Paving Stone Degeneration Research Articles

Wagner Syndrome-like fundus presentation of atypical Persistent Fetal Vasculature.

To report the case of a woman with atypical Persistent fetal vasculature (PFV) accompanied by more typical findings of Wagner Syndrome. A 58-year-old woman complained about persistent flashes and floaters for more than 6 months. Multimodal retinal imaging showed Bergmeister papilla and a fibrous gray strand floating behind the macula in the right eye. Ultra-wide field retinography revealed a 270° paving-stone degeneration and a nasal circumferential vitreous veil in both eyes. Functional and genetic testing were negative for inherited retinal diseases. PFV spectrum confirms its heterogeneous presentation. We report an atypical adult PFV case in presence of retrolental and optic nerve head stalks, accompanied by extensive peripheral vitreoretinal degenerations. This case may expand the current understanding of PFV presentation in adulthood.

Intelligent Diagnosis of Multiple Peripheral Retinal Lesions in Ultra-widefield Fundus Images Based on Deep Learning.

Compared with traditional fundus examination techniques, ultra-widefield fundus (UWF) images provide 200° panoramic images of the retina, which allows better detection of peripheral retinal lesions. The advent of UWF provides effective solutions only for detection but still lacks efficient diagnostic capabilities. This study proposed a retinal lesion detection model to automatically locate and identify six relatively typical and high-incidence peripheral retinal lesions from UWF images which will enable early screening and rapid diagnosis. A total of 24,602 augmented ultra-widefield fundus images with labels corresponding to 6 peripheral retinal lesions and normal manifestation labelled by 5 ophthalmologists were included in this study. An object detection model named You Only Look Once X (YOLOX) was modified and trained to locate and classify the six peripheral retinal lesions including rhegmatogenous retinal detachment (RRD), retinal breaks (RB), white without pressure (WWOP), cystic retinal tuft (CRT), lattice degeneration (LD), and paving-stone degeneration (PSD). We applied coordinate attention block and generalized intersection over union (GIOU) loss to YOLOX and evaluated it for accuracy, sensitivity, specificity, precision, F1 score, and average precision (AP). This model was able to show the exact location and saliency map of the retinal lesions detected by the model thus contributing to efficient screening and diagnosis. The model reached an average accuracy of 96.64%, sensitivity of 87.97%, specificity of 98.04%, precision of 87.01%, F1 score of 87.39%, and mAP of 86.03% on test dataset 1 including 248 UWF images and reached an average accuracy of 95.04%, sensitivity of 83.90%, specificity of 96.70%, precision of 78.73%, F1 score of 81.96%, and mAP of 80.59% on external test dataset 2 including 586 UWF images, showing this system performs well in distinguishing the six peripheral retinal lesions. Focusing on peripheral retinal lesions, this work proposed a deep learning model, which automatically recognized multiple peripheral retinal lesions from UWF images and localized exact positions of lesions. Therefore, it has certain potential for early screening and intelligent diagnosis of peripheral retinal lesions.

Ultra-Widefield Swept-Source Optical Coherence Tomography Findings of Peripheral Retinal Degenerations and Breaks.

PurposeTo investigate whether ultra-widefield (UWF) swept-source optical coherence tomography (SSOCT) system (Silverstone, Nikon Healthcare Japan, Inc, Tokyo, Japan) can obtain OCT images of peripheral retinal degenerations and breaks.MethodsThirty-seven eyes of 31 consecutive cases (16 men, 15 women; mean age 51 years) who had peripheral retinal degenerations and underwent a UWF-SSOCT imaging were enrolled. The convenience and usefulness were investigated.ResultsIn all eyes, OCT images were capable and interpretable without any special techniques. The respective findings on OCT were retinal degeneration in 16 eyes: lattice degeneration in 8 eyes, paving stone degeneration in 4 eyes, and unclassified in 4 eyes, retinal tear in 12 eyes, and retinal hole in 9 eyes. The respective locations of the retinal degenerations or breaks were the posterior pole in 0 eyes, mid-periphery in 23 eyes, and far-periphery in 14 eyes. Fifteen eyes had a rhegmatogenous retinal detachment (RRD), one of which was preoperative and the other 14 eyes were postoperative. A buckle was placed in 8 eyes for RRD repair. Subretinal fluid was observed in 9 of 21 eyes with retinal break or retinal hole. Vitreoretinal traction was observed in 10 of 27 eyes without a history of vitrectomy. Inverted artifacts on OCT images were observed in 20 of 37 eyes, which were not related to the location or axial length, but were supposed to be due to the limited scan depth.ConclusionThe UWF-SSOCT system could capture the OCT images of peripheral retinal degenerations and breaks without any special technique.

