Retinal Cysts Research Articles

OPTICAL COHERENCE TOMOGRAPHY–BASED EPIRETINAL MEMBRANE STAGE CORRELATES WITH TANGENTIAL RETINAL DISPLACEMENT AND METAMORPHOPSIA

Purpose: To investigate correlations of the optical coherence tomography–based epiretinal membrane (ERM) classification with metamorphopsia and tangential retinal displacement after ERM surgery. Methods: ERM stage (stage 1–4) was defined as originally described. Metamorphopsia scores at baseline, 1 month, 3 months, and 6 months after ERM surgery were measured with M-CHARTS (Inami, Co, Tokyo). Tangential retinal displacement was measured as described previously. Eyes with retinal cysts, lamellar hole with epiretinal proliferation, or retinoschisis were excluded. Results: One hundred thirty-five eyes of 135 consecutive patients who underwent ERM surgery at a single academic hospital were enrolled. There were 20 eyes of stage 1, 57 eyes of stage 2, 54 eyes of stage 3, and 4 eyes of stage 4. Epiretinal membrane stage correlated with tangential retinal displacement at 1 month, 3 months, and 6 months postoperatively (Spearman rank correlation coefficient, P < 0.001), which also correlated with both horizontal and vertical preoperative M-CHARTS scores (P < 0.001) and horizontal scores at 1 month (P = 0.001) and 3 months (P = 0.016). Visual acuities did not show any correlations with the stage. Conclusion: Optical coherence tomography–based ERM classification correlates strongly with tangential retinal displacement after ERM surgery. This classification is particularly useful to predict pre- and postoperative metamorphopsia, but not for visual acuity.

An osmolarity dependent mechanism partially ameliorates retinal cysts and rescues cone function in a mouse model of X-linked retinoschisis.

X-linked retinoschisis (XLRS) is a vitreoretinal dystrophy caused by RS1 gene mutations which disrupt retinoschisin-1 (RS1) function. Vital for retinal architecture, the absence of functional RS1 leads to the development of intraretinal cysts. Intravitreal injection of a gene therapy for treating XLRS caused ocular inflammation in high dose groups in a phase I/II clinical trial. This study investigates a low dose subretinal gene therapy in Rs1 knockout (Rs1-KO) mice compared to injection of buffer alone. Observation of an unexpected therapeutic effect following the subretinal injection of the hypertonic buffer led to novel findings in XLRS. Rs1-KO mice were subretinally injected with an AAV2/4 vector (n = 10) containing the RS1 gene driven by an Ef1α promoter, a hypertonic buffer (n = 15) (180 mM NaCl 0.001% F68/PBS (pH 7.4)), or isotonic buffer (n = 7) (155.2 mM NaCl 0.001% F68/PBS, pH 7.0). A sham puncture group was also included (n = 6). Endpoints included electroretinogram (ERG), optical coherence tomography (OCT), a visually guided swim assay (VGSA), and immunohistochemistry. Unexpectedly, hypertonic buffer-injected eyes had reduced cyst severity at 1-month post-injection (MPI) (p < 0.0001), higher amplitudes in cone-dominant ERGs persisting to 5 MPI (5 Hz flicker; p < 0.0001; 3.0 flash; p = 0.0033) and a trend for improved navigational vision in the light compared to untreated Rs1-KO eyes. To investigate the role of tonicity on this effect, an isotonic buffer-injected cohort was created (155.2 mM NaCl 0.001% F68/PBS, pH 7.0) (n = 7). Surprisingly, hypertonic buffer-injected eyes exhibited a greater reduction in cyst severity and demonstrated improved cone-dominant ERG metrics over isotonic buffer-injected and sham puncture eyes. An immunohistochemistry assay demonstrated greater cone density in hypertonic buffer-injected eyes than untreated Rs1-KO eyes at 5-6 MPI (p = 0.0198), suggesting a possible cone preservation mechanism. Moreover, our findings reveal a negative correlation between the peak severity of cysts and long-term ERG amplitudes in cone-dominant pathways, implying that effectively managing cysts could yield enduring benefits for cone function. This study presents evidence that cyst resolution can be triggered through an osmolarity-dependent pathway, and early cyst resolution has long-term effects on cone signaling and survival, offering potential insights for the development of novel treatments for XLRS patients.

