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Ortuño-Lizarán I, Sánchez-Sáez X, Lax P, Serrano GE, Beach TG, Adler CH, Cuenca N. Dopaminergic Retinal Cell Loss and Visual Dysfunction in Parkinson Disease. Ann Neurol 2020; 88:893-906. [PMID: 32881029 PMCID: PMC10005860 DOI: 10.1002/ana.25897] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Considering the demonstrated implication of the retina in Parkinson disease (PD) pathology and the importance of dopaminergic cells in this tissue, we aimed to analyze the state of the dopaminergic amacrine cells and some of their main postsynaptic neurons in the retina of PD. METHODS Using immunohistochemistry and confocal microscopy, we evaluated morphology, number, and synaptic connections of dopaminergic cells and their postsynaptic cells, AII amacrine and melanopsin-containing retinal ganglion cells, in control and PD eyes from human donors. RESULTS In PD, dopaminergic amacrine cell number was reduced between 58% and 26% in different retinal regions, involving a decline in the number of synaptic contacts with AII amacrine cells (by 60%) and melanopsin cells (by 35%). Despite losing their main synaptic input, AII cells were not reduced in number, but they showed cellular alterations compromising their adequate function: (1) a loss of mitochondria inside their lobular appendages, which may indicate an energetic failure; and (2) a loss of connexin 36, suggesting alterations in the AII coupling and in visual signal transmission from the rod pathway. INTERPRETATION The dopaminergic system impairment and the affection of the rod pathway through the AII cells may explain and be partially responsible for the reduced contrast sensitivity or electroretinographic response described in PD. Also, dopamine reduction and the loss of synaptic contacts with melanopsin cells may contribute to the melanopsin retinal ganglion cell loss previously described and to the disturbances in circadian rhythm and sleep reported in PD patients. These data support the idea that the retina reproduces brain neurodegeneration and is highly involved in PD pathology. ANN NEUROL 2020;88:893-906.
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Affiliation(s)
- Isabel Ortuño-Lizarán
- Department of Physiology, Genetics and Microbiology, University of Alicante, Alicante, Spain
| | - Xavier Sánchez-Sáez
- Department of Physiology, Genetics and Microbiology, University of Alicante, Alicante, Spain
| | - Pedro Lax
- Department of Physiology, Genetics and Microbiology, University of Alicante, Alicante, Spain
| | | | | | | | - Nicolás Cuenca
- Department of Physiology, Genetics and Microbiology, University of Alicante, Alicante, Spain
- Institute Ramón Margalef, University of Alicante, Alicante, Spain
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52
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Collison FT, Lee W, Fishman GA, Park JC, Zernant J, McAnany JJ, Allikmets R. CLINICAL CHARACTERIZATION OF STARGARDT DISEASE PATIENTS WITH THE p.N1868I ABCA4 MUTATION. Retina 2020; 39:2311-2325. [PMID: 30204727 DOI: 10.1097/iae.0000000000002316] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the Stargardt disease phenotype associated with an unusually common and "extremely hypomorphic" ABCA4 variant, p.N1868I. METHODS The charts of 27 patients with p.N1868I on one allele and a severe/deleterious mutation on the other allele were reviewed. Subjective age of onset, best-corrected visual acuity, and stage of disease were recorded for all 27 patients, 18 of whom had multiple visits. When available, fundus photography, spectral domain optical coherence tomography, fundus autofluorescence, full-field electroretinograms, Goldmann visual fields, and fluorescein angiography were included. Five families with multiple affected members were analyzed. RESULTS The median age at symptom onset was 41.5 years, and 3 p.N1868I patients had not developed visual symptoms as of the most recent eye examination. Median best-corrected visual acuity in the better-seeing eye at baseline was 20/25, and the median duration from symptom onset to legal blindness was 25 years. The five families described in this study demonstrated clinically significant intrafamilial variability, and affected family members who did not share the p.N1868I variant had relatively more severe phenotypes. CONCLUSION This study demonstrates the consistency of foveal sparing, the variation in age at onset, the intrafamilial variability, and the prognosis with regard to visual acuity in p.N1868I-associated Stargardt disease.
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Affiliation(s)
- Frederick T Collison
- The Pangere Center for Inherited Retinal Diseases, The Chicago Lighthouse, Chicago, Illinois
| | - Winston Lee
- Department of Ophthalmology, Columbia University, New York, New York
| | - Gerald A Fishman
- The Pangere Center for Inherited Retinal Diseases, The Chicago Lighthouse, Chicago, Illinois.,Department of Ophthalmology and Visual Sciences, The University of Illinois at Chicago, Chicago, Illinois
| | - Jason C Park
- Department of Ophthalmology and Visual Sciences, The University of Illinois at Chicago, Chicago, Illinois
| | - Jana Zernant
- Department of Ophthalmology, Columbia University, New York, New York
| | - J Jason McAnany
- Department of Ophthalmology and Visual Sciences, The University of Illinois at Chicago, Chicago, Illinois
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, New York.,Department of Pathology and Cell Biology, Columbia University, New York, New York
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53
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Ha A, Kim YK, Lee J, Bak E, Han YS, Kim YW, Jeoung JW, Park KH. Interdigitation Zone Change According to Glaucoma-Stage Advancement. Invest Ophthalmol Vis Sci 2020; 61:20. [PMID: 32301971 PMCID: PMC7401448 DOI: 10.1167/iovs.61.4.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose To compare the macular interdigitation zone (IZ) of normal eyes with eyes showing different normal-tension glaucoma (NTG) stages. Methods Forty-two normal eyes (age, 56 ± 5.4 years), 45 pre-perimetric eyes (age, 59 ± 6.9 years), 51 mild-to-moderate glaucoma eyes (age, 58 ± 7.2 years; mean deviation [MD], –5.5 ± 3.0 dB), and 50 severe glaucoma eyes (age, 59 ± 6.9 years; MD, –15.1 ± 5.4 dB) were enrolled. All of the subjects underwent high-resolution spectral-domain optical coherence tomography (SD-OCT) to obtain 19 horizontal and 19 vertical macular B-scans 9 mm in length. The en face image of the scan area was divided into 589 rectangular boxes (side length of 375 µm). The IZ locations were marked on the corresponding image boxes. The IZ area was then quantified according to the number of boxes showing IZs among the 589 total boxes. Results The IZ area in the severe glaucoma eyes was significantly smaller than in the mild-to-moderate glaucoma eyes (28.99 ± 7.88 mm2 vs. 40.79 ± 7.46 mm2; P < 0.001), was smaller in the mild-to-moderate glaucoma eyes than in the pre-perimetric glaucoma eyes (40.79 ± 7.46 mm2 vs. 49.92 ± 8.10 mm2; P < 0.001), and was smaller still in the pre-perimetric glaucoma eyes than in the normal eyes (49.92 ± 8.10 mm2 vs. 56.85 ± 7.94 mm2; P < 0.001). In the 146 NTG eyes, a statistically significant correlation was found between IZ area and MD (r = 0.64; P < 0.001). Conclusions SD-OCT revealed a reduction in IZ area in NTG eyes, and the extent of the reduction was positively associated with glaucoma severity. These findings suggest, though tentatively, that changes in the outer retinal layer can occur in the course of glaucoma progression.
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54
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Sumaroka A, Cideciyan AV, Sheplock R, Wu V, Kohl S, Wissinger B, Jacobson SG. Foveal Therapy in Blue Cone Monochromacy: Predictions of Visual Potential From Artificial Intelligence. Front Neurosci 2020; 14:800. [PMID: 32848570 PMCID: PMC7416698 DOI: 10.3389/fnins.2020.00800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/07/2020] [Indexed: 11/13/2022] Open
Abstract
Novel therapeutic approaches for treating inherited retinal degenerations (IRDs) prompt a need to understand which patients with impaired vision have the anatomical potential to gain from participation in a clinical trial. We used supervised machine learning to predict foveal function from foveal structure in blue cone monochromacy (BCM), an X-linked congenital cone photoreceptor dysfunction secondary to mutations in the OPN1LW/OPN1MW gene cluster. BCM patients with either disease-associated large deletion or missense mutations were studied and results compared with those from subjects with other forms of IRD and various degrees of preserved central structure and function. A machine learning technique was used to associate foveal sensitivities and best-corrected visual acuities to foveal structure in IRD patients. Two random forest (RF) models trained on IRD data were applied to predict foveal function in BCM. A curve fitting method was also used and results compared with those of the RF models. The BCM and IRD patients had a comparable range of foveal structure. IRD patients had peak sensitivity at the fovea. Machine learning could successfully predict foveal sensitivity (FS) results from segmented or un-segmented optical coherence tomography (OCT) input. Application of machine learning predictions to BCM at the fovea showed differences between predicted and measured sensitivities, thereby defining treatment potential. The curve fitting method provided similar results. Given a measure of visual acuity (VA) and foveal outer nuclear layer thickness, the question of how many lines of acuity would represent the best efficacious result for each BCM patient could be answered. We propose that foveal vision improvement potential in BCM is predictable from retinal structure using machine learning and curve fitting approaches. This should allow estimates of maximal efficacy in patients being considered for clinical trials and also guide decisions about dosing.
