Temporal Disc Research Articles

Structural and vascular density affection of macular and peripapillary areas in patients having multiple sclerosis versus neuromyelitis optica with previous optic neuritis

Purpose The aim of this study was to compare the peripapillary and macular vascular density changes in neuromyelitis optica spectrum disorders (NMOSD) patients to multiple sclerosis (MS) patients with previous history of optic neuritis and to correlate the loss in the retinal nerve fiber layer (RNFL) and the ganglion cell complex (GCC) with the vascular density. Patients and methods This observational cross-sectional retrospective study was carried out on 25 patients divided into two equal groups of eyes (20 eyes of 13 MS patients and 20 eyes of 12 NMOSD patients), aged 18–50 years of both sexes and 11 age-matched and sex-matched healthy individuals as a control group. The patients were evaluated by history taking, neurological examination, Symbol Digit Modalities Test, and ophthalmic examination including best-corrected visual acuity, Goldmann applanation tonometry (adjusted for central corneal thickness), and slit-lamp biomicroscopy, followed by spectral-domain optical coherence tomography, and optical coherence tomography angiography. Results The NMOSD patients were significantly older, with lower Symbol Digit Modalities Test score, more prevalence of temporal disc pallor, larger foveal avascular zone, and with higher Expanded Disability Status Scale compared to the MS patients and the control group (P<0.05). In the deep vascular plexus, the foveal density and the central macular thickness were significantly less in the NMOSD patients (P<0.05), while in the superficial vascular plexus (SVP), the whole image density, foveal density, parafoveal density, parafoveal superior hemi, parafoveal inferior hemi, and perifoveal density were significantly less in the NMOSD patients (P<0.05). In addition, in the radial peripapillary capillary density (RPCD %), the whole image, total peripapillary, peripapillary superior hemi, and peripapillary inferior hemi were significantly less in the NMOSD patients (P<0.05). The average, superior, and inferior RNFL and GCC were significantly thinner in the NMOSD patients compared to the other two groups (P<0.05). In the MS group, there were strong positive correlations between the RNFL thickness and the choriocapillaris flow area, most of the SVP density, and the RPCD parameters, and between the GCC thickness and most of the SVP density parameters and the whole image of RPCD %, while in the NMOSD group, the best-corrected visual acuity was correlated with duration, number of eye attacks, central macular thickness of the deep vascular plexus, most of the RPCD %, all RNFL and GCC parameters. Conclusion Subclinical primary retinal vasculopathy was detected more frequently in the NMOSD than in the MS disease. It has an essential impact on this disease and the Expanded Disability Status Scale may be a useful adjunct for differentiation between NMOSD and MS individuals who developed previous optic neuritis.

Exploring optical coherence tomography parameters in eyes with myopic tilted disc

BackgroundTo investigate the impact of optic disc torsion (ODT), horizontal disc tilt (HDT) angle, and ovality index (OI) on different retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) segments in healthy myopic eyes.MethodsODT and OI were measured from fundus photographs. HDT angle, peripapillary RNFL, and macular GCIPL were measured by swept-source optical coherence tomography (SS-OCT). The association between optic disc morphology and the RNFL/GCIPL thickness were evaluated, with age and axial length (AL) adjusted.ResultsAmong 530 healthy myopic eyes of 284 participants (mean age: 41.7 years, mean spherical equivalent: − 7.70 D, and mean AL: 26.6 mm), 335 eyes (63.2%) had temporal disc torsion (temporal group) and 195 eyes (36.8%) had nasal disc torsion (nasal group). For the nasal group, a larger OI was associated with thinner superior-to-superonasal GCIPL (β = − 7.465 to − 6.972, both P = 0.024) and temporal RNFL sectors (β = − 49.596 to − 27.748, P ≤ 0.014). For the temporal group, a larger OI was associated with thinner superior-to-nasal (β = − 50.255 to − 22.093, P ≤ 0.006) and thicker temporal RNFL sectors (β = 29.015 to 56.890, P ≤ 0.003). Additionally, a larger HDT angle was associated with thinner superior-to-nasal RNFL sectors (β = − 0.559 to − 0.242, P ≤ 0.036) and thinner superior-to-superotemporal GCIPL sectors (β = − 0.084 to − 0.069, P ≤ 0.037).ConclusionsThe optic disc tortional direction was associated with the measurement of different RNFL and GCIPL sectors independent of the AL and age. These should be considered when constructing a myopic normative database.

