1
|
Fang D, Liang J, Diao Y, Cui D, Hou F, Zheng B, Zheng H, Pan C, Feng L, Li W, Xie T, Li P, Zhang J, Zhang G, Chen L, Zhang S. Morphologic and Functional Assessment of Photoreceptors in Laser-Induced Retinopathy Using Adaptive Optics Scanning Laser Ophthalmoscopy and Microperimetry. Am J Ophthalmol 2024; 265:61-72. [PMID: 38555010 DOI: 10.1016/j.ajo.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE To assess the cone photoreceptors' morphology and associated retinal sensitivity in laser-induced retinopathy (LIR) using adaptive optics scanning laser ophthalmoscopy (AO-SLO) and microperimetry (MP). DESIGN Cohort study. METHODS This study included 13 patients (15 eyes) with LIR and 38 age-matched healthy volunteers (38 eyes). Participants underwent comprehensive evaluations including AO-SLO, MP, and spectral-domain OCT. Lesion morphology, cone density, dispersion, and regularity in AO-SLO were assessed and correlated with visual function. RESULTS In AO-SLO images, LIR lesions were predominantly characterized by hyporeflective regions, suggesting potential cone loss at the fovea, accompanied by the presence of sizable clumps of hyperreflective material within these lesions. The average size of lesions in affected eyes was 97,128±107,478 µm², ranging from 6705 to 673,348 µm². Compared with the healthy contralateral eye and control group, LIR demonstrated significantly reduced cone density, increased cone dispersion, and notably decreased cone regularity in all 4 quadrants at 3° eccentricity (all P values < .05). Lesion morphology in AO-SLO correlated with ellipsoid zone defects observed in OCT, showing a positive correlation in size (r = 0.84, P < .001) but not with retinal sensitivities (P = .09). Similarly, cone density at 3° eccentricity did not correlate with retinal sensitivities (P = .13). CONCLUSIONS AND RELEVANCE The study provides crucial insights into the morphologic and functional impacts of LIR on cone photoreceptors, revealing significant morphologic changes in cones that do not consistently align with functional outcomes. This research highlights the need for continued exploration into the relationship between retinal structure and function in LIR, and the importance of heightened public awareness and preventive strategies to mitigate the risk of LIR.
Collapse
Affiliation(s)
- Dong Fang
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Jia Liang
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Yingying Diao
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Dongmei Cui
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Fei Hou
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Bingru Zheng
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Huiyan Zheng
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Changfeng Pan
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Lujia Feng
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Wangting Li
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Ting Xie
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Pengfeng Li
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Jie Zhang
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong; Advanced Ophthalmology Laboratory, Robotrak Technologies (J.Z.), Nanjing, China
| | - Guoming Zhang
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Lu Chen
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong.
| | - Shaochong Zhang
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong.
| |
Collapse
|
2
|
Reiter GS, Bogunovic H, Schlanitz F, Vogl WD, Seeböck P, Ramazanova D, Schmidt-Erfurth U. Point-to-point associations of drusen and hyperreflective foci volumes with retinal sensitivity in non-exudative age-related macular degeneration. Eye (Lond) 2023; 37:3582-3588. [PMID: 37170011 PMCID: PMC10686390 DOI: 10.1038/s41433-023-02554-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 04/13/2023] [Accepted: 04/20/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES To evaluate the quantitative impact of drusen and hyperreflective foci (HRF) volumes on mesopic retinal sensitivity in non-exudative age-related macular degeneration (AMD). METHODS In a standardized follow-up scheme of every three months, retinal sensitivity of patients with early or intermediate AMD was assessed by microperimetry using a custom pattern of 45 stimuli (Nidek MP-3, Gamagori, Japan). Eyes were consecutively scanned using Spectralis SD-OCT (20° × 20°, 1024 × 97 × 496). Fundus photographs obtained by the MP-3 allowed to map the stimuli locations onto the corresponding OCT scans. The volume and mean thickness of drusen and HRF within a circle of 240 µm centred at each stimulus point was determined using automated AI-based image segmentation algorithms. RESULTS 8055 individual stimuli from 179 visits from 51 eyes of 35 consecutive patients were matched with the respective OCT images in a point-to-point manner. The patients mean age was 76.85 ± 6.6 years. Mean retinal sensitivity at baseline was 25.7 dB. 73.47% of all MP-spots covered drusen area and 2.02% of MP-spots covered HRF. A negative association between retinal sensitivity and the volume of underlying drusen (p < 0.001, Estimate -0.991 db/µm3) and HRF volume (p = 0.002, Estimate -5.230 db/µm3) was found. During observation time, no eye showed conversion to advanced AMD. CONCLUSION A direct correlation between drusen and lower sensitivity of the overlying photoreceptors can be observed. For HRF, a small but significant correlation was shown, which is compromised by their small size. Biomarker quantification using AI-methods allows to determine the impact of sub-clinical features in the progression of AMD.
