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Chandran K, Giridhar A, Gopalakrishnan M, Sivaprasad S. Relation of interdigitation zone changes and right-angle vessels in Macular Telangiectasia Type-2 (MacTel). Eye (Lond) 2023; 37:2977-2986. [PMID: 36841866 PMCID: PMC10516857 DOI: 10.1038/s41433-023-02453-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/05/2023] [Accepted: 02/13/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND To study the relation between interdigitation zone (IDZ) and right-angle vessel (RAV) in Macular Telangiectasia Type-2 (MacTel). METHODS A total of 43 eyes of 38 patients with presence of definite RAV on colour fundus photograph (Gass and Blodi-only stage-3) were confirmed on multimodal imaging. The relation of IDZ changes and associated ellipsoid zone (EZ) alterations on spectral-domain optical coherence tomography (OCT) with RAV were studied at baseline and these OCT changes were followed up in 15 eyes over a mean of 3.86 years. RESULTS A total of 58 RAVs were found in the 43 eyes and 53/58 (91.3%) RAVs were associated with IDZ alterations in 39 eyes. On follow-up, IDZ attenuation progressed to IDZ loss and subsequent EZ attenuation and loss. A pre-existing IDZ loss was associated with subsequent EZ defect (P = 0.002). In 36 eyes that had OCT angiography, eyes with RAV showed deep capillary plexus telangiectasia in all 36 (100%) eyes and 32/36 (89%) eyes showed IDZ changes with or without EZ loss. CONCLUSIONS IDZ attenuation and/or loss are associated with RAV and may serve as predictor of EZ loss in MacTel.
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Affiliation(s)
- Kiran Chandran
- Department of Vitreoretinal Services, Giridhar Eye Institute, Cochin, Kerala, India
- SSM Eye Research Foundation, Giridhar Eye Institute, Cochin, Kerala, India
| | - Anantharaman Giridhar
- Department of Vitreoretinal Services, Giridhar Eye Institute, Cochin, Kerala, India.
- SSM Eye Research Foundation, Giridhar Eye Institute, Cochin, Kerala, India.
| | | | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
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Bull's Eye Maculopathy in Near-Infrared Reflectance as An Early Sign of Hydroxychloroquine Toxicity. Diagnostics (Basel) 2023; 13:diagnostics13030445. [PMID: 36766550 PMCID: PMC9913952 DOI: 10.3390/diagnostics13030445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023] Open
Abstract
Hydroxychloroquine (HCQ) ocular toxicity is rare but severe, and progression can occur even after termination of therapy. Case reports have suggested that a bull's eye maculopathy detected by near-infrared reflectance (NIR) may indicate early HCQ toxicity. This retrospective cross-sectional study evaluated patients treated with HCQ who underwent routine screening with optical coherence tomography (OCT), fundus autofluorescence (FAF) and 10-2 perimetry. NIR images captured alongside OCT were subsequently graded independently by 2 masked graders for the presence of bull's eye maculopathy, and the result was compared to the outcome of the screening. A total of 123 participants (246 eyes) were included, and 101 (90%) were female. The patients' mean age was 55.2 ± 13.8 years. The mean time of HCQ usage was 84.0 ± 72.3 months, and the mean weekly dose was 2327 ± 650 mg. Two eyes showed toxicity in all 3 routine screening exams, with one patient suspending HCQ. The prevalence of bull´s eye lesions in NIR was 13% (33 eyes) with substantial intergrader agreement, a 71.3% specificity and 88.0% negative predictive value for HCQ toxicity. We suggest that NIR changes may be a sign of early HCQ toxicity. The detection of NIR bull´s eye lesions may warrant an increased screening frequency.
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Amarasekera S, Williams AM, Freund KB, Rossi EA, Dansingani KK. MULTIMODAL IMAGING OF MULTIFOCAL CHOROIDITIS WITH ADAPTIVE OPTICS OPHTHALMOSCOPY. Retin Cases Brief Rep 2022; 16:747-753. [PMID: 36288621 PMCID: PMC9606444 DOI: 10.1097/icb.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To describe longitudinal, anatomical, and functional alterations caused by inflammatory and neovascular lesions of idiopathic multifocal choroiditis/punctate inner choroidopathy using adaptive optics imaging and microperimetry. METHODS Longitudinal case study using multiple imaging modalities, including spectral-domain optical coherence tomography, fluorescein angiography, indocyanine green angiography, optical coherence tomography angiography, flood illumination adaptive optics, and microperimetry. RESULTS A 21-year-old myopic Asian man presented with blurred vision in the right eye. Clinical examination was notable for an isolated hypopigmented, perifoveal lesion in each eye. Multimodal imaging showed inflammatory lesions in the outer retina, retina pigment epithelium, and inner choroid lesions of both eyes. The right eye additionally exhibited active Type-2 macular neovascularization with loss of cone mosaic regularity that was associated with reduced sensitivity on microperimetry. The clinical picture was consistent with multifocal choroiditis/punctate inner choroidopathy. The patient was treated with oral steroids and three injections of intravitreal bevacizumab in the right eye. After therapy, imaging showed reestablishment of the cone mosaic on flood illumination adaptive optics and improvement in sensitivity on microperimetry. CONCLUSION Adaptive optics imaging and microperimetry may detect biomarkers that help to characterize the nature and activity of multifocal choroiditis lesions and to help monitor response to therapy. With timely intervention, structural abnormalities in the outer retina and choroid can be treated, and anatomical improvements precede improvements in visual function.
