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Schumann RG, Banyai D, Hagenau F, Mautone L, Hammer T, Wolf A, Priglinger SG, Vogt D. PORES OF THE INTERNAL LIMITING MEMBRANE: A Common Finding in Vitreomaculopathies. Retina 2023; 43:1773-1779. [PMID: 37315515 DOI: 10.1097/iae.0000000000003859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE To describe presence and distribution of pores of the inner limiting membrane (ILM) in eyes with vitreomaculopathies. METHODS Inner limiting membrane specimens were harvested from 117 eyes of 117 patients during vitrectomy with membrane peeling from eyes with vitreomacular traction syndrome, idiopathic and secondary epiretinal gliosis, and idiopathic full-thickness macular hole. All specimens were processed as flat-mounts for immunocytochemistry and examined by phase-contrast, interference, and fluorescence microscopy. Demographic and clinical data were correlated. RESULTS Inner limiting membrane pores were found in all vitreomaculopathies. They were identified in 47 (40.2%) of 117 eyes being most evident with antilaminin. In eyes with full-thickness macular hole >400 µ m, pores were seen in more than half of all eyes. They occur as numerous and uniformly distributed defects of the flat-mounted ILM with a mean diameter of 9.5 ± 2.4 µ m. Edges of ILM pores are round with an irregular contour and no specific cellular pattern. Pores were distinguished from retinal vessel thinning and iatrogenic artefacts. CONCLUSION Contrary to previous reports, ILM pores are a common finding in vitreomaculopathies easily visible with antilaminin staining. Further studies are needed to clarify whether their presence correlates with differences in disease progression or imaging before and after vitrectomy with ILM peeling.
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Affiliation(s)
- Ricarda G Schumann
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Munich Eye & Vascular Medicine Center, Munich, Germany
| | - Daniel Banyai
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Ophthalmology, University Hospital Halle (Saale), Halle, Germany
| | - Felix Hagenau
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and
| | - Luca Mautone
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and
| | - Thomas Hammer
- Department of Ophthalmology, University Hospital Halle (Saale), Halle, Germany
| | - Armin Wolf
- Department of Ophthalmology, University Hospital Ulm, Ulm, Germany
| | - Siegfried G Priglinger
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Denise Vogt
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Ophthalmology, University Hospital Ulm, Ulm, Germany
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Abstract
The human retina is amenable to direct, noninvasive visualization using a wide array of imaging modalities. In the ∼140 years since the publication of the first image of the living human retina, there has been a continued evolution of retinal imaging technology. Advances in image acquisition and processing speed now allow real-time visualization of retinal structure, which has revolutionized the diagnosis and management of eye disease. Enormous advances have come in image resolution, with adaptive optics (AO)-based systems capable of imaging the retina with single-cell resolution. In addition, newer functional imaging techniques provide the ability to assess function with exquisite spatial and temporal resolution. These imaging advances have had an especially profound impact on the field of inherited retinal disease research. Here we will review some of the advances and applications of AO retinal imaging in patients with inherited retinal disease.