Collapse
Affiliation(s)
- Gregor S Reiter
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Hrvoje Bogunovic
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ferdinand Schlanitz
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | | | - Philipp Seeböck
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Dariga Ramazanova
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
3
|
Dentel A, Brazhnikova E, Norberg N, Jaillard C, Grieve K, Paques M, Sahel JA, Bertin S, Forster V, Picaud S. Adaptive Optics Flood Illumination Ophthalmoscopy in Nonhuman Primates: Findings in Normal and Short-term Induced Detached Retinae. OPHTHALMOLOGY SCIENCE 2023; 3:100316. [PMID: 37274010 PMCID: PMC10238594 DOI: 10.1016/j.xops.2023.100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/18/2023] [Accepted: 04/13/2023] [Indexed: 06/06/2023]
Abstract
Objective To describe adaptive optics flood illumination ophthalmoscopy (AO-FIO) of the photoreceptor layer in normal nonhuman primates (NHPs) and in the case of a short-term induced retinal detachment (RD). Design Longitudinal fundamental research study. Subjects Four NHPs were used to image normal retinae with AO-FIO (in comparison with 4 healthy humans); 2 NHPs were used to assess the effects of RD. Intervention The photoreceptor layer (cone mosaic metrics, including cone density, cone spacing, and cone regularity) was followed with AO-FIO imaging (rtx1, Imagine Eyes) during a surgically induced RD in 2 NHPs using a vehicle solution containing dimethyl sulfoxide, classically used as a chemical solvent. We also performed functional testing of the retina (full-field and multifocal electroretinogram [ERG]). Main Outcome Measures Correlation of cone mosaic metrics (cone density, spacing, and regularity) between normal retinae of NHPs and humans, and cone metrics, power spectrum, and ERG wave amplitudes after RD. Results Imaging features were very similar in terms of cone reflectivity, cell density, regularity, and spacing values, showing strong positive correlations between NHPs and humans. After RD, AO-FIO revealed several alterations of the cone mosaic slowly recovering during the 3 months after the reattachment, which were not detected functionally by ERG. Conclusions These results demonstrate by in vivo AO-FIO imaging the transient structural changes of photoreceptors after an RD in the primate retina. They also provide an interesting illustration of the AO-FIO potential for investigating photoreceptor toxicity during preclinical studies in NHPs with a high translatability to human studies. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
Collapse
Affiliation(s)
- Alexandre Dentel
- Institut de la Vision, INSERM, CNRS, Sorbonne Université, Paris, France
| | - Elena Brazhnikova
- Institut de la Vision, INSERM, CNRS, Sorbonne Université, Paris, France
| | | | - Céline Jaillard
- Institut de la Vision, INSERM, CNRS, Sorbonne Université, Paris, France
| | - Kate Grieve
- CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, Paris, France
| | - Michel Paques
- Institut de la Vision, INSERM, CNRS, Sorbonne Université, Paris, France
- CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, Paris, France
| | - José A. Sahel
- Institut de la Vision, INSERM, CNRS, Sorbonne Université, Paris, France
- CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, Paris, France
- Department of Ophthalmology, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania
| | | | - Valérie Forster
- Institut de la Vision, INSERM, CNRS, Sorbonne Université, Paris, France
| | - Serge Picaud
- Institut de la Vision, INSERM, CNRS, Sorbonne Université, Paris, France
| |
Collapse
|
4
|
Huvard MJ, Patnaik JL, Kleinman DM, Preston M, Zacks DN, Kocab AJ, van de Goor J, Wagner BD, Cho S, Lynch AM, Mandava N. An Evaluation of the Repeatability of Visual Function Following Surgical Repair of Macula-Off Rhegmatogenous Retinal Detachment. Transl Vis Sci Technol 2023; 12:35. [PMID: 38019499 PMCID: PMC10691393 DOI: 10.1167/tvst.12.11.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 10/21/2023] [Indexed: 11/30/2023] Open
Abstract
Purpose To evaluate the reliability and reproducibility of visual function assessments for patients with macula-off rhegmatogenous retinal detachment (RRD). Methods This prospective study included patients with unilateral macula-off RRD of <10-day duration successfully treated with a single, uncomplicated surgery at least 1 year following repair. Visual function assessments were performed at time of enrollment and 1 month later. Testing included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA), low-luminance visual acuity (LLVA), low-contrast visual acuity (VA) 2.5% and 5%, contrast sensitivity assessment with Mars and Gabor patches, reading speed (acuity, speed, and critical print size), color vision testing (protan, deutan, and tritan), and microperimetry. Spectral-domain ocular coherence tomography (SD-OCT) was performed. Paired t-statistics were used to compare values between visits and between the study and fellow eyes. Results Fourteen patients (9 male, 5 female) with a mean age of 69 years at time of surgery were evaluated. Correlation coefficients across the two visits were highest for ETDRS BCVA (0.97), tritan color vision testing (0.96), and low-contrast VA 5% (0.96), while the average t-statistic was largest for low-luminance deficit (4.2), ETDRS BCVA (4.1), and reading speed critical print size (3.7). ETDRS BCVA did not correlate with SD-OCT findings. Conclusions ETDRS BCVA can be considered a highly reliable and reproducible outcome measure. LLVA, protan color discrimination, contrast sensitivity, and reading speed may be useful secondary outcome measures. Translational Relevance This study provides guidance on the selection of visual function outcome measures for clinical trials of patients with macula-off RRD.
