Outer Segments Research Articles

Long-Term Visual Outcomes in Patients With Idiopathic Epiretinal Membrane Surgery.

Our aim was to assess long-term outcomes following surgical repair of idiopathic epiretinal membrane (ERM) with pars plana vitrectomy (PPV) and membrane peel (MP). A retrospective study evaluated patients with idiopathic ERM who underwent surgical repair at a single academic tertiary center with five to nine years of postoperative follow-up, assessing preoperative characteristics, surgical techniques, best visual acuity (BVA), and optical coherence tomography biomarkers at various time points. The study involved 67 patients (72 eyes) with an average postoperative follow-up of 82.8 ± 18.8 months. Patients with cone outer segment tips integrity at initial presentation and 1-year follow-up and patients with external limiting membrane and ellipsoid zone integrity at 1-year follow-up were noted to have significantly better long-term visual acuity than those without. More than 85% of patients achieved a BVA > 70 seven years after surgical repair. Vitreoretinal surgery for idiopathic ERM resulted in improved anatomical recovery and sustained visual acuity gain over long-term follow-up. [Ophthalmic Surg Lasers Imaging Retina 2024;55:70-77.].

Molecular characterization of an iPSC line derived from a patient with cone‐rod dystrophy related to a mutation in the PROM1 gene

Aims/Purpose: The PROM1 gene encodes the protein Prominin‐1, which plays a crucial role in the morphogenesis of photoreceptor outer segments. The c.1354dupT mutation, associated with various inherited retinal diseases (IRD) phenotypes, leads to a premature stop codon. This study aimed to assess the silencing efficiency of reprogramming vectors and the expression of endogenous pluripotency genes in the iPSC line [DCB]‐FiPSC1‐Ep5F‐2.Methods: The iPSC line [DCB]‐FiPSC1‐Ep5F‐2 was generated from a patient with Cone‐rod dystrophy (CRD) linked to the c.1354dupT mutation in the PROM1 gene. iPSC colonies were stained using alkaline phosphatase (AP) blue membrane substrate. The c.1354dupT mutation was Sanger sequenced. To confirm the absence of episomal vector integration, quantitative PCR (qPCR) targeting a region common to all reprogramming vectors (within the EBNA1 gene) was conducted. Vector‐specific primer‐based quantitative reverse transcription PCR (qRT‐PCR) was used to assess the expression of reprogramming genes from the episomal vectors. Additionally, qRT‐PCR with gene‐specific primers was utilized to evaluate the expression of endogenous pluripotency genes. Untransfected fibroblasts served as the negative control, while fibroblasts transfected with the episomal vectors 72 h earlier were used as the positive control.Results: The iPSC line [DCB]‐FiPSC1‐Ep5F‐2 exhibited positive AP activity. The presence of the c.1354dupT mutation was confirmed. Furthermore, the number of copies of the EBNA1 gene was significantly lower in the generated iPSC line compared to the control. The relative mRNA expression of the reprogramming vectors was also significantly lower in the iPSC line, while the relative mRNA expression of the endogenous pluripotency genes was significantly higher than in the control.Conclusions: While further immunocytochemical characterization is necessary to fully ascertain iPSC pluripotency, the patient‐derived iPSC line [DCB]‐FiPSC1‐Ep5F‐2 shows promise as a disease model for personalized therapy development.

Neuroprotective effects of syngeneic bone marrow‐derived mononuclear stem cell transplantation and intraperitoneal minocycline in the treatment of inherited photoreceptor retinal degeneration

