Retinal Periphery Research Articles

Current possibilities in visualization of retinal periphery in diabetic retinopathy

Diabetic retinopathy (DR) is an important, socially significant complication of diabetes mellitus that leads to irreversible loss of vision. This article reviews the studies of peripheral changes in DR, different methods used in its diagnostics, monitoring and assessment of therapeutic effects. The article contains detailed examination of the modern widefield imaging methods that allow studying the middle and extreme periphery of the retina and help obtain a wide range of DR biomarkers. Of greatest interest in this matter is optical coherence tomography angiography due to possibility of detailed non-invasive assessment of the condition of retinal microvasculature, precise determination of the area and visualization of the sites of neovascularization and non-perfused regions of the retina. Quantitative characteristics of these changes serve as important diagnostic and prognostic visual biomarkers of DR.

Modern optical methods of peripheral defocus correction

Experimental animal studies proved that by manipulating with the defocus one can slow down or speed up the eye growth. The leading mechanism among modern optical strategies of myopia progression treatment is to induce myopic defocus to retinal periphery or decrease the hyperopic defocus. This review sums up the data on peripheral refraction in orthokeratological, multifocal contact, and multifocal spectacle correction. The effectiveness of these methods in myopia control in children and teenagers is shown.

PRESENCE OF PERIPHERAL LESIONS AND CORRELATION TO MACULAR PERFUSION, OXYGENATION AND NEURODEGENERATION IN EARLY TYPE II DIABETIC RETINAL DISEASE.

The impact of peripheral retinal lesions (PL) visualized with ultra-wide-field imaging on diabetic retinopathy (DR) remains unclear. The purpose of this study was to assess the presence of PL and their association with macular microvasculopathy, metabolic dysfunction, and neurodegeneration in patients with Type II diabetes and early retinal disease. Forty-five degree color fundus (Topcon) and 200° ultra-wide-field images (Optos) were assessed for the presence and severity of DR. Lesions anterior to the 45° were considered peripheral. The foveal avascular zone area, perimeter and acircularity index, and foveal full-retina and parafoveal superficial/deep complex vessel density were evaluated with RTVue optical coherence tomography angiography. Vessel oxygen saturation was measured with oximetry. Peripapillary retinal nerve fiber and individual macular retinal layer thicknesses were measured with Spectralis optical coherence tomography. Among the 161 eyes (80 left eyes) of 81 patients (34 female), 64 (39.8%) showed higher levels of DR on ultra-wide-field than on 45° fundus images (P < 0.0001). PL were identified in 97 eyes (60.3%) and in 59 among 115 eyes without central signs of DR. No significant correlation to biomarkers of central microvascular disease (foveal avascular zone/vessel density variables), oxygen saturation, and retinal layer thickness was found. Ultra-wide-field imaging helps to detect more eyes with early DR due to the detection of PL, which appear independently of biomarkers of macular microvascular impairment, metabolic function, and neuropathy in eyes without central signs of DR. These results suggest that the evaluation of the retinal periphery may become crucial in DR screening if PL are proven to influence disease outcomes.

A novel cellular structure in the retina of insectivorous birds

The keen visual systems of birds have been relatively well-studied. The foundations of avian vision rest on their cone and rod photoreceptors. Most birds use four cone photoreceptor types for color vision, a fifth cone for achromatic tasks, and a rod for dim-light vision. The cones, along with their oil droplets, and rods are conserved across birds – with the exception of a few shifts in spectral sensitivity – despite taxonomic, behavioral and ecological differences. Here, however, we describe a novel photoreceptor organelle in a group of New World flycatchers (Empidonax spp.) in which the traditional oil droplet is replaced with a complex of electron-dense megamitochondria surrounded by hundreds of small, orange oil droplets. The photoreceptors with this organelle were unevenly distributed across the retina, being present in the central region (including in the fovea), but absent from the retinal periphery and the area temporalis of these insectivorous birds. Of the many bird species with their photoreceptors characterized, only the two flycatchers described here (E. virescens and E. minimus) possess this unusual retinal structure. We discuss the potential functional significance of this unique sub-cellular structure, which might provide an additional visual channel for these small predatory songbirds.

