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Schmidt-Erfurth U, Mai J, Reiter GS, Riedl S, Vogl WD, Sadeghipour A, McKeown A, Foos E, Scheibler L, Bogunovic H. Disease activity and therapeutic response to pegcetacoplan for geographic atrophy identified by deep learning-based analysis of OCT. Ophthalmology 2024:S0161-6420(24)00487-1. [PMID: 39151755 DOI: 10.1016/j.ophtha.2024.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 07/29/2024] [Accepted: 08/08/2024] [Indexed: 08/19/2024] Open
Abstract
PURPOSE To quantify morphological changes of the photoreceptors (PR) and retinal pigment epithelium (RPE) layers under pegcetacoplan therapy in geographic atrophy (GA) using deep learning-based analysis of optical coherence tomography (OCT) images. DESIGN Post-hoc longitudinal image analysis SUBJECTS: Patients with GA due to age-related macular degeneration from two prospective randomized phase III clinical trials (OAKS and DERBY) METHODS: Deep learning-based segmentation of RPE loss and PR degeneration, defined as loss of the ellipsoid zone (EZ) layer on OCT, over 24 months on SD-OCT images MAIN OUTCOME MEASURES: Change in the mean area of RPE loss and EZ loss over time in the pooled sham arms and the monthly (PM)/every other month (PEOM) treatment arms RESULTS: 897 eyes of 897 patients were included. There was a therapeutic reduction of RPE loss growth by 22%/20% in OAKS and 27%/21% in DERBY for PM/PEOM compared to sham, respectively, at 24 months. The reduction on the EZ level was significantly higher with 53%/46% in OAKS and 47%/46% in DERBY for PM/PEOM compared to sham at 24 months. The baseline EZ-RPE difference had an impact on disease activity and therapeutic response. The therapeutic benefit for RPE loss growth increased with larger EZ-RPE difference quartiles from 21.9%, 23.1%, 23.9% to 33.6% for PM vs. sham (all p<0.01) and from 13.6% (p=0.11), 23.8%, 23.8% to 20.0% for PEOM vs. sham (p<0.01) in quartiles 1,2,3 and 4, respectively, at 24 months. Regarding EZ layer maintenance, the therapeutic reduction of loss increased from 14.8% (p=0.09), 33.3%, 46.6% to 77.8% (p<0.0001) between PM and sham and from 15.9% (p=0.08), 33.8%, 52.0% to 64.9% (p<0.0001) between PEOM and sham for quartiles 1-4 at 24 months. CONCLUSION OCT-based AI analysis objectively identifies and quantifies PR and RPE degeneration in GA. Reductions in further PR degeneration consistent with EZ loss on OCT are even higher than the effect on RPE loss in phase 3 trials of pegcetacoplan treatment. The EZ-RPE difference has a strong impact on disease progression and therapeutic response. Identification of patients with higher EZ-RPE loss difference may become an important criterion for the management of GA secondary to AMD.
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Affiliation(s)
- Ursula Schmidt-Erfurth
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
| | - Julia Mai
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Gregor S Reiter
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Sophie Riedl
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | | | | | - Alex McKeown
- Apellis Pharmaceuticals, Boston, Massachusetts, United States
| | - Emma Foos
- Apellis Pharmaceuticals, Boston, Massachusetts, United States
| | - Lukas Scheibler
- Apellis Pharmaceuticals, Boston, Massachusetts, United States
| | - Hrvoje Bogunovic
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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Frank S, Reiter GS, Leingang O, Fuchs P, Coulibaly LM, Mares V, Bogunovic H, Schmidt-Erfurth U. ADVANCES IN PHOTORECEPTOR AND RETINAL PIGMENT EPITHELIUM QUANTIFICATIONS IN INTERMEDIATE AGE-RELATED MACULAR DEGENERATION: High-Res Versus Standard SPECTRALIS Optical Coherence Tomography. Retina 2024; 44:1351-1359. [PMID: 39047196 PMCID: PMC11280440 DOI: 10.1097/iae.0000000000004118] [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: 07/27/2024]
Abstract
PURPOSE In this study, differences in retinal feature visualization of high-resolution optical coherence tomography (OCT) devices were investigated with different axial resolutions in quantifications of retinal pigment epithelium and photoreceptors (PRs) in intermediate age-related macular degeneration. METHODS Patients were imaged with standard SPECTRALIS HRA + OCT and the investigational High-Res OCT device (both by Heidelberg Engineering, Heidelberg, Germany). Drusen, retinal pigment epithelium, and PR layers were segmented using validated artificial intelligence-based algorithms followed by manual corrections. Thickness and drusen maps were computed for all patients. Loss and thickness measurements were compared between devices, drusen versus nondrusen areas, and early treatment diabetic retinopathy study subfields using mixed-effects models. RESULTS Thirty-three eyes from 28 patients with intermediate age-related macular degeneration were included. Normalized PR integrity loss was significantly higher with 4.6% for standard OCT compared with 2.5% for High-Res OCT. The central and parafoveal PR integrity loss was larger than the perifoveal loss (P < 0.05). Photoreceptor thickness was increased on High-Res OCT and in nondrusen regions (P < 0.001). Retinal pigment epithelium appeared thicker on standard OCT and above drusen (P < 0.01). CONCLUSION Our study shows that High-Res OCT is able to identify the condition of investigated layers in intermediate age-related macular degeneration with higher precision. This improved in vivo imaging technology might promote our understanding of the pathophysiology and progression of age-related macular degeneration.