Collapse
Affiliation(s)
- Michael J. Huvard
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI, USA
| | - Jennifer L. Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - David M. Kleinman
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Mary Preston
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - David N. Zacks
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI, USA
| | | | | | | | - Steve Cho
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anne M. Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Naresh Mandava
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
5
|
Barequet D, Shemesh R, Zvi D, Cohen R, Trivizki O, Schwartz S, Barak A, Loewenstein A, Rabina G. Functional and anatomical outcomes of fovea on, fovea off and fovea-splitting rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol 2023; 261:3187-3192. [PMID: 37477738 DOI: 10.1007/s00417-023-06169-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 06/12/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023] Open
Abstract
PURPOSE To compare the anatomical and functional outcomes of fovea-on, fovea-off, and fovea-split rhegmatogenous retinal detachment (RRD). METHODS Retrospective case series of consecutive patients diagnosed with RRD and treated with only pars plana vitrectomy (PPV). Preoperative and postoperative optical coherence tomography (OCT) and functional outcomes were obtained prior to and 6 months after surgery. RRD extending to the edge of the fovea on OCT was termed fovea-split RRD. RESULTS A total of 152 eyes were included, out of which 89 eyes presented with a fovea-off, 36 with a fovea-on, and 27 with a fovea-split RRD. The mean visual acuity (VA) preoperatively was 1.32 ± 0.58 logMAR (20/400 equivalent on Snellen chart), 0.19 ± 0.20 (20/30), and 0.71 ± 0.56 (20/100) for the fovea-off, fovea-on, and fovea-split groups, respectively (p < 0.001). The mean VA at 6 months of follow-up significantly improved for the fovea-split and fovea-off groups to 0.54 ± 0.79 (20/70) (p < 0.001) and 0.45 ± 0.29 (20/50) (p = 0.01), respectively, and remained stable for the fovea-on group 0.24 ± 0.20 (20/30) (p = 0.25). Differences in alterations of the outer retinal layers (p < 0.001) and in the in-segment/outer-segment ratio (p < 0.001) were found between the groups. CONCLUSION Eyes with fovea-split RRD had both a preoperative and a final postoperative VA between those of fovea-on and fovea-off eyes and different anatomical changes on OCT. This new entity warrants different patient expectations for postoperative outcomes.
Collapse
Affiliation(s)
- Dana Barequet
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Rachel Shemesh
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Dana Zvi
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ram Cohen
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Omer Trivizki
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shulamit Schwartz
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Adiel Barak
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad Rabina
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
6
|
Anguita R, Charteris D. Visual loss in surgical retinal disease: retinal imaging and photoreceptor cell counts. Br J Ophthalmol 2023; 107:1583-1589. [PMID: 36396343 DOI: 10.1136/bjo-2022-321845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022]
Abstract
Vision loss after detachment of the neurosensory retina is a complex process which is not fully understood. Clinical factors have been identified which contribute to loss of macular function after retinal detachment and laboratory studies have played an important role in understanding the cellular and subcellular pathological processes which underlie the loss of visual function. As clinical imaging has advanced, multiple studies have focused on identifying and correlating clinicopathological features with visual outcomes in patients with rhegmatogenous retinal detachment. Optical coherence tomography, fundus autofluorescence, optical coherence tomography angiography and adaptive optics studies have contributed to the understanding of the anatomical changes in relation to clinical outcomes. A clear understanding of the macular pathology of retinal detachment is fundamental to develop strategies to improve outcomes in patients with rhegmatogenous retinal detachment and analogous retinal diseases where macular neurosensory retinal detachment is part of the pathology. This review assesses the evidence from experimental and pathological studies together with clinical imaging analyses (optical coherence tomography, fundus autofluorescence, optical coherence tomography angiography and adaptive optics) and the contribution of these studies to our understanding of visual outcomes.