The Prevalence and Associations of Peripheral Retinopathy: Baseline Study of Guangzhou Office Computer Workers.

Purpose To determine the prevalence of peripheral retinopathy and its associated risk factors among a sample of Guangzhou office computer workers. Methods A cross-sectional study of Guangzhou Chinese computer workstations and operators in different departments and units of the Guangzhou Power Supply Bureau, China, in 2016. Peripheral retinopathy was recorded and analyzed using a scanning laser ophthalmoscope (SLO; Optos, Daytona, United Kingdom) and slit-lamp microscopy combined with a three-mirror contact lens. Results The 1934 eyes of 967 subjects (513 females and 454 males) were included in this study. In total, 79.1% of the eyes were myopic in workers aged 20–29 years, 72.9% in workers aged 30–39 years, 62.2% in workers aged 40–49 years, and 43.4% in workers aged 50–59 years (p < 0.001). Most eyes had optic nerve crescents (81.3%). Various peripheral degenerations were found: 7 eyes (0.4%) had microcystoid degeneration, 40 (2.1%) had peripheral pigmentary degeneration, 87 (4.5%) had lattice degeneration, and 4 (0.2%) had snail-track degeneration. Nineteen (1.0%) eyes had paving-stone degeneration, 11 (0.6%) eyes had a retinal hole or tear, and 16 (0.8%) eyes had chorioretinal degeneration. Multivariate regression confirmed that greater axial length (OR: 1.18 (1.03, 1.35), p=0.012) and more serious spherical equivalent (OR: 0.82 (0.77, 0.88), p < 0.001) were significant risk factors for peripheral retinal changes. Conclusion Peripheral retinal degenerative changes were found in a larger proportion of younger computer workers than older ones. Myopia is occurring in younger and younger people, accompanied by peripheral retinal degeneration.

Observational study of peripheral retinal degenerations in normal population in Sarojini Devi eye hospital

The study of retinal periphery has a significance in clinical evaluation of an eye. By virtue of it's peculiar characteristics it is prone for certain lesions, and some of them could be pathological. The study by various workers indicates the varied type of pathological lesions residing in the retinal periphery. Various lesions found in this region in supposedly normal persons like paving stone degeneration, Lattice degeneration, cystoid degeneration, white with pressure and white without pressure areas are likely to be missed by routine examination. unless specifically looked for

Morphological and Angiographic Peripheral Retinal Changes in Patients with Age-Related Macular Degeneration

To show morphologic and angiographic changes in the peripheral retina in patients with age-related macular degeneration (AMD) using wide-field fundus imaging, and to compare these findings with those from healthy controls. Cross-sectional clinical study. In total, 152 patients with clinical AMD and 150 healthy controls (without AMD in either macula) were studied. Subjects were ≥50 years of age. Exclusion criteria were diabetic retinopathy, previous retinal surgery, high myopia, or dense cataract, as well as any retinal inflammatory, degenerative, or occlusive disease. For both groups of patients, color fundus images were captured with the Optos P200 MA camera (Optos, Dunfermline, Scotland). Image analysis software was used to characterize each image. Angiography was performed on the AMD group only. Morphological and angiographic peripheral retinal changes were studied per the frequency of their occurrence, the affected peripheral retina (clock hours), and the localization of peripheral changes with regard to the eye equator. Statistical significance was defined at a level of P < 0.05. Peripheral changes in both groups according to their type and frequency (percentage of eyes with detected retinal changes), the number of clock hours of affected peripheral retina, and their localization with regard to the equator of the eye. Drusen, reticular pigmentary changes, and paving stone degeneration occurred more frequently in the AMD group than in controls (P < 0.001, P < 0.001, and P < 0.001 respectively), whereas white without pressure occurred more frequently in the control group (P= 0.027). In both groups, peripheral retinal changes were observed peripheral to the equator in more than 40% of analyzed eyes. In control Croatian subjects, peripheral drusen were seen in 38% of subjects compared with 68% of AMD subjects. Drusen, reticular pigmentary change , and paving stone degeneration occur significantly more frequently in subjects with AMD compared with controls. White without pressure degeneration was present in a high percentage of control subjects.