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Affiliation(s)
- Sophie Frank
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria;
| | - Gregor Sebastian Reiter
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria;
| | - Oliver Leingang
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria;
| | - Philipp Fuchs
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria;
| | - Leonard Mana Coulibaly
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria;
| | - Virginia Mares
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria;
- Department of Ophthalmology, Federal University of Minas Gerais, Belo Horizonte, Brazil; and
| | - Hrvoje Bogunovic
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria;
- Christian Doppler Lab for Artificial Intelligence in Retina, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
| | - Ursula Schmidt-Erfurth
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria;
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Trinh M, Cheung R, Duong A, Nivison-Smith L, Ly A. OCT Prognostic Biomarkers for Progression to Late Age-related Macular Degeneration: A Systematic Review and Meta-analysis. Ophthalmol Retina 2024; 8:553-565. [PMID: 38154619 DOI: 10.1016/j.oret.2023.12.006] [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: 10/16/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
TOPIC To evaluate which OCT prognostic biomarkers best predict the risk of progression from early/intermediate to late age-related macular degeneration (AMD). CLINICAL RELEVANCE Among > 100 OCT prognostic biomarkers for AMD, it is unclear which are the most relevant for clinicians and researchers to focus on. This review evaluated which OCT biomarkers confer the greatest magnitude of prediction for progression to late AMD. METHODS Study protocol was registered on PROSPERO (CRD42023400166). PubMed and Embase were searched from inception to March 2, 2023, and eligible studies assessed following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The primary outcome was any quantified risk of progression from treatment-naive early/intermediate AMD to late AMD, including hazard ratios (HRs), odds ratios (ORs), and standardized mean differences (at baseline, between eyes with versus without progression), subgrouped by each OCT biomarker. Further meta-analyses were subgrouped by progression to geographic atrophy or neovascularization. RESULTS A total of 114 quantified OCT prognostic biomarkers were identified. With high GRADE certainty of evidence, the greatest magnitudes of prediction to late AMD belonged to: external limiting membrane abnormality (OR, 15.42 [7.63, 31.17]), ellipsoid zone abnormality (OR, 10.8 [4.58, 25.46]), interdigitation zone abnormality (OR, 7.68 [2.57, 23]), concurrent large drusen and reticular pseudodrusen (HR, 6.73 [1.35, 33.65], hyporeflective drusen cores (HR, 2.48 [1.8, 3.4]; OR 1.85 [1.29, 2.66]), intraretinal hyperreflective foci (IHRF; HR, 2.16 [0.92, 5.07]; OR 5.08 [3.26, 7.92]), and large drusen (HR, 2.01 [1.35, 2.99]); OR, 1.98 [1.27, 3.08]). There was greater risk of geographic atrophy for IHRF and hyporeflective drusen cores (P < 0.05), and neovascularization for ellipsoid zone abnormality (P < 0.05). Other OCT biomarkers such as drusenoid pigment epithelium detachment, shallow irregular retinal pigment epithelium elevations, and nascent geographic atrophy exhibited large magnitudes of risk but required further studies for validation. CONCLUSION This review synthesizes the 6 most relevant OCT prognostic biomarkers for AMD with greater predictive ability than large drusen alone, for clinicians and researchers to focus on. Further study is required to validate other biomarkers with less than high certainty of evidence, and assess how the copresence of biomarkers may affect risks. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Matt Trinh