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Affiliation(s)
- Alexander Sumaroka
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Artur V. Cideciyan
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca Sheplock
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Vivian Wu
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Susanne Kohl
- Molecular Genetics Laboratory, Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tüebingen, Tüebingen, Germany
| | - Bernd Wissinger
- Molecular Genetics Laboratory, Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tüebingen, Tüebingen, Germany
| | - Samuel G. Jacobson
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Pollreisz A, Neschi M, Sloan KR, Pircher M, Mittermueller T, Dacey DM, Schmidt-Erfurth U, Curcio CA. Atlas of Human Retinal Pigment Epithelium Organelles Significant for Clinical Imaging. Invest Ophthalmol Vis Sci 2020; 61:13. [PMID: 32648890 PMCID: PMC7425708 DOI: 10.1167/iovs.61.8.13] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/27/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose To quantify organelles impacting imaging in the cell body and intact apical processes of human retinal pigment epithelium (RPE), including melanosomes, lipofuscin-melanolipofuscin (LM), mitochondria, and nuclei. Methods A normal perifovea of a 21-year-old white male was preserved after rapid organ recovery. An aligned image stack was generated using serial block-face scanning electron microscopy and was annotated by expert readers (TrakEM, ImageJ). Acquired measures included cell body and nuclear volume (n = 17); organelle count in apical processes (n = 17) and cell bodies (n = 8); distance of cell body organelles along a normalized apical-basal axis (n = 8); and dimensions of organelle-bounding boxes in apical processes in selected subsamples of cell bodies and apical processes. Results In 2661 sections through 17 cells, apical processes contained 65 ± 24 melanosomes in mononucleate (n = 15) and 131 ± 28 in binucleate cells (n = 2). Cell bodies contained 681 ± 153 LM and 734 ± 170 mitochondria. LM was excluded from the basal quartile, and mitochondria from the apical quartile. Lengths of melanosomes, LM, and mitochondria, respectively were 2305 ± 528, 1320 ± 574, and 1195 ± 294 nm. The ratio of cell body to nucleus volume was 4.6 ± 0.4. LM and mitochondria covered 75% and 63%, respectively, of the retinal imaging plane. Conclusions Among RPE signal sources for optical coherence tomography, LM and mitochondria are the most numerous reflective cell body organelles. These and our published data show that most melanosomes are in apical processes. Overlapping LM and previously mitochondria cushions may support multiple reflective bands in cell bodies. This atlas of subcellular reflectivity sources can inform development of advanced optical coherence tomography technologies.
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Affiliation(s)
- Andreas Pollreisz
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Martina Neschi
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Kenneth R. Sloan
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Computer Science, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Michael Pircher
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | | | - Dennis M. Dacey
- Department of Biologic Structure, University of Washington, Seattle, Washington, United States
| | | | - Christine A. Curcio
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Bringmann A, Duncker T, Jochmann C, Barth T, Duncker GIW, Wiedemann P. Spontaneous closure of small full-thickness macular holes: Presumed role of Müller cells. Acta Ophthalmol 2020; 98:e447-e456. [PMID: 31654489 DOI: 10.1111/aos.14289] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/03/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To document with spectral domain optical coherence tomography the formation and spontaneous closure of small full-thickness macular holes and to propose the active role of Müller cells in macular hole closure. METHODS A retrospective case series of five patients with spontaneous closure of macular holes is reviewed. In one patient, foveal images were recorded over a period of 18 months. RESULTS In a 66-year-old man, vitreofoveal traction caused a detachment of the inner Müller cell layer of the foveola from the outer nuclear layer (ONL) which was associated with a large pseudocyst and a horizontal gap in the central ONL. The traction caused an elongation and subsequent disruption of the stalk of the Müller cell cone in the foveola. A small full-thickness macular hole developed when a portion of the inner Müller cell layer of the foveola was pulled out. After phacoemulsification and shortly before the subsequent spontaneous closure of the hole, there were rapid increases in the number and size of the cystic cavities in the foveal walls resulting in a narrowing of the hole. The hole closed by bridging the gap in the inner part of the central ONL; a new inner Müller cell layer of the foveola was formed, and the gap of the external limiting membrane (ELM) was closed. The cystic cavities in the foveal walls rapidly disappeared within 2 weeks after the closure of the hole. One to 2.5 months after hole closure, the thickness of the central ONL increased which decreased the distance between the central ELM and retinal pigment epithelium. In three of the four other patients, the hole also closed by bridging the gap in the inner part of the ONL. CONCLUSION It is suggested that the spontaneous closure of small macular holes and the subsequent reconstruction of the normal foveal structure are mediated by active mechanisms of Müller cells which resemble those involved in ontogenetic foveal development.
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Affiliation(s)
- Andreas Bringmann
- Department of Ophthalmology and Eye Hospital University of Leipzig Leipzig Germany
| | | | - Claudia Jochmann
- Department of Ophthalmology and Eye Hospital University of Leipzig Leipzig Germany
| | - Thomas Barth
- Department of Ophthalmology and Eye Hospital University of Leipzig Leipzig Germany
| | | | - Peter Wiedemann
- Department of Ophthalmology and Eye Hospital University of Leipzig Leipzig Germany
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Tracing the retina to analyze the integrity and phagocytic capacity of the retinal pigment epithelium. Sci Rep 2020; 10:7273. [PMID: 32350384 PMCID: PMC7190639 DOI: 10.1038/s41598-020-64131-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 04/09/2020] [Indexed: 12/24/2022] Open
Abstract
We have developed a new technique to study the integrity, morphology and functionality of the retinal neurons and the retinal pigment epithelium (RPE). Young and old control albino (Sprague-Dawley) and pigmented (Piebald Virol Glaxo) rats, and dystrophic albino (P23H-1) and pigmented (Royal College of Surgeons) rats received a single intravitreal injection of 3% Fluorogold (FG) and their retinas were analyzed from 5 minutes to 30 days later. Retinas were imaged in vivo with SD-OCT and ex vivo in flat-mounts and in cross-sections. Fifteen minutes and 24 hours after intravitreal administration of FG retinal neurons and the RPE, but no glial cells, were labeled with FG-filled vesicles. The tracer reached the RPE 15 minutes after FG administration, and this labeling remained up to 30 days. Tracing for 15 minutes or 24 hours did not cause oxidative stress. Intraretinal tracing delineated the pathological retinal remodelling occurring in the dystrophic strains. The RPE of the P23H-1 strain was highly altered in aged animals, while the RPE of the RCS strain, which is unable to phagocytose, did not accumulate the tracer even at young ages when the retinal neural circuit is still preserved. In both dystrophic strains, the RPE cells were pleomorphic and polymegathic.
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Steptoe PJ, Momorie F, Fornah AD, Komba P, Emsley E, Scott JT, Williams SJ, Harding SP, Vandy MJ, Sahr F, Beare NAV, Semple MG. Evolving Longitudinal Retinal Observations in a Cohort of Survivors of Ebola Virus Disease. JAMA Ophthalmol 2020; 138:395-403. [PMID: 32134433 PMCID: PMC7146102 DOI: 10.1001/jamaophthalmol.2020.0173] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance The 2-year ophthalmic sequelae of Ebola virus disease (EVD) in survivors of the 2013 to 2016 epidemic is unknown and may have public health implications for future outbreaks. Objective To assess the potential for uveitis recurrence, the behavior of dark without pressure, and visual outcomes in a cohort of Sierra Leonean survivors of EVD 2 years following the 2013 to 2016 Ebola epidemic. Design, Setting, and Participants Prospective, 1-year observational cohort study performed between 2016 and 2017 at 34 Military Hospital, Freetown, Sierra Leone. Participants included survivors of EVD who reported ocular symptoms since Ebola treatment unit discharge and were participants of a previous case-control study. Participants were invited for ophthalmic reexamination and finger-prick blood sampling for immunoglobulin G (IgG) to Toxoplasma gondii and HIV. Exposures Ebola virus disease. Main Outcomes and Measures Primary outcome measure: comparative ultra-widefield retinal imaging. Secondary outcome measures: visual acuity and detection of IgG to T gondii and HIV. Results Of 57 survivors of EVD who underwent repeated ophthalmic evaluation, 37 were women (64.9%). Mean (SD) age was 31.9 (11.1) years. Median interval between first and last examination was 370 days (interquartile range [IQR], 365-397.5 days), and median time from discharge to last examination was 779 days (IQR, 732-821 days). Fifteen eyes of 10 survivors (17.5%) had retinal lesions secondary to EVD. No new EVD-associated retinal lesions were observed. Two survivors (3.5%) developed new posterior uveitis resembling toxoplasmosis chorioretinitis and 41 (73%) were seropositive for T gondii IgG. Areas of dark without pressure were observed either confined to the perimeter of Ebola retinal lesions (n = 7) and non-Ebola lesions (n = 2), involving extensive retinal areas adjacent to Ebola retinal lesions (n = 4) and non-Ebola lesions (n = 2) or in isolation (n = 6). Both expansion and regression of areas of dark without pressure were observed over the study period. Best eye-presenting visual acuity had mild or no visual impairment in 55 survivors (96.4%) 2 years following discharge. Conclusions and Relevance Vision was maintained in survivors of EVD 2 years following discharge. Evolving regions of dark without pressure may be associated with EVD retinal lesions and might suggest the presence of an ongoing intraretinal stimulus, which may be associated with infective etiology. Treatment strategies should account for the possibility of toxoplasmosis chorioretinitis recurrence within survivors of EVD.