English

AIM: Study of peripheral retinal degeneration in relation to axial length of eyeball in myopic patient. METHOD: Study of 200 eyes of 100 patients who attended our hospital between 2010-2012.Detailed history was taken in every case. Inclusion criteria were patient with age group of 11years -70years, Patient with myopia. Exclusion criteria were patient with photopsia, history of trauma, diabetes hypertensive and undergone RD surgeries. Vision and refraction with Streak Retinoscopy was done. Axial length was recorded by A-scan biometry. Fundoscopy was done in all cases. RESULT: In our study number of males was 54 and females were 46. Peripheral chorioretinal lesions were noted to be associated with increased axial length of eye 1, 2 .Greater the antero-posterior ocular diameter the greater chance of peripheral chorioretinal degeneration 2 . CONCLUSION: Examination of periphery of retina is important in all myopic cases. Lattice degenerations are most common lesions1, 3. 60% of lesions are found in superotemporal quadrant. Tendency of bilaterality4 is noted in all degenerations except paving stone degeneration. Prevalence of lattice degeneration is maximum in axial length between 28-30mm 5 .

TYPES OF PERIPHERAL RETINAL DEGENERATIONS IN HIGHLY MYOPIC IRAQI

Purpose: To determine the types of peripheral retinal degenerations in highly myopic Iraqi patients Design: cross sectional study Participants: Two hundred patients with high myopia attending the outpatient clinic of ophthalmologic department in Alkadhimyia teaching hospital in Baghdad and AL-Sadr teaching hospital in Basrah from the period of July 2008 to march 2010. Methods: Each patient was examined thoroughly starting with visual acuity and refraction to determine the degree of myopia followed by anterior segment examination to exclude media opacity and inflammatory eye diseases then the pupil was dilated and the vitreous with the peripheral retina were examined by the indirect ophthalmoscope and then by the three mirror. Results: One hundred twenty two (61%) patients were found to have posterior vitreous detachment. The peripheral retina showed the following types of retinal changes and degenerations: 66(33%) patients had pigment clumps, 54(27%) patients had paving stone degeneration, 24(12%) patients had snow flakes degenerations, 20(10%) patients had lattice degeneration, 10(5%) patients had peripheral cystoids degeneration, 6(3%) patients had white without pressure degeneration and only 20(10%) patients had normal peripheral retina. Conclusions: high myopia is a pathological condition that predisposes the patient to peripheral retinal degenerations. Most of the patients in the study group had a benign type of degeneration while a minority had a more serious type of degeneration. Three mirror examinations is important in high myopia to detect these degenerations and to prevent eventual complications.

Le vitré du myope : quelles anomalies importantes peut-on déceler en périphérie ?

Vitreoretinal periphery in myopic eyes may present abnormalities whose frequency and severity are correlated with axial elongation of the eye: white-without-pressure, lattice degeneration, pigmentary degeneration, and paving stone degeneration. Sometimes one can find atrophic round holes, retinal breaks, or retinoschisis whose differential diagnosis with slow progressive retinal detachment can be made on the presence of an absolute field defect. The presence of peripheral vitreous strands, pigmentary migrations, holes, associated with extensive liquefaction of the central vitreous body and facial dysmorphy are symptomatic of Stickler syndrome often complicated with bilateral retinal detachments. Congenital hereditary retinoschisis should be raised in the presence of temporal and inferior bullous detachment of a thin inner layer of the retina associated with large multiple holes in a boy with poor vision and cystic macular changes. Examination of peripheral retina should be systematic after the age of 40in myopic patients to specify the presence of abnormalities predisposing to retinal detachment. It is more important to inform the patient of posterior vitreous detachment or retinal detachment symptoms, a true emergency situation, rather than to suggest regular and repeated consultations in the nonsymptomatic eye.

In vivo sectional imaging of the retinal periphery using conventional optical coherence tomography systems

Optical coherence tomography (OCT) has transformed macular disease practices. This report describes the use of conventional OCT systems for peripheral retinal imaging. Thirty-six eyes with peripheral retinal pathology underwent imaging with conventional OCT systems. In vivo sectional imaging of lattice degeneration, snail-track degeneration, and paving-stone degeneration was performed. Differences were noted between phenotypes of lattice degeneration. Several findings previously unreported in histopathology studies were encountered. Certain anatomic features were seen that could conceivably explain clinical and intraoperative behavior of peripheral lesions. Peripheral OCT imaging helped elucidate clinically ambiguous situations such as retinal breaks, subclinical retinal detachment, retinoschisis, choroidal nevus, and metastasis. Limitations of such scanning included end-gaze nystagmus and far peripheral lesions. This first of its kind study demonstrates the feasibility of peripheral retinal OCT imaging and expands the spectrum of indications for which OCT scanning may be clinically useful.