A novel pathogenic variant in the KCTD7 gene in a patient with neuronal ceroid lipofuscinosis (CLN14): a case report and review of the literature

BackgroundNeuronal ceroid lipofuscinosis (NCL) is a heterogeneous group of 13 rare, progressive neurodegenerative diseases of the brain and retina. CLN14 is a very rare subtype of NCL caused by pathogenic variants in the KCTD7 gene. Only four cases of this subtype have been reported in the literature.Case presentationA nine-month-old, previously healthy male who was firstborn to first-cousin parents presented with progressive psychomotor regression, dysmorphic facial features, myoclonus, and vision loss. Neurological examination showed generalized hypotonia and brisk reflexes. He continued to deteriorate until age 18 months, when he developed his first generalized tonic-clonic seizure. An ophthalmological examination showed a hypopigmented fundus and slight temporal disc pallor. Brain MRI showed mild generalized brain atrophy and white matter disease. EEG revealed a severely abnormal trace marked by generalized, high amplitude, sharply contoured, polymorphic delta slowing intermixed with theta slowing and some alpha activity, with disorganized and scattered spikes and sharp waves. The patient continued to have uncontrolled seizures and further psychomotor regression until he died of status epilepticus and pneumonia at the age of 44 months. WES identified a novel homozygous variant c.413T > C, p.(Leu138Pro) in the KCTD7 gene, causing an amino acid transition from leucine to proline at position 138. Both parents were carriers of the same variant.ConclusionsWe present the fifth known case of CLN14 in the literature and report the clinical course and a novel underlying likely causative variant in the KCTD7 gene. The improving accessibility and affordability of genetic testing will likely uncover more NCL cases and further expand the disease’s genotypic and phenotypic spectrum.

Multi-class segmentation of temporomandibular joint using ensemble deep learning

Temporomandibular joint disorders are prevalent causes of orofacial discomfort. Diagnosis predominantly relies on assessing the configuration and positions of temporomandibular joint components in magnetic resonance images. The complex anatomy of the temporomandibular joint, coupled with the variability in magnetic resonance image quality, often hinders an accurate diagnosis. To surmount this challenge, we developed deep learning models tailored to the automatic segmentation of temporomandibular joint components, including the temporal bone, disc, and condyle. These models underwent rigorous training and validation utilizing a dataset of 3693 magnetic resonance images from 542 patients. Upon evaluation, our ensemble model, which combines five individual models, yielded average Dice similarity coefficients of 0.867, 0.733, 0.904, and 0.952 for the temporal bone, disc, condyle, and background class during internal testing. In the external validation, the average Dice similarity coefficients values for the temporal bone, disc, condyle, and background were 0.720, 0.604, 0.800, and 0.869, respectively. When applied in a clinical setting, these artificial intelligence-augmented tools enhanced the diagnostic accuracy of physicians, especially when discerning between temporomandibular joint anterior disc displacement and osteoarthritis. In essence, automated temporomandibular joint segmentation by our deep learning approach, stands as a promising aid in refining temporomandibular joint disorders diagnosis and treatment strategies.

Optic Neuropathy Associated with POLG Mutations: A Case Series and Literature Review.

The clinical characteristics of patients with polymerase gamma (POLG) mutation-associated optic neuropathy remain incompletely characterized. We describe the clinical characteristics of 3 patients with POLG-associated optic neuropathy. We performed a literature review of optic neuropathy cases associated with POLG mutations and compared them with our cohort. Many published cases of POLG-associated optic neuropathy in our literature review lacked details regarding severity of vision loss, visual field defects, and optical coherence tomography analysis. The clinical presentation of POLG mutations remains widely variable in age (from pediatric cases to adults) and associated systemic findings. All patients in our literature review presented with systemic symptoms, most commonly muscle weakness, ptosis, and ophthalmoplegia, whereas many young patients had severe systemic symptoms. In our case series, all 3 cases had isolated optic neuropathy affecting the papillomacular bundle, with signs such as reduced visual acuity and color vision, central visual field defects, temporal retinal nerve fiber layer loss with temporal optic disc pallor, and retinal ganglion cell complex loss. In addition, 2 of the 3 cases had added mitochondrial stressors in addition to the POLG mutation. Clinicians should be aware that POLG mutations can present as isolated optic neuropathy primarily affecting the papillomacular bundle. With mitochondrial failure being the likely underlying pathogenic mechanism in POLG-associated optic neuropathy, helping affected patients eliminate mitochondrial stressors may be important in reducing the risk for progressive vision loss in this otherwise currently untreatable disorder.