Evaluation of Hydroxychloroquine Retinopathy Using Ultra-Widefield Fundus Autofluorescence: Peripheral Findings in the Retinopathy

To investigate the application of ultra-widefield fundus autofluorescence (UWF-FAF) imaging in evaluating hydroxychloroquine (HCQ) retinopathy and to report peripheral autofluorescence findings in Asian patients with this condition. Retrospective case series. Setting: institutional. 58 eyes of 29 patients with HCQ retinopathy. UWF-FAF imaging was performed, and the images were compared to conventional FAF images obtained using a confocal digital ophthalmoscope. The sensitivities of detecting retinopathy using the 2 modalities were compared. Peripheral autofluorescence findings in the eyes with HCQ retinopathy were assessed, and their association with the Humphrey visual field test results obtained using the 30-2 and full-field 120 (FF-120) protocols was analyzed. Main outcome measurements were abnormal FAF findings. In 41 of 58 eyes (70.7%) with HCQ retinopathy, abnormal FAF findings were noted in the retinal periphery outside the field of view of conventional FAF as hypoautofluorescent (23 eyes, 39.7%) and hyperautofluorescent (38 eyes, 65.5%) lesions. In 5 eyes (8.6%), differences were revealed between conventional FAF and UWF-FAF in detecting retinopathy. Most of the eyes with severe retinopathy showed the most extensive hypoautofluorescence in the nasal peripheral retina. The areas with abnormal FAF findings were significantly correlated with the number of unseen spots on FF-120 results and mean deviation and pattern standard deviation of the 30-2 test results (all P < .001). Peripheral autofluorescence findings varied in eyes with HCQ retinopathy according to the severity of the retinopathy. The retinal findings with UWF-FAF were functionally correlated to visual field results. UWF-FAF may be useful for evaluating HCQ retinopathy, particularly in Asian patients.

Phenotypic Spectrum of Pentosan Polysulfate Sodium–Associated Maculopathy

A unique pigmentary maculopathy was recently described in 6 patients with long-term exposure to pentosan polysulfate sodium (PPS), a long-standing oral therapy for interstitial cystitis. To characterize the exposure characteristics and clinical manifestations of PPS-associated maculopathy. In this multi-institutional case series, medical records of patients who exhibited the characteristic maculopathy in the setting of prior PPS exposure were retrospectively reviewed. Data were collected from August 1, 2012, to October 1, 2018, and data were analyzed from October 2018 to January 2019. Drug exposure, visual acuity, and retinal imaging characteristics. Of the 35 included patients (70 eyes), 34 (97%) were female, and the median (range) age was 60 (37-79) years. The median (range) duration of PPS intake was 15 (3-22) years, and the median (range) cumulative exposure was 1.61 (0.44-4.31) kg. The leading visual symptoms were metamorphopsia, blurred vision, and prolonged dark adaptation. Median (range) logMAR visual acuity of all eyes was 0.10 (-0.12 to 1.18). Fundus examination often revealed hyperpigmented macular spots (34 of 64 eyes [53%]) with interspersed pale-yellow deposits, although less commonly in eyes that exhibited retinal pigment epithelial atrophy (6 of 26 eyes [23%]; P < .001). Optical coherence tomography showed foci of retinal pigment epithelium elevation or thickening associated with hyperreflectance on near-infrared reflectance imaging. Fundus autofluorescence imaging typically revealed a symmetric, confluent pattern of hyperautofluorescent and hypoautofluorescent spots that involved the fovea in all eyes and extended to the retinal periphery in 24 eyes (36%). Longitudinal evaluation demonstrated dynamic changes in pigmentary abnormalities. These findings suggest that PPS-associated maculopathy is a vision-threatening condition that can manifest in the setting of long-term exposure to the drug. Multimodal imaging posits a distinctive clinical phenotype, characterized in this cohort by dynamic alterations within the retinal pigment epithelium and at the retinal pigment epithelium-photoreceptor interface. Ongoing work might explore causality and direct screening guidelines.