Collapse
Affiliation(s)
- Rodrigo Anguita
- Vitreoretinal Unit, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - David Charteris
- Vitreoretinal Unit, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
7
|
Kalas T, Newman A, Whyte J, Sharma A. Clinical utilization of microperimetry in ophthalmic surgery: A narrative review. Surv Ophthalmol 2023:S0039-6257(23)00142-X. [PMID: 37918576 DOI: 10.1016/j.survophthal.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
Microperimetry is an emerging technology that provides concurrent analysis of retinal structure and function by combining retinal sensitivity and fixation analysis with fundus imaging. We summarize the substantial evidence validating the evolving role of microperimetry as an adjunctive assessment of visual function in the perioperative setting. We show that microperimetry provides useful complementary information to other established imaging and functional modalities in the perioperative setting for a wide range of vitreoretinal surgical procedures, as well as in cataract and refractive surgeries. This includes preoperative uses such as prognostication of visual and anatomical outcomes, timing of surgical intervention, and assessment of patient suitability for surgery-as well as postoperative uses including quantification of visual recovery, investigation of unexplained postoperative vision loss, and informing expected long term functional outcomes.
Collapse
Affiliation(s)
- Timothy Kalas
- Department of Ophthalmology, Queensland Children's Hospital, Queensland, Australia.
| | - Alexander Newman
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Jonathan Whyte
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Abhishek Sharma
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Queensland Eye Institute, South Brisbane, Queensland, Australia
| |
Collapse
|
8
|
Felfeli T, Mandelcorn MS, Trussart R, Mandelcorn ED. PREOPERATIVE GAS FOR PARS PLANA VITRECTOMY: A SURGICAL TECHNIQUE FOR REPAIR OF RHEGMATOGENOUS RETINAL DETACHMENTS WITH MULTIPLE, LARGE, OR INFERIOR BREAKS. Retin Cases Brief Rep 2023; 17:374-379. [PMID: 34652305 PMCID: PMC10284130 DOI: 10.1097/icb.0000000000001197] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the role of preoperative gas for pars plana vitrectomy (PGP) as an adjunct to surgical repair of rhegmatogenous retinal detachment (RRD). METHODS This is a retrospective consecutive case series of all rhegmatogenous retinal detachments with multiple breaks in more than one quadrant, large breaks extending greater than one clock hour, and/or inferior breaks requiring PPV, who received intravitreal injection of sulfur hexafluoride (SF 6 ) or perfluoropropane (C 3 F 8 ) 1-2 weeks before PPV between 2016 and 2020 at a tertiary care center. RESULTS A total of 109 eyes underwent the PGP technique, 73% of which had macular involvement. The rhegmatogenous retinal detachments on average involved 5.5 (SD 2.1) clock hours with inferior retinal breaks in 51%. Based on clinical examination, subretinal fluid was noted to be dissipated in parts of the detached retina before PPV in 57% of cases. The use of perfluorocarbon heavy liquid or posterior drainage retinotomy was required in 16% of cases. A 95% primary anatomical success rate was achieved over the median 177 (interquartile range 105-526) follow-up days. A final visual acuity of 20/50 or better was achieved in 65%. CONCLUSION PGP as an adjunct to PPV may facilitate ease of surgery, as well as anatomical and functional success for rhegmatogenous retinal detachments with multiple, large, and/or inferior breaks.
Collapse
Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- The Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark S. Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; and
| | - Rachel Trussart
- Hospital Affiliated University Regional, Trois-Rivières, Quebec, Canada
| | - Efrem D. Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; and
| |
Collapse
|
9
|
Muni RH, Lee WW, Bansal A, Ramachandran A, Hillier RJ. A paradigm shift in retinal detachment repair: The concept of integrity. Prog Retin Eye Res 2022; 91:101079. [DOI: 10.1016/j.preteyeres.2022.101079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022]
|
10
|
Optical Coherence Tomography Findings in Rhegmatogenous Retinal Detachment: A Systematic Review. J Clin Med 2022; 11:jcm11195819. [PMID: 36233684 PMCID: PMC9571044 DOI: 10.3390/jcm11195819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/25/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Rhegmatogenous retinal detachment is a sight-threatening condition that may lead to blindness if left untreated. Surgical treatments may vary and are tailored to a single patient. Anatomical and functional results may vary, due to factors that are currently under study. Optical coherence tomography (OCT) allows a detailed visualization of the retinal structure. Some studies have been performed using OCT on eyes with retinal detachment. We performed a review on the subject. Several data have been obtained using different OCT applications. Some alterations may represent potential biomarkers since they are associated with visual and anatomical prognoses. Increased knowledge on the subject may be helpful to choose among different surgical strategies and endotamponades. More research on the topic is needed.