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Affiliation(s)
- Jacque L Duncan
- Department of Ophthalmology, University of California, San Francisco, California 94143-4081, USA
| | - Joseph Carroll
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin Eye Institute, Milwaukee, Wisconsin 53226, USA
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GUNN's DOTS AS INDICATORS OF RENAL FUNCTION, FINDINGS FROM THE TONGREN HEALTH CARE STUDY. Retina 2022; 42:789-796. [PMID: 35350051 DOI: 10.1097/iae.0000000000003354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the prevalence of Gunn's dots (GDs) and associated systemic factors in adult Chinese. METHODS A cross-sectional study enrolling participants older than 45 years from a community-based study. Gunn's dots were evaluated using fundus photography, and associated systemic factors were analyzed. Patients with any retinal or optic neuropathy were excluded. RESULTS The study included 4,118 participants (mean age: 58.3 ± 9.9 years; male: 1,699/41.3%). Gunn's dots were found in 931 participants, with a prevalence of 22.6 ± 0.8% (95% confidence interval [CI]: 21.3-23.9). Systemic factors associated with a higher GD prevalence were younger age (odds ratio [OR]: 0.92; 95% CI: 0.91-0.93; P < 0.001), higher estimated glomerular filtration rate (eGFR) (OR: 1.01; 95% CI: 1.001-1.02; P = 0.022), and higher serum concentration of triglycerides (OR: 1.08; 95% CI: 1.004-1.16; P = 0.040). The GD prevalence was 3.5 (OR = 3.46; 95% CI: 1.06-11.35) and 4.4 (OR = 4.37; 95% CI: 1.27-15.09) times greater for participants with an eGFR of ≥90 mL/minute/1.73 m2 and an eGFR of ≥100 mL/minute/1.73 m2, respectively, as compared with participants with an eGFR of <60 mL/minute/1.73 m2. CONCLUSION The GD prevalence (mean: 22.6%) was associated with younger age, higher eGFR, and higher serum triglyceride concentrations. The presence of GDs may serve as indicators of healthy renal function.
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Retinal alterations in patients with Lafora disease. Am J Ophthalmol Case Rep 2021; 23:101146. [PMID: 34195479 PMCID: PMC8239732 DOI: 10.1016/j.ajoc.2021.101146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/04/2021] [Accepted: 06/12/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose Lafora disease is a genetic neurodegenerative metabolic disorder caused by insoluble polyglucosan aggregate accumulation throughout the central nervous system and body. The retina is an accessible neural tissue, which may offer alternative methods to assess neurological diseases quickly and noninvasively. In this way, noninvasive imaging may provide a means to characterize neurodegenerative disease, which enables earlier identification and diagnosis of disease and the ability to monitor disease progression. In this study, we sought to characterize the retina of individuals with Lafora disease using non-invasive retinal imaging. Methods One eye of three individuals with genetically confirmed Lafora disease were imaged with optical coherence tomography (OCT) and adaptive optics scanning light ophthalmoscopy (AOSLO). When possible, OCT volume and line scans were acquired to assess total retinal thickness, ganglion cell-inner plexiform layer thickness, and outer nuclear layer + Henle fiber layer thickness. OCT angiography (OCTA) scans were acquired in one subject at the macula and optic nerve head (ONH). AOSLO was used to characterize the photoreceptor mosaic and examine the retinal nerve fiber layer (RNFL). Results Two subjects with previous seizure activity demonstrated reduced retinal thickness, while one subject with no apparent symptoms had normal retinal thickness. All other clinical measures, as well as parafoveal cone density, were within normal range. Nummular reflectivity at the level of the RNFL was observed using AOSLO in the macula and near the ONH in all three subjects. Conclusions This multimodal retinal imaging approach allowed us to observe a number of retinal structural features in all three individuals. Most notably, AOSLO revealed nummular reflectivity within the inner retina of each subject. This phenotype has not been reported previously and may represent a characteristic change produced by the neurodegenerative process.
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Mishra AV, Pollmann AS, Choudhry N, Demmings E, Gupta RR. Unilateral benign yellow dot maculopathy. Am J Ophthalmol Case Rep 2021; 22:101068. [PMID: 33796798 PMCID: PMC7995479 DOI: 10.1016/j.ajoc.2021.101068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 02/14/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To describe a unique case of unilateral benign yellow dot maculopathy. Observations A 25-year-man was evaluated after incidental finding of yellow dots in the right macula. The findings of examination and multimodal imaging were in keeping with a diagnosis of benign yellow dot maculopathy. Conclusions and importance Benign yellow dot maculopathy is a recently described entity with either a sporadic or dominant inheritance pattern. This is the first known report of the characteristic findings of this phenotype presenting unilaterally.