Optical Coherence Tomography of Peripheral Retinal Lesions in Enucleated Human Eye Specimens with Histologic Correlation

To report optical coherence tomography (OCT) histologic correlations of three common peripheral retinal lesions and to explore the feasibility of the use of OCT to image retinal pathologic conditions in fixed tissue specimens. Experimental study. We studied peripheral retinal lesions that were available to us in 11 formalin-fixed caps of seven human eyes that had been enucleated previously for choroidal melanoma. OCT scans were performed through these lesions, and the images were correlated with corresponding histologic sections. Three peripheral retinal diseases that included cystoid degeneration, localized retinal detachment, and paving stone degeneration were imaged successfully, and their optical characteristics correlated well with their histologic data. We explored potential utility for OCT imaging of peripheral retinal pathologic conditions in fixed tissue specimens. That these OCT images correlate with findings from histologic sections suggests a possible role for OCT in the eye pathology laboratory.

High Myopia Progression and Visual Impairment in a Nonselected Group of Danish 14-Year-Olds Followed Over 40 Years

The purpose of this study was to document the adult age progression of myopia and the incidence of visual impairment in a representative sample of Danish adolescents with high myopia. This study consisted of a scheduled regular ophthalmic follow-up over 40 years of 39 otherwise unselected Copenhagen 14 year olds with uni- and bilateral myopia of at least -6 D, as screened from a 1948 birth-year school cohort comprising 9243 pupils. Thirty-six of the 39 had satisfactory refractive and corrected visual acuity data for a longitudinal analysis. Myopia progression for the full period ranged from 0 to 14 D, and the peak myopia value increased from -14 to -26 D. The mean progression from age 16 to 26 years was 2.09 D, and from age 26 and on it was 1 D. Using both eyes and relevant correction, at the preliminary end point of 54 years, 32 of the 36 had a corrected visual acuity (VA) of 0.5 or better. Four had a corrected VA of < or = 0.3, but the visual loss was partly explained by other eye pathology. Significant visual reduction in single eyes mainly affected the subgroup of eyes with unilateral high myopia (n = 9). With only a slight overrisk recorded as associated with high myopia (in three or four of 36 subjects), the adult visual prognosis for working age appeared better than usually claimed. There seems to be a correlation between degree of myopia at age 14 and consecutive visual loss, but it was not possible to identify subjects at high risk at that early age.

Prevalence and Characteristics of Peripheral Retinal Degeneration in Chinese Adults with High Myopia: A Cross-Sectional Prevalence Survey

The purpose of this study was to study the prevalence of peripheral retinal findings in adult Chinese patients with high myopia (refraction < or = -6.00 D) and to investigate the correlation between the retinal lesions and the severity of myopia or axial length. A cross-sectional prevalence survey screening was conducted in high ethnic Chinese myopes with refractions equal to or less than -6.00 D. The examinations included cycloplegic refraction, A and B scan ultrasonography, and retinal examinations by indirect ophthalmoscopy with scleral indentation and Goldmann three-mirror contact lens examination. Two hundred thirteen eyes in 213 patients with a mean refraction of -10.10 +/- 4.23 D (range = -6.00 to -27.00 D) were examined. The mean axial length was 26.69 +/- 1.68 mm (range = 25.18-33.62 mm) and the mean age was 33.5 +/- 10.6 years (range = 18-73 years). The most common peripheral retinal finding was pigmentary degeneration (51.2%), followed by lattice degeneration in 12.2% and retinal holes in 7.5% of eyes. A positive correlation was noted between axial length and the lesions of pigmentary degeneration and pavingstone degeneration. The prevalence of retinal holes was 6.4% and 30.0% in eyes with axial length of < 30 mm and > or = 30 mm, respectively (chi-squared test, p = 0.006). A high prevalence of peripheral retinal degenerations was found in adult Chinese high myopes. The presence of retinal holes was positively correlated with very high myopia of an axial length of > or = 30 mm.

Retinal peripheral changes after laser in situ keratomileusis in patients with high myopia