Collapse
|
11
|
Alexopoulos P, Madu C, Wollstein G, Schuman JS. The Development and Clinical Application of Innovative Optical Ophthalmic Imaging Techniques. Front Med (Lausanne) 2022; 9:891369. [PMID: 35847772 PMCID: PMC9279625 DOI: 10.3389/fmed.2022.891369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022] Open
Abstract
The field of ophthalmic imaging has grown substantially over the last years. Massive improvements in image processing and computer hardware have allowed the emergence of multiple imaging techniques of the eye that can transform patient care. The purpose of this review is to describe the most recent advances in eye imaging and explain how new technologies and imaging methods can be utilized in a clinical setting. The introduction of optical coherence tomography (OCT) was a revolution in eye imaging and has since become the standard of care for a plethora of conditions. Its most recent iterations, OCT angiography, and visible light OCT, as well as imaging modalities, such as fluorescent lifetime imaging ophthalmoscopy, would allow a more thorough evaluation of patients and provide additional information on disease processes. Toward that goal, the application of adaptive optics (AO) and full-field scanning to a variety of eye imaging techniques has further allowed the histologic study of single cells in the retina and anterior segment. Toward the goal of remote eye care and more accessible eye imaging, methods such as handheld OCT devices and imaging through smartphones, have emerged. Finally, incorporating artificial intelligence (AI) in eye images has the potential to become a new milestone for eye imaging while also contributing in social aspects of eye care.
Collapse
Affiliation(s)
- Palaiologos Alexopoulos
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Chisom Madu
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Gadi Wollstein
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, United States
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, United States
- Center for Neural Science, College of Arts & Science, New York University, New York, NY, United States
| | - Joel S. Schuman
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, United States
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, United States
- Center for Neural Science, College of Arts & Science, New York University, New York, NY, United States
- Department of Electrical and Computer Engineering, NYU Tandon School of Engineering, Brooklyn, NY, United States
| |
Collapse
|
12
|
Datlinger F, Datlinger A, Pollreisz A, Sacu S, Schmidt-Erfurth U, Datlinger P. Intraprocedural OCT monitoring of the immediate treatment response during indocyanine green angiography-guided laser therapy of teleangiectatic capillaries in diabetic macular edema. Sci Rep 2022; 12:2315. [PMID: 35145156 PMCID: PMC8831600 DOI: 10.1038/s41598-022-05950-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/20/2022] [Indexed: 11/24/2022] Open
Abstract
In this retrospective study the morphological response of teleangiectatic capillaries (TCs) to focal laser treatment and the functional and morphological outcome after Indocyanine green angiography (ICGA)-guided laser therapy was evaluated. TCs in eyes with diabetic macular edema (DME) were treated with laser therapy. The immediate and subsequent reaction of the TCs lumina to direct photocoagulation was monitored with customized OCT single scans. Additionally, patients were treated with intravitreal anti-VEGF as needed. 12 eyes of 9 patients with treatment naive (6 eyes) and pretreated (6 eyes) DME were followed-up for a mean of 24 months (± 8.1SD). Best-corrected visual acuity improved from 0.25 logMar (± 0.2SD) to 0.12 (± 0.10SD; p = 0.06) at each patient’s last visit. During laser treatment a darkening of the TCs lumina was achieved in 91.3% of lesions. All these lesions fully resolved, whereas TCs, which showed no darkening of their lumen in OCT persisted and required re-treatment with laser. Additional anti-VEGF injections were indicated in only one eye (8.3%). The darkening of the TCs lumina visible in OCT might provide an image-biomarker that indicates successful coagulation of aneurysmatic lesions. Consequently, a significant functional and morphological improvement with need for anti-VEGF treatment in only one eye, was achieved. Information concerning the registration of the trial: date of registration: 11th of december, 2019. Trial registration number: 107/2019.
Collapse
Affiliation(s)
- Felix Datlinger
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.,Ophthalmological Practice Datlinger, Sonnwendgasse 5, 7210, Mattersburg, Austria.,Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
| | - Anja Datlinger
- Ophthalmological Practice Datlinger, Sonnwendgasse 5, 7210, Mattersburg, Austria
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.,Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.,Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria.,Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria
| | - Peter Datlinger
- Ophthalmological Practice Datlinger, Sonnwendgasse 5, 7210, Mattersburg, Austria.
| |
Collapse
|
13
|
Rasool S, Kaushik M, Chaudhary R, Blachford K, Berry M, Scott RAH, Logan A, Blanch RJ. Visual deterioration in patients with photoreceptor loss after retinal reattachment surgery. Graefes Arch Clin Exp Ophthalmol 2022; 260:2141-2147. [PMID: 35080648 PMCID: PMC9203401 DOI: 10.1007/s00417-021-05519-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/19/2021] [Accepted: 12/07/2021] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Assess the relationship between photoreceptor degeneration and visual function after retinal reattachment surgery (RRS) in a prospective cohort. METHODS Patients with rhegmatogenous retinal detachment (RRD) were reviewed before and 6 months after vitreoretinal surgery. Optical coherence tomographical thickness of the outer nuclear layer (ONL), outer retinal segment (ORS), retinal pigmented epithelium to ellipsoid zone (RPE-EZ) and external limiting membrane to EZ (ELM-EZ) were recorded 6 months post-operatively. These were compared to best corrected visual acuity (BCVA) and retinal sensitivity (Humphrey visual field). RESULTS Thirteen macula-off and 8 macula-on RRD patients were included. The mean ONL thickness was higher after macula-on RRD compared to macula-off RRD (97.70 ± 3.62 μm vs. 73.10 ± 4.98 μm). In all RRD eyes, every 1 μm decrease in ONL thickness correlated with a 0.052 dB decrease and in retinal sensitivity and every 1 μm decrease in ORS thickness was associated with a 0.062 dB reduction in retinal sensitivity. ORS, ELM-EZ and RPE-EZ thickness did not correlate with BCVA post-RRS. CONCLUSION There was greater ONL and ORS thinning following macula-off compared to macula-on RRD. Correlations between ONL and ORS thinning with decreased retinal sensitivity may be explained by RRD-induced photoreceptor death.