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Affiliation(s)
- Amit V. Mishra
- Department of Ophthalmology and Visual Sciences, Dalhousie University, 1276 South Park Street, Room 2035D, 2 West Victoria Building, Halifax, Nova Scotia, B3H 2Y9, Canada
- Corresponding author. Department of Ophthalmology & Visual Sciences, Dalhousie University/Nova Scotia Health Authority, 1276 South Park Street, Room 2035D, 2 West Victoria Building, Halifax, Nova Scotia, B3H 2Y9, Canada.
| | - André S. Pollmann
- Department of Ophthalmology and Visual Sciences, Dalhousie University, 1276 South Park Street, Room 2035D, 2 West Victoria Building, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Netan Choudhry
- Vitreous Retina Macula Specialists of Toronto, 3280 Bloor St. W. Suite 310, Etobicoke, ON, M8X 3X3, Canada
- Cleveland Clinic Canada, 181 Bay St. 30th Floor, Toronto, ON, M5J 2T3, Canada
| | - Erin Demmings
- Department of Ophthalmology and Visual Sciences, Dalhousie University, 1276 South Park Street, Room 2035D, 2 West Victoria Building, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - R. Rishi Gupta
- Department of Ophthalmology and Visual Sciences, Dalhousie University, 1276 South Park Street, Room 2035D, 2 West Victoria Building, Halifax, Nova Scotia, B3H 2Y9, Canada
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Liu Z, Saeedi O, Zhang F, Villanueva R, Asanad S, Agrawal A, Hammer DX. Quantification of Retinal Ganglion Cell Morphology in Human Glaucomatous Eyes. Invest Ophthalmol Vis Sci 2021; 62:34. [PMID: 33760041 PMCID: PMC7995922 DOI: 10.1167/iovs.62.3.34] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose To characterize retinal ganglion cell morphological changes in patients with primary open-angle glaucoma associated with hemifield defect (HD) using adaptive optics–optical coherence tomography (AO-OCT). Methods Six patients with early to moderate primary open-angle glaucoma with an average age of 58 years associated with HD and six age-matched healthy controls with an average age of 61 years were included. All participants underwent in vivo retinal ganglion cell (RGC) imaging at six primary locations across the macula with AO-OCT. Ganglion cell layer (GCL) somas were manually counted, and morphological parameters of GCL soma density, size, and symmetry were calculated. RGC cellular characteristics were correlated with functional visual field measurements. Results GCL soma density was 12,799 ± 7747 cells/mm2, 9370 ± 5572 cells/mm2, and 2134 ± 1494 cells/mm2 at 3°, 6°, and 12°, respectively, in glaucoma patients compared with 25,058 ± 4649 cells/mm2, 15,551 ± 2301 cells/mm2, and 3891 ± 1105 cells/mm2 (P < 0.05 for all locations) at the corresponding retinal locations in healthy participants. Mean soma diameter was significantly larger in glaucoma patients (14.20 ± 2.30 µm) compared with the health controls (12.32 ± 1.94 µm, P < 0.05 for all locations); symmetry was 0.36 ± 0.32 and 0.86 ± 0.13 in glaucoma and control cohorts, respectively. Conclusions Glaucoma patients had lower GCL soma density and symmetry, greater soma size, and increased variation of GCL soma reflectance compared with age-matched control subjects. The morphological changes corresponded with HD, and the cellular level structural loss correlated with visual function loss in glaucoma. AO-based morphological parameters could be potential sensitive biomarkers for glaucoma.