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Affiliation(s)
- Paul J Steptoe
- Department of Women's and Children's Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, England.,St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England.,National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, England
| | - Fayiah Momorie
- Medical Research Council, University of Glasgow Centre for Virus Research, Glasgow, Scotland.,34 Military Hospital, Freetown, Sierra Leone
| | - Alimamy D Fornah
- Medical Research Council, University of Glasgow Centre for Virus Research, Glasgow, Scotland.,34 Military Hospital, Freetown, Sierra Leone
| | - Patrick Komba
- Medical Research Council, University of Glasgow Centre for Virus Research, Glasgow, Scotland.,34 Military Hospital, Freetown, Sierra Leone
| | - Elizabeth Emsley
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England
| | - Janet T Scott
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, England.,Medical Research Council, University of Glasgow Centre for Virus Research, Glasgow, Scotland
| | - Samantha J Williams
- Department of Women's and Children's Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, England
| | - Simon P Harding
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England.,Department of Eye and Vision Science, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, England
| | | | - Foday Sahr
- Medical Research Council, University of Glasgow Centre for Virus Research, Glasgow, Scotland.,34 Military Hospital, Freetown, Sierra Leone
| | - Nicholas A V Beare
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England.,Department of Eye and Vision Science, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, England
| | - Malcolm G Semple
- Department of Women's and Children's Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, England.,National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, England
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Pi S, Hormel TT, Wei X, Cepurna W, Morrison JC, Jia Y. Imaging retinal structures at cellular-level resolution by visible-light optical coherence tomography. OPTICS LETTERS 2020; 45:2107-2110. [PMID: 32236080 PMCID: PMC8575555 DOI: 10.1364/ol.386454] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/05/2020] [Indexed: 05/10/2023]
Abstract
In vivo high-resolution images are the most direct way to understand retinal function and diseases. Here we report the use of visible-light optical coherence tomography with volumetric registration and averaging to achieve cellular-level retinal structural imaging in a rat eye, covering the entire depth of the retina. Vitreous fibers, nerve fiber bundles, and vasculature were clearly revealed, as well as at least three laminar sublayers in the inner plexiform layer. We also successfully visualized ganglion cell somas in the ganglion cell layer, cells in the inner nuclear layer, and photoreceptors in the outer nuclear layer and ellipsoid zone. This technique provides, to the best of our knowledge, a new means to visualize the retina in vivo at a cellular resolution and may enable detection or discovery of cellular neuronal biomarkers to help better diagnose ocular disease.
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Affiliation(s)
- Shaohua Pi
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon 97239, USA
| | - Tristan T. Hormel
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon 97239, USA
| | - Xiang Wei
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon 97239, USA
| | - William Cepurna
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon 97239, USA
| | - John C. Morrison
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon 97239, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon 97239, USA
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Torm MEW, Belmouhand M, Munch IC, Larsen M, Rothenbuehler SP. Migration of an outer retinal element in a healthy child followed by longitudinal multimodal imaging. Am J Ophthalmol Case Rep 2020; 18:100637. [PMID: 32154438 PMCID: PMC7057146 DOI: 10.1016/j.ajoc.2020.100637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/21/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe the migration of an outer retinal element using longitudinal multimodal imaging. Observations In the retina of a healthy 7-year-old girl, movement of a hyperreflective element of 15 μm extent was seen using optical coherence tomography (OCT), confocal scanning laser ophthalmoscopy (cSLO), and adaptive optics fundus photography (AO). On the OCT B-scan, the element initially appeared at the level of the outer limiting membrane with an umbra reaching the retinal pigment epithelium from where it gradually diminished and disappeared over 33 days. A corresponding disruption of the photoreceptor pattern on AO diminished over 52 days. Conclusions and importance This non-invasive observation of an isolated, cell-sized, migrating element in the human retina was made in vivo in the absence of confounding retinal disease or similar nearby elements. Based on prior preclinical observations we hypothesize that such a migrating element could be a macrophage. The case provides information about the time-scale and resolution needed for the monitoring of infiltrative processes in the retina.
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Affiliation(s)
- Marie Elise Wistrup Torm
- Department of Ophthalmology, Rigshospitalet, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark
- Corresponding author. Department of Ophthalmology, Rigshospitalet, Valdemar Hansens Vej 13, DK-2600, Glostrup, Denmark.
| | - Mohamed Belmouhand
- Department of Ophthalmology, Rigshospitalet, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark
| | - Inger Christine Munch
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark
- University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Simon Paul Rothenbuehler
- Department of Ophthalmology, Rigshospitalet, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark
- Department of Ophthalmology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
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Katsuyama A, Kusuhara S, Asahara SI, Nakai SI, Mori S, Matsumiya W, Miki A, Kurimoto T, Imai H, Kido Y, Ogawa W, Nakamura M. En face slab optical coherence tomography imaging successfully monitors progressive degenerative changes in the innermost layer of the diabetic retina. BMJ Open Diabetes Res Care 2020; 8:8/1/e001120. [PMID: 32238364 PMCID: PMC7170410 DOI: 10.1136/bmjdrc-2019-001120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/31/2020] [Accepted: 03/09/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the usefulness of en face slab optical coherence tomography (OCT) imaging for monitoring diabetic retinal neurodegeneration with supporting animal experimental data. RESEARCH DESIGN AND METHODS We retrospectively examined 72 diabetic eyes over 3 years using Cirrus-HD OCT. Two-dimensional en face slab OCT images of the innermost retina were reconstructed and graded according to the ratio of dark area to total area, and relative red, green, and blue color area ratios were calculated and used as indexes for each en face slab OCT image. Values from en face OCT images were used for statistical analyses. To obtain insight into the pathogenesis of diabetic retinal neurodegeneration, we used the InsPr-Cre;Pdk1flox/flox diabetic mouse model. RESULTS Both OCT grade and relative red color area ratio significantly increased with the advancing stage of diabetic retinopathy (p=0.018 and 0.006, respectively). After a mean follow-up period of 4.6 years, the trend was unchanged in the analyses of 42 untreated eyes (p<0.001 and 0.001, respectively). Visual acuity showed a weak but significant negative correlation with the red color ratio on en face slab OCT images, but central retinal thickness did not exhibit a clinically meaningful correlation with values obtained from en face slab OCT images. Immunohistochemical analyses of InsPr-Cre;Pdk1flox/flox diabetic mice demonstrated the loss of ganglion axon bundles and thinning of laminin without apparent retinal vascular change at the age of 20 weeks. CONCLUSIONS En face slab OCT imaging would be a novel useful modality for the assessment of diabetic retinal neurodegeneration as it could detect subtle optical changes occurring in the innermost retina in diabetic eyes. Our animal experimental data suggest that dark areas observed on en face slab OCT images might be the impairment of the extracellular matrix as well as neurons.