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Affiliation(s)
- Sohani Amarasekera
- Department of Ophthalmology, Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew M. Williams
- Department of Ophthalmology, Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - K. Bailey Freund
- Vitreous Retina Macular Consultants of New York, New York, New York
- LuEsther T. Merz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
| | - Ethan A. Rossi
- Department of Ophthalmology, Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kunal K. Dansingani
- Department of Ophthalmology, Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Kawashima R, Matsushita K, Hashida N, Kuniyoshi K, Fujikado T, Nishida K. Complete Visual Recovery From Severe Outer Retinitis After Tonsillitis. J Neuroophthalmol 2021; 41:e578-e583. [PMID: 32956228 PMCID: PMC8584224 DOI: 10.1097/wno.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To report a case of severe acute bilateral outer retinitis after tonsillitis and rapid morphologic and functional recovery after steroid treatment. METHODS Observational case report. RESULTS A 26-year-old woman with acute bilateral blurred vision that developed after tonsillitis underwent spectral-domain optical coherence tomography (SD-OCT) that showed photoreceptor outer segment damage. Full-field electroretinography (ERG) and multifocal ERG were nonrecordable. The patient had a remarkable anatomic and functional recovery in response to steroid treatment; however, partial damage remained around the macula on SD-OCT, and an adaptive optics imaging system showed damaged cone photoreceptors. CONCLUSIONS Prednisolone is an effective treatment for a disease that is believed to be due to suspicious involvement of the autoimmune system. Even severe outer retinitis can recover completely with rapid diagnosis and treatment.
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Affiliation(s)
- Rumi Kawashima
- Department of Ophthalmology (RK, KM, NH, KN), Osaka University Graduate School of Medicine, Osaka, Japan; Department of Ophthalmology (KK), Kindai University Faculty of Medicine, Osaka-Sayama City, Japan; Osaka University Graduate School of Frontier Biosciences (TF), Osaka, Japan; and Integrated Frontier Research for Medical Science Division (KN), Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
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Ong JX, Zandi R, Fawzi AA. Early-stage macular telangiectasia type 2 vascular abnormalities are associated with interdigitation zone disruption. PLoS One 2021; 16:e0259811. [PMID: 34767582 PMCID: PMC8589180 DOI: 10.1371/journal.pone.0259811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/26/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To investigate the relationship between disruption in different photoreceptor layers and deep capillary plexus (DCP) telangiectasias in eyes with macular telangiectasia type 2 (MacTel). METHODS 35 eyes (21 patients) with MacTel imaged with optical coherence tomography angiography (OCTA) were included. Circumscribed areas of DCP telangiectasia were traced from OCTA slabs and the corresponding spectral-domain OCT (SD-OCT) slabs were used to visualize the photoreceptor layer interdigitation zone (IZ) and ellipsoid zone (EZ). IZ attenuation, IZ loss, and EZ loss were graded by reviewing en face SD-OCT slabs for hypo-reflective areas and confirming their status on cross-sectional views. Total area of photoreceptor disruption and overlap with DCP telangiectasia were evaluated with respect to OCT-based MacTel stage. Longitudinal changes were evaluated in a subset of patients with follow-up imaging. RESULTS Overlap of DCP telangiectasia with IZ attenuation significantly decreased with MacTel severity, while overlap with IZ and EZ loss significantly increased. Overlap with IZ loss peaked in moderate MacTel (Stages 3-5). Longitudinal imaging showed that new EZ loss at 6 months was largely predicted by baseline IZ loss. CONCLUSIONS Worsening MacTel severity is characterized by greater overlap between DCP telangiectasia and zones of increasing severity of photoreceptor disruption, with EZ loss enlarging over time within areas of preexisting IZ disruption. We suggest that IZ disruption may indicate early photoreceptor dysfunction that eventually progresses to EZ loss, with IZ loss being a more reliable metric than IZ attenuation. Additional studies will be necessary to further explore long-term photoreceptor changes and evaluate their relationship with visual function in MacTel.
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Affiliation(s)
- Janice X. Ong
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Roya Zandi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Amani A. Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
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Scarinci F, Varano M, Parravano M. Resilience of the Photoreceptors in Posterior Multifocal Placoid Pigment Epitheliopathy Observed by Microperimetry over Time. Ocul Immunol Inflamm 2020; 30:379-385. [PMID: 33136457 DOI: 10.1080/09273948.2020.1817502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS To analyze the morphological and functional findings using microperimetry and optical coherence tomography angiography (OCTA) in patients with acute posterior multifocal placoid pigment epitheliopathy (APMPPE). METHODS This retrospective observational case series included four eyes of two patients with APMPPE. Best-corrected visual acuity range was from 20/20 to 20/250. Microperimetry and OCTA evaluation were obtained in the acute and healed phase. The OCTA images of the choriocapillaris were superimposed on the microperimetry map at the last visit. RESULTS The retinal sensitivity improved between the baseline and the last visit in three out of the four eyes. At resolution phase, OCTA revealed zones with choriocapillaris flow deficit, which were associated with points of reduced retinal sensitivity. CONCLUSIONS Microperimetry allows for a better evaluation of the extent of the unhealed functional defect in eyes with AMPPE. The multimodal imaging showed that structural and functional findings were associated in the resolution phase.
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Gascon P, Matonti F, Beylerian M, Feldman A, Comet A, Donnadieu B, Loria O, Denis D, Kodjikian L, Mathis T. Persistent Placoid Maculopathy: Prognosis Factors and Functional Outcomes. Ocul Immunol Inflamm 2020; 28:1136-1148. [PMID: 31419178 DOI: 10.1080/09273948.2019.1645187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To identify prognosis factors and functional outcomes of persistent placoid maculopathy (PPM). Methods: We collected personal PPM cases and combined them with the data from the literature. Results: 68 eyes of 37 patients with PPM were analyzed, including six new cases. Twenty-six patients were men (70%) with a mean age of 51.8 years old. The mean initial visual acuity (VA) was 0.52 LogMar ± 0.55 for a mean final VA of 0.49 LogMar ± 0.51. Risk factors for poor VA included: initial VA less than 0.2 LogMar (p < .0001), cardiovascular risk factor (p = .008), autoimmune-related and/or systemic pro-inflammatory conditions (p = .003), choroidal neovascularization (p = .001), macular atrophy (p = .03) and absence of systemic corticosteroid treatment (p = .03). Conclusion: PPM is a choroidal inflammation. Identifying prognosis factors may help to guide treatment and follow-up. We showed that anti-inflammatory drugs, and anti-VEGF injections in cases of choroidal neovascularization, may lead to better outcomes.