Scanning Laser Ophthalmoscopy Demonstrates Pediatric Optic Disc and Peripapillary Strain During Horizontal Eye Rotation

Purpose: We employed automated analysis of scanning laser ophthalmoscopy (SLO) to determine if mechanical strains imposed on disc, and retinal and choroidal vessels during horizontal duction in children differ from those of adults. Methods: Thirty-one children aged 11.3 ± 2.7 (standard deviation) years underwent SLO in central gaze, and 35° ab- and adduction. Automated registration with deep learning-based optical flow analysis quantified vessel deformations as horizontal, vertical, shear, and equivalent strains. Choroidal vessel displacements in lightly pigmented fundi, and central disc vessel displacements, were also observed. Results: As in adults, strain in vessels during horizontal duction was greatest at the disc and decreased with distance from it. Strain in the pediatric disc was similar to published values in young adults, 1 but in the peripapillary region was greater and propagated significantly more peripherally to at least three disc radii from it. During adduction in children, the nasal disc was compressed and disc vessels distorted, but the temporal half experienced tensile strain, while peripapillary tissues were compressed. The pattern was similar but strains were less in abduction (p < .001). Choroidal vessels were visualized in 24 of the 62 eyes and shifted directionally opposite overlying retinal vessels. Conclusions: Horizontal duction deforms the normal pediatric optic disc, central retinal vessels, peripapillary retina, and choroid, shearing the inner retina over the choroid. These mechanical effects occur at the sites of remodeling of the disc, sclera, and choroid associated with typical adult features that later emerge later, including optic cup enlargement, temporal disc tilting, and peripapillary atrophy.

A Study of Ocular Manifestations in Children with Developmental Delay

Background and Objective: The study was conducted to determine the occurrence and types of ophthalmologic abnormalities in children with developmental delay. Methods: children with developmental delay between age group of 6 months to 16 years visiting Himalayan hospital were studied for presence and types of ocular manifestations over a period of 1year. Results: Among 54 children, ocular manifestation was noted in 48 (88.89%) children. Among various ocular manifestations refractive error was commonest seen in 29 out of 54(53.70%) cases of which hypermetropia was most common. Second most common manifestations was esotropia 11 out of 54 (20.37%) followed by exotropia 7 out of (12.96%). In 12 out of 54 (22.22%) subjects temporal disc pallor was present. Conclusion: In developmentally delayed children, visual handicap plays an important role in overall morbidity. early assessment and correction of visual problems will provide such children greater chances of achieving their true potential and will prevent unnecessary visual impairment

THU095 Multilineage Plurihormonal (FSH LH TSH PRL ACTH) Pituitary Neuroendocrine Tumour: A Case Report

Abstract Disclosure: U.K. Mahfuza: None. V.A. Preda: None. A. Di Ieva: None. M. Rodiguez: None. Plurihormonal pituitary neuroendocrine tumors (PitNETs) are adenomas that produce more than one hormone. This is an uncommon entity. The 2022 WHO classification has differentiated these pitNETs along histological subtyping based on the tumour cell lineage, cell type, and related characteristics1.We present a case of a 48-year-old gentleman, who initially sought attention for visual symptoms with findings of raised intraocular pressure. His ophthalmologist assessment showed temporal disc pallor. Subsequently, the MRI revealed a 30mm pituitary macroadenoma compressing the optic apparatus. He was referred to our Endocrinology service. He had a low testosterone level. He underwent an endoscopic trans-sphenoidal resection. Post-operatively he remained on testosterone replacement, the rest of the pituitary axes were intact. Pre- and post-operative visual assessment showed retinal ganglion cell loss which has negative prognostic implications. Overall, his eye pressure and visual fields improved following surgery. The histopathology diagnosis was a PitNET/adenoma with predominantly gonadotroph SF1, FSH and LH staining. In addition, there were single cells and nests of strongly TSH and PRL-positive cells scattered through the tumour, but no GH staining. There was specific ACTH staining; also in monophenotypic nests. Pit1 positive nuclei present. The TPit was negative within the tumour. There were some residual adenohypophysis cells which is a rare finding deep within a solid tumour. The tumour extended to the inferior surface of the dura. These unique features lead to uncertainty regarding the potential recurrence rate over time. Conclusion: Multilineage PitNETs are uncommon2. The literature reports that the surgical outcome depends on the histopathology characteristics of the immunohistochemistry and transcription factors. However, PitNETs positive for SF1, FSH, LH, PRL,rl and ACTH staining are not widely reported. With the updated WHO classification and consideration of cell lineage and cell type the knowledge of these tumours will eventually improve. Follow-up and tailored management in this patient’s cohort are needed.