Prevalence and Distribution of Macular Fluid with Central Retinal Artery Occlusion and Anterior Ischemic Optic Neuropathy.

To examine the prevalence and distribution of fluid within a cohort of eyes with acute central retinal artery occlusion (CRAO) and non-arteritic anterior ischemic optic neuropathy (AION) using optical coherence tomography (OCT). A retrospective analysis of patient records and OCT imaging. Patients presenting with acute CRAO or AION who had available macular OCT imaging and no co-morbidities known to cause macular fluid were included in the analysis. Baseline characteristics, visual acuity (VA), and fluid presence and distribution among the retinal layers were recorded. In the 16 eyes with acute CRAO, fluid was noted in 5 eyes (31%), which was mainly subretinal (3 eyes) or intraretinal located within the outer retinal layers (3 eyes). Only one eye had inner retinal cysts. Of the 11 eyes with acute AION, fluid was present in 8 eyes (73%). Subretinal fluid was noted in 4 eyes and extended to the foveal area in 3 of them, and outer retinal versus inner retinal cysts were noted in 6 versus 3 eyes, respectively. None of the eyes showed hard exudate deposition. In the small subset of eyes with CRAO and macular fluid that were followed-up, VA improved, while in eyes with AION, VA remained stable. Macular fluid on OCT is not an uncommon feature of acute CRAO and AION and is mainly distributed within the outer retinal layers or subretinal space. Fluid is an understudied feature of retinal and optic nerve head infarction and may have a role in predicting neuronal damage extent and visual outcome.

Vaccine needle prick-related retinal injury

A 7-year-old male presented with left eye subconjunctival hemorrhage following injury with a 23-G vaccine needle (COVID-19 vaccine) while playing. Examination revealed a best-corrected visual acuity of 20/30 in the left eye with the presence of localized subconjunctival hemorrhage and trace vitreous hemorrhage with normal intraocular pressure. Peripheral fundus examination revealed the presence of a peripheral retinal tear with an adjacent retinal cyst. A laser barrage was done to the retinal tear, and the patient was kept under close follow-up. On follow-up at 3 months, vision improved to 20/20 with the resolution of vitreous hemorrhage and attached retina. Thus, we report a rare case of retinal tear due to an inefficiently disposed vaccine needle, stating the importance of following occupational safety by the vaccinators as well as other health administrators.

EVALUATION OF PARAVASCULAR INNER RETINAL DEFECTS USING EN FACE OPTICAL COHERENCE TOMOGRAPHY.

To evaluate the prevalence and risk factors for development of paravascular inner retinal defects (PIRDs) using en face optical coherence tomography. This is a retrospective cross-sectional study. En face and cross-sectional optical coherence tomography images were reviewed (9 × 9 mm or 12 × 12 mm). Paravascular inner retinal defects were classified as either Grade 1 (i.e., paravascular inner retinal cysts) when the lesion was confined within the nerve fiber layer without any communication to the vitreous cavity or Grade 2 (i.e., paravascular lamellar hole) when the defects communicated to the vitreous. Paravascular inner retinal defect grading was correlated with presence of high myopia, stage of posterior vitreous detachment, and presence of epiretinal membrane and retinoschisis. Of 1,074 patients (2,148 eyes), PIRDs were detected in 261 eyes with a prevalence of 261 per 2,148 eyes (12.2%) and 176 per 1,074 patients (16.4%). A total of 116 eyes (44.4%) displayed Grade 2 PIRDs while 145 eyes (55.6%) were Grade 1. In the multivariate logistic regression model, the presence of partial/complete posterior vitreous detachment, retinoschisis, and epiretinal membrane was significantly correlated with PIRDs (OR = 2.78 [1.7-4.4], P < 0.001; OR = 2.93 [1.7-5], P < 0.001; and OR = 25.9 [2.8-242.5], P < 0.001, respectively). The presence of partial/complete posterior vitreous detachment and epiretinal membrane was also significantly associated with Grade 2 PIRDs versus Grade 1 PIRDs ( P = 0.03 and P < 0.001). Our results indicate that wide-field en face optical coherence tomography facilitates the identification of PIRDs over a large area of retina with a single capture. The presence of PIRDs was significantly associated with posterior vitreous detachment, epiretinal membrane, and retinoschisis, confirming the role of vitreoretinal traction in the pathogenesis of PIRDs.