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Affiliation(s)
- Pierre Gascon
- North Hospital of Marseille , Marseille, France.,Timone Institute of Neurosciences, CNRS, Aix-Marseille Université , Marseille, France
| | - Frederic Matonti
- Timone Institute of Neurosciences, CNRS, Aix-Marseille Université , Marseille, France.,Paradis Monticelli Centre , Marseille
| | | | | | - Alban Comet
- North Hospital of Marseille , Marseille, France
| | | | | | | | - Laurent Kodjikian
- Croix-Rousse university Hospital , Lyon, France.,UMR-CNRS 5510 Matéis , Villeurbanne, France
| | - Thibaud Mathis
- Croix-Rousse university Hospital , Lyon, France.,UMR-CNRS 5510 Matéis , Villeurbanne, France
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9
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Determination of Length of Interdigitation Zone by Optical Coherence Tomography and Retinal Sensitivity by Microperimetry and Their Relationship to Progression of Retinitis Pigmentosa. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1217270. [PMID: 31321226 PMCID: PMC6609339 DOI: 10.1155/2019/1217270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/24/2019] [Accepted: 05/30/2019] [Indexed: 01/17/2023]
Abstract
Purpose To investigate the annual progression of retinitis pigmentosa (RP) by changes in retinal sensitivity and length of photoreceptor microstructures. Method The medical records of patients with typical RP followed at Chiba University Hospital were reviewed. The retinal sensitivity was measured by Micro Perimeter-1, and the lengths of the intact external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ) were measured by spectral-domain optical coherence tomography. The baseline values and annual progression rates were determined. The significance of the correlations among these factors was determined by generalized estimating equation regression analysis. Results Forty-six eyes of 24 patients who were examined over a mean follow-up period of 3 years were studied. The annual changes in the retinal sensitivity (p = 0.0035) and the lengths of the EZ (p = 0.037) and IZ (p = 0.0033) were significantly correlated with their baseline values. The annual change in the retinal sensitivity was significantly correlated with the length of the EZ at the baseline (p = 0.020). Conclusions The significant correlation between the annual progression of the retinal sensitivity and the baseline retinal sensitivity and lengths of the EZ and IZ in patients with RP indicate that the retinal sensitivity, the EZ, and the IZ can be useful parameters to predict the annual progression of RP.
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Walters S, Schwarz C, Sharma R, Rossi EA, Fischer WS, DiLoreto DA, Strazzeri J, Nelidova D, Roska B, Hunter JJ, Williams DR, Merigan WH. Cellular-scale evaluation of induced photoreceptor degeneration in the living primate eye. BIOMEDICAL OPTICS EXPRESS 2019; 10:66-82. [PMID: 30775083 PMCID: PMC6363191 DOI: 10.1364/boe.10.000066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 05/06/2023]
Abstract
Progress is needed in developing animal models of photoreceptor degeneration and evaluating such models with longitudinal, noninvasive techniques. We employ confocal scanning laser ophthalmoscopy, optical coherence tomography (OCT) and high-resolution retinal imaging to noninvasively observe the retina of non-human primates with induced photoreceptor degeneration. Photoreceptors were imaged at the single-cell scale in three modalities of adaptive optics scanning light ophthalmoscopy: traditional confocal reflectance, indicative of waveguiding; a non-confocal offset aperture technique visualizing scattered light; and two-photon excited fluorescence, the time-varying signal of which, at 730 nm excitation, is representative of visual cycle function. Assessment of photoreceptor structure and function using these imaging modalities revealed a reduction in retinoid production in cone photoreceptor outer segments while inner segments appeared to remain present. Histology of one retina confirmed loss of outer segments and the presence of intact inner segments. This unique combination of imaging modalities can provide essential, clinically-relevant information on both the structural integrity and function of photoreceptors to not only validate models of photoreceptor degeneration but potentially evaluate the efficacy of future cell and gene-based therapies for vision restoration.
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Affiliation(s)
- Sarah Walters
- The Institute of Optics, University of Rochester, Rochester, NY, USA
- Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Christina Schwarz
- Center for Visual Science, University of Rochester, Rochester, NY, USA
- Currently with the Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
| | - Robin Sharma
- The Institute of Optics, University of Rochester, Rochester, NY, USA
- Center for Visual Science, University of Rochester, Rochester, NY, USA
- Currently with Facebook Reality Labs, Redmond, WA, USA
| | - Ethan A. Rossi
- Center for Visual Science, University of Rochester, Rochester, NY, USA
- Currently with the Departments of Ophthalmology & Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Jennifer Strazzeri
- Center for Visual Science, University of Rochester, Rochester, NY, USA
- Flaum Eye Institute, University of Rochester, Rochester, NY, USA
| | - Dasha Nelidova
- Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Botond Roska
- Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Jennifer J. Hunter
- The Institute of Optics, University of Rochester, Rochester, NY, USA
- Center for Visual Science, University of Rochester, Rochester, NY, USA
- Flaum Eye Institute, University of Rochester, Rochester, NY, USA
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
| | - David R. Williams
- The Institute of Optics, University of Rochester, Rochester, NY, USA
- Center for Visual Science, University of Rochester, Rochester, NY, USA
- Flaum Eye Institute, University of Rochester, Rochester, NY, USA
| | - William H. Merigan
- Center for Visual Science, University of Rochester, Rochester, NY, USA
- Flaum Eye Institute, University of Rochester, Rochester, NY, USA
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OPTICAL COHERENCE TOMOGRAPHY AND HISTOLOGY OF AGE-RELATED MACULAR DEGENERATION SUPPORT MITOCHONDRIA AS REFLECTIVITY SOURCES. Retina 2018; 38:445-461. [PMID: 29210936 DOI: 10.1097/iae.0000000000001946] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Widespread adoption of optical coherence tomography has revolutionized the diagnosis and management of retinal disease. If the cellular and subcellular sources of reflectivity in optical coherence tomography can be identified, the value of this technology will be advanced even further toward precision medicine, mechanistic thinking, and molecular discovery. Four hyperreflective outer retinal bands are created by the exquisite arrangement of photoreceptors, Müller cells, retinal pigment epithelium, and Bruch membrane. Because of massed effects of these axially compartmentalized and transversely aligned cells, reflectivity can be localized to the subcellular level. This review focuses on the second of the four bands, called ellipsoid zone in a consensus clinical lexicon, with the central thesis that mitochondria in photoreceptor inner segments are a major independent reflectivity source in this band, because of Mie scattering and waveguiding. METHODS We review the evolution of Band 2 nomenclature in published literature and discuss the origins of imaging signals from photoreceptor mitochondria that could make these organelles visible in vivo. RESULTS Our recent data pertain to outer retinal tubulation, a unique neurodegenerative and gliotic structure with a highly reflective border, prominent in late age-related macular degeneration. High-resolution histology and multimodal imaging of outer retinal tubulation together provide evidence that inner segment mitochondria undergoing fission and translocation toward the nucleus provide the reflectivity signal. CONCLUSION Our data support adoption of the ellipsoid zone nomenclature. Identifying subcellular signal sources will newly inform clinical.