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
| | - Rene Cheung
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Annita Duong
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Lisa Nivison-Smith
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Angelica Ly
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
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Martín JCM, Sánchez LF, Piñero DP, Navarro NC. Immunohistochemical, functional, and anatomical evaluation of patients with idiopathic epiretinal membrane. Graefes Arch Clin Exp Ophthalmol 2024; 262:1443-1453. [PMID: 38197992 PMCID: PMC11031491 DOI: 10.1007/s00417-023-06366-w] [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: 07/21/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE The main purpose of this study was to perform an immunohistochemical, functional, and anatomical evaluation of patients with idiopathic epiretinal membrane (ERM). METHODS Twenty-four specimens of idiopathic ERM from 24 consecutive patients who underwent 23 G pars plana vitrectomy for ERM and internal limiting membrane (ILM) peeling at the San Juan University Hospital in Alicante (Spain) in 2019 were analyzed. All patients underwent a complete ophthalmological examination including measurement of best corrected visual acuity (BCVA) and macular analysis by spectral-domain optical coherence tomography (SD-OCT) at the time of diagnosis and 3 months after surgery. Specific glial fibrillar acid protein antibodies (GFAP) and S100 calcium-binding protein β (S100β) immunostaining markers were used to identify the macroglial component of the ERM, Müller cells, and astrocytes. Ionized calcium-binding adapter molecule 1 protein (Iba1) antibodies were used as specific markers for inflammatory cells, such as microglia and macrophages. RESULTS Mean preoperative BCVA measured with Snellen chart was 0.3 and 0.6 preoperatively and at 3 months after surgery, respectively. SD-OCT identified 15 patients (62.5%) with a disruption of the outer retinal hyperreflective bands. The immunohistochemical study showed the presence of Müller cells in almost all cases (91.6%), as well of abundant microglia and macrophages. Microglia and macrophages were more frequently present in earlier stages of ERM. Microglia were present in ERM independently of the outer retinal hyperreflective bands integrity as measured by SD-OCT. A greater presence of macrophages was found in those ERMs with no outer retinal hyperreflective band disruption. CONCLUSIONS Müller cells seem to be the most frequent cell group in ERMs, with also presence of microglia cells and macrophages. Astrocytes were more frequently found in early stages of ERMs. Microglia and macrophages were most frequent in ERMs with early stage (1, 2, or 3) than in advanced stages (4).
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Affiliation(s)
- Julio Cesar Molina Martín
- Department of Ophthalmology, San Juan University Hospital, N-332, S/NSant Joan d'Alacant, 03550, Alicante, Spain.
| | - Laura Fernández Sánchez
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Crta San Vicente del Raspeig S/NSan Vicente del Raspeig, 03690, Alicante, Spain
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Crta San Vicente del Raspeig S/NSan Vicente del Raspeig, 03690, Alicante, Spain.