Background: Retinal detachment has been reported after laser in situ keratomileusis (LASIK) in myopic eyes.This complication may be related to the risk from myopia before surgery or may be induced by LASIK surgery itself. We performed a study to evaluate retinal peripheral changes after LASIK in patients with high myopia and to correlate symptoms on presentation and vitreoretinal anatomic changes.Methods: The study was carried out at a university-affiliated hospital in São Paulo between November 1997 and February 1999. Patients scheduled to undergo LASIK were included if their spherical equivalent was greater than 6.00 dioptres. The exclusion criteria were previous retinal treatment and myopic macular degenerations. We performed binocular indirect ophthalmoscopy with scleral indentation and fundus biomicroscopy with Goldmann lens before LASIK and 1, 3 and 6 months after surgery.Results: We examined 198 eyes preoperatively. Of the 198, 50 did not undergo LASIK surgery owing to refractive criteria, and 79 were lost to follow-up. We thus studied 69 eyes. The mean spherical equivalent preoperatively was -8.00 D (standard deviation 1.95 D). Twenty-four eyes had normal retinal periphery preoperatively; all 24 remained without alterations after LASIK. Forty-five eyes had peripheral alterations: 17 (24.6%) had cystic degeneration, 14 (20.3%) had lattice degeneration, 11 (15.9%) had white-without-pressure, 5 (7.2%) had cystic tufts, 3 (4.3%) had pavingstone degeneration, 2 (2.9%) had pigmentary alteration, 1 (1.4%) had holes with free operculum, and 1 (1.4%) had punctiform holes. The only alteration after surgery was almost punctiform holes around the previous cystic tuft I month after surgery in one patient. Retinal detachment did not develop in any of the eyes.Interpretation: In this group of patients it appears that LASIK did not lead to progressive peripheral retinal lesions in asymptomatic patients during the period studied.

Peripheral retinal changes and axial myopia.

The relationship between the presence of peripheral chorioretinal changes and axial myopia in 513 eyes (513 patients) 24 mm or more in length, or beyond the upper range of normal axial length, is studied. Axial length was measured with A-scan ultrasonography (immersion technique) and retinal periphery was studied by biomicroscopic examination and scleral indentation. The presence of lattice degeneration, pavingstone degeneration, pigmentary degeneration, white with or without pressure (WWP), retinal holes, tears, or both (RHT), retinal detachment, and posterior vitreous detachment was reported. The correlation between presence of a lesion and a longer axial length was always significant, except with retinal detachment, pigmentary degeneration, and RHT. Pavingstone degeneration was significantly related to older age and WWP and RHT to younger age. Posterior vitreous detachment was frequent in almost all axial length groups and age classes. No significant relationship was found between any kind of lesion and gender of the patient, or between axial length and patient age.

Retinal Holes

Holes of the peripheral retina, defined as full-thickness breaks of trophic origin with no associated flap or free operculum, were found in 136 (2.4%) eyes from 2,800 autopsied subjects. Primary retinal holes (those with no indication of a proximal causative lesion and with no lattice degeneration in either eye) occurred in only eight of the 5,600 eyes studied; all were unilateral, single, less than 0.25 disk diameter in size, within the basal zone, and in eyes from elderly subjects. Secondary holes were found in 128 (2.3%) of eyes and of these, lattice degeneration was the most common cause (103). Other lesions complicated by hole formation included zonular traction tufts (10), chorioretinitis (9), meridional folds (3), and pavingstone degeneration (2). Retinal holes in surgically aphakic eyes did not differ qualitatively or quantitatively from those in age-matched phakic eyes.

Peripheral Chorioretinal Lesions and Axial Length of the Myopic Eye

A study of the retinal periphery of 1,437 predominantly myopic eyes revealed a statistically significant association of four types of peripheral chorioretinal degenerations with increased axial length of the eye. These were white without pressure, pigmentary degeneration, pavingstone degeneration, and lattice degeneration. There was a tendency for both white without pressure and lattice degeneration jointly to affect eyes of individuals 19 years of age and younger. Increasing age was a significant factor in the incidence of pigmentary and pavingstone degenerations, whereas aging significantly reduced the prevalence of white without pressure.

Light- and electron-microscopic study of a paving stone degeneration of a peripheral human retina: (exhibit)

Light- and electron-microscopic study of a paving stone degeneration of a peripheral human retina: (exhibit)

PAVING-STONE DEGENERATION OF THE RETINA.

Of importance in the evaluation of the peripheral fundus is a distinctive and fairly common disease process termed paving-stone degeneration of the retina. In its typical form, this condition is located between the ora serrata and the equator and is characterized by small, discrete, rounded areas of depigmentation and retinal thinning. These lesions are yellow-white in color, frequently reveal prominent underlying choroidal vessels, and often possess a pigmented margin. Occurring singly or in groups, the lesions of paving-stone degeneration not uncommonly become confluent and may even coalesce to form bands. The prominent distinguishing features of this condition undoubtedly contributed to its initial recognition by Donders more than 100 years ago. 2 A number of subsequent reports, including a meticulous analysis by Rehsteiner, 9 noted the clinical features of paving-stone degeneration and, quite recently, Wolter and Wilson 11 and Okun 8 recorded pertinent observations on its histopathology. During the past century,