Mitochondrial DNA m.3243A&gt;G mutation in ethambutol-induced optic neuropathy: A case report

A 35-year-old man with maternally inherited diabetes presented with blurring of vision in both eyes for 6 months. He previously received antituberculous therapy including ethambutol (EMB) for 2 years. Temporal disc pallor and central scotomas were noticed in both eyes. P100 latency was delayed in visual evoked potential bilaterally. In addition, an elevated blood lactate concentration was observed. Interestingly, although EMB's potential optic neuropathy toxicity was our first consideration, a m.3243A&gt;G mutation of mitochondrial DNA was found in the blood. Herein, we reported a young patient carrying a novel Leber's hereditary optic neuropathy mutation who developed EMB-induced optic neuropathy.

Temporal Optic Disc Microvasculature Dropout in Glaucoma.

To assess the clinical characteristics of focal temporal optic disc microvasculature dropout (MvD-D) in primary open-angle glaucoma (POAG) patients. One hundred and eighty-seven eyes of 187 POAG patients having MvD-D on Swept-Source optical coherence tomography angiography (SS-OCTA) were enrolled. Three groups were categorized according to the presence of temporal MvD-D within the upper and lower 45° of the fovea-Bruch's membrane (BM) opening axis: focal temporal MvD-D (Group 1, isolated focal temporal MvD-D; 44 eyes), supero/inferotemporal MvD-D (Group 2, MvD-D only in superotemporal or inferotemporal sector; 78 eyes), and diffuse temporal MvD-D (Group 3, MvD-D spanning ≥ 2 consecutive sectors, at least one of which being temporal sector; 65 eyes). Group 1 had a significantly longer axial length and β-zone parapapillary atrophy without BM. There also was a larger horizontal tilt angle and ovality index than the other two groups (P < 0.001). Group 1 had a significantly thinner retinal nerve fiber layer (RNFL) in the temporal sector than did Group 2 (P < 0.001), despite similar thicknesses in all other areas (P > 0.05). Group 3 had significantly worse visual field mean deviation and thinner RNFL than the other two groups in all areas other than the nasal, temporal, and superotemporal sectors (P < 0.05). Focal temporal MvD-D detected by SS-OCTA was associated with a longer axial length and related subsequent morphological changes of the optic disc and parapapillary area. This suggests that stretching of the optic disc consequent on axial elongation may lead to absence of temporal optic disc microvasculature.

OPA1 Dominant Optic Atrophy: Pathogenesis and Therapeutic Targets.

OPA1 Dominant Optic Atrophy: Pathogenesis and Therapeutic Targets.