Diagnóstico de enfermedad de Eales a partir de una membrana epirretiniana

Macular involvement is a common finding in patients with Eales disease. The purpose of this communication is to describe the diagnosis of Eales disease from the finding of a macular epiretinal membrane in a young patient.The case is presented of a 38-year-old man referred to this medical service unit with blurred vision developed over the past 3 months, and was associated with vitreoretinal traction and a macular epiretinal membrane. After an ophthalmological examination including the retinal periphery, optical coherence tomography, tuberculin test, interferon gamma release assay (IGRA), and a systemic study, the patient was diagnosed with Eales disease.Macular oedema or epiretinal membranes due to Eales disease are relatively common. Sd-OCT is recommended in all patients with Eales disease. On the other hand, the presence of epiretinal membranes in young patients usually suggests a non-idiopathic aetiology.

Post traumatic retinal injuries: Does the ocular protective reflex play a crucial role?

Traumatic retinal injuries are commonly encountered in most retinal subspecialty clinics. Retinal dialysis, detachment and other complications consequent to blunt trauma are often thought to be due to equatorial expansion of the globe following an antero-posterior compressive force. However, stretching of the globe along the primary anatomical equator may not hold true for the adjusted globe position as a consequence of the protective Bell’s phenomenon which gets activated before impact. The upward and outward rolling of the globe likely creates a new equator, with the compressive forces acting along this new plane, thereby leading to stretching along the ocular coats closer to the retinal periphery. Additionally, the coup and countercoup mechanisms with increased vulnerability of temporal sclera predisposes to retinal complications more commonly along the temporal and the nasal retina. Further, retinal complications involving other quadrants can also be explained through understanding of the Bell’s phenomenon.

Ocular albinism with mutation in GPR143: Findings in wide-field autofluorescence and optical coherence tomography

A 12 year-old boy who consulted due to nystagmus and low vision from birth. His mother also consulted for low vision of the right eye since she was a child, which worsened recently. The physical examination revealed no alterations in skin and hair pigmentation. In the examination of the anterior segment of the child, areas of slight circumferential hypopigmentation were observed in the iris in both eyes. The fundus examination revealed a choroidal fundus due to the absence of melanin in the retinal pigment epithelium. In the autofluorescence, an absence of physiological macular hypo-autofluorescence was observed and, in optical coherence tomography, foveal hypoplasia was observed in both eyes. In the ocular fundus examination of the mother, slight macular pigmentary changes were observed in the right eye, with hyperpigmented radiated spots in the retinal periphery of both eyes, which were hypo-autofluorescent in the wide-field autofluorescence. In the optical coherence tomography of the right eye, a cavitation of the outer retinal layers was observed in the fovea. The genetic study by nucleotide sequencing was performed on the mother and the child. In the mutation found in the GPR143 gene, the son was hemizygous and the mother was heterozygous. X-linked ocular albinism was diagnosed and the genetic counselling was carried out. Ocular albinism linked to X is the most frequent genetic variant of this disease. Peripheral pigment alterations in heterozygous mothers have been previously described in the literature, but there are no reports of cavitations in the external retinal layers using optical coherence tomography.

Age-related distribution and potential role of SNCB in topographically different retinal areas of the common marmoset Callithrix jacchus, including the macula

Evidence of an age-related increase of β-synuclein (SNCB) in several parts of the visual system including the retina has been reported. SNCB is thought to function as an antagonist of α-synuclein in neurodegenerative diseases, but the exact role of SNCB remains unclear. The presented work studies two different aspects of the onset and role of SNCB in the retinal pigment epithelium (RPE). First, the topographical and intracellular distributions of SNCB in the RPE of non-human marmoset monkey (Callithrix jacchus) were evaluated in paraffin-embedded eyes and RPE whole mounts from different developmental stages (neonatal, adolescent, and adult). Thus, revealed distinct lifetime-related alterations of the topographical and intracellular distributions of SNCB in the primate macula compared to the retinal periphery. Furthermore, the function and influences of SNCB on ARPE-19 cells and primary porcine RPE (ppRPE) cells were characterized by exposing these cells with recombinant SNCB (rSNCB) at different concentrations. Moreover, apoptosis, protein- and mRNA-expression levels of factors of the p53/MDM2 signaling cascade and inflammation- and oxidation-related genes were investigated. The observed dose-depended decreased apoptosis rates together with the PLD2 mediated activation of the p53 pathway promotes senescence-related processes in SNCB exposed common ARPE-19 cells from human origin. Further, increased HMOX1 and NOX4 levels indicate increased oxidative stress and inflammatory responses triggered by SNCB. The obtained differences in the distribution of SNCB in primate RPE together with alterations of cellular functions in rSNCB-exposed RPE cells (e.g., ARPE-19, ppRPE) support SNCB-related effects like inflammatory response and stress-related properties on RPE over lifetime. The possible functional relevance of SNCB in physiological aging converting into a pathophysiological condition should be investigated in further studies.