Inherited retinal degenerations are diseases characterized by photoreceptor loss secondary to genetic defects and Retinitis Pigmentosa (RP) is the most frequent inherited retinal degeneration. This disease has a prevalence of around 1 in 4000 individuals and is caused by mutations in more than 300 genes. RP is characterized by progressive loss of photoreceptors (fist rods following by cones), activation of microglial cells and gliosis increases of macroglial cell.The Royal college of Surgeon (RCS) rat is a well characterized animal models of RP which suffer a mutation of the MERTK gene, that impedes the normal photoreceptor outer segment phagocytosis by RPE cells thus triggers the simultaneous degeneration of rods and cones. Recent studies have shown that microglial activation starts simultaneously with the beginning of photoreceptor death in the RCS retinas, suggesting that microglial cells play an important role in the retinal degeneration progression.Therapies for inherited photoreceptor degeneration aim to prevent or delay death of the photoreceptors, or in specific circumstances try to replace them.The Bone marrow derived‐mononuclear cells (BM‐MNCs) are a mononuclear CD34+ subpopulation of bone marrow‐derived cells that can be separated from the other cellular fractions of the bone marrow aspirate using a Ficoll density gradient‐based protocol. These cells have shown promising results in different animal models of neuronal degeneration, including inherited photoreceptor degenerations such us: improve the morphology of the photoreceptors outer segment, decrease synaptic degeneration in the outer plexiform layer and reduce glial fibrillary acidic protein expression in Müller cells.On the other hands minocycline is a broad‐spectrum tetracycline antibiotic, of which it has been demonstrated has antimicrobial, anti‐inflammatory, antiapoptotic, neuroprotective, and microglial inhibition effects in central nervous system diseases.In RCS rat retina the neuroprotective effect of minocycline against photoreceptor apoptosis is can be explained by mainly two different mechanisms: (1) a direct antiapoptotic effect on photoreceptors and/or (2) an effect through its anti‐inflammatory properties reducing microglial cells activation and migration.The question arises whether the combination of intravitreal BM‐MNCs transplantation with minocycline, substances that increase survival presumably through different mechanisms, could further increase photoreceptor survival and therefore be used for the treatment of retinal degenerations.Our results showed that intravitreal transplantation of BM‐MNCs increase photoreceptor survival, improved the morphology of the photoreceptors outer segment, and reduce retinal thinning (in vivo). On the other hands intraperitoneally minocycline treatment, and reduced activation and migration of microglia and produced a significant rescue of photoreceptors. Finally, our result show that combination both treatments had higher neuroprotective effects in the retina, increasing photoreceptor survival, than each of the treatments alone.In conclusion in RCS rat animal model of photoreceptor degeneration, minocycline reduces microglial activation and migration, and intravitreal transplantation of BM‐MNCs and minocycline increase photoreceptor survival. The combination of both treatments shows greater neuroprotective effects than their isolated effects, and therefore could be indicated for treatment of the early stages of photoreceptor degenerations.

Retinal neurodegeneration induced by sodium iodate administration and visual cortex activity

Aims/Purpose: Recently investigations have shown that using sodium iodate (NaIO3) provides a promising animal model of retinal neurodegeneration. The aim of this research is to characterize the effects of this compound in the visual pathway.Methods: First, a single dose of NaIO3 (65 mg/kg) was administered intraperitoneally to mice (C57BL/6J strain) with a knock‐out mutation for the Opn4 gene (Opn4−/−). Then, behavioural tests (light avoidance assay, optomotor test, pupillary light reflex) were performed until Day 28. Electrophysiological tests (electroretinogram, ERG; visual evoked potentials, VEP), were performed weekly until Day 42. Finally, the retina was analysed histologically by immunohistochemical methods on day 57th.Results: First, the results of the behavioural test in the experimental group (NaIO3) reflected a progressive decrease in light sensitivity after 28 days, and a decrease in visual acuity and as well as a completely loss of the pupillary light reflex after 7 days since the administration. Second, the electrophysiological activity of retina and primary visual cortex (ERG, VEP) was significantly reduced in the treated group (NaIO3) with respect to the control group. Finally, histological analysis of the retina showed structural alterations in the outer segments of the photoreceptors of the treated animals (NaIO3).Conclusions: This research demonstrates the appearance of alterations in the outer retina and a decrease in the response at the level of the visual cortex after NaIO3 administration, as expected. This confirms that NaIO3‐induced retinal neurodegeneration is effective in obtaining a promising experimental model that could be used in the study of diseases associated with the visual system and in the development of novel therapeutic strategies.

A 15 month follow‐up study characterizing the progression of retinal pathology and visual loss in CLN3 ex7/8 mice

Aims/Purpose: Juvenile form of neuronal ceroid lipofuscinosis is a is a rare neurological disease that manifests in childhood, by progressive visual dysfunction. The progression and timeline of the retinal degeneration in the eye has not been comprehensively characterized. We performed a 15‐month follow‐up study aiming to reveal the progression of retinal pathology in CLN3 ex7/8 mice modelling juvenile neuronal ceroid lipofuscinosis.Methods: ERG, OCT, and fundus imaging was performed in CLN3 ex7/8 mice every three months at 3, 6, 9, 12 and 15 months. Scotopic electroretinography was performed with Espion ERG using silver electrodes. Mice were kept overnight in dark room before testing. Eyes were exposed to flashes of light periodically increasing in intensity (0,0001–1 Cd × s/m2). Responses to multiple flashes were averaged to obtain a single waveform at each intensity. OCT and fundus images were captured with the Phoenix MICRON® Image‐Guided OCT.Results: In scotopic ERG responses lower amplitudes of a‐ and b‐wave were observed CLN3 ex7/8 mice compared to WT mice at all time points. A progressive, almost 2‐fold decrease of b‐wave amplitude (at 0.03 Cd × s/m2) was seen in CLN3 ex7/8 mice between 3 and 15 months, compared to WT. Most notable decline of b‐wave amplitude (~70% of the decrease, at 0.03 Cd × s/m2) was seen from age of 6 to 12 months. A‐wave amplitudes in CLN3 ex7/8 mice were consistently lower but not progressively reduced when compared to WT mice. The accumulation of drusen was observed in the fundus images of CLN3 ex7/8 mice. In OCT images we observed signs of retinal outer segment atrophy. These effects were not observed in WT animals to the same degree.Conclusions: We observed age‐dependent retinal outer segment atrophy with drusen‐like deposit accumulation visually with OCT and fundus imaging in CLN3 ex7/8 mice, and the results correlate well with ERG results. According to the progressive decline of b‐wave amplitude, the decrease of vision seems to be most prominent between the ages of 6 and 12 months. This result indicates progressive loss of function in inner retinal neurons. The present results reveal the progression of the pathology in CLN3 ex7/8 mice as well as the time window for testing novel disease‐modifying interventions in CLN3 ex7/8 mice.