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Affiliation(s)
- Atsuko Katsuyama
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sentaro Kusuhara
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shun-Ichiro Asahara
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shun-Ichiro Nakai
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sotaro Mori
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Wataru Matsumiya
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akiko Miki
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takuji Kurimoto
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hisanori Imai
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshiaki Kido
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
- Division of Metabolism and Disease, Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Wataru Ogawa
- Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Bringmann A, Jochmann C, Unterlauft JD, Wiedemann R, Rehak M, Wiedemann P. Different modes of foveal regeneration after closure of full-thickness macular holes by (re)vitrectomy and autologous platelet concentrate. Int J Ophthalmol 2020; 13:36-48. [PMID: 31956568 PMCID: PMC6942947 DOI: 10.18240/ijo.2020.01.06] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/03/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To describe using spectral-domain optical coherence tomography the regeneration of the foveal morphology after pars plana (re)vitrectomy surgery and gas tamponade combined with injection of autologous platelet concentrate to treat full-thickness macular holes, and to describe different anatomical outcome. METHODS A retrospective case series of 8 eyes of 8 patients was described. RESULTS In all cases investigated, the platelet-assisted closure of macular holes was associated with a rapid resolution of cystic cavities in the foveal walls. In two patients, there was a regular regeneration of the foveal morphology after hole closure; the regenerated central fovea had a regular structure with a foveola and photoreceptors. In three other patients, there was an irregular regeneration of the fovea; a foveola was not formed, photoreceptor cells were absent from the foveal center, and the center was composed of Müller and retinal pigment epithelial (RPE) cells. The foveal regeneration after hole closure may proceed with or without a temporary detachment of the foveal center from the RPE, and with or without a direct contact between the central outer nuclear layer (ONL) and the RPE. Contacts between the ONL and RPE were observed only in patients with an irregular foveal regeneration after hole closure. CONCLUSION The data show that there are different modes of foveal regeneration after closure of macular holes with (re)vitrectomy and platelet concentrate. It is suggested that the regular regeneration of the foveal morphology proceeds by Müller cell-mediated tissue movements without cell proliferation, whereas the irregular foveal regeneration proceeds in part by proliferation of Müller and RPE cells.
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Affiliation(s)
- Andreas Bringmann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
| | - Claudia Jochmann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
| | - Jan Darius Unterlauft
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
| | - Renate Wiedemann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
| | - Matus Rehak
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
| | - Peter Wiedemann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
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Cuenca N, Ortuño-Lizarán I, Sánchez-Sáez X, Kutsyr O, Albertos-Arranz H, Fernández-Sánchez L, Martínez-Gil N, Noailles A, López-Garrido JA, López-Gálvez M, Lax P, Maneu V, Pinilla I. Interpretation of OCT and OCTA images from a histological approach: Clinical and experimental implications. Prog Retin Eye Res 2020; 77:100828. [PMID: 31911236 DOI: 10.1016/j.preteyeres.2019.100828] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/16/2019] [Accepted: 12/30/2019] [Indexed: 12/17/2022]
Abstract
Optical coherence tomography (OCT) and OCT angiography (OCTA) have been a technological breakthrough in the diagnosis, treatment, and follow-up of many retinal diseases, thanks to its resolution and its ability to inform of the retinal state in seconds, which gives relevant information about retinal degeneration. In this review, we present an immunohistochemical description of the human and mice retina and we correlate it with the OCT bands in health and pathological conditions. Here, we propose an interpretation of the four outer hyperreflective OCT bands with a correspondence to retinal histology: the first and innermost band as the external limiting membrane (ELM), the second band as the cone ellipsoid zone (EZ), the third band as the outer segment tips phagocytosed by the pigment epithelium (PhaZ), and the fourth band as the mitochondria in the basal portion of the RPE (RPEmitZ). The integrity of these bands would reflect the health of photoreceptors and retinal pigment epithelium. Moreover, we describe how the vascular plexuses vary in different regions of the healthy human and mice retina, using OCTA and immunohistochemistry. In humans, four, three, two or one plexuses can be observed depending on the distance from the fovea. Also, specific structures such as vascular loops in the intermediate capillary plexus, or spider-like structures of interconnected capillaries in the deep capillary plexus are found. In mice, three vascular plexuses occupy the whole retina, except in the most peripheral retina where only two plexuses are found. These morphological issues should be considered when assessing a pathology, as some retinal diseases are associated with structural changes in blood vessels. Therefore, the analysis of OCT bands and OCTA vascular plexuses may be complementary for the diagnosis and prognosis of retinal degenerative processes, useful to assess therapeutic approaches, and it is usually correlated to visual acuity.
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Affiliation(s)
- Nicolás Cuenca
- Department of Physiology, Genetics and Microbiology, University of Alicante, Spain; Institute Ramón Margalef, University of Alicante, Alicante, Spain.
| | | | - Xavier Sánchez-Sáez
- Department of Physiology, Genetics and Microbiology, University of Alicante, Spain
| | - Oksana Kutsyr
- Department of Physiology, Genetics and Microbiology, University of Alicante, Spain
| | | | | | - Natalia Martínez-Gil
- Department of Physiology, Genetics and Microbiology, University of Alicante, Spain
| | - Agustina Noailles
- Department of Physiology, Genetics and Microbiology, University of Alicante, Spain
| | | | | | - Pedro Lax
- Department of Physiology, Genetics and Microbiology, University of Alicante, Spain
| | - Victoria Maneu
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Spain
| | - Isabel Pinilla
- Department of Ophthalmology, Lozano Blesa, University Hospital, Zaragoza, Spain
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Associations with photoreceptor thickness measures in the UK Biobank. Sci Rep 2019; 9:19440. [PMID: 31857628 PMCID: PMC6923366 DOI: 10.1038/s41598-019-55484-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 10/22/2019] [Indexed: 11/08/2022] Open
Abstract
Spectral-domain OCT (SD-OCT) provides high resolution images enabling identification of individual retinal layers. We included 32,923 participants aged 40-69 years old from UK Biobank. Questionnaires, physical examination, and eye examination including SD-OCT imaging were performed. SD OCT measured photoreceptor layer thickness includes photoreceptor layer thickness: inner nuclear layer-retinal pigment epithelium (INL-RPE) and the specific sublayers of the photoreceptor: inner nuclear layer-external limiting membrane (INL-ELM); external limiting membrane-inner segment outer segment (ELM-ISOS); and inner segment outer segment-retinal pigment epithelium (ISOS-RPE). In multivariate regression models, the total average INL-RPE was observed to be thinner in older aged, females, Black ethnicity, smokers, participants with higher systolic blood pressure, more negative refractive error, lower IOPcc and lower corneal hysteresis. The overall INL-ELM, ELM-ISOS and ISOS-RPE thickness was significantly associated with sex and race. Total average of INL-ELM thickness was additionally associated with age and refractive error, while ELM-ISOS was additionally associated with age, smoking status, SBP and refractive error; and ISOS-RPE was additionally associated with smoking status, IOPcc and corneal hysteresis. Hence, we found novel associations of ethnicity, smoking, systolic blood pressure, refraction, IOPcc and corneal hysteresis with photoreceptor thickness.
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65
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Ehlers JP, Uchida A, Hu M, Figueiredo N, Kaiser PK, Heier JS, Brown DM, Boyer DS, Do DV, Gibson A, Saroj N, Srivastava SK. Higher-Order Assessment of OCT in Diabetic Macular Edema from the VISTA Study: Ellipsoid Zone Dynamics and the Retinal Fluid Index. Ophthalmol Retina 2019; 3:1056-1066. [PMID: 31473172 PMCID: PMC6899163 DOI: 10.1016/j.oret.2019.06.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/27/2019] [Accepted: 06/26/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate retinal fluid features and ellipsoid zone (EZ) integrity dynamics on spectral-domain OCT (SD-OCT) in eyes with diabetic macular edema (DME) treated with intravitreal aflibercept injection (IAI) in the VISTA-DME study. DESIGN A post hoc subanalysis of a phase III, prospective clinical trial. PARTICIPANTS Eyes received either IAI 2 mg every 4 weeks (2q4) or every 8 weeks after 5 initial monthly doses (2q8). METHODS All eyes from the VISTA Phase III study in the IAI groups imaged with the Cirrus HD-OCT system (Zeiss, Oberkochen, Germany) were included. The OCT macular cube datasets were evaluated using a novel software platform to generate retinal layer and fluid boundary lines that were manually corrected for assessment of change in EZ parameters and volumetric fluid parameters from baseline. The retinal fluid index (i.e., proportion of the retinal volume consisting of cystic fluid) was also calculated at each time point. MAIN OUTCOME MEASURES The feasibility of volumetric assessment of higher-order OCT-based retinal parameters and its correlation with best-corrected visual acuity (BCVA). RESULTS Overall, 106 eyes of 106 patients were included. Specifically, 52 eyes of 52 patients were included in the IAI 2q4 arm, and 54 eyes of 54 patients were included in the IAI 2q8 arm. Ellipsoid zone integrity metrics significantly improved from baseline to week 100, including central macular mean EZ to retinal pigment epithelium (RPE) thickness (2q4: 26.6 μm to 31.6 μm, P < 0.001; 2q8: 25.2 μm to 31.4 μm, P < 0.001). At week 100, central macular intraretinal fluid volume was reduced by >65% (P < 0.001) and central macular subretinal fluid volume was reduced by >99% in both arms (P < 0.001). Central macular retinal fluid index (RFI) significantly improved in both arms (2q4: 17.9% to 7.2%, P < 0.001; 2q8: 19.8% to 4.2%, P < 0.001). Central macular mean EZ-RPE thickness (i.e., a surrogate for photoreceptor outer segment length) and central RFI were independently correlated with BCVA at multiple follow-up visits. CONCLUSIONS Intravitreal aflibercept injection resulted in significant improvement in EZ integrity and quantitative fluid metrics in both 2q4 and 2q8 arms and correlated with visual function.