Albinismo ocular con mutación en GPR143: hallazgos en autofluorescencia de campo amplio y tomografía de coherencia óptica

A 12 year-old boy who consulted due to nystagmus and low vision from birth. His mother also consulted for low vision of the right eye since she was a child, which worsened recently. The physical examination revealed no alterations in skin and hair pigmentation. In the examination of the anterior segment of the child, areas of slight circumferential hypopigmentation were observed in the iris in both eyes. The fundus examination revealed a choroidal fundus due to the absence of melanin in the retinal pigment epithelium. In the autofluorescence, an absence of physiological macular hypo-autofluorescence was observed and, in optical coherence tomography, foveal hypoplasia was observed in both eyes. In the ocular fundus examination of the mother, slight macular pigmentary changes were observed in the right eye, with hyperpigmented radiated spots in the retinal periphery of both eyes, which were hypo-autofluorescent in the wide-field autofluorescence. In the optical coherence tomography of the right eye, a cavitation of the outer retinal layers was observed in the fovea. The genetic study by nucleotide sequencing was performed on the mother and the child. In the mutation found in the GPR143 gene, the son was hemizygous and the mother was heterozygous. X-linked ocular albinism was diagnosed and the genetic counselling was carried out.Ocular albinism linked to X is the most frequent genetic variant of this disease. Peripheral pigment alterations in heterozygous mothers have been previously described in the literature, but there are no reports of cavitations in the external retinal layers using optical coherence tomography.

Densiron 68 heavy silicone oil in the management of inferior retinal detachment recurrence: analysis on functional and anatomical outcomes and complications.

To assess the efficacy and safety of a heavy silicone oil (Densiron 68) in the management of inferior retinal detachment recurrence. A retrospective non-comparative consecutive case series study. Forty-nine cases of complex inferior retinal detachment were treated using Densiron 68 heavy silicone oil (HSO) as the endotamponade. Our main purpose was anatomic reattachment following Densiron 68 removal. Functional outcomes, rate of recurrences, the presence of inflammatory complications and intraocular pressure alterations were evaluated. Forty-nine patients affected by complex retinal re-detachment were recruited. The mean follow-up was 7.6 (±1.5) mo. The mean best corrected visual acuity after Densiron 68 removal was 0.95 logMAR, standard error (SE: 0.068). Retinal reattachment was 61.2% after first surgery and 81.6% after second surgery. Nineteen cases (38.8%) had recurrences when intraocular heavy silicon oil was in situ, 26.3% (5 cases) of which involved the inferior retina. Densiron 68 efficiently fills the inferior retinal periphery and might lower the risk of inferior proliferative vitreoretinopathy development, in particular after a standard silicon oil tamponade that reduces the proliferative process in the upper quadrants of the retina.

Correlating Changes in the Macular Microvasculature and Capillary Network to Peripheral Vascular Pathologic Features in Familial Exudative Vitreoretinopathy