Ganglion cell loss in central serous chorioretinopathy

Aims/Purpose: The aim of the study was to determine the amount of deficit of best corrected visual acuity (BCVA) and individual retinal layers, including ganglion cells, in different types of CSCR and with the reference to its duration.Methods: The retrospective analysis included 69 eyes of patients with resolved CSCR managed in Dobry Wzrok Ophthalmological Clinic between 01.01.2019 and 30.06.2022. The diagnosis of CSCR was based on the criteria outlined by the Central Serous Chorioretinopathy International Group. The analysis included data obtained from medical history, BCVA testing, and spectral domain optical coherence tomography (SD‐OCT) measurements, with specific thickness values for individual retinal layers. The results were compared among affected eyes, unaffected fellow eyes and healthy controls.Results: BCVA values were significantly lower in acute (0.08 ± 0.12 logMAR) and chronic (0.26 ± 0.19 logMAR) versus controls (0.0 logMAR). The thickness of all retinal layers (central subfoveal thickness, CST; inner retina with ganglion cell complex, GC; outer retina, ORT; and photoreceptor outer segments, POS) and macular volume (MV) were significantly decreased in chronic eyes versus controls (p < 0.01). Acute eyes had significant thinning of the outer retina and POS only compared to control eyes (p < 0.01). The amount of deficit in CST, ORT, GC and MV was strongly correlated with poorer BCVA (p < 0.001), and the deficit of CST, ORT and GC was correlated with disease duration (p < 0.05). The subfoveal choroidal thickness was significantly greater in affected and fellow eyes versus controls (p < 0.001).Conclusions: Damage to the outer retina and photoreceptors occurs early in the course of CSCR, with a deficit in ganglion cells noted adjunctively in chronic forms of the disease. Further studies are required to precisely determine correlation between visual loss in CSCR and deficits in individual retinal layers.

Fundus autofluorescence in uveitis: Meeting an old friend

Fundus autofluorescence (FAF) represents a relatively new imaging modality that has been investigated in a variety of uveitic disease processes. FAF relies on the presence of innate fluorophores within ocular tissues, which can be induced to emit light when stimulated with specific frequencies of light.Autofluorescence in the RPE depends on the outer segment renewal and can be affected by the RPE's ability to clear lipofuscin. Hence, an increased autofluorescence is seen with RPE dysfunction and a decreased autofluorescence is seen with loss of photorecptors or the RPE.Abnormal autofluorescence patterns have been described in a number of infectious and non‐infectious uveitides. Most reports of abnormal FAF in patients with uveitis belong to the spectrum of white‐dot‐syndromes. In the present course we will review the main autofluorescence abnormalities in disease like Serpiginous and Serpiginous‐like choroiditis, multifocal choroiditis, punctate inner choroiditis, multiple evanescent white dot syndrome and AZOOR. The recognition of theses abnormalities (in combination with other imaging techniques like optical coherence tomography and optical coherence tomography‐angiography) is extremely helpful for understanding their pathogenesis and monitoring the inflammatory activity.