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Affiliation(s)
- Justis P Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Atsuro Uchida
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ming Hu
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Natalia Figueiredo
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | - David S Boyer
- Retinal-Vitreous Associates, Los Angeles, California
| | - Diana V Do
- Byers Eye Institute, Stanford University, Palo Alto, California
| | | | | | - Sunil K Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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66
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Meadway A, Sincich LC. Light reflectivity and interference in cone photoreceptors. BIOMEDICAL OPTICS EXPRESS 2019; 10:6531-6554. [PMID: 31853415 PMCID: PMC6913404 DOI: 10.1364/boe.10.006531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/31/2019] [Accepted: 11/03/2019] [Indexed: 05/04/2023]
Abstract
In several modes of retinal imaging, the primary means of visualizing cone photoreceptors is from reflected light. Understanding how such images are formed, particularly when adaptive optics techniques are used, will help to guide their interpretation. Toward this end, we used finite difference beam propagation to model reflections from cone photoreceptors. We investigated the formation of cone images in adaptive optics scanning laser ophthalmoscopy (AOSLO) and optical coherence tomography (AOOCT). Three cone models were tested, one made up of three segments of varying refractive index, the other two having additional boundaries at the inner/outer segment junction and outer segment tip. Images formed by the first model did not correspond to AOOCT observations in the literature, while the latter two did. The predicted distributions of reflected light intensity from the latter cone models were compared to the distribution from AOSLO images, both studied with light sources of varied coherence length. The cone model with the most reflections at the inner/outer segment junction best fit the data measured in vivo. These results show that variance in cone reflection can originate from light interfering from reflectors much more closely spaced than the outer segment length. We also show that subtracting images taken with different coherence length sources highlights these changes in interference. Differential coherence images of cones occasionally revealed an annular reflection profile, which modeling showed to be very sensitive to cone size and the gaps bracketing the outer segment, suggesting that such imaging may be useful for probing photoreceptor morphology.
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Affiliation(s)
- Alexander Meadway
- Department of Optometry and Vision Science, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Lawrence C. Sincich
- Department of Optometry and Vision Science, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Steptoe PJ, Momorie F, Fornah AD, Komba SP, Emsley E, Scott JT, Harding SP, Vandy MJ, Sahr F, Beare NAV, Semple MG. Multimodal Imaging and Spatial Analysis of Ebola Retinal Lesions in 14 Survivors of Ebola Virus Disease. JAMA Ophthalmol 2019; 136:689-693. [PMID: 29800941 DOI: 10.1001/jamaophthalmol.2018.1248] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Differentiation between Ebola retinal lesions and other retinal pathologies in West Africa is important, and the pathogenesis of Ebola retinal disease remains poorly understood. Objective To describe the appearance of Ebola virus disease (EVD) retinal lesions using multimodal imaging to enable inferences on potential pathogenesis. Design, Setting, and Participants This prospective case series study was carried out at 34 Military Hospital in Freetown, Sierra Leone. Ophthalmological images were analyzed from 14 consecutively identified survivors of EVD of Sierra Leonean origin who had identified Ebola retinal lesions. Main Outcomes and Measures Multimodal imaging findings including ultra-widefield scanning laser ophthalmoscopy, fundus autofluorescence, swept-source optical coherence tomography (OCT), Humphrey visual field analysis, and spatial analysis. Results The 14 study participants had a mean (SD) age of 37.1 (8.8) years; 6 (43%) were women. A total of 141 Ebola retinal lesions were observed in 22 of 27 eyes (81%) of these 14 survivors on ultra-widefield imaging. Of these, 41 lesions (29.1%) were accessible to OCT imaging. Retinal lesions were predominantly nonpigmented with a pale-gray appearance. Peripapillary lesions exhibited variable curvatures in keeping with the retinal nerve fiber layer projections. All lesions respected the horizontal raphe and spared the fovea. The OCT imaging demonstrated a V-shaped hyperreflectivity of the outer nuclear layer overlying discontinuities of the ellipsoid zone and interdigitation zone in the smaller lesions. Larger lesions caused a collapse of the retinal layers and loss of retinal thickness. Lesion shapes were variable, but sharp angulations were characteristic. Perilesional areas of dark without pressure (thinned ellipsoid zone hyporeflectivity) accompanied 125 of the 141 lesions (88.7%) to varying extents. Conclusions and Relevance We demonstrate OCT evidence of localized pathological changes at the level of the photoreceptors in small lesions among survivors of EVD with retinal lesions. The relevance of associated areas of dark without pressure remains undetermined.
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Affiliation(s)
- Paul J Steptoe
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.,St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.,National Institute of Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | | | | | | | - Elizabeth Emsley
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Janet T Scott
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.,National Institute of Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | - Simon P Harding
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.,Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | | | - Foday Sahr
- 34 Military Hospital, Freetown, Sierra Leone
| | - Nicholas A V Beare
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.,Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | - Malcolm G Semple
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.,National Institute of Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
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68
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Malosse L, Rousseau H, Baumann C, Angioi K, Leroy B, Sennlaub F, Berrod JP, Conart JB. Prevalence and risk factors for outer retinal layer damage after macula-off retinal detachment. Br J Ophthalmol 2019; 104:660-665. [PMID: 31462417 DOI: 10.1136/bjophthalmol-2019-314236] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/22/2019] [Accepted: 08/12/2019] [Indexed: 11/04/2022]
Abstract
PURPOSE To report the prevalence of outer retinal layer (ORL) damage after macula-off rhegmatogenous retinal detachment (RRD) surgery and to determine its associated preoperative risk factors. METHODS 253 eyes successfully operated for macula-off RRD were included in the study. The integrity of the external limiting membrane (ELM), ellipsoid zone (EZ) and cone interdigitation zone (CIZ) of the photoreceptors was assessed at 1 month and 6 months using spectral-domain optical coherence tomography. Risk factors were analysed using univariate and multivariate logistic regression. The correlation between ORL integrity and visual outcomes was also evaluated. RESULTS CIZ, EZ and ELM defects were found in, respectively, 198 (93.4%) eyes, 100 (47.2%) eyes, 64 (30.2%) eyes at 1 month and in 160 (63.2%) eyes, 44 (17.4%) eyes and 18 (7.1%) eyes at 6 months. In multivariate analysis, duration of macular detachment was the only factor associated with ORL damage at 6 months (p=0.007). Best-corrected visual acuity significantly improved from 0.5±0.3 at 1 month to 0.3±0.3 logarithm of minimal angle of resolution at 6 months (p<0.001) and was strongly correlated with the number of affected bands (p<0.001). CONCLUSION Prevalence of outer retinal band defects substantially decreased through the study period, confirming the ability of photoreceptors to recover over time. However, shorter interval to surgery and better visual outcomes were significantly associated with fewer defects within the ORL at 6 months. These findings suggest that earlier surgery may limit RRD-associated photoreceptor degeneration and improve the patient's visual prognosis.