Collapse
Affiliation(s)
- Sana Rasool
- Sandwell & West Birmingham NHS Trust, Birmingham, UK
| | - Megha Kaushik
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rishika Chaudhary
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ,Neuroscience & Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK ,National Institute of Health Research Surgical Reconstruction and Microbiology Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Robert A. H. Scott
- Neuroscience & Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Ann Logan
- Axolotl Consulting Ltd, Droitwich, WR9 0JS Worcestershire UK ,Division of Biomedical Sciences, Warwick Medical School, University of Warwick, CV4 7HL Coventry, UK
| | - Richard J. Blanch
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ,Neuroscience & Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK ,National Institute of Health Research Surgical Reconstruction and Microbiology Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ,Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| |
Collapse
|
14
|
Chidlow G, Chan WO, Wood JPM, Casson RJ. Differential Effects of Experimental Retinal Detachment on S- and M/L-Cones in Rats. Mol Neurobiol 2021; 59:117-136. [PMID: 34633652 DOI: 10.1007/s12035-021-02582-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022]
Abstract
Retinal detachment is a vision-threatening condition, which occurs when the neurosensory retina is separated from its blood supply. The main purpose of this study was to examine the effect of experimental retinal detachment in rats on cone photoreceptors. Retinal detachment was induced in the eyes of rats via subretinal injection of sodium hyaluronate. Experimental detachment caused a rapid, sustained loss of short (S)- and medium/long (M/L)-wavelength cone opsins. Importantly, S-opsin+ cones were affected earlier than M/L-opsin+ cones and were affected to a greater extent than M/L-opsin+ cones throughout the duration of detachment. In comparison, to cone opsins, reductions in other cone markers-peanut agglutinin PNA and cone arrestin-were substantially less marked. These data suggest that loss of cone opsins does not reflect cone degeneration and may rather indicate prolonged downregulation of specific proteins in affected cones. This conclusion is supported by the lack of TUNEL+- cone arrestin+ double-labelled cells at the time point of greatest rod photoreceptor cell death, together with the partial recovery of cone arrestin+ cell numbers over time. Analysis of retinas that had naturally re-attached reinforced the deduction that few cones die following detachment, but also highlighted that prolonged detachment leads to deconstruction of cone segments that may not be readily reversible. Survival and functional recovery of cones following surgery for retinal detachment is vital for successful recovery of vision. The data suggest that experimental detachment in rats may offer a useful approach to model the response of S-cones to retinal detachment in humans.
Collapse
Affiliation(s)
- Glyn Chidlow
- Ophthalmic Research Laboratories, Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Level 7 Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia.
| | - Weng Onn Chan
- Ophthalmic Research Laboratories, Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Level 7 Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
| | - John P M Wood
- Ophthalmic Research Laboratories, Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Level 7 Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
| | - Robert J Casson
- Ophthalmic Research Laboratories, Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Level 7 Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
| |
Collapse
|
15
|
Datlinger F, Wassermann L, Reumueller A, Hajdu D, Steiner I, Salas M, Drexler W, Pircher M, Schmidt-Erfurth U, Pollreisz A. Assessment of Detailed Photoreceptor Structure and Retinal Sensitivity in Diabetic Macular Ischemia Using Adaptive Optics-OCT and Microperimetry. Invest Ophthalmol Vis Sci 2021; 62:1. [PMID: 34605880 PMCID: PMC8496411 DOI: 10.1167/iovs.62.13.1] [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: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to assess density and morphology of cone photoreceptors (PRs) and corresponding retinal sensitivity in ischemic compared to nonischemic retinal capillary areas of diabetic eyes using adaptive optics optical coherence tomography (AO-OCT) and microperimetry (MP). Methods In this cross-sectional, observational study five eyes of four patients (2 eyes with proliferative diabetic retinopathy (DR) and 3 eyes moderate nonproliferative DR) were included. PR morphology and density was manually assessed in AO-OCT en face images both at the axial position of the inner-segment outer segment (IS/OS) and cone outer segment tips (COSTs). Retinal sensitivity was determined by fundus-controlled microperimetry in corresponding areas (MP-3, Nidek). Results In AO-OCT, areas affected by capillary nonperfusion showed severe alterations of cone PR morphology at IS/OS and COST compared to areas with intact capillary perfusion (84% and 87% vs. 9% and 8% of area affected for IS/OS and COST, respectively). Mean reduction of PR signal density in affected areas compared to those with intact superficial capillary plexus (SCP) and deep capillary plexus (DCP) perfusion of similar eccentricity was -38% at the level of IS/OS (P = 0.01) and -39% at the level of COST (P = 0.01). Mean retinal sensitivity was 10.8 ± 5.4 in areas affected by DCP nonperfusion and 28.2 ± 1.5 outside these areas (P < 0.001). Conclusions Cone PR morphology and signal density are severely altered in areas of capillary nonperfusion. These structural changes are accompanied by a severe reduction of retinal sensitivity, indicating the importance of preventing impaired capillary circulation in patients with DR.