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CHARACTERIZING PHOTORECEPTOR CHANGES IN ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY USING ADAPTIVE OPTICS. Retina 2018; 38:39-48. [DOI: 10.1097/iae.0000000000001520] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chew AL, Sampson DM, Chelva E, Khan JC, Chen FK. Perifoveal interdigitation zone loss in hydroxychloroquine toxicity leads to subclinical bull's eye lesion appearance on near-infrared reflectance imaging. Doc Ophthalmol 2017; 136:57-68. [PMID: 29124422 PMCID: PMC5811575 DOI: 10.1007/s10633-017-9615-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 09/29/2017] [Indexed: 11/21/2022]
Abstract
Purpose To characterize the ultrastructural and functional correlates of hydroxychloroquine (HCQ)-induced subclinical bull’s eye lesion seen on near-infrared reflectance (NIR) imaging. Methods An asymptomatic 54-year-old male taking HCQ presented with paracentral ring-like scotoma, abnormal multifocal electroretinography (mfERG) and preserved ellipsoid zone on optical coherence tomography (OCT). Dense raster OCT was performed to create en face reflectivity maps of the interdigitation zone. Macular Integrity Assessment (MAIA) microperimetry and mfERG findings were compared with NIR imaging, en face OCT, retinal thickness profiles and wave-guiding cone density maps derived from flood-illumination adaptive optics (AO) retinal photography. Results The bull’s eye lesion is an oval annular zone of increased reflectivity on NIR with an outer diameter of 1450 µm. This region corresponds exactly to an area of preserved interdigitation zone reflectivity in en face OCT images and of normal cone density on AO imaging. Immediately surrounding the bull’s eye lesion is an annular zone (3°–12° eccentricity) of depressed retinal sensitivity on MAIA and reduced amplitude density on mfERG. Wave-guiding cone density at 2° temporal was 25,400 per mm2. This declined rapidly to 12,900 and 1200 per mm2 at 3° and 4°. Conclusion Multimodal imaging illustrated pathology in the area surrounding the NIR bull’s eye, characterized by reduced reflectance, wave-guiding cone density and retinal function. Further studies are required to investigate whether the bull’s eye on NIR imaging and en face OCT is prominent or consistent enough for diagnostic use. Electronic supplementary material The online version of this article (doi:10.1007/s10633-017-9615-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Avenell L Chew
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, Crawley, WA, 6009, Australia
| | - Danuta M Sampson
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, Crawley, WA, 6009, Australia
| | - Enid Chelva
- Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
| | - Jane C Khan
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, Crawley, WA, 6009, Australia.,Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia.,Department of Ophthalmology, Royal Perth Hospital, Perth, WA, 6000, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, Crawley, WA, 6009, Australia. .,Department of Ophthalmology, Royal Perth Hospital, Perth, WA, 6000, Australia.
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CONCURRENT IDIOPATHIC MACULAR TELANGIECTASIA TYPE 2 AND CENTRAL SEROUS CHORIORETINOPATHY. Retina 2017; 38 Suppl 1:S67-S78. [PMID: 29016451 DOI: 10.1097/iae.0000000000001836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe cases presenting with features of idiopathic macular telangiectasia (MacTel) Type 2 and central serous chorioretinopathy (CSC). METHODS Databases from four tertiary retina centers were searched for cases copresenting CSC and MacTel Type 2. RESULTS Five cases were identified (4 men, 1 woman; mean age: 67.2 years). Four patients were referred for chronic or nonresolving CSC, and the diagnosis of MacTel Type 2 was made based on multimodal imaging findings. One patient had advanced MacTel Type 2, and developed acute CSC. Regarding the MacTel Type 2 findings, all subjects presented perifoveal telangiectasia on fluorescein angiography, and four subjects showed intraretinal cavitations typical of MacTel Type 2 on optical coherence tomography, in one or both eyes. Regarding the CSC findings, fluorescein angiography identified focal or extended retinal pigment epithelium alteration in all eyes, and an active leakage in two eyes. Indocyanine green angiography showed choroidal vascular hyperpermeability in four subjects. On optical coherence tomography, pigment epithelial detachments were detected in five eyes (four subjects), and foveal detachments were present in five eyes (three subjects), which spontaneously resolved (two eyes), responded to photodynamic therapy (two eyes), or persisted (one eye). Mean choroidal thickness was 402 ± 99 μm. CONCLUSION The codiagnosis of CSC and MacTel Type 2 should be considered in atypical presentations associating features from both disorders.