To evaluate the macular microvasculature in patients with familial exudative vitreoretinopathy (FEVR) using OCT angiography (OCTA) and to assess for peripheral vascular changes using widefield fluorescein angiography (WFA). Multicenter, retrospective, comparative, observational case series. We identified 411 patients with FEVR, examined between September 2014 and June 2018. Fifty-seven patients with FEVR and 60 healthy controls had OCTA images of sufficient quality for analysis. Custom software was used to assess for layer-specific, quantitative changes in vascular density and morphologic features on OCTA by way of vessel density (VD), skeletal density (SD), fractal dimension (FD), vessel diameter index (VDI), and foveal avascular zone (FAZ). Widefield fluorescein angiography images were reviewed for peripheral vascular changes including capillary dropout, late-phase angiographic posterior and peripheral vascular leakage (LAPPEL), vascular dragging, venous-venous shunts, and arteriovenous shunts. Macular microvascular parameters on OCTA and peripheral angiographic findings on WFA. OCT angiography analysis of 117 patients (187 eyes; 92 FEVR patients and 95 control participants) demonstrated significantly reduced VD, SD, and FD and greater VDI in patients with FEVR compared with controls in the nonsegmented retina, superficial retinal layer (SRL), and deep retinal layer (DRL). The FAZ was larger compared with that in control eyes in the DRL (P < 0.0001), but not the SRL (P= 0.52). Subanalysis by FEVR stage showed the same microvascular changes compared with controls for all parameters. Widefield fluorescein angiography analysis of 95 eyes (53 patients) with FEVR demonstrated capillary nonperfusion in all eyes: 47 eyes (49.5%) showed LAPPEL, 32 eyes (33.7%) showed vascular dragging, 30 eyes (31.6%) had venous-venous shunts, and 33 eyes (34.7%) had arteriovenous shunts. Decreasing macular VD on OCTA correlated with increasing peripheral capillary nonperfusion on WFA. Decreasing fractal dimension on OCTA correlated with increasing LAPPEL severity on WFA. Patients with FEVR demonstrated abnormalities in the macular microvasculature and capillary network, in addition to the peripheral retina. The macular microvascular parameters on OCTA may serve as biomarkers of changes in the retinal periphery on WFA.

ANALYSIS OF THE NORMAL PERIPHERAL RETINAL VASCULAR PATTERN AND ITS CORRELATION WITH MICROVASCULAR ABNORMALITIES USING ULTRA-WIDEFIELD FLUORESCEIN ANGIOGRAPHY.

To describe the retinal peripheral vascular morphology and to elucidate its relationship to microvascular abnormalities in normal fundus using ultra-widefield fluorescein angiography. A total of 242 eyes from 167 consecutive patients were categorized into 3 groups: bilateral normal (n = 64), normal with contralateral eye affected with vascular disease (n = 82), and early diabetic eyes (n = 96). Peripheral vascular morphology was described and classified according to the shape. Microvascular abnormalities such as capillary telangiectasia, microaneurysm, or vascular leakage were documented, and the relationship between those abnormalities in each groups were analyzed. There were two distinctive peripheral vascular morphologies-loop and branching patterns. Microvascular abnormalities were more frequently found as loop patterns; this difference was most prominent when both eyes were normal. In case of normal eyes with contralateral eye affected with vascular disease or diabetic eyes, branching pattern microvascular abnormalities were relatively increased, whereas loop pattern still showed a large degree of microvascular abnormalities. In normal retinal periphery, we observed microvascular abnormalities and their relationship with vascular morphology, which could be influenced by the condition of the contralateral eye or systemic disease such as diabetes mellitus.

A lambda‐shaped retractor lentis muscle in the yellowfin goby Acanthogobius flavimanus

We identified a morphologically uncommon piscine retractor lentis muscle in the yellowfin goby Acanthogobius flavimanus. This lentis muscle has a shape similar to the Greek small letter lambda (λ). The two legs of the muscle are attached to the retinal periphery at the ventral eyecup, while the tip is connected to the lens surface by a ligament. Scanning electron microscopy showed that the fibers of the lentis muscle run along the length of both the anterior and posterior legs. Immunolabeling with antiacetylated tubulin antibody and neuronal tracing with DiI of the whole lentis muscle revealed that the anterior leg is innervated by one or more nerves. The topographic distribution of ganglion cells in the retina was investigated to identify the visual axis. Three high cell density areas were observed in the dorso-temporal, ventro-nasals and ventro-temporal retina. These findings suggest that the λ-shaped lentis muscle may enable accommodatory movement of the lens toward the temporal as well as the nasal and/or ventral retina.

OPTICAL COHERENCE TOMOGRAPHY 2: Diagnostic Tool to Study Peripheral Vitreoretinal Pathologies.