OPA1 Dominant Optic Atrophy: Diagnostic Approach in the Pediatric Population

A clinical and genetic study was conducted with pediatric patients and their relatives with optic atrophy 1 (OPA1) mutations to establish whether there is a genotype-phenotype correlation among the variants detected within and between families. Eleven children with a confirmed OPA1 mutation were identified during the study period. The main initial complaint was reduced visual acuity (VA), present in eight patients of the cohort. Eight of eleven patients had a positive family history of optic atrophy. The mean visual acuity at the start of the study was 0.40 and 0.44 LogMAR in the right and left eye, respectively. At the end of the study, the mean visual acuity was unchanged. Optical coherence tomography during the first visit showed a mean retinal nerve fiber layer thickness of 81.6 microns and 80.5 microns in the right and left eye, respectively; a mean ganglion cell layer of 52.5 and 52.4 microns, respectively, and a mean central macular thickness of 229.5 and 233.5 microns, respectively. The most common visual field defect was a centrocecal scotoma, and nine out of eleven patients showed bilateral temporal disc pallor at baseline. Sequencing of OPA1 showed seven different mutations in the eleven patients, one of which, NM_130837.3: c.1406_1407del (p.Thr469LysfsTer16), has not been previously reported. Early diagnosis of dominant optic atrophy is crucial, both for avoiding unnecessary consultations and/or treatments and for appropriate genetic counseling.

Gas tamponade followed by laser treatment for macular retinal detachment secondary to optic pit.

The study aimed to describe anatomic and visual outcomes associated with perfluoropropane intravitreal injection followed by laser treatment for macular retinal detachment secondary to optic disc pit. A single-center, retrospective study. Medical records of all patients treated at a tertiary retina referral center were evaluated between 2011 and 2018 for congenital optic disc pit-associated macular detachment with 0.3 ml 100% perfluoropropane intravitreal injection followed by retinal laser photocoagulation along the temporal optic disc margin as the initial treatment. Six patients with optic disc pit-associated macular detachment were identified, with postoperative follow-up ranging from 13 to 52 months (mean: 28 months). Spectral domain optical coherence tomography (SD-OCT) showed complete fluid resolution without recurrence in five of the six cases. Four cases showed complete reabsorption after Intravitreal perfluoropropane plus laser, one patient needed an extra procedure (pars plana vitrectomy with inner limiting membrane peeling and pedicle flap inversion over the temporal optic disc margin) to achieve complete fluid reabsorption, and one patient had persistent intraretinal fluid and denied additional surgeries. The time between the initial procedure and total fluid reabsorption varied from 6.5 to 41 months (mean: 19.5 months). Best-corrected visual acuity improved after surgery on the last follow-up visit in all cases. 100% perfluoropropane intravitreal injection followed by photocoagulation along temporal optic disc margin was associated with anatomic and visual improvement in most cases, representing an alternative treatment approach for optic disc pit-associated macular detachment.

Complete clinical spectrum of melkersson–Rosenthal syndrome with bilateral temporal optic disc pallor – A case report

Complete clinical spectrum of melkersson–Rosenthal syndrome with bilateral temporal optic disc pallor – A case report

Mitochondrial optic neuropathies (MON)

AbstractWhen we first proposed the term, Mitochondrial Optic Neuropathies (MON) (Sadun AA. Mitochondrial optic neuropathies. J Neurol Neurosurg Psychiatry. 2002 Apr;72(4):423–5.), it may have seemed odd. The paradigm before then was that many things could injure the optic nerves, and genetic, nutritional and many toxic causes made the list alongside tumours, infections, inflammations, etc. Our experiences in Cuba changed this mode of thinking. There, an epidemic of optic neuropathy (CEON) was found to exist among those consuming small amounts of methanol in the presence of folic acid deficiency. This demonstrated the convergence of toxic and nutritional causes that affected the same (oxidative‐phosphorylation) systems. Several publications have demonstrated that certain metabolic optic neuropathies are more likely in the setting of genetic predispositions. In short, asymptomatic carriers of well characterized genetic disorders such as Leber's Hereditary Optic Neuropathy (LHON), may lose vision when additionally stressed by exposures to certain drugs like ethambutol or to nutritional deficiencies. Several studies have revisited the original diagnosis of tobacco‐alcohol amblyopia (their term) and found about 20% harboured LHON mtDNA mutations (Cullom, et al., Arch Ophthalmol. 1993 Nov;111(11):1482–5).We hereby present a framework for seeing many forms of metabolic (hereditary, nutritional and toxic) optic neuropathies as related. One unifier is the stereotypic clinical presentation. These patients have, after a while, very symmetric visual losses. The loss of visual acuity, colour vision, and high spatial frequency contrast sensitivity, reflects a pair of symmetrical central or cecocentral scotomas. These aforementioned functional defects are to be expected by the equally characteristic anatomical loss of the small fibres of the papillo‐macular bundle (PMB) which also explains the temporal optic disc pallor. The other unifier is that the molecular injuries cause impairments of mitochondria, and specifically oxidative phosphorylation (Ox‐Phos). We and others have further demonstrated that this especially entails the accumulation of reactive oxygen species (ROS) more than a problem with bioenergetics. This also explains the particular predilection for injury of the smallest and unmyelinated fibres of the PMB.Several drugs are causes or additional risk factors in MON. Remarkably, most drugs that are best demonstrated to injure the optic nerve are also understood to impair mitochondria and Ox‐Phos. These include ethambutol and linezolid, chloramphenicol, streptomycin, and some antivirals (Wang and Sadun, J Neuroophthalmol. 2013 Jun;33(2):172–8). These drugs can also be regarded, in addition to heavy smoking and binge drinking of alcohol, as exogenous sources of ROS that are likely to bring out Type II LHON (vs Type I LHON which is apt to be genetic/genetic, and occurs at an early age more acutely).In general, MON represent the unique susceptibility of the optic nerve, and most specifically, the small fibres of the PMB, to the ROS that are generated when mitochondrial Ox‐Phos is defective. When the ROS threshold is exceeded, these fibres are the first to decompensate and this leads to a remarkably consistent phenotype.