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EXPLORING PHOTORECEPTOR REFLECTIVITY THROUGH MULTIMODAL IMAGING OF OUTER RETINAL TUBULATION IN ADVANCED AGE-RELATED MACULAR DEGENERATION. Retina 2017; 37:978-988. [PMID: 27584549 DOI: 10.1097/iae.0000000000001265] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To investigate the microscopic structure of outer retinal tubulation (ORT) and optical properties of cone photoreceptors in vivo, we studied ORT appearance by multimodal imaging, including spectral domain optical coherence tomography (SD-OCT) and adaptive optics scanning laser ophthalmoscopy. METHODS Four eyes of four subjects with advanced age-related macular degeneration underwent color fundus photography, infrared reflectance imaging, SD-OCT, and adaptive optics scanning laser ophthalmoscopy with a high-resolution research instrument. Outer retinal tubulation was identified in closely spaced (11 μm) SD-OCT volume scans. RESULTS Outer retinal tubulation in cross-sectional and en face SD-OCT was a hyporeflective area representing a lumen surrounded by a hyperreflective border consisting of cone photoreceptor mitochondria and external limiting membrane, per previous histology. In contrast, ORT by adaptive optics scanning laser ophthalmoscopy was a hyporeflective structure of the same shape as in en face SD-OCT but lacking visualizable cone photoreceptors. CONCLUSION Lack of ORT cone reflectivity by adaptive optics scanning laser ophthalmoscopy indicates that cones have lost their normal directionality and waveguiding property due to loss of outer segments and subsequent retinal remodeling. Reflective ORT cones by SD-OCT, in contrast, may depend partly on mitochondria as light scatterers within inner segments of these degenerating cells, a phenomenon enhanced by coherent imaging. Multimodal imaging of ORT provides insight into cone degeneration and reflectivity sources in optical coherence tomography.
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Jonnal RS, Gorczynska I, Migacz JV, Azimipour M, Zawadzki RJ, Werner JS. The Properties of Outer Retinal Band Three Investigated With Adaptive-Optics Optical Coherence Tomography. Invest Ophthalmol Vis Sci 2017; 58:4559-4568. [PMID: 28877320 PMCID: PMC5586965 DOI: 10.1167/iovs.16-21138] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 05/17/2017] [Indexed: 12/22/2022] Open
Abstract
Purpose Optical coherence tomography's (OCT) third outer retinal band has been attributed to the zone of interdigitation between RPE cells and cone outer segments. The purpose of this paper is to investigate the structure of this band with adaptive optics (AO)-OCT. Methods Using AO-OCT, images were obtained from two subjects. Axial structure was characterized by measuring band 3 thickness and separation between bands 2 and 3 in segmented cones. Lateral structure was characterized by correlation of band 3 with band 2 and comparison of their power spectra. Band thickness and separation were also measured in a clinical OCT image of one subject. Results Band 3 thickness ranged from 4.3 to 6.4 μm. Band 2 correlations ranged between 0.35 and 0.41 and power spectra of both bands confirmed peak frequencies that agree with histologic density measurements. In clinical images, band 3 thickness was between 14 and 19 μm. Measurements of AO-OCT of interband distance were lower than our corresponding clinical OCT measurements. Conclusions Band 3 originates from a structure with axial extent similar to a single surface. Correlation with band 2 suggests an origin within the cone photoreceptor. These two observations indicate that band 3 corresponds predominantly to cone outer segment tips (COST). Conventional OCT may overestimate both the thickness of band 3 and outer segment length.
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Affiliation(s)
- Ravi S. Jonnal
- Vision Science and Advanced Retinal Imaging Laboratory, University of California, Davis, Sacramento, California, United States
| | - Iwona Gorczynska
- Vision Science and Advanced Retinal Imaging Laboratory, University of California, Davis, Sacramento, California, United States
- Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University, Torun, Poland
| | - Justin V. Migacz
- Vision Science and Advanced Retinal Imaging Laboratory, University of California, Davis, Sacramento, California, United States
| | - Mehdi Azimipour
- Vision Science and Advanced Retinal Imaging Laboratory, University of California, Davis, Sacramento, California, United States
| | - Robert J. Zawadzki
- Vision Science and Advanced Retinal Imaging Laboratory, University of California, Davis, Sacramento, California, United States
| | - John S. Werner
- Vision Science and Advanced Retinal Imaging Laboratory, University of California, Davis, Sacramento, California, United States
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Babeau F, Busetto T, Hamel C, Villain M, Daien V. Adaptive optics: a tool for screening hydroxychloroquine-induced maculopathy? Acta Ophthalmol 2017; 95:e424-e425. [PMID: 27805308 DOI: 10.1111/aos.13276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Fanny Babeau
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France
| | - Timothé Busetto
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France
| | - Christian Hamel
- INSERM U1051, Institute for Neurosciences of Montpellier, Montpellier, France.,Genetics of Sensory Diseases, Gui De Chauliac Hospital, Montpellier, France
| | - Max Villain
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France.,Univ Montpellier 1, Montpellier, France
| | - Vincent Daien
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France.,Univ Montpellier 1, Montpellier, France.,INSERM, U1061, Montpellier, France
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Ra E, Ito Y, Kawano K, Iwase T, Kaneko H, Ueno S, Yasuda S, Kataoka K, Terasaki H. Reply. Am J Ophthalmol 2017; 180:178-179. [PMID: 28577756 DOI: 10.1016/j.ajo.2017.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 05/10/2017] [Indexed: 11/17/2022]
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Sun LW, Johnson RD, Langlo CS, Cooper RF, Razeen MM, Russillo MC, Dubra A, Connor TB, Han DP, Pennesi ME, Kay CN, Weinberg DV, Stepien KE, Carroll J. Assessing Photoreceptor Structure in Retinitis Pigmentosa and Usher Syndrome. Invest Ophthalmol Vis Sci 2017; 57:2428-42. [PMID: 27145477 PMCID: PMC5089122 DOI: 10.1167/iovs.15-18246] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose The purpose of this study was to examine cone photoreceptor structure in retinitis pigmentosa (RP) and Usher syndrome using confocal and nonconfocal split-detector adaptive optics scanning light ophthalmoscopy (AOSLO). Methods Nineteen subjects (11 RP, 8 Usher syndrome) underwent ophthalmic and genetic testing, spectral-domain optical coherence tomography (SD-OCT), and AOSLO imaging. Split-detector images obtained in 11 subjects (7 RP, 4 Usher syndrome) were used to assess remnant cone structure in areas of altered cone reflectivity on confocal AOSLO. Results Despite normal interdigitation zone and ellipsoid zone appearance on OCT, foveal and parafoveal cone densities derived from confocal AOSLO images were significantly lower in Usher syndrome compared with RP. This was due in large part to an increased prevalence of non-waveguiding cones in the Usher syndrome retina. Although significantly correlated to best-corrected visual acuity and foveal sensitivity, cone density can decrease by nearly 38% before visual acuity becomes abnormal. Aberrantly waveguiding cones were noted within the transition zone of all eyes and corresponded to intact inner segment structures. These remnant cones decreased in density and increased in diameter across the transition zone and disappeared with external limiting membrane collapse. Conclusions Foveal cone density can be decreased in RP and Usher syndrome before visible changes on OCT or a decline in visual function. Thus, AOSLO imaging may allow more sensitive monitoring of disease than current methods. However, confocal AOSLO is limited by dependence on cone waveguiding, whereas split-detector AOSLO offers unambiguous and quantifiable visualization of remnant cone inner segment structure. Confocal and split-detector thus offer complementary insights into retinal pathology.