To investigate the utility of new wide-field optical coherence tomography (OCT) device in the evaluation of mid and far retinal periphery and to show its feasibility and advantages in clinical practice. Consecutive patients underwent a complete ophthalmologic examination including standard OCT and new prototype OCT2 derived from Heidelberg Spectralis. Thirty-one eyes of 31 patients were studied with a total of 44 lesions, including 18 retinal detachments, 15 retinal holes and tears, 9 retinoschisis, and 2 retinal tufts. Fourteen (32%) lesions were found in mid and 30 (68%) in far periphery with 9 (20%) lesions in the superior region, 10 (23%) in the superior temporal, 8 (18%) in the temporal, 4 (9%) in the inferior temporal, 7 (16%) in the inferior, 4 (9%) in the nasal, and 2 (5%) in the superior nasal. Among the lesions evaluated by OCT2, 10 (71%) in mid periphery and 11 (37%) in far periphery could be imaged by standard OCT. The introduction of OCT2 into clinical practice may provide significant benefits for imaging peripheral retinal disorders. The application of OCT2 technology with 55° lens and scan length and angle modulation could improve our understanding of peripheral vitreoretinal disorders and facilitate their management.

Retinal Topography in Two Species of Baleen Whale (Cetacea: Mysticeti)

Little is known about the visual systems of large baleen whales (Mysticeti: Cetacea). In this study, we investigate eye morphology and the topographic distribution of retinal ganglion cells (RGCs) in two species of mysticete, Bryde’s whale (Balaenoptera edeni) and the humpback whale (Megaptera novaeanglia). Both species have large eyes characterised by a thickened cornea, a heavily thickened sclera, a highly vascularised fibro-adipose bundle surrounding the optic nerve at the back of the eye, and a reflective blue-green tapetum fibrosum. Using stereology and retinal whole mounts, we estimate a total of 274,268 and 161,371 RGCs in the Bryde’s whale and humpback whale retinas, respectively. Both species have a similar retinal topography, consisting of nasal and temporal areas of high RGC density, suggesting that having higher visual acuity in the anterior and latero-caudal visual fields is particularly important in these animals. The temporal area is larger in both species and contains the peak RGC densities (160 cells mm^–2 in the humpback whale and 200 cells mm^–2 in Bryde’s whale). In the Bryde’s whale retina, the two high-density areas are connected by a weak centro-ventral visual streak, but such a specialisation is not evident in the humpback whale. Measurements of RGC soma area reveal that although the RGCs in both species vary substantially in size, RGC soma area is inversely proportional to RGC density, with cells in the nasal and temporal high-density areas being relatively more homogeneous in size compared to the RGCs in the central retina and the dorsal and ventral retinal periphery. Some of the RGCs were very large, with soma areas of over 2,000 µm². Using peak RGC density and eye axial diameter (Bryde’s whale: 63.5 mm; humpback whale: 48.5 mm), we estimated the peak anatomical spatial resolving power in water to be 4.8 cycles/degree and 3.3 cycles/degree in the Bryde’s whale and the humpback whale, respectively. Overall, our findings for these two species are very similar to those reported for other species of cetaceans. This indicates that, irrespective of the significant differences in body size and shape, behavioural ecology and feeding strategy between mysticetes and odontocetes (toothed whales), cetacean eyes are adapted to vision in dim light and adhere to a common “bauplan” that evolved prior to the divergence of the two cetacean parvorders (Odontoceti and Mysticeti) over 30 million years ago.

Commentary: Antivascular endothelial growth factor and retinopathy of prematurity.

Commentary: Antivascular endothelial growth factor and retinopathy of prematurity.

Эффективность и безопасность различных методик хирургического лечения эпимакулярного фиброза