Association Between Ocular Trauma and Activation of Ocular Toxoplasmosis

ABSTRACT Purpose To evaluate the association between ocular trauma and activation of ocular toxoplasmosis. Methods Retrospective review of 686 patients with ocular toxoplasmosis and its association with trauma to the eye or the head within 1 week of activation. Results Ten patients with a history of trauma and activation of ocular toxoplasmosis were detected (10/686; 1.45%). Nine patients showed a primary focus of retinitis without a previous scar and one patient had a recurrent form of ocular toxoplasmosis. From these 10 patients, Toxoplasma IgG was positive in eight of them. The median age of the patients was 35.8 years-old (range 17 to 65). Conclusions These cases suggest that trauma can be associated with activation of retinal bradyzoite cysts in ocular toxoplasmosis.

A Review of Machine Learning Algorithms for Retinal Cyst Segmentation on Optical Coherence Tomography

Optical coherence tomography (OCT) is an emerging imaging technique for diagnosing ophthalmic diseases and the visual analysis of retinal structure changes, such as exudates, cysts, and fluid. In recent years, researchers have increasingly focused on applying machine learning algorithms, including classical machine learning and deep learning methods, to automate retinal cysts/fluid segmentation. These automated techniques can provide ophthalmologists with valuable tools for improved interpretation and quantification of retinal features, leading to more accurate diagnosis and informed treatment decisions for retinal diseases. This review summarized the state-of-the-art algorithms for the three essential steps of cyst/fluid segmentation: image denoising, layer segmentation, and cyst/fluid segmentation, while emphasizing the significance of machine learning techniques. Additionally, we provided a summary of the publicly available OCT datasets for cyst/fluid segmentation. Furthermore, the challenges, opportunities, and future directions of artificial intelligence (AI) in OCT cyst segmentation are discussed. This review is intended to summarize the key parameters for the development of a cyst/fluid segmentation system and the design of novel segmentation algorithms and has the potential to serve as a valuable resource for imaging researchers in the development of assessment systems related to ocular diseases exhibiting cyst/fluid in OCT imaging.

A Deep Ensemble Learning-Based CNN Architecture for Multiclass Retinal Fluid Segmentation in OCT Images

Retinal Fluids (fluid collections) develop because of the accumulation of fluid in the retina, which may be caused by several retinal disorders, and can lead to loss of vision. Optical coherence tomography (OCT) provides non-invasive cross-sectional images of the retina and enables the visualization of different retinal abnormalities. The identification and segmentation of retinal cysts from OCT scans is gaining immense attention since the manual analysis of OCT data is time consuming and requires an experienced ophthalmologist. Identification and categorization of the retinal cysts aids in establishing the pathophysiology of various retinal diseases, such as macular edema, diabetic macular edema, and age-related macular degeneration. Hence, an automatic algorithm for the segmentation and detection of retinal cysts would be of great value to the ophthalmologists. In this study, we have proposed a convolutional neural network-based deep ensemble architecture that can segment the three different types of retinal cysts from the retinal OCT images. The quantitative and qualitative performance of the model was evaluated using the publicly available RETOUCH challenge dataset. The proposed model outperformed the state-of-the-art methods, with an overall improvement of 1.8%.

Anatomical and functional correlates of cystic macular edema in retinitis pigmentosa.