Immunohistochemical characterization of pluripotency of an iPSC line derived from a patient with cone‐rod dystrophy related to a mutation in the PROM1 gene

Purpose: PROM1 gene encodes the protein Prominin‐1 which plays a critical role in the morphogenesis of photoreceptors outer segments. The c.1354dupT mutation in PROM1 causes a premature stop codon and it has been related with different inherited retinal diseases (IRD) phenotypes. The aim of this study was to demonstrate the expression of key pluripotency genes by studying protein transcription factors and surface markers on the iPSC line [DCB]‐FiPSC1‐Ep5F‐2.Methods: Our group generated the iPSC line [DCB]‐FiPSC1‐Ep5F‐2 from a patient with Cone‐rod dystrophy (CRD) related to the mutation c.1354dupT in the PROM1 gene. iPSC was grown on matrigel coated 15 μ‐slide 8‐well culture plates and fixed with 10% formalin solution. Plates were washed with Tris Buffered Saline and blocked (0.3%Triton X‐100 and 3%Donkey serum) for 60 min. Then, different combinations of primary antibodies related to pluripotency (OCT4, SSEA3, SOX2, SSEA4, TRA1‐60, NANOG and TRA1‐81) were incubated at 4°C overnight. Afterwards, species‐specific secondary antibodies were conjugated and immunostaining with DAPI was used. Finally, the samples were evaluated by confocal microscopy.Results: Immunofluorescence analysis of the iPSC line [DCB]‐FiPSC1‐Ep5F‐2 revealed the expression of the common embryonic stem cell markers such as the transcription factors OCT4, NANOG and SOX2, and the surface markers SSEA3, TRA‐1‐81, SSEA4 and TRA‐1‐60. Transcriptional markers stain cell nuclei, while surface markers stain cell membranes showing that iPSCs have the potential for pluripotency and multilineage differentiation.Conclusions: Although molecular characterization is necessary to completely elucidate iPSC pluripotency and bank this line in an international depository, the [DCB]‐FiPSC1‐Ep5F‐2 patient derived iPSC line could be useful as a disease model for the development of personalized therapies.

Patterns of Macular Edema in Branch Retinal Vein Occlusion Diagnosed by Optical Coherence Tomography.

Branch Retinal vein occlusion is the most common retinal vascular disease after diabetic retinopathy in elderly populations. To describe morphological patterns of macular edema in branch retinal vein occlusion using optical coherence tomography. It is a hospital based; descriptive, cross-sectional study. All patients with macular edema secondary to branch retinal vein occlusion diagnosed by optical coherence tomography and fulfilling the inclusion criteria from 2017 July 1 to 2018 July 1 were studied. A total of 84 eyes of 84 patients were enrolled. The mean age of the patient was 68.0833 ± 11.22 years (range, 35-74 years). Forty-five (53.57%) were male. Forty-four eyes had right eye involvement. Major and macular branch retinal vein occlusion was found in 50 and 34 eyes respectively. Forty eight eyes had superior and 36 eyes had inferior branch retinal vein occlusion. Morphological patterns of macular edema were classified: cystoid macular edema, cystoid macular edema with serous retinal detachment, diffuse macular edema and diffuse macular edema with serous retinal detachment of which 68 (80.95%) had cystoid macular edema. Out of 84 eyes, 30 (35.71%) had inner and outer segment (IS/OS) junction disruption. Optical coherence tomography is a safe and noninvasive technique. Serous retinal detachment and photoreceptors disruption may go unnoticed unless OCT is performed. It can measure the changes in retinal thickness and thus predict the visual outcomes in patients with macular edema.

Identification and cellular localization in Xenopus laevis photoreceptors of three Peripherin-2 family members, Prph2, Rom1 and Gp2l, which arose from gene duplication events in the common ancestors of jawed vertebrates

Rod and cone photoreceptors are named for the distinct morphologies of their outer segment organelles, which are either cylindrical or conical, respectively. The morphologies of the stacked disks that comprise the rod and cone outer segments also differ: rod disks are completely sealed and are discontinuous from the plasma membrane, while cone disks remain partially open to the extracellular space. These morphological differences between photoreceptor types are more prominent in non-mammalian vertebrates, whose cones typically possess a greater proportion of open disks and are more tapered in shape. In mammals, the tetraspanin prph2 generates and maintains the highly curved disk rim regions by forming extended oligomeric structures with itself and a structurally similar paralog, rom1. Here we determined that in addition to these two proteins, there is a third Prph2 family paralog in most non-mammalian vertebrate species, including X. laevis: Glycoprotein 2-like protein or “Gp2l”. A survey of multiple genome databases revealed a single invertebrate Prph2 ‘pro-ortholog’ in Amphioxus, several echinoderms and in a diversity of protostomes indicating an ancient divergence from other tetraspanins. Based on phylogenetic analysis, duplication of the vertebrate predecessor likely gave rise to the Gp2l and Prph2/Rom1 clades, with a further duplication distinguishing the Prph2 and Rom1 clades. Mammals have lost Gp2l and their Rom1 has undergone a period of accelerated evolution such that it has lost several features that are retained in non-mammalian vertebrate Rom1. Specifically, Prph2, Gp2l and non-mammalian Rom1 encode proteins with consensus N-linked glycosylation and outer segment localization signals; mammalian rom1 lacks these motifs. We determined that X. laevis gp2l is expressed exclusively in cones and green rods, while X. laevis rom1 is expressed exclusively in rods, and prph2 is present in both rods and cones. The presence of three Prph2-related genes with distinct expression patterns as well as the rapid evolution of mammalian Rom1, may contribute to the more pronounced differences in morphology between rod and cone outer segments and rod and cone disks observed in non-mammalian versus mammalian vertebrates.

