Temporal Margin Of Optic Disc Research Articles

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.

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.

Macular Telangiectasia Type 2: Visual Acuity, Disease End Stage, and the MacTel Area: MacTel Project Report Number 8

To report the visual acuity measures from the macular telangiectasia type 2 (MacTel) registry and to investigate and describe phenotypic findings in eyes with substantial vision loss resulting from MacTel. Cross-sectional multicenter study. Participants in the MacTel Natural History Observation Registration Study. Best-corrected visual acuity (BCVA) data, retinal imaging data, and clinical data were accessed from the MacTel Study databases in May2019. Frequency distribution of BCVA and its relationship to age; morphologic changes in eyes with very late disease stages, defined by a BCVA of 20/200 or worse; average retinal thickness of macular subfields on OCT; and dimensions of the area affected by MacTel (i.e., the MacTel area). Best-corrected visual acuity was 20/50 or worse in 37.3% and 20/200 or worse in 3.8% of 4449 eyes of 2248 patients; 18.4% and 0.7% of all patients showed bilateral BCVA of 20/50 or worse and 20/200 or worse, respectively. Asymmetry between right and left eyes was present (median BCVA, 71 letters vs. 74 letters), a finding supported by more advanced morphologic changes in right eyes. Participant age correlated with BCVA, but the effect size was small. If a neovascularization or macular hole were present, bilateral occurrence was frequent (33% or 17%, respectively), and BCVA was better than 20/200 (79% or 78%, respectively) or 20/50 or better (26% or 13%, respectively). Eyes with advanced disease (BCVA, ≤20/200) showed the following characteristics: (1) atrophy of the foveal photoreceptor layer with or without associated subretinal fibrosis; (2) an affected area, termed MacTel area, limited to a horizontal diameter not exceeding the distance between the temporal optic disc margin and foveal center, and the vertical diameter not exceeding approximately 0.8 times this distance (exceptions were eyes with large active or inactive neovascular membranes); (3) reduced retinal thickness measures within the MacTel area; and (4) less frequent retinal greying and more frequent hyperpigmentations compared with eyes that have better BCVA. Severe vision loss is rare in MacTel and is related to photoreceptor atrophy in most people. Results indicate disease asymmetry with slightly worse vision and more advanced disease manifestation in right eyes. MacTel-related neurodegeneration does not spread beyond the limits of the MacTel area.

Features of the Choroidal Structures in Myopic Children Based on Image Binarization of Optical Coherence Tomography.

PurposeTo evaluate the features of the choroidal structures in the eyes of myopic children obtained by enhanced depth imaging optical coherence tomography (EDI-OCT).MethodsNinety-six myopic children with low to moderate myopia (spherical equivalent refractive error [SER], –5.75 to –1.00 diopter) were included in this cross-sectional study. Ocular biometrics were measured using an optical low-coherence reflectometry device. Data of the choroidal structures extracted from a 7500-µm cross-sectional arc of the choroid extending from the temporal optic disc margin, including the total choroidal area, luminal area, stromal area, and choroidal vascularity index, were determined by image binarization of the EDI-OCT. Associations between demographic factors, ocular parameters, and choroidal structures were evaluated using univariate and multiple linear regression analyses.ResultsThe study participants (mean age, 11.02 ± 1.70 years) had a mean axial length (AL) of 24.94 ± 0.70 mm. The mean total choroidal area was 2.64 ± 0.49 mm2 (luminal area, 1.68 ± 0.32 mm2; stromal area, 0.95 ± 0.19 mm2), and the choroidal vascularity index was 0.64 ± 0.03. Multiple regression analysis showed that the luminal area was significantly associated with the AL (standard β = –0.24, P = 0.022) after adjusting for sex and corneal radius (CR), whereas the stromal area (standard β = –0.30, P = 0.003) and choroidal vascularity index (standard β = 0.36, P = 0.001) were significantly associated with age after adjusting for sex, CR, and lens thickness (LT). Sex, CR, LT, and SER showed no significant association with choroidal structures after adjusting for age and AL (all P > 0.05).ConclusionsThe luminal area of the choroid tends to decrease with a longer AL, whereas the stromal area tends to decrease with increasing age in myopic children. These findings require further exploration in a longitudinal study.

Parapapillary Gamma Zone and Progression of Myopia in School Children: The Beijing Children Eye Study.

To assess the development and enlargement of the parapapillary gamma zone in school children. This school-based prospective longitudinal study included Chinese children attending grade 1 in 2011 and returning for yearly follow-up examinations until 2016. These examinations consisted of a comprehensive ocular examination with biometry and color fundus photographs. The parents underwent a standardized interview. The parapapillary gamma zone was defined as the area with visible sclera at the temporal optic disc margin, and the optic disc itself was measured on fundus photographs. The study included 294 children (mean age in 2016, 11.4 ± 0.5 years [range, 10-13 years]; mean axial length, 24.1 ± 1.1 mm [range, 21.13-27.29 mm]). In multivariate analysis, larger increases in the gamma zone area during the study period were correlated (coefficient of determination for bivariate analysis [r2], r2 = 0.69) with larger increases in the vertical-to-horizontal disc diameter ratios (P < 0.001; standardized regression coefficient beta [beta], 0.53; nonstandardized regression coefficient B [B], 4.05; 95% confidence intervals [CI], 3.37-4.73), larger axial elongation (P < 0.001; beta, 0.32; B, 0.37; 95% CI, 0.26-0.47), a larger vertical disc diameter at baseline (P < 0.001; beta, 0.22; B, 0.98; 95% CI, 0.62-1.33), a larger gamma zone area at baseline (P < 0.001; beta, 0.14; B, 0.41; 95% CI, 0.17-0.64), and more time spent indoors studying (P = 0.015; beta, 0.10; B, 0.09; 95% CI, 0.02-0.17). The development and enlargement of the gamma zone in the temporal parapapillary region were associated with an optic disc rotation around the vertical disc axis as indicated by an increasing vertical-to-horizontal disc diameter ratio. These morphologic findings fit with the notion of a backward pull of the temporal peripapillary sclera through the optic nerve dura mater in axially elongated eyes.