Choroidal Neurofibromatosis

A 38-year-old woman with neurofibromatosis type 1 was referred to the ophthalmology department after magnetic resonance imaging detected a left optic nerve glioma. Visual acuity was 20/20 in the right eye and 20/30 in the left eye with temporal optic disc pallor left eye and normal appearing posterior poles in both eyes (Fig A-B). Near-infrared reflectance (NIR) imaging demonstrated multifocal areas of bright signal at the level of the choroid (Fig C, D, E, arrow) in both eyes. These choroidal abnormalities (CAs) are conspicuous on NIR imaging but are often not visible on clinical examination or fluorescein angiography.

Melphalan intra-arterial chemotherapy for choroidal melanoma chemoreduction

BackgroundIntra-arterial chemotherapy (IAC) has been used to treat multiple cancers including liver metastasis from uveal and cutaneous melanoma but not as primary tumor treatment. We report the compassionate use of chemoreduction with intra-arterial melphalan before ruthenium brachytherapy to salvage an eye with choroidal melanoma.Case presentationA 61-year-old female patient complained of decreased vision and central-temporal scotoma in OS (left eye) for 1 month. Visual acuity was 20/20 in right eye (OD) and 20/125 OS. Anterior segment examination and intraocular pressure were unremarkable in both eyes, as was fundus examination of the OD. Fundus examination of OS revealed a brown, solid tumor partially obscuring the temporal optic disc margin and extending to the equatorial fundus midzone. Serous retinal detachment was present over the lesion and around it. Ultrasonography revealed a solid choroidal tumor with a largest basal diameter (LBD) of 13.0 mm and thickness of 10.4 mm. The tumor presented acoustic hollowness and a superimposing retinal detachment. After metastatic screening was negative, the patient underwent intra-arterial chemotherapy with melphalan. Three weeks later, her visual acuity was 20/200 and there was noticeable tumor regression to 11.9 mm (LBD) by 7.9 mm (thickness) allowing brachytherapy to be performed. Ten weeks after brachytherapy (13 weeks after IAC), visual acuity was HM due to biopsy-related vitreous hemorrhage (VH). Tumor dimensions were 9.9 (LBD) mm and 6.5 mm (thickness) and PPV was performed to remove VH. Six weeks after PPV (20 weeks after IAC), her visual acuity was 20/200 and further reduction of tumor dimensions was observed: largest basal diameter was 8.9 mm and thickness was 4.9 mm.ConclusionThis case illustrates the feasibility of combining induction IAC prior to ruthenium brachytherapy for large choroidal melanoma. More studies are warranted to confirm these early preliminary findings.

Characteristics of the Optic Nerve Head in Myopic Eyes Using Swept-Source Optical Coherence Tomography.