| | - Nicolás Cuenca Navarro
- Department of Physiology, Genetic and Microbiology, University of Alicante, San Vicente del Raspeig, Alicante, Spain
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Meng Z, Chen Y, Li H, Zhang Y, Yao X, Meng Y, Shi W, Liang Y, Hu Y, Liu D, Xie M, Yan B, Luo J. Machine learning and optical coherence tomography-derived radiomics analysis to predict persistent diabetic macular edema in patients undergoing anti-VEGF intravitreal therapy. J Transl Med 2024; 22:358. [PMID: 38627718 PMCID: PMC11022368 DOI: 10.1186/s12967-024-05141-7] [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: 10/08/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Diabetic macular edema (DME) is a leading cause of vision loss in patients with diabetes. This study aimed to develop and evaluate an OCT-omics prediction model for assessing anti-vascular endothelial growth factor (VEGF) treatment response in patients with DME. METHODS A retrospective analysis of 113 eyes from 82 patients with DME was conducted. Comprehensive feature engineering was applied to clinical and optical coherence tomography (OCT) data. Logistic regression, support vector machine (SVM), and backpropagation neural network (BPNN) classifiers were trained using a training set of 79 eyes, and evaluated on a test set of 34 eyes. Clinical implications of the OCT-omics prediction model were assessed by decision curve analysis. Performance metrics (sensitivity, specificity, F1 score, and AUC) were calculated. RESULTS The logistic, SVM, and BPNN classifiers demonstrated robust discriminative abilities in both the training and test sets. In the training set, the logistic classifier achieved a sensitivity of 0.904, specificity of 0.741, F1 score of 0.887, and AUC of 0.910. The SVM classifier showed a sensitivity of 0.923, specificity of 0.667, F1 score of 0.881, and AUC of 0.897. The BPNN classifier exhibited a sensitivity of 0.962, specificity of 0.926, F1 score of 0.962, and AUC of 0.982. Similar discriminative capabilities were maintained in the test set. The OCT-omics scores were significantly higher in the non-persistent DME group than in the persistent DME group (p < 0.001). OCT-omics scores were also positively correlated with the rate of decline in central subfield thickness after treatment (Pearson's R = 0.44, p < 0.001). CONCLUSION The developed OCT-omics model accurately assesses anti-VEGF treatment response in DME patients. The model's robust performance and clinical implications highlight its utility as a non-invasive tool for personalized treatment prediction and retinal pathology assessment.
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Affiliation(s)
- Zhishang Meng
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, China
| | - Yanzhu Chen
- Department of Radiation Oncology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Haoyu Li
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, China
| | - Yue Zhang
- Faculty of Infrastructure Engineering, Dalian University of Technology, Dalian, China
| | | | - Yongan Meng
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, China
| | - Wen Shi
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, China
| | - Youling Liang
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, China
| | - Yuqian Hu
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, China
| | - Dan Liu
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, China
| | - Manyun Xie
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, China
| | - Bin Yan
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, China.
| | - Jing Luo
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, China.
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Thibos L, Lenner K, Thibos C. Carl Bergmann (1814-1865) and the discovery of the anatomical site in the retina where vision is initiated. JOURNAL OF THE HISTORY OF THE NEUROSCIENCES 2024; 33:180-203. [PMID: 38109332 DOI: 10.1080/0964704x.2023.2286991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
A preeminent quest of nineteenth-century visual neuroscience was to identify the anatomical elements of the retina that respond to light. A major breakthrough came in 1854, when Carl Bergmann discovered through direct observation that the human fovea contains only rods and cones. On this basis, he argued that these must necessarily be the light-sensitive elements (i.e., photoreceptors) that initiate vision. Bergmann also argued that Henle's fibers form part of the necessary anatomical link between these distal elements and the proximal ganglion cells, which transmit visual signals to the brain via the optic nerve. However, despite his achievement, Heinrich Müller, not Bergmann, is remembered as the discoverer of human photoreceptors in the literature. This article seeks to correct the record. It situates Bergmann's work alongside that of his contemporaries, sets out his arguments and the critique he received using archival documents, and makes this history more accessible for current readers by comparing what was said to what we know now. We argue that Bergmann's arguments are at least as compelling as those of Müller, and that he should be recognized as a codiscoverer of the anatomic site in the retina where vision is initiated.