Pathogenetic Aspects of the Development and Course of Rhegmatogenous Retinal Detachment against the Background of Proliferative Vitreoretinopathy. Literature Review

Retinal detachment (RD) is the most serious problem of modern ophthalmology, often leading to a decrease or irreversible loss of visual functions. The literature review is devoted to the latest trends in the study of the mechanisms of development and course of rhegmatogenous retinal detachment (RRD) against the background of proliferative vitreoretinopathy. In the pathogenesis of RD, there are five theories, as well as nine main risk factors for development. It is known that the contact between the retinal neuroepithelium and the retinal pigment epithelium is maintained by physical and metabolic forces, as well as by the friction force of the outer segments of photoreceptors and RPE cells. With synchisis and simultaneous syneresis, vitreous detachment develops, with increased traction forces and the possible development of RRD. Retinal detachment is the most serious problem of modern ophthalmology, often leading to a decrease or irreversible loss of visual functions. The review of the literature is devoted to the latest trends in the study of the mechanisms of development and course of rhegmatogenous retinal detachment against the background of proliferative vitreoretinopathy. In the pathogenesis of RD, there are five theories, as well as nine main risk factors for development. It is known that the contact between the retinal neuroepithelium and the retinal pigment epithelium is maintained by physical and metabolic forces, as well as by the friction force of the outer segments of photoreceptors and RPE cells. With synchisis and simultaneous syneresis, vitreous detachment develops, with an increase in traction forces and the possible development of RRD. The presence of a retinal tear rarely leads to RRD. It has been established that a pronounced traction effect, rather than a through rupture of the retina, is a key factor in the development and progression of RRD. Traction occurs in the course of proliferative vitreoretinopathy and the epiretinal layer of the vitreum remaining in the posterior vitreous detachment. With the development of detachment, damage to the hematoophthalmic barrier occurs, leading to the release of cells into the vitreous cavity that affect the development of PVR (epi-, sub- and intraretinally) with the formation of an epiretinal membrane. At the same time, communication with the choroid is lost, hypoxia and acidosis develop. ERMs formed during retinal detachment include glial cells and their subtypes — fibrous astrocytes, Muller cells, microglia, hyalocytes, RPE cells, fibroblasts and myofibroblasts. However, the leading role in the formation and development of ERM belongs to Muller cells and astrocytes. Also involved in the pathological process of ERM formation are: transforming growth factor β2, fibroblast growth factor, nerve growth factor, vascular endothelial growth factor, platelet growth factor, laminin, fibronectin, thrombospondin-1, osteonectin, transcription factor. Against the background of ROS, one should not forget about the change in the chemical composition of the vitreous body (increased content): serum albumin, transferrin, antithrombin III, α1-antichymotrypsin, α1-antitrypsin, α2-HS-glycoprotein, hemopexin, transthyretin, apolipoprotein A1, and fibrinogen

Ultrastructural changes in the rat retina in the presence of long-term opioid exposure