Purpose . To evaluate the efficiency and safety of three different techniques in the surgical treatment of epimacular fibrosis. Material and methods. A comparative evaluation of surgical treatment results was carried out in three groups of patients with epimacular fibrosis. In the first group – 20 patients (20 eyes), epiretinal membrane (ERM) was removed without vitrectomy. In the second group 30 patients (30 eyes), epiretinal membrane was removed after subtotal vitrectomy. In the third group – 30 patients (30 eyes), epiretinal membrane was removed after local vitrectomy. Local vitrectomy was performed by the following procedure: installing three 25G ports, induction of posterior hyaloids detachment in the macular area, local vitrectomy within the zone of vascular arcades (approximately 20% of the total vitreous volume), except for the area over the optic nerve head, layer-by-layer staining with MembraneBlueDual, removal of ERM, and then ILM. In all the groups a control of visual acuity was monitored, as well as intraocular pressure, the retinal thickness in the central zone, and the thickness of the retinal nerve fiber layer (RNFL) in different sectors. The OCT was used for a control the optic nerve head. The control of fusion of flickering frequency was made. The control of the optic nerve head was made using OCT and the control of fusion of flickering frequency (CFFF). Sensitivity of the macular zone of the retina was determined using the Maia microperimeter, and peripheral zones (Peripheral 60-4) were detected by means of the Humpfrey computer perimeter. The patients were examined before the surgery and 1, 3, 6 and 12 months after the sur gery. Results . The average duration of surgery was 8 minutes in the group without vitrectomy, 32 minutes in the group of subtotal vitrectomy and 18 minutes in the group of local vitrectomy. In the group of ERM removal without vitrectomy 6 patients out of 20 had a relapse of fibrosis found in follow-up period of 3 to 6 months. The groups showed a comparable improvement in visual acuity and photosensitivity of the central retina, as well as a decrease in the thickness of the r etina. In the group of subtotal vitrectomy, a significant IOP increase 1.6mmHg was recorded, as well as an increase in optic disc excavation, a more significant effect on the thickness of RNFL, indicators of the CFFF (drop from 38.4Hz to 34.3Hz), and a decrease in the light sensitivity of the retina periphery. In the local vitrectomy group, the IOP decreased significantly (from 16.5mmHg initially to 14.6mmHg). In addition, there was no decrease in the light sensitivity of the peripheral regions of the retina, and the changes in excavation of optic disc and RNFL were significantly smaller compared to the group of subtotal vitrectomy. Surgical cataract treatment was required in 47% of cases (14 patients) in the group of subtotal vitrectomy, and only 15% (5 patients) in the group of local vitrectomy. Patients of the first group did not require any cataract treatment. Conclusion . Subtotal vitrectomy with epiretinal membrane peeling is effective (30% increase in visual acuity), however, this intervention increases a risk of cataract development (47% of patients were operated on for cataract), negatively affects the optic nerve (CFFF decreased by 4Hz, increase of excavation of optic disk) and intraocular pressure (a 2mmHg persistent IOP increase 12 months later), and also, probably, reduces the sensitivity of the peripheral zone of the retina (-17dB in the upper-temporal quadrant). An alternative method of treatment is a removal of the membrane without vitrectomy. It allows to avoids the above-mentioned complications, but this method is associated with a high relapse rate (6 out of 20 patients had a relapse with a preservation complaints), due to the complexity of implementation and it significantly lim its the use of this method. Local vitrectomy demonstrated the most optimal balance between efficacy, safety, risk of recurrence and difficulty of implementation (no elevation of IOP, less pronounced negative impact on the optic disc and RNFL, no relapse, a low percentage of cataract development – 15%).

Fluorescein Angiography, Wide Field Angiography, and Indocyanine Green Angiography in Behcet Uveitis

In Behcet's disease, the anterior and posterior segments of the eye may be affected separately or together. Fundus fluorescein angiography should be performed in addition to ophthalmoscopic examination for early diagnosis and treatment of ocular involvement. Fundus fluorescein angiography (FFA) is the gold standard for the evaluation of the retinal vascular system and pathologies. Fundus fluorescein angiography is more sensitive than fundus examination in the detection of vasculitis, and angiographic involvement is always more common than clinical involvement. Fluorescein angiography may reveal leakage from retinal veins in eyes whose visual impression is not affected and the fundus examination is normal. The absence of vascular leakage with fluorescein angiography indicates that the disease is in a completely inactive period. Because of the development of blindness due to posterior segment involvement, early detection of the disease with fundus angiography and the initiation of the treatment is successful in terms of visual prognosis. It has an important place in terms of early activation of patients with FFA in the early diagnosis of eye involvement and follow-up of the disease and treatment. Wide-field imaging angiography imaging of the retinal periphery revealed the importance of lesions in retinal periphery and peripheral areas invisible by standard angiography. The use of indocyanine green angiography in Behcet uveitis is limited.