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Affiliation(s)
- Laure Malosse
- Department of Ophthalmology, University Hospital Centre Nancy, Nancy, France
| | - Hélène Rousseau
- ESPRI-BioBase Unit, Platform of PARC, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Cédric Baumann
- ESPRI-BioBase Unit, Platform of PARC, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Karine Angioi
- Department of Ophthalmology, University Hospital Centre Nancy, Nancy, France
| | - Bertrand Leroy
- Department of Ophthalmology, University Hospital Centre Nancy, Nancy, France
| | - Florian Sennlaub
- Institut de la Vision, 17 rue Moreau, Sorbonne Universités, UPMC Univ Paris 06, INSERM, CNRS, Paris, France
| | - Jean-Paul Berrod
- Department of Ophthalmology, University Hospital Centre Nancy, Nancy, France
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Curcio CA, Sparrow JR, Bonilha VL, Pollreisz A, Lujan BJ. Re: Cuenca et al.: Cellular characterization of OCT and outer retinal bands using specific immunohistochemistry markers and clinical implications (Ophthalmology. 2018;125;407-422). Ophthalmology 2019; 125:e47-e48. [PMID: 29935676 DOI: 10.1016/j.ophtha.2018.02.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 02/23/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Christine A Curcio
- Department of Ophthalmology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University Medical Center, New York, New York; Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Vera L Bonilha
- Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna Austria
| | - Brandon J Lujan
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
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70
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Uğurlu N, Taşlıpınar Uzel AG, Şengün A, Yülek F, Özdaş D, Tam AA, Ersoy R, Çakır B. Evaluation of the correlation between quantitative measurement of the foveal avascular zone and retinal vessel density and outer retinal disruptions in diabetic patients. Turk J Med Sci 2019; 49. [PMID: 30920190 PMCID: PMC7018324 DOI: 10.3906/sag-1901-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background/aim The aim of the current study was to evaluate the correlation between the integrity of the outer retinal layers on optical coherence tomography (OCT) and objective parameters of retinal microvascular perfusion on optical coherence tomography angiography (OCTA). Materials and methods A total of 105 eyes of 54 diabetic patients were included in the study. Integrity of the outer retinal layers including the external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ) was assessed by spectral-domain optical coherence tomography. The foveal avascular zone (FAZ) area and vessel density (VD) measurements in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in all the Early Treatment Diabetic Retinopathy Study (ETDRS) sectors were evaluated by OCTA. Associations between the quantitative measurement of the FAZ and retinal VD measurements and outer retinal disruptions were evaluated. Results The FAZ area was correlated with outer retinal layer disruption both in the superficial plexus (r = 0.244, 0.228, 0.212, P = 0.013, 0.02, 0.031 for the ELM, EZ, and IZ, respectively) and the deep capillary plexus (r = 0.298, 0.234, 0.197, P = 0.002, 0.019, 0.048 for the ELM, EZ, and IZ, respectively). A significant relationship was also found between the VD measurements in the SCP and DCP in ETDRS sectors and the outer retinal layers disruption. Conclusion The results of the current study show a significant relationship between the quantitative OCTA parameters and the integrity of the outer retinal layers. This finding reveals a correlation between retinal capillary nonperfusion and outer retinal disruption in eyes with diabetic retinopathy.
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Affiliation(s)
- Nagihan Uğurlu
- Department of Ophthalmology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | | | - Ahmet Şengün
- Department of Ophthalmology, Faculty of Medicine, Ufuk University, Ankara, Turkey
| | - Fatma Yülek
- Department of Ophthalmology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Demet Özdaş
- Department of Ophthalmology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Abbas Ali Tam
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Bekir Çakır
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Soukup P, Maloca P, Altmann B, Festag M, Atzpodien EA, Pot S. Interspecies Variation of Outer Retina and Choriocapillaris Imaged With Optical Coherence Tomography. ACTA ACUST UNITED AC 2019; 60:3332-3342. [DOI: 10.1167/iovs.18-26257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Petr Soukup
- Roche Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center, Basel, Switzerland
- Ophthalmology Section, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Peter Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- OCTlab Research Laboratory, Department of Ophthalmology, University of Basel, Basel, Switzerland
- Moorfields Eye Hospital, London, United Kingdom
| | - Bernd Altmann
- Roche Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center, Basel, Switzerland
| | - Matthias Festag
- Roche Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center, Basel, Switzerland
| | - Elke-Astrid Atzpodien
- Roche Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center, Basel, Switzerland
| | - Simon Pot
- Ophthalmology Section, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Subirà O, Català-Mora J, Díaz-Cascajosa J, Padrón-Pérez N, Claveria MA, Coll-Alsina N, Bonnet C, Petit C, Caminal JM, Prat J. Retinal findings in pediatric patients with Usher syndrome Type 1 due to mutations in MYO7A gene. Eye (Lond) 2019; 34:499-506. [PMID: 31320737 DOI: 10.1038/s41433-019-0536-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 06/02/2019] [Accepted: 07/01/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To describe retinal alterations detected by swept-source optical coherence tomography (SS-OCT) in paediatric patients with Usher syndrome type 1 (USH1) and to compare these findings to previously published reports. METHODS Thirty-two eyes from 16 patients (11 males and 5 females) with a genetic diagnosis of USH1 because of MYO7A mutations underwent SS-OCT. Patients ranged in age from 4 to 17 years (mean, 11,13 ± 4,29). The subfoveal and macular area were analysed with SS-OCT at 1050 nm using 12 radial scans of 12.0 mm. Structural abnormalities were evaluated and correlated with best-corrected visual acuity (BCVA). RESULTS The most common qualitative retinal abnormality was external layer damage in macular area. Specific alterations included external limiting membrane loss/disruption (27 eyes; 84.4%), disruption of the Myoid zone (27 eyes; 84.4%); Ellipsoid zone disruption (28 eyes; 87.5%), and loss of the outer segments (29 eyes; 90.6%). The damage of the retinal pigment epithelium was divided according to the loss of the different layers: phagosome zone (30 eyes; 93.8%), melanosome zone (29 eyes; 90.6%) and mitochondria zone (0 eyes; 0%). The presence of cystoid macular oedema (CMO) was significantly correlated with alterations in photoreceptors. Disruption or absence of the myoid and ellipsoid zones of the photoreceptors were the only variables independently associated with decreased BCVA. CONCLUSIONS The findings of this study suggest that the physiopathologic basis of early-stage Usher syndrome (USH) may be changes in the outer retinal layer, particularly the photoreceptors, which in turn may cause alterations-such as CMO-in the inner retinal layers. Accordingly, monitoring the condition of photoreceptors during follow-up may be advisable for the early detection of pathologic changes.
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Affiliation(s)
- Olaia Subirà
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Jaume Català-Mora
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.,Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | | | - Noel Padrón-Pérez
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M A Claveria
- Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | | | - Crystel Bonnet
- Syndrome de Usher et Autres Atteintes Rétino-Cochléaires, Institut de la Vision, Paris, France.,Institut National de la Santé et de la Recherche Médicale, UMRS120, Paris, France.,Sorbonne Universités, UPMC University Paris, Complexité du Vivant, Paris, France
| | - Christine Petit
- Institut National de la Santé et de la Recherche Médicale, UMRS120, Paris, France.,Sorbonne Universités, UPMC University Paris, Complexité du Vivant, Paris, France.,Genetics and Physiology of Hearing Laboratory, Institut Pasteur, Paris, France.,College de France, Paris, France
| | - J M Caminal
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Prat
- Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
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73
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Takagi S, Kudo S, Yokota H, Akiba M, Mandai M, Hirami Y, Takahashi M, Kurimoto Y, Ishida M. Assessment of the deformation of the outer nuclear layer in the Epiretinal membrane using spectral-domain optical coherence tomography. BMC Ophthalmol 2019; 19:113. [PMID: 31101025 PMCID: PMC6525344 DOI: 10.1186/s12886-019-1124-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/08/2019] [Indexed: 11/10/2022] Open
Abstract
Background We aimed to investigate the deformation of the outer nuclear layer using optical coherence tomography in patients with epiretinal membrane (ERM) and its relationship with metamorphopsia. Methods Thirty-nine eyes from 39 patients with ERM were included in the study. Patients with the subtypes of pseudo macula hole and lamellar hole were excluded. Twenty-one fellow eyes without macular disease were included as normal controls. Forty-nine B-scan images were obtained in the range of 20 degrees around the macula using SD-OCT. The outer nuclear layer (ONL) was evaluated as a three-dimensional image (3D-ONL) reconstructed using the distance between the ONL and retinal pigment epithelium (RPE) line. The deformation of the ONL was figured at the reference plane and evaluation plane (ONL-B). The characteristic parameters of the ONL-B were defined as circularity, area ratio, and axis ratio. The correlations between these parameters and visual acuity and MCHART score ratio (MH/MV) were then evaluated. Results ONL height was significantly higher in ERM patients than in normal controls (54.1 ± 5.3 μm and 84.1 ± 12.9 μm, respectively; P < 0.001). In ERM patients, the MV score was 0.53 ± 0.50, the MH score was 0.71 ± 0.61, and the distance from the RPE line to the ONL-B was 153.5 ± 13.5 μm. The axis of the ONL-B in normal controls and ERM patients was − 6.25 ± 21.8 and − 1.28 ± 29.1, respectively, which indicates that the ONL is horizontally long in both normal individuals and ERM patients. The circularity and area ratio were significantly smaller in ERM patients than in normal controls. In all ERM patients, MH/MV had a significant correlation with axis (r = − 0.29, p = 0.034), circularity (r = − 0.28, p = 0.044), and area ratio (r = − 0.47, p = 0.001). Moreover, we found that the correlation was more significant if the subjects had an axis of the ONL within ±10 degrees (n = 16); the correlations of MH/MV with axis (r = − 0.29, p = 0.034), circularity (r = − 0.53, p = 0.021), and area ratio were more significant (r = − 0.78, P < 0.0001). Conclusion The ONL is horizontally long in normal individuals and ERM patients. The direction of metamorphopsia is correlated with the direction of ONL deformation.