Collapse
Affiliation(s)
- Felix Datlinger
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Lorenz Wassermann
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Adrian Reumueller
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Dorottya Hajdu
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Irene Steiner
- Center of Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Matthias Salas
- Center of Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Drexler
- Center of Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Michael Pircher
- Center of Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
16
|
Felfeli T, Murtaza F, Abueh B, Mandelcorn MS, Wong DD, Mandelcorn ED. Clinical Significance of Macula-Off Rhegmatogenous Retinal Detachment Preoperative Features on Optical Coherence Tomography. Ophthalmic Surg Lasers Imaging Retina 2021; 52:S23-S29. [PMID: 34310238 DOI: 10.3928/23258160-20210518-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the clinical significance of preoperative spectral-domain optical coherence tomography (OCT) features and their association with postoperative outcomes in eyes with primary macula-off rhegmatogenous retinal detachment (RRD). PATIENTS AND METHODS This is a retrospective case series of all consecutive cases undergoing repair of primary macula-off RRD at two tertiary care academic centers between January 2018 to January 2021. RESULTS Among 406 eyes, baseline visual acuity (β = 0.184, P = .001) and time to surgery (β = 0.009, P = .033) were predictive of postoperative visual acuity at 1-year follow-up after adjusting for age, sex and lens status, as well as presence of preoperative features on OCT such as outer retinal corrugations and height of the retinal detachment. CONCLUSION Baseline visual acuity and time to surgical repair are the best predictors of vision outcomes following macula-off RRD repair. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:S23-S29.].
Collapse
|
17
|
Schmidt-Erfurth U, Reiter GS, Riedl S, Seeböck P, Vogl WD, Blodi BA, Domalpally A, Fawzi A, Jia Y, Sarraf D, Bogunović H. AI-based monitoring of retinal fluid in disease activity and under therapy. Prog Retin Eye Res 2021; 86:100972. [PMID: 34166808 DOI: 10.1016/j.preteyeres.2021.100972] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/21/2022]
Abstract
Retinal fluid as the major biomarker in exudative macular disease is accurately visualized by high-resolution three-dimensional optical coherence tomography (OCT), which is used world-wide as a diagnostic gold standard largely replacing clinical examination. Artificial intelligence (AI) with its capability to objectively identify, localize and quantify fluid introduces fully automated tools into OCT imaging for personalized disease management. Deep learning performance has already proven superior to human experts, including physicians and certified readers, in terms of accuracy and speed. Reproducible measurement of retinal fluid relies on precise AI-based segmentation methods that assign a label to each OCT voxel denoting its fluid type such as intraretinal fluid (IRF) and subretinal fluid (SRF) or pigment epithelial detachment (PED) and its location within the central 1-, 3- and 6-mm macular area. Such reliable analysis is most relevant to reflect differences in pathophysiological mechanisms and impacts on retinal function, and the dynamics of fluid resolution during therapy with different regimens and substances. Yet, an in-depth understanding of the mode of action of supervised and unsupervised learning, the functionality of a convolutional neural net (CNN) and various network architectures is needed. Greater insight regarding adequate methods for performance, validation assessment, and device- and scanning-pattern-dependent variations is necessary to empower ophthalmologists to become qualified AI users. Fluid/function correlation can lead to a better definition of valid fluid variables relevant for optimal outcomes on an individual and a population level. AI-based fluid analysis opens the way for precision medicine in real-world practice of the leading retinal diseases of modern times.
Collapse
Affiliation(s)
- Ursula Schmidt-Erfurth
- Department of Ophthalmology Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Gregor S Reiter
- Department of Ophthalmology Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Sophie Riedl
- Department of Ophthalmology Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Philipp Seeböck
- Department of Ophthalmology Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Wolf-Dieter Vogl
- Department of Ophthalmology Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Barbara A Blodi
- Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA.
| | - Amitha Domalpally
- Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA.
| | - Amani Fawzi
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Yali Jia
- Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA.
| | - David Sarraf
- Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USA.
| | - Hrvoje Bogunović
- Department of Ophthalmology Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| |
Collapse
|
18
|
The urgency of surgical treatment for rhegmatogenous retinal detachment. Ophthalmologe 2021; 118:160-165. [PMID: 33751188 DOI: 10.1007/s00347-021-01364-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
The ideal timing of surgery in patients with rhegmatogenous retinal detachment has been discussed for decades. The study situation has improved in recent years so that recommendations can now be made. When the macula is detached, surgical treatment of the retinal detachment should be undertaken within a few days. When the macula is still attached, the near fovea and bullous superotemporal detachment should be classified as an emergency. When planning the operation environmental factors must also be considered, meaning that the performance of the intervention by an experienced surgical team is usually more important for the final result than the retinal condition alone. Influencing factors are discussed in this article and recommendations for dealing with these emergency patients are discussed.