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Affiliation(s)
- Lynn W Sun
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Ryan D Johnson
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Christopher S Langlo
- Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Robert F Cooper
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin, United States
| | - Moataz M Razeen
- Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Madia C Russillo
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Alfredo Dubra
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States 2Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States 3Department of Biomedical Engineering, Ma
| | - Thomas B Connor
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Dennis P Han
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Mark E Pennesi
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
| | - Christine N Kay
- Vitreo Retinal Associates, Gainesville, Florida, United States
| | - David V Weinberg
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Kimberly E Stepien
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Joseph Carroll
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States 2Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States 3Department of Biomedical Engineering, Ma
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Litts KM, Cooper RF, Duncan JL, Carroll J. Photoreceptor-Based Biomarkers in AOSLO Retinal Imaging. Invest Ophthalmol Vis Sci 2017; 58:BIO255-BIO267. [PMID: 28873135 PMCID: PMC5584616 DOI: 10.1167/iovs.17-21868] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/28/2017] [Indexed: 01/08/2023] Open
Abstract
Improved understanding of the mechanisms underlying inherited retinal degenerations has created the possibility of developing much needed treatments for these relentless, blinding diseases. However, standard clinical indicators of retinal health (such as visual acuity and visual field sensitivity) are insensitive measures of photoreceptor survival. In many retinal degenerations, significant photoreceptor loss must occur before measurable differences in visual function are observed. Thus, there is a recognized need for more sensitive outcome measures to assess therapeutic efficacy as numerous clinical trials are getting underway. Adaptive optics (AO) retinal imaging techniques correct for the monochromatic aberrations of the eye and can be used to provide nearly diffraction-limited images of the retina. Many groups routinely are using AO imaging tools to obtain in vivo images of the rod and cone photoreceptor mosaic, and it now is possible to monitor photoreceptor structure over time with single cell resolution. Highlighting recent work using AO scanning light ophthalmoscopy (AOSLO) across a range of patient populations, we review the development of photoreceptor-based metrics (e.g., density/geometry, reflectivity, and size) as candidate biomarkers. Going forward, there is a need for further development of automated tools and normative databases, with the latter facilitating the comparison of data sets across research groups and devices. Ongoing and future clinical trials for inherited retinal diseases will benefit from the improved resolution and sensitivity that multimodal AO retinal imaging affords to evaluate safety and efficacy of emerging therapies.
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Affiliation(s)
- Katie M. Litts
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Robert F. Cooper
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Jacque L. Duncan
- Department of Ophthalmology, University of California, San Francisco, California, United States
| | - Joseph Carroll
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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Regeneration of Photoreceptor Outer Segments After Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment. Am J Ophthalmol 2017; 177:17-26. [PMID: 28189482 DOI: 10.1016/j.ajo.2017.01.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/28/2017] [Accepted: 01/30/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate the regeneration of the cone outer segments in eyes after surgery for fovea-off rhegmatogenous retinal detachment with an adaptive optics (AO) fundus camera and to correlate these findings with the findings of optical coherence tomography (OCT). DESIGN Retrospective, observational case series. METHODS Medical charts of 21 eyes of 21 patients who had undergone surgery for fovea-off rhegmatogenous retinal detachment were retrospectively studied. Cone mosaic images were obtained with an AO fundus camera. Cone packing density at 2 degrees from the fovea within the previously detached area was measured 6 and 12 months after surgery. Retinal thicknesses between the interdigitation zone and the retinal pigment epithelium (IZ-RPE) and between the ellipsoid zone and the retinal pigment epithelium (EZ-RPE) were measured in OCT images. RESULTS Cone density 12 months after surgery was significantly increased from that at 6 months (P = .001), but was still significantly lower than that of normal fellow eyes (P < .001). IZ-RPE and EZ-RPE thickness significantly increased from 6 to 12 months (P = .045, P = .033, respectively), and these values were not significantly different from those of normal fellow eyes. Multivariate analysis showed that cone density at 12 months was significantly associated with IZ-RPE thickness (P = .002), and increases in cone packing density were significantly associated with increases in IZ-RPE thickness (P = .001). CONCLUSIONS Recovery of cone packing density measured by AO was associated with structural recovery of the outer retina observed in OCT, suggesting regeneration of the photoreceptor outer segment after surgery.