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Affiliation(s)
- Seiji Takagi
- Department of Ophthalmology, Teikyo University, University Hospital Mizonokuchi, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan. .,Department of Ophthalmology, Kobe City Eye Hospital, 2-1-8, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Shigeki Kudo
- Cloud-Based Eye Disease Diagnosis Joint Research Team, RIKEN Center for Advanced Photonics, 2-1, Hirosawa, Wako-shi, Saitama, 351-0198, Japan
| | - Hideo Yokota
- Cloud-Based Eye Disease Diagnosis Joint Research Team, RIKEN Center for Advanced Photonics, 2-1, Hirosawa, Wako-shi, Saitama, 351-0198, Japan.,Image Processing Research Team, RIKEN Center for Advanced Photonics, 2-1, Hirosawa, Wako-shi, Saitama, 351-0198, Japan
| | - Masahiro Akiba
- Cloud-Based Eye Disease Diagnosis Joint Research Team, RIKEN Center for Advanced Photonics, 2-1, Hirosawa, Wako-shi, Saitama, 351-0198, Japan.,R&D Division, Topcon Corporation, Tokyo, Japan
| | - Michiko Mandai
- Department of Ophthalmology, Kobe City Eye Hospital, 2-1-8, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.,Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, 2-2-3 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yasuhiko Hirami
- Department of Ophthalmology, Kobe City Eye Hospital, 2-1-8, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.,Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, 2-2-3 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Masayo Takahashi
- Department of Ophthalmology, Kobe City Eye Hospital, 2-1-8, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.,Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, 2-2-3 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yasuo Kurimoto
- Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, 2-2-3 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Masahiro Ishida
- Department of Ophthalmology, Teikyo University, University Hospital Mizonokuchi, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan
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Escrivá Pastor E, Sanz Gonzalez SM, Torregrosa S, Pinazo Durán MD, Benítez-Del-Castillo J, Ramírez-Sebastián AI, Zanón Moreno V. Evaluation of the retinal nerve fiber layer thickness in smokers. ACTA ACUST UNITED AC 2019; 94:157-159. [PMID: 30871738 DOI: 10.1016/j.oftal.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/06/2019] [Accepted: 02/12/2019] [Indexed: 11/26/2022]
Affiliation(s)
- E Escrivá Pastor
- Unidad de Investigación Oftalmológica «Santiago Grisolia»/FISABIO, Valencia, España; Hospital Lluís Alcanyís, Játiva, Valencia, España
| | - S M Sanz Gonzalez
- Unidad de Investigación Oftalmológica «Santiago Grisolia»/FISABIO, Valencia, España; Grupo de Oftalmobiología Celular y Molecular, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, España; Red Temática de Investigación cooperativa OFTARED RD16/0008/0022, España
| | - S Torregrosa
- Hospital Punta de Europa, Algeciras, Cádiz, España
| | - M D Pinazo Durán
- Unidad de Investigación Oftalmológica «Santiago Grisolia»/FISABIO, Valencia, España; Grupo de Oftalmobiología Celular y Molecular, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, España; Red Temática de Investigación cooperativa OFTARED RD16/0008/0022, España
| | | | - A I Ramírez-Sebastián
- Instituto de Investigaciones Oftalmológicas «Ramón Castroviejo», Universidad Complutense, Madrid, España.
| | - V Zanón Moreno
- Unidad de Investigación Oftalmológica «Santiago Grisolia»/FISABIO, Valencia, España; Grupo de Oftalmobiología Celular y Molecular, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, España; Red Temática de Investigación cooperativa OFTARED RD16/0008/0022, España; Universidad Internacional de Valencia, Valencia, España.
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75
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Evaluation of focal damage in the retinal pigment epithelium layer in serous retinal pigment epithelium detachment. Sci Rep 2019; 9:3278. [PMID: 30824736 PMCID: PMC6397318 DOI: 10.1038/s41598-019-39688-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 01/28/2019] [Indexed: 11/28/2022] Open
Abstract
The purpose of this study was to evaluate focal damage in the retinal pigment epithelium (RPE) layer in serous retinal pigment epithelium detachment (PED) with multi-contrast optical coherence tomography (OCT), which is capable of simultaneous measurement of OCT angiography, polarization-sensitive OCT and standard OCT images. We evaluated 37 eyes with age-related macular degeneration that had serous PED. Focal RPE damage was indicated by hyper-transmission beneath the RPE-Bruch’s membrane band in standard OCT images. Distribution of RPE melanin was calculated using the dataset from multi-contrast OCT. Twenty-four points with hyper-transmission were detected in 21 of the 37 eyes. Standard OCT images failed to show disruption of the RPE-Bruch’s membrane band at 5 of the 24 hyper-transmission points. Conversely, multi-contrast OCT images clearly showed melanin defects in the RPE-Bruch’s membrane band at all points. Areas of melanin defects with disruption of the RPE-Bruch’s membrane band were significantly larger than those without disruption. The volume of intraretinal hyper-reflective foci was significantly larger in eyes with hyper-transmission than that in eyes without hyper-transmission. Multi-contrast OCT is more sensitive than standard OCT for displaying changes at the RPE-Bruch’s membrane band when there are small areas of RPE damage.
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76
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Cheng J, Sohn EH, Jiao C, Adler KL, Kaalberg EE, Russell SR, Mullins RF, Stone EM, Tucker BA, Han IC. Correlation of Optical Coherence Tomography and Retinal Histology in Normal and Pro23His Retinal Degeneration Pig. Transl Vis Sci Technol 2018; 7:18. [PMID: 30519502 PMCID: PMC6269133 DOI: 10.1167/tvst.7.6.18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 09/23/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose We correlate optical coherence tomography (OCT) retinal layer thickness measurements with histology in wild-type and retinal degenerative pigs. Methods OCT scans were obtained using the Bioptigen Envisu R2200. In normal pigs, three eyes were imaged in vivo, and three eyes were imaged after enucleation. In the Pro23His retinal degeneration pigs (P23H), one eye was imaged in vivo and four eyes were imaged after enucleation. All eyes were fixed in 4% paraformaldehyde and processed for histology. Corresponding retinal locations on OCT and histology were identified using anatomic landmarks (optic nerve, retinal vessels, visual streak). Individual retinal layer thicknesses were measured by two independent, masked graders, and intraclass correlation coefficients were used to determine agreement. OCT and histologic retinal thickness measurements were averaged and compared. Results OCT and histologic measurements correlated highly in normal and diseased eyes (R2 = 0.91 and 0.92, respectively), and scans performed in vivo and ex vivo did not differ significantly. Despite good overall correlation, certain individual retinal layers (e.g., retinal nerve fiber layer [NFL], inner [INL] and outer [ONL] nuclear layers) appeared thicker on OCT compared to histology, while other layers (e.g., retinal pigment epithelium) appeared thinner. No statistically significant difference was found between OCT and histology for any retinal layer thickness measurement. Conclusions Retinal layer thickness measurements correlate well with histology in pig eyes, but differences in individual retinal layers may be seen. Translational Relevance OCT may be used in pigs to measure retinal thicknesses with good overall correlation to histologic measurements.
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Affiliation(s)
- Justine Cheng
- Carver College of Medicine, Department of Ophthalmology and Visual Sciences, Institute for Vision Research, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Elliott H Sohn
- Carver College of Medicine, Department of Ophthalmology and Visual Sciences, Institute for Vision Research, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Chunhua Jiao
- Carver College of Medicine, Department of Ophthalmology and Visual Sciences, Institute for Vision Research, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Kelsey L Adler
- Carver College of Medicine, Department of Ophthalmology and Visual Sciences, Institute for Vision Research, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Emily E Kaalberg
- Carver College of Medicine, Department of Ophthalmology and Visual Sciences, Institute for Vision Research, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Stephen R Russell
- Carver College of Medicine, Department of Ophthalmology and Visual Sciences, Institute for Vision Research, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Robert F Mullins
- Carver College of Medicine, Department of Ophthalmology and Visual Sciences, Institute for Vision Research, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Edwin M Stone
- Carver College of Medicine, Department of Ophthalmology and Visual Sciences, Institute for Vision Research, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Budd A Tucker
- Carver College of Medicine, Department of Ophthalmology and Visual Sciences, Institute for Vision Research, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Ian C Han
- Carver College of Medicine, Department of Ophthalmology and Visual Sciences, Institute for Vision Research, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Ugwuegbu O, Uchida A, Singh RP, Beven L, Hu M, Kaiser S, Srivastava SK, Ehlers JP. Quantitative assessment of outer retinal layers and ellipsoid zone mapping in hydroxychloroquine retinopathy. Br J Ophthalmol 2018; 103:3-7. [PMID: 30190364 DOI: 10.1136/bjophthalmol-2018-312363] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/20/2018] [Accepted: 07/26/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND To quantitatively assess outer retinal layers in eyes with hydroxychloroquine (HCQ) toxicity. METHODS A retrospective case-control study was performed to identify eyes with HCQ retinopathy/toxicity at Cleveland Clinic. A clinical diagnosis of HCQ retinopathy was made based on clinical and imaging features including the presence of parafoveal ellipsoid zone (EZ) loss on spectral-domain optical coherence tomography (OCT) and visual field defects. All participants underwent macular cube scan using the Cirrus HD-OCT (Zeiss, Oberkochen, Germany). Quantitative assessment of outer nuclear layer (ONL)/Henle fibre layer complex (HFL) metrics and EZ mapping were performed with a novel software platform and compared with age-matched controls. HCQ toxicity group was divided into three subgroups based on the severity. RESULTS There were 14 eyes from 14 patients in HCQ toxicity group (mean age 57.0±18.6 years), and 14 eyes from 14 subjects in age-matched control group (mean age 59.4±18.6 years). Multiple outer retinal parameters including ONL/HFL-EZ volume, parafoveal ONL/HFL-EZ thickness and EZ-retinal pigment epithelium (RPE) volume were significantly reduced in all HCQ toxicity subgroups (early, moderate and advanced toxicity) compared with controls. Semiautomated layer segmentation tool produced en face representation of EZ-RPE mapping and allowed unique visualisation of EZ attenuation in eyes with HCQ toxicity. The longitudinal analysis of HCQ toxicity group demonstrated progressive decline in some outer retinal parameters. CONCLUSION HCQ toxicity resulted in significant outer retinal layer volumetric thinning compared with controls. Quantitative assessment of outer retinal parameters and EZ mapping on SD-OCT may become a useful biomarker to identify and monitor HCQ toxicity.