Purpose: To determine the features of the untrastructural reorganization in the rat retina by the end of week 4 and week 6 of experimental opioid exposure. Material and Methods: Forty-eight adult male albino rats (weight, 200-250 g; age, 4.5 months) were used in this study. They received nalbuphine hydrochloride intramuscularly daily for 42 days. Particularly, the drug was administered daily at a dose of 0.212 mg/kg for weeks 1 and 2, 0.225 mg/kg for weeks 3 and 4, and 0.252 mg/kg for weeks 5 and 6. In this way, we experimentally created the conditions of chronic opioid exposure. Animals were divided into three groups. Group 1 (19 animals) received nalbuphine for 28 days, and group 2 (19 animals), for 42 days. Group 3 (control group) comprised 10 animals. Of these, 5 animals were treated with normal saline at a dose of 0.22 mg/kg intramuscularly daily for 28 days, and the rest were treated in a similar manner for 42 days. Transmission electron microscopy studies of the rat retina were conducted in a routine manner. Results: By the end of week 4 of experimental opioid exposure, there was an increase in the number of retinal microvessels with signs of hyperemia and degenerative changes in retinal pigment epithelium (RPE) cells, increase in the destruction of membranous discs of photoreceptor outer segments, necrobiotic changes in the nuclei of individual photoreceptors, axonal degeneration in the outer and inner plexiform layers, degenerative changes in retinal horizontal neurons, and the appearance of necrotic structural changes in the cytoplasm of bipolar and amacrine cells. By the end of week 6, there was a further increase in hyperemia of retinal vessels and degenerative and necrotic changes in individual RPE cells and photoreceptor outer segments. In addition, we observed destruction and shortening of mitochondrial cristae of photoreceptor inner segments, necrotic nuclear changes in individual photoreceptors, degeneration of axons of the outer and inner plexiform layers, degenerative and necrotic changes in bipolar and amacrine cells, hypertrophic Müller cell processes, degeneration of ganglion cells, and vascular hyperemia and moderate perivascular edema in the outer and inner plexiform layers. Conclusion: Therefore, in the current rat study, after a 4-week exposure to daily nalbuphine injections at a dose ranging 0.212 to 0.253 mg/kg, there was ultrastuctural evidence of destructive processes in the RPE and photoreceptor outer segments, axonal degeneration in the outer and inner plexiform layers, degenerative and necrotic changes in bipolar and amacrine cells, hypertrophic Müller cell processes, ganglion cell degeneration and hyperemia due to an impaired retinal microcirculatory ultrastructure. At week 6 of the experiment, there was evidence of increased destructive and degenerative processes in structural components of the retina.

Peak Cone Density Predicted from Outer Segment Length Measured on Optical Coherence Tomography

Purpose To compare peak cone density predicted from outer segment length measured on optical coherence tomography with direct measures of peak cone density from adaptive optics scanning light ophthalmoscopy. Methods Data from 42 healthy participants with direct peak cone density measures and optical coherence tomography line scans available were used in this study. Longitudinal reflectivity profiles were analyzed using two methods of identifying the boundaries of the ellipsoid and interdigitation zones to estimate maximum outer segment length: peak-to-peak and the slope method. These maximum outer segment length values were then used to predict peak cone density using a previously described geometrical model. A comparison between predicted and direct peak cone density measures was then performed. Results The mean bias between observers for estimating maximum outer segment length across methods was less than 2 µm. Cone density predicted from the peak-to-peak method against direct cone density measures showed a mean bias of 6,812 cones/mm2 with 50% of participants displaying a 10% difference or less between predicted and direct cone density values. Cone density derived from the slope method showed a mean bias of −17,929 cones/mm2 relative to direct cone density measures, with only 41% of participants demonstrating less than a 10% difference between direct and predicted cone density values. Conclusion Predicted foveal cone density derived from peak-to-peak outer segment length measurements using commercial optical coherence tomography show modest agreement with direct measures of peak cone density from adaptive optics scanning light ophthalmoscopy. The methods used here are imperfect predictors of cone density, however, further exploration of this relationship could reveal a clinically relevant marker of cone structure.

Volumetric Reconstruction of a Human Retinal Pigment Epithelial Cell Reveals Specialized Membranes and Polarized Distribution of Organelles.

Despite the centrality of the retinal pigment epithelium (RPE) in vision and retinopathy our picture of RPE morphology is incomplete. With a volumetric reconstruction of human RPE ultrastructure, we aim to characterize major membranous features including apical processes and their interactions with photoreceptor outer segments, basolateral infoldings, and the distribution of intracellular organelles. A parafoveal retinal sample was acquired from a 21-year-old male organ donor. With serial block-face scanning electron microscopy, a tissue volume from the inner-outer segment junction to basal RPE was captured. Surface membranes and complete internal ultrastructure of an individual RPE cell were achieved with a combination of manual and automated segmentation methods. In one RPE cell, apical processes constitute 69% of the total cell surface area, through a dense network of over 3000 terminal branches. Single processes contact several photoreceptors. Basolateral infoldings facing the choriocapillaris resemble elongated filopodia and comprise 22% of the cell surface area. Membranous tubules and sacs of endoplasmic reticulum represent 20% of the cell body volume. A dense basal layer of mitochondria extends apically to partly overlap electron-dense pigment granules. Pores in the nuclear envelope form a distinct pattern of rows aligned with chromatin. Specialized membranes at the apical and basal side of the RPE cell body involved in intercellular uptake and transport represent over 90% of the total surface area. Together with the polarized distribution of organelles within the cell body, these findings are relevant for retinal clinical imaging, therapeutic approaches, and disease pathomechanisms.

Iron overload and chelation modulates bisretinoid levels in the retina.

