreased by two at the end of the study period (from 2.69 ± 1.05 to 0.32 ± 0.75). Complete and qualified success were achieved in 58.7% and 68.7% of the patients, respectively, at the end of follow-up. An incomplete cannulation of Schlemm's canal was the most common intraoperative complication, occurring in 32 eyes (20%). The most frequent postoperative complications were hyphema, Descemet's membrane detachment, and a transient increase in intraocular pressure. Additional surgical procedure was required in seven cases (4.4%). In 16 patients (10%), medical treatment was re-administered. Overall, our findings suggest that ab externo canaloplasty is a good option for Polish Caucasian patients with primary open-angle glaucoma. It reduces intraocular pressure and has a low postoperative complication rate. Additional glaucoma surgery or re-administration of medications is required if the target intraocular pressure is unsatisfactory.

Corticosteroids and glaucoma: How do treatments trigger ocular nerve damage? - A systematic literature review

Corticosteroids are steroid hormone derivatives produced by the adrenal glands. Corticosteroids in the health sector have been widely utilized as anti-inflammatory agents because of their strong and rapid effects. This study aimed to identify the impact of long-term corticosteroid use on eye damage. This study uses a systematic literature review, which is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to the article screening process. The data of this study, in the form of demographic variables, route of administration, steroid type, comorbidities, and patient risk factors, were descriptively analyzed. As a result, 15 of the 22 articles were selected for analysis. Chronic corticosteroid administration may precipitate optic neuropathy, manifesting as glaucoma, which is characterized by progressive structural degeneration of retinal ganglion cells (RGCs) and concomitant visual function deterioration. The locus of primary pathological insult in glaucomatous conditions is the optic nerve head, specifically at the optic disc. This anatomical site is notable for the abrupt 90-degree angular deviation of RGC axons as they transition from the retinal nerve fiber layer to their trajectory within the optic nerve proper. The use of corticosteroids can damage ocular nerve tissue through an increase in intraocular pressure (IOP) beyond 21 mmHg. This increase in IOP is due to changes in the microstructure of the trabeculum webbing, resulting in increased obstruction to the outflow of aqueous humor.

An investigation on choroidal and retinal thickness alterations in Posner-Schlossman syndrome patients

BackgroundWe aimed to compare choroidal thickness (ChT) and retinal nerve fiber layer (RNFL) thickness in the affected and contralateral eyes of patients with Posner-Schlossman Syndrome (PSS) during acute, remission, and intermittent phases.MethodsThis prospective observational study included 18 patients(36 eyes) diagnosed with PSS. These patients underwent a comprehensive ophthalmologic evaluation including slit lamp examination, visual acuity testing, intraocular pressure (IOP) measurement, and funduscopic examination, and assessment of RNFL thickness, macular thickness, and macular ChT. Patient data collected included gender, age, number of keratic precipitates (KPs), and number of episodes. Optical coherence tomography (OCT) was used to measure RNFL thickness, macular thickness, and macular ChT in both eyes during the acute, remission, and intermittent phases. The affected eye was compared with the unaffected eye at each phase.ResultsIn affected eyes, macular ChT was lower in the acute phase compared to the remission phase at N1500, N1000, N500, and subfoveal locations (allp < 0.05).The central macular recess ChT was also significantly thinner in the acute phase compared to the intermittent and remission phases. Age significantly correlated with ChT in the central recess (p = .024). Macular thickness was thinner during the acute phase in the affected eye (p = .048). The RNFL in the affected eye was thinner in the intermittent phase than in the acute phase at the inferior-temporal (p = .011) and global sectors (p = .044). During the acute phase, RNFL in the affected eye was thinner at the superior-nasal (p = .049), inferior-temporal (p = .003), and global (p = .041) sectors compared to the unaffected eye. In the intermittent phase, the affected eye’s RNFL was thinner at the superior-nasal, inferior-temporal, inferior-nasal, and global sectors compared to the unaffected eye (allp < 0.05), while no difference was observed in both eyes at the nasal, superior-temporal, and temporal sectors. The number of episodes and age were significantly associated with RNFL thickness (p < .05).ConclusionThis study demonstrated that in eyes affected by PSS, RNFL, macular ChT, and macular thickness thinned during the acute phase. The number of episodes and age are significant factors in the development of PSS.

Variability in Optic Nerve Head Morphology in High Axial Myopia and Its Association with Glaucoma

