Outer Macular Layers Research Articles

Normative Database of the Superior-Inferior Thickness Asymmetry for All Inner and Outer Macular Layers of Adults for the Posterior Pole Algorithm of the Spectralis SD-OCT.

This study aims to establish a reference for the superior-inferior hemisphere asymmetry in thickness values for all macular layers for the posterior pole algorithm (PPA) available for the Spectralis SD-OCT device. We examined 300 eyes of 300 healthy Caucasian volunteers aged 18-84 years using the PPA, composed of a grid of 64 (8 × 8) cells, to analyze the thickness asymmetries of the following automatically segmented macular layers: retinal nerve fiber layer (RNFL); ganglion cell layer (GCL); inner plexiform layer (IPL); inner nuclear layer (INL); outer plexiform layer (OPL); outer nuclear layer (ONL); retinal pigment epithelium (RPE); inner retina; outer retina; complete retina. Mean ± standard deviation and the 2.5th and 97.5th percentiles of the thickness asymmetry values were obtained for all the corresponding cells. All the macular layers had significant superior-inferior thickness asymmetries. GCL, IPL, INL, ONL and RPE showed significantly greater thicknesses in the superior than the inferior hemisphere, whereas RNFL and OPL were thicker in the inferior hemisphere. The largest differences between hemispheres were for RNFL and ONL. This is the first normative database of macular thickness asymmetries for the PPA and should be considered to distinguish normal from pathological values when interpreting superior-inferior macular asymmetries.

Morphological Outer Retina Findings in Multiple Sclerosis Patients With or Without Optic Neuritis.

Purpose: To investigate on the morphology of the macular inner (IR) and outer (OR) layers in multiple sclerosis (MS) patients with and without history of optic neuritis (ON), followed by good or poor recovery of best corrected visual acuity (BCVA).Methods: Thirty-five normal control subjects and 93 relapsing remitting MS patients were enrolled. Of this, 40 MS patients without ON (MS-noON, 40 eyes), 27 with history of ON and good BCVA recovery (MS-ON-G, 27 eyes), and 26 with history of ON and poor BCVA recovery (MS-ON-P, 26 eyes) were studied. Controls and MS patients underwent an extensive ophthalmological examination including spectral-domain optical coherence tomography evaluating in 3 localized macular areas (0–1 mm, Area 1; 1–3 mm, Area 2; 3- 6 mm, Area 3), volumes (MV), and thicknesses (MT) of the whole retina (WR), further segmented in IR and OR. The differences of MV and MT between the groups were tested by ANOVA. In the MS-ON-P group, the correlations between MV and MT and BCVA were evaluated by Pearson's test.Results: When compared to controls, the MS-noON group showed not significantly (p > 0.01) different MVs, whereas MTs were significantly (p < 0.01) reduced in the evaluation of WR and IR. In the MS-ON-G group, a significant (p < 0.01) reduction of WR and IR MVs and MTs was found in Areas 2 and 3; OR MVs and MTs were similar (p > 0.01) to controls. In the MS-ON-P group a significant (p < 0.01) reduction of WR, IR, and OR MVs and MTs was detected in all areas; the BCVA reduction was significantly (p < 0.01) correlated with WR and IR MVs and MTs.Conclusions: In MS without history of ON or when ON is followed by a good BCVA recovery, the neurodegenerative process is limited to IR macular layers; in the presence of ON, with a poor BCVA recovery, a morphological impairment of both IR and OR macular layers occurs.

Glaucomatous Maculopathy: Thickness Differences on Inner and Outer Macular Layers between Ocular Hypertension and Early Primary Open-Angle Glaucoma Using 8 × 8 Posterior Pole Algorithm of SD-OCT.