Iron dysregulation in conjunction with other disease processes may exacerbate retinal degeneration. We employed models of iron overload and iron chelation to explore the interactions between iron-catalyzed oxidation and photoreactive bisretinoid lipofuscin. The mice were injected intravitreally with ferric ammonium citrate (FAC) or were treated using the iron chelator deferiprone (DFP) from birth to 2months of age. Short-wavelength fundus autofluorescence (SW-AF) and spectral-domain optical coherence tomography (SD-OCT) scans were acquired. The bisretinoid levels were quantified using ultra performance liquid chromatography (UPLC) and in vivo through quantitative fundus autofluorescence (qAF). In histologic sections, the photoreceptor cell viability was assessed by measuring the thickness of the outer nuclear layer (ONL). The levels of bisretinoids, all-trans-retinal dimers, and A2PE were significantly increased in the FAC-injected eyes of C57BL/6J mice. Seven days after FAC injection, hyperautofluorescent foci were visible in fundus autofluorescence (488nm) images, and in SD-OCT scans, aberrant hyperreflectivity was present in the outer retina and ONL thinning was observed. In FAC-injected Abca4-/- mice with pronounced RPE bisretinoid lipofuscin accumulation, the hyperautofluorescent puncta were more abundant than in the wild-type mice, and the extent of ONL thinning was greater. Conversely, the intravitreal injection of FAC in Mertk-/- mice led to a more modest increase in A2PE after 2 days. In contrast to the effect of iron accumulation, chelation with DFP resulted in significantly increased levels of A2E and A2-GPE and qAF due to the reduced iron-catalyzed oxidation of bisretinoids. In Mertk-/- mice, the A2E level was significantly lower and the ONL area was smaller than in DFP-treated mice. DFP chelation did not impair the visual cycle in BALB/cJ mice. Iron accumulation was associated with progressive impairment in photoreceptor cells that was associated with the increased formation of a bisretinoid species known to form in photoreceptor outer segments as a precursor to A2E. Additionally, disease features such as the development of hyperautofluorescence puncta in fundus AF images, hyperreflectivity in the outer retina of SD-OCT scans, and ONL thinning were more pronounced when iron was delivered to Abca4-/- mice with a greater propensity for bisretinoid formation. Higher bisretinoid levels and enhanced qAF are indicative of lesser bisretinoid loss due to oxidation.

Treatment Strategy With Gene Editing for Late-Onset Retinal Degeneration Caused by a Founder Variant in C1QTNF5.

Genome editing is an emerging group of technologies with the potential to ameliorate dominant, monogenic human diseases such as late-onset retinal degeneration (L-ORD). The goal of this study was to identify disease stages and retinal locations optimal for evaluating the efficacy of a future genome editing trial. Twenty five L-ORD patients (age range, 33-77 years; median age, 59 years) harboring the founder variant S163R in C1QTNF5 were enrolled from three centers in the United Kingdom and United States. Patients were examined with widefield optical coherence tomography (OCT) and chromatic perimetry under dark-adapted and light-adapted conditions to derive phenomaps of retinal disease. Results were analyzed with a model of a shared natural history of a single delayed exponential across all subjects and all retinal locations. Critical age for the initiation of photoreceptor loss ranged from 48years at the temporal paramacular retina to 74 years at the inferior midperipheral retina. Subretinal deposits (sRET-Ds) became more prevalent as critical age was approached. Subretinal pigment epithelial deposits (sRPE-Ds) were detectable in the youngest patients showing no other structural or functional abnormalities at the retina. The sRPE-D thickness continuously increased, reaching 25µm in the extrafoveal retina and 19µm in the fovea at critical age. Loss of light sensitivity preceded shortening of outer segments and loss of photoreceptors by more than a decade. Retinal regions providing an ideal treatment window exist across all severity stages of L-ORD.

Diabetic choriocapillaris flow deficits affect the outer retina and are related to hemoglobin A1c and systolic blood pressure levels

Patient systemic and ocular data based on optical coherence tomography (OCT) and OCT angiography images were analyzed (n = 45; control and diabetic eyes with or without diabetic retinopathy [DR]; mean age, 49.6 ± 8.1 years). All participants had best-corrected visual acuity < 0.05 in logMAR. The choriocapillaris flow area (CCFA) ratio was lower and the coefficient of variation (CV) of CCFA ratio was higher in diabetic eyes with or without DR than in control eyes. CCFA ratio of DR eyes was lower than that of diabetic eyes without DR. Superficial retinal vessel length density (VLD) was reduced only in DR eyes. CCFA ratio correlated with retinal VLD, photoreceptor outer segment (PROS) length, and retinal pigment epithelium (RPE) volume in the study population; mean PROS decreased in diabetic eyes with or without DR, and RPE volume increased in DR eyes. CCFA ratio < 65.9% and CV of CCFA ratio ≥ 0.140 were more frequently found in diabetic eyes (odds ratio [OR], 13.333; P = 0.001), and related to HbA1c ≥ 7.0% (OR, 4.992; 95% confidence interval [CI] 1.164–21.412; P = 0.030) or systolic blood pressure ≥ 135 mmHg (OR, 5.572; 95% CI 1.156–26.863; P = 0.032). These findings could help understand diabetic pathogenesis in the choriocapillaris and outer retina, and remind clinicians to manage both diabetes and hypertension.