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Gaudric A, Mrejen S. WHY THE DOTS ARE BLACK ONLY IN THE LATE PHASE OF THE INDOCYANINE GREEN ANGIOGRAPHY IN MULTIPLE EVANESCENT WHITE DOT SYNDROME. Retin Cases Brief Rep 2017; 11 Suppl 1:S81-S85. [PMID: 27662233 DOI: 10.1097/icb.0000000000000422] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To determine what retinal layer is primarily involved in multiple evanescent white dot syndrome compared with acute posterior multifocal placoid pigment epitheliopathy using multimodal imaging including indocyanine green angiography. METHODS Color fundus photographs and fluorescein angiography, ICGA and spectral domain optical coherence tomography images of two typical acute cases, one of acute posterior multifocal placoid pigment epitheliopathy and one of multiple evanescent white dot syndrome, were assessed and compared. RESULTS In both diseases, white plaques or dots were seen at the posterior pole. The hypofluorescence of acute posterior multifocal placoid pigment epitheliopathy in the early phase of the fluorescein angiography and throughout the ICGA sequence suggested a multifocal choroidal hypoperfusion as the cause of the opacification of the outer retina corresponding to its hyper-reflectivity on spectral domain optical coherence tomography. In multiple evanescent white dot syndrome, there was no choroidal filling defect and the white spots were silent in the early phase of the ICGA, whereas they became black only in the late phase. The outer retina was also altered at the spots. CONCLUSION In multiple evanescent white dot syndrome, the late hypofluorescence of the white spots on ICGA was likely due to the absence of ICG uptake by a damaged retinal pigment epithelium. Multiple evanescent white dot syndrome seems as a primary reversible nondestructive retinal pigment epitheliopathy, whereas acute posterior multifocal placoid pigment epitheliopathy is a true choroidopathy.
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Affiliation(s)
- Alain Gaudric
- *Service d'Ophtalmologie, AP-HP, Hôpital Lariboisière, Université Paris Diderot, Paris, France; and †Quinze-Vingts Hospital Departement Hospitalo-Universitaire SightMaintain, Institut National de la Recherche Medicale (INSERM)-Direction de l'Hospitalisation et de l'Organisation des Soins CIC, Paris, France
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Khanna S, Nesper PL, Koreishi AF, Goldstein DA, Fawzi AA. Visualization of Photoreceptors in Birdshot Chorioretinopathy Using Adaptive Optics Scanning Laser Ophthalmoscopy: A Pilot Study. Ocul Immunol Inflamm 2017; 25:610-620. [PMID: 28362542 DOI: 10.1080/09273948.2017.1298819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Adaptive optics scanning laser ophthalmoscopy (AOSLO) allows en face visualization of specific layers of the retina. This pilot study evaluated the ability of AOSLO to visualize photoreceptor integrity in patients with birdshot chorioretinopathy (BCR). METHOD A total of 16 consecutive patients with HLA-A29+ BCR were imaged using the prototype Apaeros retinal imaging system. Images of high quality were aligned with infrared reflectance photos and correlated with spectral domain optical coherence tomography (SD-OCT). RESULTS Images of four eyes of three patients were of sufficient quality to allow posterior pole montage and point-to-point correlation with SD-OCT. Areas of photoreceptor disruption on SD-OCT were seen as patchy areas of loss on AOSLO, whereas areas of intact interdigitation zone and inner segment/outer segment junction correlated with normal appearing photoreceptors on AOSLO. CONCLUSIONS Using AOSLO, we found one instance of subclinical photoreceptor disruption not seen on SD-OCT. Ultimately, there are unique challenges associated with imaging BCR patients using AOSLO.
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Affiliation(s)
- Sheena Khanna
- a Feinberg School of Medicine, Northwestern University , Chicago , Illinois , USA
| | - Peter L Nesper
- b Department of Ophthalmology , Feinberg School of Medicine, Northwestern University , Chicago , Illinois , USA
| | - Anjum F Koreishi
- b Department of Ophthalmology , Feinberg School of Medicine, Northwestern University , Chicago , Illinois , USA
| | - Debra A Goldstein
- b Department of Ophthalmology , Feinberg School of Medicine, Northwestern University , Chicago , Illinois , USA
| | - Amani A Fawzi
- b Department of Ophthalmology , Feinberg School of Medicine, Northwestern University , Chicago , Illinois , USA
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Yusuf IH, Sharma S, Luqmani R, Downes SM. Hydroxychloroquine retinopathy. Eye (Lond) 2017; 31:828-845. [PMID: 28282061 DOI: 10.1038/eye.2016.298] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 08/24/2016] [Indexed: 12/16/2022] Open
Abstract
Hydroxychloroquine (HCQ; Plaquenil) is used increasingly in the management of a variety of autoimmune disorders, with well established roles in dermatology and rheumatology and emerging roles in oncology. Hydroxychloroquine has demonstrated a survival benefit in patients with systemic lupus erythematosus; some clinicians advocate its use in all such patients. However, Hydroxychloroquine and chloroquine (CQ) have been associated with irreversible visual loss due to retinal toxicity. Hydroxychloroquine retinal toxicity is far more common than previously considered; an overall prevalence of 7.5% was identified in patients taking HCQ for greater than 5 years, rising to almost 20% after 20 years of treatment. This review aims to provide an update on HCQ/CQ retinopathy. We summarise emerging treatment indications and evidence of efficacy in systemic disease, risk factors for retinopathy, prevalence among HCQ users, diagnostic tests, and management of HCQ retinopathy. We highlight emerging risk factors such as tamoxifen use, and new guidance on safe dosing, reversing the previous recommendation to use ideal body weight, rather than actual body weight. We summarise uncertainties and the recommendations made by existing HCQ screening programmes. Asian patients with HCQ retinopathy may demonstrate an extramacular or pericentral pattern of disease; visual field testing and retinal imaging should include a wider field for screening in this group. HCQ is generally safe and effective for the treatment of systemic disease but because of the risk of HCQ retinal toxicity, modern screening methods and ideal dosing should be implemented. Guidelines regarding optimal dosing and screening regarding HCQ need to be more widely disseminated.