Effect of myopia and age on optic disc margin anatomy within the parapapillary atrophy area

To evaluate the effect of myopia and age on temporal optic disc margin anatomy within the parapapillary atrophy (PPA) area by use of spectral-domain optical coherence tomography (OCT). Fifty young myopic eyes with PPA (myopic PPA group), 50 aged non-myopic eyes with PPA (aged PPA group), and 50 young non-myopic eyes without PPA (control group) were enrolled. High-definition OCT scanning was used to obtain horizontal cross-sectional optic nerve head (ONH) images. By use of these OCT scans we investigated three temporal optic disc margin structures: the configuration of the border tissue of Elschnig; the cross-sectional ONH structure coinciding with the clinically detected optic disc margin; and the integrity of the retinal layers within the PPA area. The distribution of the configuration of the border tissue of Elschnig and the cross-sectional ONH structure coinciding with the clinically detected optic disc margin of the myopic PPA group differed significantly from those of the control group (P < 0.01) whereas those of the aged PPA group did not (P > 0.05). Other than the photoreceptor layer, the retinal layers within the PPA area were more commonly impaired in the myopic PPA group than in the aged PPA group (P < 0.001). Myopia and aging led to different structural changes in temporal optic disc margin anatomy within the PPA area. This finding implies that different mechanisms may underlie myopic and age-related PPA development.

Differentiation of Parapapillary Atrophy Using Spectral-Domain Optical Coherence Tomography

To develop a classification of parapapillary atrophy (PPA) based on its relationship with the location of Bruch's membrane (BM) termination in primary open-angle glaucoma (POAG) patients. Cross-sectional observational study. This study analyzed 161 eyes from 161 POAG patients who had temporal β-zone PPA, the width of which was more than 200 μm on at least 1 horizontal scan image obtained by spectral-domain optical coherence tomography within the mid horizontal one third of the optic nerve. Based on the extent of BM within the PPA area, eyes were categorized as group A (intact BM; 76 eyes), group B (discontinuous BM; 65 eyes), and group C (lacking BM; 20 eyes). Differences in the demographic, clinical, and ocular characteristics were compared using analysis of variance and chi-square tests among the 3 groups. The distance from the temporal optic disc margin to the temporal margin of the β-zone PPA (PPA width) and to the edge of the BM (width of PPA without BM [PPA-BM]) were measured on 3 horizontal scans within the mid horizontal one third of the optic nerve, and the averages of the measured values were analyzed. The configuration of the border tissue of Elschnig at the temporal disc margin was assessed. Factors and configuration of the border tissue of Elschnig associated with each PPA type. The mean age of group A was significantly higher than that of groups of B and C (P<0.001). The mean axial length was greatest in group C (group C>group B>group A; P<0.001). In group A, the border tissue mainly had a nonoblique configuration (49/76 eyes; 64.5%), whereas most of the eyes in group B (59/65 eyes; 90.8%) and all eyes in group C (20 eyes) it had an externally oblique configuration (P<0.001). A longer axial length was correlated significantly with a larger PPA-BM width (r = 0.478; P<0.001). A morphologic classification of PPA, which may reflect differing pathogenesis among the groups, is proposed. Parapapillary atrophy with intact BM may be an age-related atrophic change, whereas PPA lacking BM may result from scleral stretching associated with elongation of the globe. Proprietary or commercial disclosure may be found after the references.

Errors in neuroretinal rim measurement by Cirrus high-definition optical coherence tomography in myopic eyes

Background/aimsTo investigate the prevalence of, and factors associated with, errors in neuroretinal rim measurement by Cirrus high-definition (HD) spectral-domain optical coherence tomography (OCT) in myopic eyes.MethodsNeuroretinal rim thicknesses of 255...

Limited long‐term efficacy of intravitreous anti‐VEGF pharmacotherapy in sarcoidosis complicated by peripapillary choroidal neovascular membrane

Limited long‐term efficacy of intravitreous anti‐VEGF pharmacotherapy in sarcoidosis complicated by peripapillary choroidal neovascular membrane

Long-term study of patients with congenital pit of the optic nerve and persistent macular detachment.

During the period 1970-87 we evaluated the changes of the optic disc, peripapillary area, detached macula and visual acuity in 16 cases with congenital pit of the optic nerve and macular detachment. The study revealed in 9 of the 16 cases (56%) an increase of the dimension of the pit or changes in its color, findings which were directly related to the duration of the macular detachment. Chorioretinal scarring, pigment migration, or both, were also noted mainly at the temporal margin of optic disc. In 5/16 cases we found during the follow-up an extension of macular elevation. In altogether 10 out of 16 cases the retinal elevation covered the larger portion of the mid-periphery temporally. In 7/16 cases the final visual acuity remained unchanged, in 9/16 cases deteriorated. The difference, however, in the latter 9 cases between initial and final visual acuity was negligible. During the follow-up period deterioration of the visual fields was also noted.