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Affiliation(s)
- Larry Thibos
- School of Optometry, Indiana University, Bloomington, Indiana, USA
| | - Katharina Lenner
- Department of Social & Policy Sciences, University of Bath, Bath, UK
| | - Cameron Thibos
- Department of Social & Policy Sciences, University of Bath, Bath, UK
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Ramtohul P, Au A, Kunkler AL, Bacci T, Dolz-Marco R, Gallego-Pinazo R, Yannuzzi N, Sarraf D, Freund KB. CENTRAL BOUQUET HEMORRHAGE: Clinical and Multimodal Imaging Features. Retina 2024; 44:551-557. [PMID: 38109663 DOI: 10.1097/iae.0000000000004025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
PURPOSE To describe the clinical characteristics, multimodal imaging features, and anatomic basis of a distinctive pattern of deep retinal hemorrhages located in the central fovea, a presentation referred to as "central bouquet hemorrhage." METHODS Retrospective, observational, multicenter case series of eyes with central bouquet hemorrhage. Multimodal imaging features were reviewed and analyzed. RESULTS Ten eyes from 10 patients (4 women and 6 men), with a mean age of 55.6 ± 21.7 years (range 25-84 years) were included. Underlying etiologies were neovascular age-related macular degeneration (40%), lacquer cracks in pathological myopia (30%), macular telangiectasia Type 2 (10%), proliferative diabetic retinopathy (10%), and ocular trauma associated with angioid streaks (10%). On ophthalmoscopy, all eyes with central bouquet hemorrhage displayed a deep retinal hemorrhage with round margins in the central fovea and associated with petaloid hemorrhages radiating in the surrounding Henle fiber layer. Cross-sectional optical coherence tomography showed a well-delineated round hyperreflective lesion involving the central foveal Henle fiber layer/outer nuclear layer in all cases. Accompanying hyperreflective hemorrhages tracking along the obliquely oriented Henle fiber layer were present in all eyes. Resolution occurred in all patients, either spontaneously (30%) or after treatment with intravitreal anti-vascular endothelial growth factor injections (70%), and was associated with partial visual acuity improvement (from 20/113 to 20/36). CONCLUSION "Central bouquet hemorrhage" is a novel descriptive term describing a characteristic round pattern of intraretinal blood in the fovea associated with Henle fiber layer hemorrhage and encountered in a spectrum of macular disease.
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Affiliation(s)
- Prithvi Ramtohul
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Adrian Au
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Anne L Kunkler
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Tommaso Bacci
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | | | | | - Nicolas Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York
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Heath Jeffery RC, Lo J, Thompson JA, Lamey TM, McLaren TL, De Roach JN, Ayton LN, Vincent AL, Sharma A, Chen FK. Analysis of the Outer Retinal Bands in ABCA4 and PRPH2-Associated Retinopathy using OCT. Ophthalmol Retina 2024; 8:174-183. [PMID: 37209970 DOI: 10.1016/j.oret.2023.05.010] [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: 04/02/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE To evaluate the outer retinal bands using OCT in ABCA4- and PRPH2-associated retinopathy and develop a novel imaging biomarker to differentiate between these 2 genotypes. DESIGN Multicenter case-control study. PARTICIPANTS Patients with a clinical and genetic diagnosis of ABCA4- or PRPH2-associated retinopathy and an age-matched control group. METHODS Macular OCT was used to measure the thickness of the outer retinal bands 2 and 4 by 2 independent examiners at 4 retinal loci. MAIN OUTCOME MEASURES Outcome measures included the thicknesses of band 2, band 4, and the band 2/band 4 ratio. Linear mixed modeling was used to make comparisons across the 3 groups. Receiver operating characteristic (ROC) analysis determined the optimal cutoff for the band 2/band 4 ratio to distinguish PRPH2- from ABCA4-associated retinopathy. RESULTS We included 45 patients with ABCA4 variants, 45 patients with PRPH2 variants, and 45 healthy controls. Band 2 was significantly thicker in patients with PRPH2 compared with ABCA4 (21.4 vs. 15.9 μm, P < 0.001) variants, whereas band 4 was thicker in patients with ABCA4 variants than those with PRPH2 variants (27.5 vs. 21.7 μm, P < 0.001). Similarly, the band 2/band 4 ratio was significantly different (1.0 vs. 0.6 for PRPH2 vs. ABCA4, P < 0.001). The area under the ROC curve was 0.87 for either band 2 (> 18.58 μm) or band 4 (< 26.17 μm) alone and 0.99 (95% confidence interval: 0.97-0.99) for the band 2/band 4 ratio with a cutoff threshold of 0.79, providing 100% specificity. CONCLUSIONS We report an altered outer retinal band profile whereby the band 2/band 4 ratio was able to discriminate between PRPH2- and ABCA4-associated retinopathy. This may have future clinic utility in predicting the genotype and provide further insight into the anatomic correlate of band 2. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Rachael C Heath Jeffery
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia; Ocular Tissue Engineering Laboratory, Lions Eye Institute, Nedlands, Western Australia, Australia; Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Johnny Lo
- School of Science, Edith Cowan University, Perth, Western Australia, Australia
| | - Jennifer A Thompson
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Tina M Lamey