Collapse
|
19
|
Three-dimensional composition of the photoreceptor cone layers in healthy eyes using adaptive-optics optical coherence tomography (AO-OCT). PLoS One 2021; 16:e0245293. [PMID: 33412568 PMCID: PMC7790532 DOI: 10.1371/journal.pone.0245293] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/25/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose To assess the signal composition of cone photoreceptors three-dimensionally in healthy retinas using adaptive optics optical coherence tomography (AO-OCT). Methods Study population. Twenty healthy eyes of ten subjects (age 23 to 67). Procedures. After routine ophthalmological assessments, eyes were examined using AO-OCT. Three-dimensional volumes were acquired at 2.5° and 6.5° foveal eccentricity in four main meridians (superior, nasal, inferior, temporal). Cone densities and signal compositions were investigated in four different planes: the cone inner segment outer segment junction (IS/OS), the cone outer segment combined with the IS/OS (ISOS+), the cone outer segment tips (COST) and full en-face plane (FEF) combining signals from all mentioned cone layers. Additionally, reliability of a simple semi-automated approach for assessment of cone density was tested. Main outcome measures. Cone density of IS/OS, IS/OS+, COST and FEF. Qualitative depiction and composition of each cone layer. Inter-rater agreement of cone density measurements. Results Mean overall cone density at all eccentricities was highest at the FEF plane (21.160/mm2), followed by COST (20.450/mm2), IS/OS+ (19.920/mm2) and IS/OS (19.530/mm2). The different meridians and eccentricities had a significant impact on cone density, with lower eccentricity resulting in higher cone densities (p≤.001), which were highest at the nasal, then temporal, then inferior and then superior meridian. Depiction of the cone mosaic differed between all 4 layers regarding signal size and packing density. Therefore, different cone layers showed evident but not complete signal overlap. Using the semi-automated technique for counting of cone signals achieved high inter-rater reliability (ICC > .99). Conclusions In healthy individuals qualitative and quantitative changes in cone signals are found not only in different eccentricities and meridians, but also within different photoreceptor layers. The variation between cone planes has to be considered when assessing the integrity of cone photoreceptors in healthy and diseased eyes using adaptive optics technology.
Collapse
|
20
|
Reumueller A, Wassermann L, Salas M, Schranz M, Told R, Kostolna K, Drexler W, Pircher M, Schmidt-Erfurth U, Pollreisz A. Three-dimensional assessment of para- and perifoveal photoreceptor densities and the impact of meridians and age in healthy eyes with adaptive-optics optical coherence tomography (AO-OCT). OPTICS EXPRESS 2020; 28:36723-36739. [PMID: 33379760 DOI: 10.1364/oe.409076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/08/2020] [Indexed: 06/12/2023]
Abstract
An adaptive optics optical coherence tomography (AO-OCT) system is used to assess sixty healthy eyes of thirty subjects (age 22 to 75) to evaluate how the outer retinal layers, foveal eccentricity and age effect the mean cone density. The cone mosaics of different retinal planes (the cone inner segment outer segment junction (IS/OS), the cone outer segment combined with the IS/OS (ISOS+), the cone outer segment tips (COST), and the full en-face plane (FEF)) at four main meridians (superior, nasal, inferior, temporal) and para- and perifoveal eccentricities (ecc 2.5° and 6.5°) were analyzed quantitatively. The mean overall cone density was 19,892/mm2 at ecc 2.5° and 13,323/mm2 at ecc 6.5°. A significant impact on cone density was found for eccentricity (up to 6,700/mm2 between ecc 2.5° and 6.5°), meridian (up to 3,700/mm2 between nasal and superior meridian) and layer (up to 1,400/mm2 between FEF and IS/OS). Age showed only a weak negative effect. These factors as well as inter-individual variability have to be taken into account when comparing cone density measurements between healthy and pathologically changed eyes, as their combined effect on density can easily exceed several thousand cones per mm2 even in parafoveal regions.
Collapse
|
21
|
Feltgen N, Callizo J, Hattenbach LO, Hoerauf H. Dringlichkeit der operativen Versorgung bei der rissbedingten Netzhautablösung. Ophthalmologe 2020; 117:858-865. [DOI: 10.1007/s00347-020-01191-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|