Purpose: To investigate optic disc morphology in high axial myopia and its associations with the deep-layer structure of the optic disc using optical coherence tomography and glaucoma.Methods: We retrospectively reviewed the medical records of 69 eyes (33 normal and 36 glaucomatous eyes) with an axial length of 26-27 mm. The eyes were categorized into two groups based on the optic disc tilt ratio (≥ 1.3 or &lt; 1.3). Characteristics of optic disc morphology, including lamina cribrosa depth, peripapillary atrophy width, and Bruch’s membrane opening area, were compared between the two groups. Furthermore, factors related to mean deviation and global retinal nerve fiber layer (RNFL) thickness were analyzed.Results: The mean optic disc tilt ratio was 1.31 ± 0.23. Eyes with a tilt ratio ≥ 1.3 (30 eyes) had a higher likelihood of glaucoma (&lt;i&gt;p&lt;/i&gt; = 0.035) and severe visual field (VF) defects (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), a thinner global RNFL thickness (&lt;i&gt;p&lt;/i&gt; = 0.046), and larger gamma peripapillary atrophy width (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) compared to eyes with a tilt ratio &lt; 1.3 (39 eyes). Linear regression analysis revealed that the optic disc tilt ratio was significantly associated with VF loss (&lt;i&gt;p&lt;/i&gt; = 0.018) but not with global RNFL thinning (&lt;i&gt;p&lt;/i&gt; = 0.203).Conclusions: Variations in optic disc morphology are observed in eyes with similar axial lengths, and a higher optic disc tilt ratio is associated with more severe VF defects. These findings suggest the potential influence of optic disc morphological changes due to axial elongation on the severity of glaucomatous damage.

Demyelination and neurodegeneration early in experimental autoimmune encephalomyelitis contribute to functional deficits in the anterior visual pathway

Impaired visual function is a prevalent feature of optic neuritis (ON) in multiple sclerosis (MS). Abnormal visual evoked potential (VEP) findings of increased latencies, reduced amplitudes and abnormal waveforms as well as decreased retinal nerve fiber layer (RNFL) assessed by optical coherence tomography (OCT) are hallmarks of ON-induced visual dysfunction. Here we utilized the experimental autoimmune encephalomyelitis (EAE) mouse model of MS to investigate the functional and pathological progression during early (before any clinical symptoms), peak (initial maximal clinical symptoms), and late (chronic disease for > 3 weeks) disease stages. Demyelination and initial stages of axon damage were observed in early EAE. Significant demyelination, inflammation, increased axon damage and impaired P1/N2 amplitudes and latencies by VEP were seen in middle and late EAE groups. A decrease in RNFL thickness by OCT was observed only during late EAE. NanoString analysis of optic nerves from late EAE indicated elevated inflammation-related genes, reduced myelin-related genes, and changes in axon degeneration-related genes. Early inflammatory demyelination and functional deficits of the visual pathway, if untreated, may lead to severe irrecoverable axon damage in EAE. These studies potentially help explain the progression of visual dysfunction during MS.

Vitrectomy in Small idiopathic MAcuLar hoLe (SMALL) study: Internal limiting membrane peeling versus no peeling.

To compare vitrectomy with and without internal limiting membrane (ILM) peeling in small idiopathic macular holes. Retrospective multicentre study including consecutive eyes with ≤250 μm idiopathic macular hole treated with vitrectomy. The primary outcome was hole closure rate. Best-corrected visual acuity (BCVA) change, closure patterns on optical coherence tomography, rates of external limiting membrane (ELM) and ellipsoid zone (EZ) recovery, and rate of complications were also investigated. In total, 693 eyes were included. Hole closure rate was 98% in the peeling and 85% in the no-peeling group (p < 0.001). At 12 months, mean BCVA change was 0.38 ± 0.22 logMAR in the peeling and 0.45 ± 0.21 logMAR in the no-peeling group (p = 0.02); 66% versus 80% of eyes had a U-shaped morphology, respectively; EZ recovery rate was 75% and 93%, respectively (p = 0.02). In the no-peeling group, eyes with a vitreomacular traction (VMT) showed a 96% closure rate, comparable to the peeling group (p = 0.40). The incidence of adverse events was similar except for dissociated optic nerve fibre layer (55% in the peeling vs. 9% in the no-peeling group, p < 0.001). In small idiopathic macular holes, ILM peeling provides a higher closure rate compared to no-peeling; however, if a VMT is present closure rates are comparable. In closed macular holes, the no-peeling technique provides advantages in terms of visual outcome and anatomical recovery.

PreserFlo MicroShunt versus trabeculectomy: an updated meta-analysis and systematic review.