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia; Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Terri L McLaren
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia; Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - John N De Roach
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia; Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Lauren N Ayton
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea L Vincent
- Department of Ophthalmology, FMHS, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand; Eye Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Abhishek Sharma
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia; Ocular Tissue Engineering Laboratory, Lions Eye Institute, Nedlands, Western Australia, Australia; Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
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Xie H, Pan Z, Xue CC, Chen D, Jonas JB, Wu X, Wang YX. Arterial hypertension and retinal layer thickness: the Beijing Eye Study. Br J Ophthalmol 2023; 108:105-111. [PMID: 36428008 DOI: 10.1136/bjo-2022-322229] [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: 07/14/2022] [Accepted: 11/11/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate relationships between blood pressure and the thickness of single retinal layers in the macula. METHODS Participants of the population-based Beijing Eye Study, free of retinal or optic nerve disease, underwent medical and ophthalmological examinations including optical coherence tomographic examination of the macula. Applying a multiple-surface segmentation solution, we automatically segmented the retina into its various layers. RESULTS The study included 2237 participants (mean age 61.8±8.4 years, range 50-93 years). Mean thicknesses of the retinal nerve fibre layer (RNFL), ganglion cell layer (GCL), inner plexiform layer, inner nuclear layer (INL), outer plexiform layer, outer nuclear layer/external limiting membrane, ellipsoid zone, photoreceptor outer segments (POS) and retinal pigment epithelium-Bruch membrane were 31.1±2.3 µm, 39.7±3.5 µm, 38.4±3.3 µm, 34.8±2.0 µm, 28.1±3.0 µm, 79.2±7.3 µm, 22.9±0.6 µm, 19.2±3.3 µm and 20.7±1.4 µm, respectively. In multivariable analysis, higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) were associated with thinner GCL and thicker INL, after adjusting for age, sex and axial length (all p<0.0056). Higher SBP was additionally associated with thinner POS and higher DBP with thinner RNFL. For an elevation of SBP/DBP by 10 mm Hg, the RNFL, GCL, INL and POS changed by 2.0, 3.0, 1.5 and 2.0 µm, respectively. CONCLUSIONS Thickness of RNFL, GCL and POS was inversely and INL thickness was positively associated with higher blood pressure, while the thickness of the other retinal layers was not significantly correlated with blood pressure. The findings may be helpful for refinement of the morphometric detection of retinal diseases.
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Affiliation(s)
- Hui Xie
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Zhe Pan
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Can Can Xue
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Danny Chen
- Department of Computer Science and Engineering, University of Notre Dame, Notre Dame, Indiana, USA
| | - Jost B Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
- Ruprecht-Karls-University Heidelberg, Seegartenklinik Heidelberg, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Xiaodong Wu
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, USA
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USA
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
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10
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Domdei N, Ameln J, Gutnikov A, Witten JL, Holz FG, Wahl S, Harmening WM. Cone Density Is Correlated to Outer Segment Length and Retinal Thickness in the Human Foveola. Invest Ophthalmol Vis Sci 2023; 64:11. [PMID: 38064229 PMCID: PMC10709802 DOI: 10.1167/iovs.64.15.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Purpose Assessment of the relationship between in vivo foveolar cone density, cone outer segment length (OSL), and foveal retinal thickness (RT). Methods Foveolar cone density maps covering the central ±300 µm of the retina were derived from adaptive optics scanning laser ophthalmoscopy images. The corresponding maps of foveal cone OSL and RT were derived from high-resolution optical coherence tomography volume scans. Alignment of the two-dimensional maps containing OSL and RT with the cone density map was achieved by placing the location of maximum OSL on the cone density centroid (CDC). Results Across 10 participants (27 ± 9 years; 6 female), cone density at the CDC was found to be between 147,038 and 215,681 cones/mm². The maximum OSL and minimum RT were found to lie between 31 and 40, and 193 and 226 µm, respectively. A significant correlation was observed between cone density at the CDC and maximum OSL (P = 0.001), as well as the minimal RT (P < 0.05). Across all participants, the best fit for the relationship between normalized cone density and normalized OSL within the central 300 µm was given by a quadratic function. Conclusions Using optical coherence tomography-derived measurements of OSL enables to estimate CDC cone density and two-dimensional foveal cone density maps for example in patient eyes unsuitable for adaptive optics imaging. Furthermore, the observation of a fixed relationship between the normalized OSL and cone density points to a conserved mechanism shaping the foveal pit.