The purpose of this study was to compare the thickness of all inner and outer macular layers between ocular hypertension (OHT) and early primary open-angle glaucoma (POAG) using spectral domain optical coherence tomography (SD-OCT) 8 × 8 posterior pole algorithm (8 × 8 PPA). Fifty-seven eyes of 57 OHT individuals and fifty-seven eyes of 57 early POAG patients were included. The thickness of macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform and nuclear layer, photoreceptor layer (PRL) and retinal pigment epithelium were obtained in 64 cells for each macular layer and mean thickness of superior and inferior hemispheres was also calculated. Thinning of superior and inferior hemisphere mean thickness in mRNFL, GCL and IPL and thickening of superior and inferior hemisphere mean thickness in PRL and inferior hemisphere in INL were found in early GPAA group. Otherwise, heatmaps representing cell-to-cell comparisons showed thinning patterns in inner retinal layers (except for INL) and thickening patterns in outer retinal layers in GPAA group. We found that 8 × 8 PPA not only allows the detection of significant thinning patterns in inner retinal layers, but also thickening patterns in outer retinal layers when comparing early POAG eyes to OHT eyes.

Functionally Relevant Maculopathy and Optic Atrophy in Spinocerebellar Ataxia Type 1.

BackgroundSpinocerebellar ataxia type 1 (SCA‐ATXN1) is an inherited progressive ataxia disorder characterized by an adult‐onset cerebellar syndrome combined with nonataxia signs. Retinal or optic nerve affection are not systematically described.ObjectivesTo describe a retinal phenotype and its functional relevance in SCA‐ATXN1.MethodsWe applied optical coherence tomography (OCT) in 20 index cases with SCA‐ATXN1 and 22 healthy controls (HCs), investigating qualitative changes and quantifying the peripapillary retinal nerve fiber layer (pRNFL) thickness and combined ganglion cell and inner plexiform layer (GCIP) volume as markers of optic atrophy and outer retinal layers as markers of maculopathy. Visual function was assessed by high‐ (HC‐VA) and low‐contrast visual acuity (LC‐VA) and the Hardy‐Rand‐Rittler pseudoisochromatic test for color vision.ResultsFive patients (25%) showed distinct maculopathies in the ellipsoid zone (EZ). Furthermore, pRNFL (P < 0.001) and GCIP (P = 0.002) were reduced in patients (pRNFL, 80.86 ± 9.49 μm; GCIP, 1.84 ± 0.16 mm3) compared with HCs (pRNFL, 97.02 ± 8.34 μm; GCIP, 1.98 ± 0.12 mm3). Outer macular layers were similar between groups, but reduced in patients with maculopathies. HC‐VA (P = 0.002) and LC‐VA (P < 0.001) were reduced in patients (HC‐VA [logMAR]: 0.01 ± 010; LC‐VA [logMAR]: 0.44 ± 0.16) compared with HCs (HC‐VA [logMAR]: –0.12 ± 0.08; LC‐VA [logMAR]: 0.25 ± 0.05). Color vision was abnormal in 2 patients with maculopathies.ConclusionsA distinct maculopathy, termed EZ disruption, as well as optic atrophy add to the known nonataxia features in SCA‐ATXN1. Whereas optic atrophy may be understood as part of a widespread neurodegeneration, EZ disruption may be explained by effects of ataxin‐1 gene or protein on photoreceptors. Our findings extend the spectrum of nonataxia signs in SCA‐ATXN1 with potential relevance for diagnosis and monitoring.

The importance of different preoperative factors in the prognosis of functional results of uncomplicated surgery for idiopathic epimacular membranes