Cystoid macular edema (CME) is a major cause of central visual deterioration in retinitis pigmentosa. The exact reason for CME and its prognostic significance in this patient population is unknown. We seek to find clues to answer these questions by examining the anatomical correlations between retinal cysts and retinal morphometric parameters in a cohort of patients with retinitis pigmentosa and CME. For this reason, 103 patients (196 eyes) with untreated cystoid macular edema (CME) were identified from a pool of 578 genotyped patients with retinitis pigmentosa. Image analyses were conducted using three central horizontal OCT scans of these patients to calculate cross-sectional areas of the retinal nerve fiber layer, outer retinal, inner retinal, cysts, and total retinal areas. Lengths of the ellipsoid zone and outer limiting membrane were also measured. Best-fit curves were derived for analyzing the factors playing a role in the size of the retinal cysts and the patients’ visual acuity. Generalized Estimating Equation and multivariate linear regression analyses were conducted to determine the correlations between visual acuity, morphometric and clinical data, and the significant cyst size and visual acuity determinants. Twenty-five percent of the screened patients (103/578) had CME. Patients with autosomal dominant retinitis pigmentosa had the highest incidence of CME (43.6%, p<0.001) but also had the best visual acuity (20/34±20/30, p = 0.02). The total cyst area was 0.14±0.18 mm2. Outer retinal area (B = 0.214; p = 0.008), age (B = -0.003; p<0.001) and retinal nerve fiber area (B = 0.411; p = 0.005) were main determinants of the (r = 0.44; p<0.001) cyst size. Cysts resolved with progressing retinal degeneration. Length of the intact ellipsoid zone (B = -5.16E-5; p<0.001), the inheritance pattern (B = 0.04; p = 0.028) and retinal nerve fiber area (B = 0.751; p<0.001) were the main determinants of visual acuity. In patients with retinitis pigmentosa and cystoid macular edema, retinal nerve fiber layer thickness is associated with decreasing visual acuity and cyst size. This finding suggests that intraretinal cysts may compress retinal axons and cause subsequent visual loss in retinitis pigmentosa.

Macular Bruch's membrane defects and other myopic lesions in high myopia.

To compare the ocular fundus features of highly myopic eyes with and without macular Bruch's membrane (BM) defects and investigate the associations between macular BM defects and other myopic lesions. This retrospective, observational case series included 262 eyes (139 patients) with high myopia (HM) refractive error ≥-6.0 diopters (D) or axial length ≥26.5 mm from March 2019 to December 2019. The patients underwent a comprehensive ophthalmic examination, including swept-source optical coherence tomography (SS-OCT). The features of macular BM defects and other ocular fundus lesions were examined in OCT images. Totally 51 eyes (19.5%) were detected with macular BM defects, which were characterized by a lack of BM, retinal pigment epithelium (RPE), and an almost complete loss of photoreceptors or choriocapillaris. Eyes with macular BM defects had worse best-corrected visual acuity (BCVA) than those without (P<0.001). Dome-shaped macula (DSM, P=0.042), retinal cysts (P=0.006), choroidal neovascularization (CNV, P<0.001), choroidal defects and abnormality (P=0.003), scleral defects (P=0.015), scleral deformation (P=0.005), posterior staphyloma (P=0.011), and perforating vessels (P<0.001) occurred more frequently in eyes with macular BM defects. In multivariate analysis, the presence of macular BM defects remained the significant association with presence of DSM (P=0.013), scleral defects (P=0.015), posterior staphyloma (P=0.001), perforating vessels (P<0.001) and CNV (P=0.004). Macular BM defects has a prevalence of approximately 20% in HM and it has tight association with other myopic fundus lesions. BM might be crucial in the pathogenesis of myopic fundus lesions due to its biomechanical function. A comprehensive understanding of BM's role is useful for further researches about myopic lesions.

Multimodal imaging of soccer ball-related ocular posterior segment injuries.

To investigate the clinical and anatomic characteristics of soccer ball-induced posterior segment injuries in the era of modern multi-modal imaging. Retrospective case series of patients with soccer ball injury and diagnostic imaging from 2007 to 2020 at a single vitreoretinal practice. Eight patients met inclusion criteria. Fundus photographs (FP) and optical coherence tomography (OCT) were obtained in eight patients, fundus autofluorescence (FAF) in five patients, fluorescein angiography (FA) in three patients, and en-face OCT and OCT-Angiography (OCT-A) were obtained in two patients each. FA and FAF identified traumatic pigment epitheliopathy secondary to commotio. Increased hypo-autofluorescence was associated with shallow, peripheral retinal detachment on FAF. OCT of the macula displayed outer retinal changes associated with commotio, and offered insight into the acute and subacute changes of traumatic macular hole formation. A patient displayed foveal hyper-reflectivity in the shape of an hourglass with retinal cyst at the level of the external limiting membrane (ELM) as seen on OCT and En-face OCT. A patient with commotio involving the macula lacked microvascular changes on OCT-A. OCT, FA, and FAF imaging may aid in the work-up and management of the soccer ball-related posterior segment injuries.