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Affiliation(s)
- Niklas Domdei
- Carl Zeiss Vision International GmbH, Aalen, Germany
| | - Julius Ameln
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Jenny L Witten
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Siegfried Wahl
- Carl Zeiss Vision International GmbH, Aalen, Germany
- Institute for Ophthalmic Research, Eberhard Karls University Tübingen, Tübingen, Germany
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11
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Lindell M, Kar D, Sedova A, Kim YJ, Packer OS, Schmidt-Erfurth U, Sloan KR, Marsh M, Dacey DM, Curcio CA, Pollreisz A. Volumetric Reconstruction of a Human Retinal Pigment Epithelial Cell Reveals Specialized Membranes and Polarized Distribution of Organelles. Invest Ophthalmol Vis Sci 2023; 64:35. [PMID: 38133501 PMCID: PMC10746928 DOI: 10.1167/iovs.64.15.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/04/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose Despite the centrality of the retinal pigment epithelium (RPE) in vision and retinopathy our picture of RPE morphology is incomplete. With a volumetric reconstruction of human RPE ultrastructure, we aim to characterize major membranous features including apical processes and their interactions with photoreceptor outer segments, basolateral infoldings, and the distribution of intracellular organelles. Methods A parafoveal retinal sample was acquired from a 21-year-old male organ donor. With serial block-face scanning electron microscopy, a tissue volume from the inner-outer segment junction to basal RPE was captured. Surface membranes and complete internal ultrastructure of an individual RPE cell were achieved with a combination of manual and automated segmentation methods. Results In one RPE cell, apical processes constitute 69% of the total cell surface area, through a dense network of over 3000 terminal branches. Single processes contact several photoreceptors. Basolateral infoldings facing the choriocapillaris resemble elongated filopodia and comprise 22% of the cell surface area. Membranous tubules and sacs of endoplasmic reticulum represent 20% of the cell body volume. A dense basal layer of mitochondria extends apically to partly overlap electron-dense pigment granules. Pores in the nuclear envelope form a distinct pattern of rows aligned with chromatin. Conclusions Specialized membranes at the apical and basal side of the RPE cell body involved in intercellular uptake and transport represent over 90% of the total surface area. Together with the polarized distribution of organelles within the cell body, these findings are relevant for retinal clinical imaging, therapeutic approaches, and disease pathomechanisms.
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Affiliation(s)
- Maximilian Lindell
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Deepayan Kar
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Aleksandra Sedova
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Yeon Jin Kim
- Department of Biological Structure, University of Washington, Seattle, Washington, United States
| | - Orin S. Packer
- Department of Biological Structure, University of Washington, Seattle, Washington, United States
| | | | - Kenneth R. Sloan
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Mike Marsh
- Object Research Systems, Montreal, Quebec, Canada
| | - Dennis M. Dacey
- Department of Biological Structure, University of Washington, Seattle, Washington, United States
| | - Christine A. Curcio
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Andreas Pollreisz
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
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12
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Nathans J. Seeing is believing: The development of optical coherence tomography. Proc Natl Acad Sci U S A 2023; 120:e2311129120. [PMID: 37732756 PMCID: PMC10523475 DOI: 10.1073/pnas.2311129120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
The 2023 Lasker-DeBakey Clinical Medical Research Award is being presented to James Fujimoto, David Huang, and Eric Swanson for their invention and development of optical coherence tomography (OCT), an imaging technology that uses light to visualize microscopic structures within tissues such as the retina. OCT has dramatically changed the practice of ophthalmology and improved the lives of millions of people. It also has great potential in a wide range of other medical fields.