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Affiliation(s)
- Zhuolin Liu
- Center for Devices and Radiological Health (CDRH), U.S. Food and Drug Administration, Silver Spring, Maryland, United States
| | - Osamah Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore Maryland, United States
| | - Furu Zhang
- Center for Devices and Radiological Health (CDRH), U.S. Food and Drug Administration, Silver Spring, Maryland, United States
| | - Ricardo Villanueva
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore Maryland, United States
| | - Samuel Asanad
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore Maryland, United States
| | - Anant Agrawal
- Center for Devices and Radiological Health (CDRH), U.S. Food and Drug Administration, Silver Spring, Maryland, United States
| | - Daniel X Hammer
- Center for Devices and Radiological Health (CDRH), U.S. Food and Drug Administration, Silver Spring, Maryland, United States
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Label-free adaptive optics imaging of human retinal macrophage distribution and dynamics. Proc Natl Acad Sci U S A 2020; 117:30661-30669. [PMID: 33168747 PMCID: PMC7720180 DOI: 10.1073/pnas.2010943117] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Microglia, a type of macrophage, were discovered a little more than a century ago by Pío del Río-Hortega. Since that time, we have gained an immense amount of knowledge on their origin and multifaceted function with the aid of labeling techniques and animal models, among other tools. Only recently have macrophage cells been imaged in living humans. Here we characterize macrophage spatial distribution and temporal dynamics in live human eyes using a label-free adaptive optics imaging approach. This investigation lays a foundation to better understand the body’s immune response not only to ocular diseases like glaucoma, but also to a vast array of neurological diseases with ocular manifestations, including Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis. Microglia are resident central nervous system macrophages and the first responders to neural injury. Until recently, microglia have been studied only in animal models with exogenous or transgenic labeling. While these studies provided a wealth of information on the delicate balance between neuroprotection and neurotoxicity within which these cells operate, extrapolation to human immune function has remained an open question. Here we examine key characteristics of retinal macrophage cells in live human eyes, both healthy and diseased, with the unique capabilities of our adaptive optics–optical coherence tomography approach and owing to their propitious location above the inner limiting membrane (ILM), allowing direct visualization of cells. Our findings indicate that human ILM macrophage cells may be distributed distinctly, age differently, and have different dynamic characteristics than microglia in other animals. For example, we observed a macular pattern that was sparse centrally and peaked peripherally in healthy human eyes. Moreover, human ILM macrophage density decreased with age (∼2% of cells per year). Our results in glaucomatous eyes also indicate that ILM macrophage cells appear to play an early and regionally specific role of nerve fiber layer phagocytosis in areas of active disease. While we investigate ILM macrophage cells distinct from the larger sample of overall retinal microglia, the ability to visualize macrophage cells without fluorescent labeling in the live human eye represents an important advance for both ophthalmology and neuroscience, which may lead to novel disease biomarkers and new avenues of exploration in disease progression.
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Wynne N, Carroll J, Duncan JL. Promises and pitfalls of evaluating photoreceptor-based retinal disease with adaptive optics scanning light ophthalmoscopy (AOSLO). Prog Retin Eye Res 2020; 83:100920. [PMID: 33161127 DOI: 10.1016/j.preteyeres.2020.100920] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 12/15/2022]
Abstract
Adaptive optics scanning light ophthalmoscopy (AOSLO) allows visualization of the living human retina with exquisite single-cell resolution. This technology has improved our understanding of normal retinal structure and revealed pathophysiological details of a number of retinal diseases. Despite the remarkable capabilities of AOSLO, it has not seen the widespread commercial adoption and mainstream clinical success of other modalities developed in a similar time frame. Nevertheless, continued advancements in AOSLO hardware and software have expanded use to a broader range of patients. Current devices enable imaging of a number of different retinal cell types, with recent improvements in stimulus and detection schemes enabling monitoring of retinal function, microscopic structural changes, and even subcellular activity. This has positioned AOSLO for use in clinical trials, primarily as exploratory outcome measures or biomarkers that can be used to monitor disease progression or therapeutic response. AOSLO metrics could facilitate patient selection for such trials, to refine inclusion criteria or to guide the choice of therapy, depending on the presence, absence, or functional viability of specific cell types. Here we explore the potential of AOSLO retinal imaging by reviewing clinical applications as well as some of the pitfalls and barriers to more widespread clinical adoption.
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Affiliation(s)
- Niamh Wynne
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joseph Carroll
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jacque L Duncan
- Department of Ophthalmology, University of California, San Francisco, CA, USA.
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