PurposeTo investigate the characteristics of the optic nerve head (ONH) in myopia using swept-source optical coherence tomography (SS-OCT).MethodsParticipants were divided into three groups according to the axial length (AL). The optic disc morphology, retinal nerve fiber layer (RNFL) thickness, and radial peripapillary capillary (RPC) vessel density (VD), optic disc tilt, rotation, Bruch's membrane opening distance (BMOD), border length (BL), border tissue angle, focal lamina cribrosa (LC) defects, β- and γ-zone peripapillary atrophy (PPA), microvasculature dropout (MvD), choroidal thickness (CT), and the choroidal vascularity index (CVI) were compared. Linear regression analysis evaluated relationships between spherical equivalent, AL, and ONH parameters.ResultsOne hundred five, 98, and 118 eyes were included in groups 1, 2, and 3, respectively. With AL increasing, the mean, superior and temporal CT, central mean and temporal, pericentral mean, inferior and nasal RPC VD, and temporal CVI decreased, whereas the mean and temporal RNFL thickness, optic disc, RIM and β-PPA area, presence and area of γ-PPA, BMOD and BL increased. Compared to other groups, group 3 depicted a larger cup area, more focal LC defect and total and juxtapapillary MvD; a lower central superior, inferior and nasal, pericentral superior, and temporal RPC VD. Group 1 demonstrated more tilted disc, larger inferior and nasal CT, mean, superior, inferior, and nasal CVI.ConclusionsMyopia eyes have larger ONH changes, PPAs, regional RNFL, and MvD, but smaller regional CTs, RPC VD, and CVIs. SS-OCT may be useful in detecting ONH variations during myopia.

Analysis of Microcirculation Changes in the Macular Area and Para-Optic Disk Region After Implantable Collamer Lens Implantation in Patients With High Myopia.

Myopia has become an important public health problem to be solved urgently. Posterior chamber phakic implantable Collamer lens (ICL) implantation is one of the latest and safest products for myopia correction worldwide. This prospective cross-sectional case series aimed to observe changes in the macular retinal thickness, retinal nerve fiber layer (RNFL) thickness of para-optic disk region, and blood flow density after posterior ICL implantation in patients with high myopia using optical coherence tomography angiography (OCTA). A total of 67 eyes of 67 patients with high myopia, who underwent ICL implantation at The Affiliated Eye Hospital of Nanjing Medical University from January 2020 and December 2020, were included. The spherical equivalent (SE) of the operative eyes was >−6.00 D. The changes in vision, intraocular pressure (IOP), SE, and vault were observed pre-operatively, and follow-up were performed 1 week, 1 month, and 3 months. OCTA was used to observe the changes in the CRT, retinal thickness of paracentral fovea, FAZ, superficial and deep retinal blood flow density in the macular area, RNFL thickness of para-optic disk region, and blood flow density before and after ICL implantation. The uncorrected distance visual acuity (UDVA) and best corrected distance visual acuity (CDVA) of the patients post-operation were significantly improved (P < 0.001). The IOP increased in comparison with other time points at 1 week post-operation (P < 0.05). There were no significant changes in CRT post-operation. The retinal thickness in the upper, lower, nasal, and temporal quadrants of the paracentral fovea increased significantly at 1 month and 3 months post-operation (P < 0.05). The FAZ area at all postoperative time points were decreased (P < 0.001). At 3 months post-operation, the blood flow density of the superficial and deep retinal layers in the upper, lower, and nasal macular area were significantly reduced (P < 0.05). At 1 month post-operation, the RNFL thickness in the temporal para-optic disk region and blood flow density were significantly reduced (P = 0.001 and P < 0.05, respectively). ICL implantation for highly myopic eyes led to an increase of the retinal thickness in the upper, lower, nasal, and temporal regions of the paracentral fovea; reduction of RNFL thickness in the temporal area of para-optic disk; decrease in FAZ area; and decrease in the blood flow density of some deep and superficial retinal layers as well as that of the temporal para-optic disk region.

Functional Amblyopia in Segmental Optic Nerve Hypoplasia

A 5-year-old boy had a visual acuity of 20/80 in the right eye (OD) and 20/20 in the left eye (OS). Examination showed anisometropia (+1.00 OD and plano OS) without strabismus. Retinal examination demonstrated segmental hypoplasia of the temporal optic disc with absence of the corresponding retinal nerve fiber layer (Fig A-B). Despite a structural defect involving the temporal disc and papillomacular bundle, combined treatment with glasses providing his full cycloplegic refraction and part-time occlusion OS resulted in visual improvement to 20/20 OD.