Complications After Anti-VEGF Therapy in Patients with Wet Form of AMD

Anti-VEGF therapy is the main treatment in patients with the wet form of AMD. Although successful in most cases, prolonged use of intravitreal therapy can lead to serious complications. The aim of this study is to present the possible longterm complications of anti-VEGF therapy in patients with the wet form of AMD, as well as the ways to prevent them. Methods: In our study, we included 32 patients with a wet form of AMD. They were all examined ophthalmologically in detail for VA, fundus color photography, OCT (Revue, Optovue) and OCT-A (Angiophlex, Zeiss). All patients were treated with aflibercept (Eylea) - according to the Treat and Extend scheme for a period of 2 years. They were followed for complications for a period of 2 years. Results: In the long run we observed the following complications expressed in %: tachyphylaxis to the drug substance – 20%; tears of RPE-10%; fibrosis and scarring - 45%; retinal atrophy 25%. In 20% of the observed patients we found tachyphylaxis after the first year, which led to a decrease in the effectiveness of treatment. In 10% of cases we observed rupture of RPE. This occurred mainly in patients with previous detachment of RPE with a large area and height. Retinal fibrosis developed in patients with macular hemorrhage, low VA, refractory retinal cysts, or cases of RAP. Retinal fibrosis usually appeared after 10 injections. These are patients with low initial visual acuity, thin choroid especially subfoveolar and usually occurred after a small number of intravitreal injections. Conclusion: Complications after anti-VEGF therapy are relatively rare, but always associated with very serious visual impairment. The stronger the effect of the anti-VEGF drug, the more common the complications, especially retinal fibrosis. Early detection of risk factors such as low initial vision, refractory retinal cysts, macular hemorrhage, large neovascular membrane, are a prerequisite for successful prevention and treatment of these complications.

Clinical Characteristics of Pediatric Coats' Disease With Retinal Cyst Using Wide-Angle Fluorescein Angiography.

Purpose: To assess the demographic and treatment features of pediatric patients of Coats' disease with retinal cyst using wide-angle FA.Design: A retrospective, hospital based, cross-sectional study.Participants: Pediatric patients of Coats' disease underwent wide-angle FA.Methods: A retrospective review of pediatric patients of Coats' disease who underwent wide-angle FA at a single center from January 2015 to July 2020. Demographic and treatment features were compared between patients with or without retinal cyst.Main Outcome Measures: Demographic and treatment outcomes.Results: There were 123 pediatric Coats' patients in our study, and 18.70% (23/123) of the patients developed complications with retinal cyst, 73.9% (17/23) of the retinal cysts were located in the inferior-temporal quadrant and 82.6% (19/23) of the retinal cysts were located in the peripheral retina anterior to the vortex veins. Compared with patients without retinal cyst, patients with retinal cyst had more clock-hours of telangiectasia on FA (7.32 vs. 5.41, p = 0.031), and may need more total treatments (7.47 vs. 3.53, p = 0.023) including laser photocoagulation (4.08 vs. 2.31, p = 0.019) or intravitreal anti-VEGF (3.13 vs. 2.23, p = 0.039), and also required a longer time for telangiectasia resolution (22.33 vs. 18.53 months, p = 0.043).Conclusion: Pediatric patients with Coats' disease complicated by retinal cyst presented with more clock-hours of telangiectasia on FA and needed more total treatments and longer time for telangiectasia resolution.

Bacillary layer detachment in a case of sympathetic ophthalmia

The terminology of bacillary layer detachment (BLD) has been used vicariously to describe the splitting of the photoreceptor layers at the level of the myoids and has been discerned in multiple uveitic pathologies. To add to the existing literature, we report BLD in the acute stage of sympathetic ophthalmia presenting as an enclosed outer retinal cyst extending between the external limiting membrane and retinal pigment epithelium with disruption of the outer retinal layers and apparent splitting of the photoreceptor myoid zone at its margins. The cystic-appearing BLD collapsed following treatment with systemic steroids with improvement in vision.

Challenges in Diabetic Macular Edema Management: An Expert Consensus Report.