The Metabolism of 2-arachidonoylglycerol in Rod Outer Segments Is Modulated by Proteins Involved in the Phototransduction Process.

We previously reported that 2-arachidonoylglycerol (2-AG) synthesis by diacylglycerol lipase (DAGL) and lysophosphatidate phosphohydrolase (LPAP) and hydrolysis by monoacylglycerol lipase (MAGL) in rod outer segments (ROS) from bovine retina were differently modified by light applied to the retina. Based on these findings, the aim of the present research was to evaluate whether 2-AG metabolism could be modulated by proteins involved in the visual process. To this end, ROS kept in darkness (DROS) or obtained in darkness and then subjected to light (BROS) were treated with GTPγS and GDPβS, or with low and moderate ionic strength buffers for detaching soluble and peripheral proteins, or soluble proteins, respectively. Only DAGL activity was stimulated by the application of light to the ROS. GTPγS-stimulated DAGL activity in DROS reached similar values to that observed in BROS. The studies using different ionic strength show that (1) the highest decrease in DROS DAGL activity was observed when both phosphodiesterase (PDE) and transducin α (Tα) are totally membrane-associated; (2) the decrease in BROS DAGL activity does not depend on PDE association to membrane, and that (3) MAGL activity decreases, both in DROS and BROS, when PDE is not associated to the membrane. Our results indicate that the bioavailability of 2-AG under light conditions is favored by G protein-stimulated increase in DAGL activity and hindered principally by Tα/PDE association with the ROS membrane, which decreases DAGL activity.

Spatially-dependent model for rods and cones in the retina

We develop a mathematical model for photoreceptors in the retina. We focus on rod and cone outer segment dynamics and interactions with a nutrient source associated with the retinal pigment epithelium cells. Rod and cone densities (number per unit area of retinal surface) are known to have significant spatial dependence in the retina with cones located primarily near the fovea and the rods located primarily away from the fovea. Our model accounts for this spatial dependence of the rod and cone photoreceptor density as well as for the possibility of nutrient diffusion. We present equilibrium and dynamic solutions, discuss their relation to existing models, and estimate model parameters through comparisons with available experimental measurements of both spatial and temporal photoreceptor characteristics. Our model compares well with existing data on spatially-dependent regrowth of photoreceptor outer segments in the macular region of Rhesus Monkeys. Our predictions are also consistent with existing data on the spatial dependence of photoreceptor outer segment length near the fovea in healthy human subjects. We focus primarily on the healthy eye but our model could be the basis for future efforts designed to explore various retinal pathologies, eye-related injuries, and treatments of these conditions.

Random Allelic Expression in Inherited Retinal Disease Genes.

Inherited retinal diseases (IRDs) are a significant contributor to visual loss in children and young adults, falling second only to diabetic retinopathy. Understanding the pathogenic mechanisms of IRDs remains paramount. Some autosomal genes exhibit random allelic expression (RAE), similar to X-chromosome inactivation. This study identifies RAE genes in IRDs. Genes in the Retinal Information Network were cross-referenced with the recent literature to identify expression profiles, RAE, or biallelic expression (BAE). Loss-of-function intolerance (LOFI) was determined by cross-referencing the existing literature. Molecular and biological pathways that are significantly enriched were evaluated using gene ontology. A total of 184 IRD-causing genes were evaluated. Of these, 31 (16.8%) genes exhibited RAE. LOFI was exhibited in 6/31 (19.4%) of the RAE genes and 18/153 (11.8%) of the BAE genes. Brain tissue exhibited BAE in 107/128 (83.6%) genes for both sexes. The molecular pathways significantly enriched among BAE genes were photoreceptor activity, tubulin binding, and nucleotide/ribonucleotide binding. The biologic pathways significantly enriched for RAE genes were equilibrioception, parallel actin filament bundle assembly, photoreceptor cell outer segment organization, and protein depalmitoylation. Allele-specific expression may be a mechanism underlying IRD phenotypic variability, with clonal populations of embryologic precursor cells exhibiting RAE. Brain tissue preferentially exhibited BAE, possibly due to selective pressures against RAE. Pathways critical for cellular and visual function were enriched in BAE, which may offer a survival benefit.