Purpose : to estimate the cumulative effect of different preoperative predictors on the functional results of the removal of idiopathic epimacular membranes (EMMs) 12 months after the surgery. Material and methods . 62 patients (63 eyes) with idiopathic EMMs aged 49 to 85 were operated according to the standard procedure and followed up for 12 months. The monitoring included, in addition to standard methods, Amsler grid test and optical coherence tomography of the macula. Results . Throughout the postoperative period, significant improvement in visual acuity, reduction of metamorphopsias, and restoration of both inner and outer fovea layers as well as macular thickness were observed. Twelve months after surgery, visual acuity strongly correlated with baseline visual acuity (R = 0.571, p &lt; 0.05), the span of the defects of the external limiting membrane (ELM) (R = -0.359, p &lt; 0.05), and interdigitation zone (IZ) defects (R = -0.394, p &lt; 0.05). At the end of the follow-up period, metamorphopsia value correlated the most strongly with the duration of the disease (R = 0.380, p &lt; 0.05), baseline visual acuity (R = -0.398, p &lt; 0.05), initial metamorphopsias intensity (R = 0.271, p &lt; 0.05), central retinal thickness (R=0.318, p&lt;0.05) and the ectopic inner macular layers (R = 0.358, p &lt; 0.05). A trend was observed toward the correlation between the final visual acuity and presurgical metamorphopsias severity (R = 0.248, p = 0.113), thickness of EMM (R = -0.246; p = 0.111), central retinal thickness (R = -0.203, p = 0.198) and the presence of a cystoid macular edema (CME) (p = 0.181). A correlation was also observed between metamorphopsias severity noted 1 year after surgery and the length of ELM (R = 0.222, p = 0.159) and IZ (R = 0.211, p = 0.201) defects before surgery. Regression with a 0,597-determination coefficient showed that the baseline visual acuity and central retinal thickness had the biggest impact on the visual acuity measured 1 year after surgery (p &lt; 0.001 and p = 0.002, respectively). Conclusions . The surgery for idiopathic EMMs leads to a significant improvement in the quality of visual functions and anatomical characteristics of the macula. Restoration of outer macular layers may indicate the ability of photoreceptors to repair. The most significant preoperative predictors which determine the quality of visual functions after EMMs removal are thickness of the membrane, central retinal thickness, deformation degree of the inner foveal layers, state of photoreceptors, CME, visual acuity and metamorphopsias severity. At the same time, the baseline visual acuity and central retinal thickness had the biggest impact on the visual acuity achieved by surgery. Early surgery is reasonable, while the evaluation of both anatomical and functional results is advisable not earlier than 12 months after surgery.

Multifocal Electroretinography in Assessment of Macular Function after Internal Limiting Membrane Peeling in Macular Hole Surgery.

Purpose Internal limiting membrane (ILM) peeling is important for macular hole (MH) surgery but may have secondary effects visible on spectral domain optical coherence tomography (OCT) and multifocal electroretinography (mfERG). We relate integrity of inner and outer macular layers with functional results with mfERG. Methods Nonrandomized prospective study of 33 consecutive eyes of 33 patients with macular hole who underwent vitrectomy with ILM peeling. Best-corrected visual acuity was assessed, and integrity of external layers was measured using OCT. Each component of mfERG, N1 and P1 amplitude and latency, was also measured. Results All eyes showed macular hole closure. Visual acuity improved from 20/400 to 20/40 in the Snellen visual acuity chart (P < 0.001), and OCT external lines were intact in 19 eyes and disrupted in 14 eyes. Postoperatively, N1 and P1 amplitudes in ring 1 increased compared to preoperative values (P < 0.001 for both). Latency remained delayed for both N1 and P1 wave. In the group of 19 eyes with integrity of outer retinal layers, N1 amplitude in ring 1 was superior to the group of 14 patients with disrupted outer retinal layers (P=0.042). Conclusions In macular hole surgery, structure analysis in OCT is one of the important outcomes for the retinal surgeon. Functional results are parallel with anatomic results, but visual gain is limited. The limited recovery in mfERG suggests an alteration of retinal physiology that could explain limited vision recover.

Structure-function relationships in the visual system in multiple sclerosis: an MEG and OCT study.

BackgroundWe conducted a multi‐modal optical coherence tomography (OCT) and magnetoencephalography (MEG) study to test whether there is a relationship between retinal layer integrity and electrophysiological activity and connectivity (FC) in the visual network influenced by optic neuritis (ON) in patients with multiple sclerosis (MS).MethodsOne hundred and two MS patients were included in this MEG/OCT study. Retinal OCT data were collected from the optic discs, macular region, and segmented. Neuronal activity and FC in the visual cortex was estimated from source‐reconstructed resting‐state MEG data by computing relative power and the phase lag index (PLI). Generalized estimating equations (GEE) were used to account for intereye within‐patient dependencies.ResultsThere was a significant relationship for both relative power and FC in the visual cortex with retinal layer thicknesses. The findings were influenced by the presence of MSON, particularly for connectivity in the alpha bands and the outer macular layers. In the absence of MSON, this relationship was dominated by the lower frequency bands (theta, delta) and inner and outer retinal layers.ConclusionThese results suggest that visual cortex FC more than activity alters in the presence of MSON, which may guide the understanding of FC plasticity effects following MSON.