PurposeThis paper aimed to present daily-practice recommendations for the management of diabetic macular edema (DME) patients based on available scientific evidence and the clinical experience of the consensus panel.MethodsA group of Spanish retina experts agreed to discuss different aspects related with the clinical management of DME patients.ResultsPanel was mainly focused on therapeutic objectives in DME management; definition terms; and role of biomarkers as prognostic and predictive factors to intravitreal treatment response. The panel recommends to start DME treatment as soon as possible in those eyes with a visual acuity less than 20/25 (always according to the retina unit capacity). Naïve patient was defined, in a strict manner, as a patient who, up to that moment, had never received any treatment. A refractory DME patient may be defined as the one who did not achieve a complete resolution of the disease, regardless of the treatment administered. Different optical coherence tomography biomarkers, such as disorganization of the retinal inner layers, hyperreflective dots, and cysts, have been identified as prognostic factors.ConclusionThis document has sought to lay down a set of recommendations and to identify key issues that may be useful for the daily management of DME patients.

Difference between Diabetic Macular Edema and Pseudophakic Macular Edema Using Optical Coherence Tomography

Context: Macular edema (ME) is a common pathologic condition causing vision impairment. Diabetic retinopathy is a common cause of ME which can also develop after cataract surgery. Optical coherence tomography (OCT) is a noninvasive diagnostic technique that provides imaging of fine retinal details. Proper diagnosis of the underlying etiology shall affect the management. Aims: This study aims to differentiation between diabetic and pseudophakic ME (DME and PME) using OCT. Settings and Design: Cross-sectional study of 2 Groups; A: 30 eyes with DME and B: 20 eyes with PME. Subjects and Methods: Full clinical evaluation, OCT scanning, and data analysis were done for both groups. Statistical Analysis Used: SPSS software v. 16 was used for: Descriptive statistics, mean, range, and standard deviation. Student's t-test was used for comparison between means. Pearson correlation coefficient was used to assess correlation between variables. Results: Maximum macular thickness and central macular thickness were elevated in both groups but were higher in PME group (P = 0.042 and P = 0.00001, respectively). Macular thickness/volume ratio (TVR) was higher in PME group (P = 0.00001). Cystic changes had different distribution patterns; ganglion cell layer and retinal nerve fiber layer layers were free in PME(Pseudophakic macular edema) while inner nuclear layer and outer nuclear layer were affected in both groups (P = 0.0061). Epiretinal membranes were found much more in DME group (P = 0.0452). Dome-shaped macula was frequently noticed in PME group (P = 0.043). Conclusions: PME and DME have different OCT features; higher TVR, dome-shaped macula, absence of ERM suggest PME while lower TVR, presence of inner retinal cysts and/or ERM suggest DME.

Кистообразование сетчатки – предлагаемое лечение

Кистообразование сетчатки – предлагаемое лечение

Suspended scattering particles in motion using OCT angiography in branch retinal vein occlusion disease cases with cystoid macular edema

We aimed to investigate the clinical implication of suspended scattering particles in motion (SSPiM) using optical coherence tomography angiography (OCTA) among branch retinal vein occlusion disease (BRVO) cases with macular edema (ME). Medical records of BRVO patients were reviewed. Central retinal thickness (CRT), ME type, and cyst size on optical coherence tomography images were evaluated before and after intravitreal bevacizumab injection. Nonperfusion area, SSPiM, and microvascular abnormalities in OCTA images were evaluated using a Heidelberg machine. SSPiM was identified in 24 of 56 cases. There were no differences in baseline characteristics between groups with and without SSPiM. Disease duration, disease-free duration, previous injection number, microaneurysms in the superficial vascular complex, and microaneurysms in the deep vascular complex (DVC) (p = 0.003, 0.013, 0.028, 0.003, < 0.001, respectively) differed significantly between the two groups. After multivariate logistic analysis, microaneurysms in the DVC were the only different factor between the two groups (odds ratio [OR]: 0.091; p = 0.001). Furthermore, SSPiM in the DVC (OR 10.908; p = 0.002) and nonperfusion grade (OR 0.039; p < 0.001) were significantly associated with cyst response after intravitreal injection. SSPiM may be correlated with microaneurysms in the DVC and a poor anatomical response after intravitreal injection.