This meta-analysis compares PreserFlo (PF) and trabeculectomy (TB) in moderate-to-advanced glaucoma (defined by visual fields with a mean deviation (MD) worse than -6dB). Key outcomes include success rates (qualified success is defined as a target IOP of less than 21mm Hg or a 20% reduction from baseline at the endpoint, with or without medications. Complete success is achieving these targets without any medications), intraocular pressure (IOP), complications, reinterventions, needling, glaucoma medication reduction, retinal nerve fibre layer (RNFL), and visual field progression. We searched PubMed, Scopus, and Cochrane Central up to 13/01/24, including randomized and non-randomized studies with at least 2months follow-up. Bias risk was assessed using ROB-2 for RCTs and ROBIN-I for non-RCTs. Publication bias was evaluated via funnel plots and Egger's regression. Ten studies (n = 1833 eyes; 57.4% PF) were analyzed. Preoperative IOP was 22.1mmHg; 56.1% had moderate-to-severe glaucoma. No significant differences were found in qualified (QSR) and complete success rates (CSR) between PF and TB. Trabeculectomy achieved better IOP outcomes (mean difference, MD 1.59mmHg; p = 0.0004) and greater IOP reduction (MD -2.52mmHg; p = 0.0003), but PF showed less visual field progression (MD -1.21; p = 0.03) and lower hypotony maculopathy risk (OR 0.30; p = 0.03). PF had a higher reintervention rate, particularly in patients without prior glaucoma surgery (OR 1.74; p = 0.02) or with primary open-angle glaucoma (OR 1.84; p = 0.04). Trabeculectomy is more effective for uncontrolled glaucoma up to 2years, while PF presents a lower risk of hypotony-related events and may benefit patients sensitive to visual field progression. Study strengths include detailed subgroup analyses and mid-term follow-up, with limitations noted in the number of RCTs. What is known PreserFlo MicroShunt has been shown to provide an efficient surgical solution for intraocular pressure (IOP) control with a favourable safety profile. Compared to trabeculectomy thereis still contentious regarding the best surgical approach. What is new Trabeculectomy is more effective in uncontrolled glaucoma patients up to 2 years, particularly if lower target IOPs are considered. PreserFlo had lower hypotony-related events risk and may be preferred for patients sensitive to visual field loss. PreserFlo showed a higher risk of reintervention, especially without prior glaucoma surgery or primary open-angle glaucoma diagnosis.

Diagnostic Performance for Detection of Glaucomatous Structural Damage Using Pixelwise Analysis of Retinal Thickness Measurements.

To compare the diagnostic accuracy of thickness measurements of individual and combined macular retinal layers to discriminate 188 glaucomatous and 148 glaucoma suspect eyes from 362 healthy control (HC) eyes on a pixel-by-pixel basis. For this retrospective study, we manually corrected the segmentations of posterior pole optical coherence tomography (OCT) scans to determine the thickness of the nerve fiber layer (NFL), ganglion cell layer (GCL), inner plexiform layer (IPL), the ganglion cell complex (GCC), and the total neural retina (TR). For each eye, the total number of pixels with thickness values less than the fifth percentile of the HC distribution was used to create a receiver operating characteristic (ROC) curve for each layer and for layer combinations. Using total abnormal pixel count criteria to discriminate glaucoma from HC eyes, the individual layers with the highest area under the ROC curve (AUC) were the NFL and GCL; IPL performance was significantly lower (P < 0.05). GCC had a significant higher AUC (94.3%) than individual the AUC of the NFL (92.3%) (P = 0.0231) but not higher than AUC of the GCL (93.4%) (P = 0.3487). The highest AUC (95.4%) and sensitivity (85.1%) at 95% specificity was found for the Boolean combination of NFL or GCL. The highest AUC is not significantly higher (P = 0.0882) than the AUC of the GCC but the highest sensitivity is significantly higher than the sensitivity of the GCC. This pattern was similar for discriminating between suspect and HC eyes (P = 0.0356). Using pixel-based methods, the diagnostic accuracy of NFL and GCL exceeded that of IPL and TR. GCC had equivalent performance as NFL and GCL. The specific spatial locations within the posterior pole that exhibit best performance vary depending on which layer is being assessed. Recognizing this dependency highlights the importance of considering multiple layers independently, as they offer complementary information for effective and comprehensive diagnosis.

DAMPs Drive Fibroinflammatory Changes in the Glaucomatous ONH.

The optic nerve head (ONH) is well known to be the initial site of glaucomatous damage; however, the molecular mechanisms initiating this pathology are not fully understood. To further understand the initiating factors in glaucomatous damage we utilized a novel mouse model of glaucoma, B6.EDA+/+ mice, which constitutively express fibronectin containing the extra domain A (FN+EDA). FN+EDA is a known damage-associated molecular pattern (DAMP) that activates Toll-like receptor 4 and elicits a fibro-inflammatory response. Eyes from B6.EDA+/+ and C57BL/6J mice were evaluated for retinal ganglion cell (RGC) death, retinal nerve fiber layer (RNFL) thickness, and optic nerve (ON) damage at 12 months and 22 months of age. ONH sections were isolated using laser capture microdissection for subsequent RNA-sequencing and Gene Set Enrichment Analysis (GSEA). GSEA results were confirmed using immunohistochemical (IHC) staining. B6.EDA+/+ mice exhibit significantly higher intraocular pressure, loss of RGCs, thinning of the RNFL, and progressive levels of ON damage at 12 months and 22 months of age compared to C57BL/6J controls. Protein expression of DAMPs FN+EDA and biglycan was significantly increased in B6.EDA+/+ mice compared to C57BL/6J controls. GSEA analysis identified significantly up- and downregulated gene groupings at both 12 months and 22 months of age, and IHC staining at 12 and 18 months of age demonstrated significant increases of IFNα, IFNβ, and pSTAT1 expression in B6.EDA+/+ mice compared to C57BL/6J controls. Our study characterizes glaucomatous changes to the retina, ON, and ONH over the course of 2 years and identifies novel molecular pathways associated with these pathophysiological changes. These data illustrate the effects of FN+EDA on the fibro-inflammatory response in the aging ONH in a novel mouse model of glaucoma.