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Affiliation(s)
- I H Yusuf
- The Oxford Eye Hospital, West Wing, John Radcliffe Hospital, Oxford, UK
| | - S Sharma
- The Oxford Eye Hospital, West Wing, John Radcliffe Hospital, Oxford, UK
| | - R Luqmani
- Department of Rheumatology, Nuffield Orthopaedic Centre, Oxford, UK
| | - S M Downes
- The Oxford Eye Hospital, West Wing, John Radcliffe Hospital, Oxford, UK
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Lo Giudice G, Catania AG, Galan A. Adaptive optics study of photoreceptors layer damage from presumed sun exposure: A case report. Indian J Ophthalmol 2016; 64:860-861. [PMID: 27958216 PMCID: PMC5200995 DOI: 10.4103/0301-4738.195619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - Alessandro Galan
- San Paolo Ophthalmic Center, San Antonio Hospital, Padova, Italy
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Mariotti L, Devaney N, Lombardo G, Lombardo M. Understanding the changes of cone reflectance in adaptive optics flood illumination retinal images over three years. BIOMEDICAL OPTICS EXPRESS 2016; 7:2807-22. [PMID: 27446708 PMCID: PMC4948632 DOI: 10.1364/boe.7.002807] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/12/2016] [Accepted: 05/12/2016] [Indexed: 05/18/2023]
Abstract
Although there is increasing interest in the investigation of cone reflectance variability, little is understood about its characteristics over long time scales. Cone detection and its automation is now becoming a fundamental step in the assessment and monitoring of the health of the retina and in the understanding of the photoreceptor physiology. In this work we provide an insight into the cone reflectance variability over time scales ranging from minutes to three years on the same eye, and for large areas of the retina (≥ 2.0 × 2.0 degrees) at two different retinal eccentricities using a commercial adaptive optics (AO) flood illumination retinal camera. We observed that the difference in reflectance observed in the cones increases with the time separation between the data acquisitions and this may have a negative impact on algorithms attempting to track cones over time. In addition, we determined that displacements of the light source within 0.35 mm of the pupil center, which is the farthest location from the pupil center used by operators of the AO camera to acquire high-quality images of the cone mosaic in clinical studies, does not significantly affect the cone detection and density estimation.
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Affiliation(s)
- Letizia Mariotti
- Applied Optics Group, School of Physics, National University of Ireland, Galway,
Ireland
| | - Nicholas Devaney
- Applied Optics Group, School of Physics, National University of Ireland, Galway,
Ireland
| | - Giuseppe Lombardo
- Istituto per i Processi Chimico-Fisici, Consiglio Nazionale delle Ricerche, Viale F. Stagno D’Alcontres 37, 98158, Messina,
Italy
- Vision Engineering Italy srl, Via Adda 7, 00198 Rome,
Italy
| | - Marco Lombardo
- Fondazione G.B. Bietti IRCCS, Via Livenza 3, 00198 Rome,
Italy
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Nakamura T, Ueda-Consolvo T, Oiwake T, Hayashi A. Correlation between outer retinal layer thickness and cone density in patients with resolved central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2016; 254:2347-2354. [DOI: 10.1007/s00417-016-3403-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/27/2016] [Accepted: 05/25/2016] [Indexed: 01/03/2023] Open
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Bruce KS, Harmening WM, Langston BR, Tuten WS, Roorda A, Sincich LC. Normal Perceptual Sensitivity Arising From Weakly Reflective Cone Photoreceptors. Invest Ophthalmol Vis Sci 2015; 56:4431-8. [PMID: 26193919 PMCID: PMC4509056 DOI: 10.1167/iovs.15-16547] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/22/2015] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine the light sensitivity of poorly reflective cones observed in retinas of normal subjects, and to establish a relationship between cone reflectivity and perceptual threshold. METHODS Five subjects (four male, one female) with normal vision were imaged longitudinally (7-26 imaging sessions, representing 82-896 days) using adaptive optics scanning laser ophthalmoscopy (AOSLO) to monitor cone reflectance. Ten cones with unusually low reflectivity, as well as 10 normally reflective cones serving as controls, were targeted for perceptual testing. Cone-sized stimuli were delivered to the targeted cones and luminance increment thresholds were quantified. Thresholds were measured three to five times per session for each cone in the 10 pairs, all located 2.2 to 3.3° from the center of gaze. RESULTS Compared with other cones in the same retinal area, three of 10 monitored dark cones were persistently poorly reflective, while seven occasionally manifested normal reflectance. Tested psychophysically, all 10 dark cones had thresholds comparable with those from normally reflecting cones measured concurrently (P = 0.49). The variation observed in dark cone thresholds also matched the wide variation seen in a large population (n = 56 cone pairs, six subjects) of normal cones; in the latter, no correlation was found between cone reflectivity and threshold (P = 0.0502). CONCLUSIONS Low cone reflectance cannot be used as a reliable indicator of cone sensitivity to light in normal retinas. To improve assessment of early retinal pathology, other diagnostic criteria should be employed along with imaging and cone-based microperimetry.
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Affiliation(s)
- Kady S. Bruce
- Department of Vision Sciences University of Alabama at Birmingham, Birmingham, Alabama, United States
| | | | - Bradley R. Langston
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - William S. Tuten
- School of Optometry, Vision Science Graduate Group, University of California at Berkeley, Berkeley, California, United States
| | - Austin Roorda
- School of Optometry, Vision Science Graduate Group, University of California at Berkeley, Berkeley, California, United States
| | - Lawrence C. Sincich
- Department of Vision Sciences University of Alabama at Birmingham, Birmingham, Alabama, United States
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