Importance of Paravascular Vitreal Adhesions for Development of Myopic Macular Retinoschisis Detected by Ultra-Widefield OCT

To examine most postequatorial retina in eyes with myopic macular retinoschisis (MRS) by ultra-widefield (UWF) OCT and to determine whether paravascular vitreal adhesions play a role in the development of MRS. Retrospective single-center observational case series. One hundred fifty highly myopic participants who were older than 50 years with and without an MRS were studied. High myopia was defined as an eye with an axial length of more than 26.5 mm. All participants underwent UWF OCT imaging with a scan width of 23 mm and a depth of 5 mm using a prototype swept-source OCT device. The vitreoretinal adhesions to the foveal retina and retinal vessels and paravascular abnormalities, including paravascular retinal cysts, paravascular retinoschisis, and paravascular lamellar holes, were analyzed in the UWF OCT images. The findings in eyes with an MRS were compared with those in eyes without an MRS. The relationships between MRS and vitreal adhesions to the retinal vessels or to the fovea were determined. An MRS was found in 49 of the 150 eyes (33%). Vitreal adhesions to the retinal vessels were found more frequently in eyes with an MRS than in eyes without an MRS (63% vs. 44%; P= 0.04). In contrast, the number of eyes with adhesions to the fovea in eyes with an MRS was not significantly different from that in eyes without an MRS (57% vs. 59%). Paravascular lesions, for example, retinal cysts, retinoschisis, and lamellar holes, were more common in eyes with an MRS than in eyes without an MRS (71% vs. 36%, 61% vs. 17 %, and 20% vs. 8% [P < 0.001, P < 0.001, and P= 0.03], respectively). Multivariate analysis showed that the presence of paravascular vitreal adhesions was a significant predictor for MRS development (odds ratio, 2.56; P= 0.02). Paravascular vitreal adhesions may be related to the development of the different types of paravascular lesions including retinal cysts and retinoschisis, and play a more important role in the development of an MRS than vitreal adhesions to the fovea.

Relief of Cystoid Macular Edema-Induced Focal Axonal Compression with Anti-Vascular Endothelial Growth Factor Treatment.

PurposeTo evaluate the mechanical compression of retinal nerve fiber layer (RNFL) by intraretinal cysts in macular edema and its relief with anti-vascular endothelial growth factor (anti-VEGF) treatment.MethodsOptical coherence tomography scans were used to measure RNFL thickness and reflectance at seven preselected points at and around the peak of the edema before and after anti-VEGF treatment in 10 patients (11 eyes) with branch retina vein occlusion (BRVO) and diabetic macular edema (DME). Scans through nonedematous retina and from the fellow eyes were taken as controls. Correlations were sought between the changes in retinal and RNFL thickness, RNFL reflectance, and the size of the intraretinal cysts.ResultsPostinjection RNFL thickness decreased significantly only at peak point of the edema (18.1 ± 2.7 vs. 13.8 ± 1.2 µm; P = 0.038), at its nasal edge (20.1 ± 2.7 vs. 15.5 ± 1.4 µm; P = 0.026), and 500 µm away from its nasal border (35.7 ± 6.0 vs. 20.1 ± 2.7 µm; P = 0.006) suggesting focal stagnation of the axoplasmic flow owing to compression at its peak point. Significant postinjection decreases in RNFL reflectivity were also noted at peak point of the cyst (164.9 ± 10.3 vs. 141.5 ± 12.6 arbitrary units [AU]; P = 0.037), at its nasal edge (166.8 ± 7.8 vs. 135.1 ± 10.2 AU; P = 0.02), and 1500 µm away from temporal edge (160.2 ± 6.2 vs. 141.1 ± 6.4 AU; P = 0.022). Cyst proximity to RNFL (D50 = 50 µm) was the only determinant significantly affecting the magnitude of the RNFL thickness change after anti-VEGF treatment (P = 0.001).ConclusionsIntraretinal cysts due to BRVO and DME locally compress overlying axons and induce anatomic changes suggestive of axoplasmic stagnation. This compression can be relieved with anti-VEGF treatment.Translational RelevanceFocal compression of RFNL by retinal cysts may indicate a need for early treatment of macular edema to prevent axonal loss, especially in patients with low axonal reserve