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Affiliation(s)
- Obinna Ugwuegbu
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, USA.,Cole Eye Institute, Cleveland Clinic, Cleveland, USA
| | - Atsuro Uchida
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, USA.,Cole Eye Institute, Cleveland Clinic, Cleveland, USA
| | - Rishi P Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, USA
| | - Lucas Beven
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, USA.,Cole Eye Institute, Cleveland Clinic, Cleveland, USA
| | - Ming Hu
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, USA.,Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - Stephanie Kaiser
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, USA
| | - Sunil K Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, USA.,Cole Eye Institute, Cleveland Clinic, Cleveland, USA
| | - Justis P Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, USA .,Cole Eye Institute, Cleveland Clinic, Cleveland, USA
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78
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Xie W, Zhao M, Tsai SH, Burkes WL, Potts LB, Xu W, Payne HR, Hein TW, Kuo L, Rosa RH. Correlation of spectral domain optical coherence tomography with histology and electron microscopy in the porcine retina. Exp Eye Res 2018; 177:181-190. [PMID: 30120928 DOI: 10.1016/j.exer.2018.08.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 02/07/2023]
Abstract
Spectral domain optical coherence tomography (SD-OCT) is used as a non-invasive tool for retinal morphological assessment in vivo. Information on the correlation of SD-OCT with retinal histology in the porcine retina, a model resembling the human retina, is limited. Herein, we correlated the hypo- and hyper-reflective bands on SD-OCT with histology of the lamellar architecture and cellular constituents of the porcine retina. SD-OCT images were acquired with the Heidelberg Spectralis HRA + OCT. Histological analysis was performed using epoxy resin embedded tissue and transmission electron microscopy. Photomicrographs from the histologic sections were linearly scaled to correct for tissue shrinkage and correlated with SD-OCT images. SD-OCT images correlated well with histomorphometric data. A hyper-reflective band in the mid-to-outer inner nuclear layer correlated with the presence of abundant mitochondria in horizontal cell processes and adjacent bipolar cells. A concentration of cone nuclei corresponded to a relative hypo-reflective band in the outer portion of the outer nuclear layer. The presence of 3 hyper-reflective bands in the outer retina corresponded to: 1) the external limiting membrane; 2) the cone and rod ellipsoid zones; and 3) the interdigitation zone of photoreceptor outer segments/retinal pigment epithelium (RPE) apical cell processes and the RPE. These correlative and normative SD-OCT data may be employed to characterize and assess the in vivo histologic changes in retinal vascular and degenerative diseases and the responses to novel therapeutic interventions in this large animal model.
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Affiliation(s)
- Wankun Xie
- Department of Medical Physiology, Texas A&M University Health Science Center, Temple, TX, USA; Department of Ophthalmology and Ophthalmic Vascular Research Program, Scott & White Eye Institute, Temple, TX, USA
| | - Min Zhao
- Department of Medical Physiology, Texas A&M University Health Science Center, Temple, TX, USA; Department of Ophthalmology and Ophthalmic Vascular Research Program, Scott & White Eye Institute, Temple, TX, USA
| | - Shu-Huai Tsai
- Department of Medical Physiology, Texas A&M University Health Science Center, Temple, TX, USA
| | - William L Burkes
- Department of Medical Physiology, Texas A&M University Health Science Center, Temple, TX, USA
| | - Luke B Potts
- Department of Ophthalmology and Ophthalmic Vascular Research Program, Scott & White Eye Institute, Temple, TX, USA
| | - Wenjuan Xu
- Department of Medical Physiology, Texas A&M University Health Science Center, Temple, TX, USA
| | - H Ross Payne
- Image Analysis Laboratory, Texas A&M University College of Veterinary Medicine, College Station, TX, USA
| | - Travis W Hein
- Department of Medical Physiology, Texas A&M University Health Science Center, Temple, TX, USA; Department of Ophthalmology and Ophthalmic Vascular Research Program, Scott & White Eye Institute, Temple, TX, USA
| | - Lih Kuo
- Department of Medical Physiology, Texas A&M University Health Science Center, Temple, TX, USA; Department of Ophthalmology and Ophthalmic Vascular Research Program, Scott & White Eye Institute, Temple, TX, USA
| | - Robert H Rosa
- Department of Medical Physiology, Texas A&M University Health Science Center, Temple, TX, USA; Department of Ophthalmology and Ophthalmic Vascular Research Program, Scott & White Eye Institute, Temple, TX, USA.
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Cuenca N, Ortuño-Lizarán I, Pinilla I. Reply. Ophthalmology 2018; 125:e48-e49. [DOI: 10.1016/j.ophtha.2018.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/23/2018] [Indexed: 11/26/2022] Open
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BEST1 gene therapy corrects a diffuse retina-wide microdetachment modulated by light exposure. Proc Natl Acad Sci U S A 2018; 115:E2839-E2848. [PMID: 29507198 PMCID: PMC5866594 DOI: 10.1073/pnas.1720662115] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
One of the most common forms of monogenic macular degeneration worldwide is caused by dominant or recessive bestrophinopathies associated with mutations in the BEST1 gene. Disease expression is known to start with a retina-wide electrophysiological defect leading to localized vitelliform and atrophic lesions and vision loss. To develop lasting therapies for this incurable disease, there is a need for greater understanding of the early pathophysiology before lesion formation. Here we find that the loss of retinal pigment epithelium apical microvilli and resulting microdetachment of the retina represent the earliest features of canine bestrophinopathies. We show that retinal light exposure expands, and dark adaptation contracts, the microdetachments. Subretinal adeno-associated virus-based gene therapy corrects both the vitelliform lesions and the light-modulated microdetachments. Mutations in the BEST1 gene cause detachment of the retina and degeneration of photoreceptor (PR) cells due to a primary channelopathy in the neighboring retinal pigment epithelium (RPE) cells. The pathophysiology of the interaction between RPE and PR cells preceding the formation of retinal detachment remains not well-understood. Our studies of molecular pathology in the canine BEST1 disease model revealed retina-wide abnormalities at the RPE-PR interface associated with defects in the RPE microvillar ensheathment and a cone PR-associated insoluble interphotoreceptor matrix. In vivo imaging demonstrated a retina-wide RPE–PR microdetachment, which contracted with dark adaptation and expanded upon exposure to a moderate intensity of light. Subretinal BEST1 gene augmentation therapy using adeno-associated virus 2 reversed not only clinically detectable subretinal lesions but also the diffuse microdetachments. Immunohistochemical analyses showed correction of the structural alterations at the RPE–PR interface in areas with BEST1 transgene expression. Successful treatment effects were demonstrated in three different canine BEST1 genotypes with vector titers in the 0.1-to-5E11 vector genomes per mL range. Patients with biallelic BEST1 mutations exhibited large regions of retinal lamination defects, severe PR sensitivity loss, and slowing of the retinoid cycle. Human translation of canine BEST1 gene therapy success in reversal of macro- and microdetachments through restoration of cytoarchitecture at the RPE–PR interface has promise to result in improved visual function and prevent disease progression in patients affected with bestrophinopathies.
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