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Affiliation(s)
- Jeremy Nathans
- Department of Molecular Biology and Genetics, Johns Hopkins University School of Medicine, Baltimore, MD21205
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD21205
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD21205
- HHMI, Johns Hopkins University School of Medicine, Baltimore, MD21205
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13
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Wang YX, Pan Z, Xue CC, Xie H, Wu X, Jonas JB. Macular outer nuclear layer, ellipsoid zone and outer photoreceptor segment band thickness, axial length and other determinants. Sci Rep 2023; 13:5386. [PMID: 37012316 PMCID: PMC10070240 DOI: 10.1038/s41598-023-32629-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
The study aims to assess the thickness of the retinal outer nuclear layer (ONL), ellipsoid zone (EZ) and photoreceptor outer segment (POS) band in various macular regions and its associations with axial length and other parameters. Participants of the Beijing Eye Study 2011 underwent a series of examinations including spectral-domain optical coherence tomography of the macula. The current study included 2213 participants without retinal or optic nerve diseases (age: 61.7 ± 8.4 years; range 50-93 years); axial length: 23.15 ± 0.95 mm; range 18.96-29.15 mm). The ONL (fovea: 98.9 ± 8.8 µm), EZ (fovea: 24.1 ± 0.5 µm) and POS band (fovea: 24.3 ± 3.5 µm) were the thickest (P < 0.001) in the fovea (defined as the thinnest central point), followed by the temporal inner, nasal inner, inferior inner, superior inner, inferior outer, temporal outer, nasal outer, and superior outer region. In multivariable analysis, a thicker retinal ONL was associated (correlation coefficient r: 0.40) with shorter axial length (beta: - 0.14; P < 0.001) and shorter disc-fovea distance (beta: - 0.10; P = 0.001), after adjusting for younger age (beta: - 0.26; P < 0.001), male sex (beta: 0.24; P < 0.001), lower serum cholesterol concentration (beta: - 0.05; P = 0.04), and thicker subfoveal choroidal thickness (beta: 0.08; P < 0.001). The POS thickness increased with shorter axial length (beta: - 0.06; P < 0.001) and shorter optic disc-fovea distance (beta: - 0.05; P = 0.03), after adjusting for younger age (beta: - 0.34; P < 0.001), male sex (beta: 0.15; P < 0.001), and thicker subfoveal choroidal thickness (beta: 0.24; P < 0.001). As a conclusion, the photoreceptor ONL, EZ and POS band vary in thickness between different macular regions and differ in their correlations with axial length, disc-fovea distance, age, sex, and subfoveal choroidal thickness. The ONL thickness decrease with longer axial length and longer disc-fovea distance may point to an axial elongation-associated retinal stretching in the macula.
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Affiliation(s)
- Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital University of Medical Science, Beijing, China.
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital University of Medical Science, 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, China.
| | - Zhe Pan
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital University of Medical Science, Beijing, China
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Can Can Xue
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital University of Medical Science, Beijing, China
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Hui Xie
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, USA
| | - Xiaodong Wu
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, USA
| | - Jost B Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital University of Medical Science, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
- Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany
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14
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Rozanova OI, Shchuko AG, Grigoryeva AV, Samsonov DY. [Patterns of structural and functional changes in the retina and choroid in acute posterior multifocal placoid pigment epitheliopathy]. Vestn Oftalmol 2023; 139:44-51. [PMID: 37638571 DOI: 10.17116/oftalma202313904144] [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] [Indexed: 08/29/2023]
Abstract
PURPOSE The study analyzes the patterns of pathological changes in the retina and choroid in acute posterior multifocal placoid pigmented epitheliopathy (APMPPE). MATERIAL AND METHODS The results of the examination of two patients with bilateral APMPPE were analyzed retrospectively. The examination had included visometry, tonometry, static perimetry, autofluorescence, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). RESULTS The analysis revealed signs of the inflammatory nature of the choriocapillary vascular wall lesion with the development of their local obstruction and, consequently, local ischemia of the retinal pigment epithelium (RPE) and the outer layers of the retina in the acute period. At the same time, partial destruction of the ellipsoid zone, uneven hyperreflectivity of the RPE with local areas of its elevation and impaired connection with photoreceptors were revealed. The subsequent restoration of choriocapillaris perfusion was accompanied by significant restoration of the functional and structural state of the RPE over a larger area, as well as partial restoration of the ellipsoid zone of the retina. Two years after the onset of the disease, separate areas of defects of the RPE and the outer retina were observed, coinciding in localization with zones of severe circulatory deficiency at the level of choriocapillaris in the acute stage. CONCLUSION According to the results of multimodal imaging, choriocapillaritis is the initial link in the pathogenesis of APMPPE. The change in RPE and the outer retina is secondary to the local ischemic zones due to choriocapillaris nonperfusion. The nature of RPE change over a larger area manifests as a functional structural disorder, with the potential for recovery in case of choriocapillaris reperfusion.
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Affiliation(s)
- O I Rozanova
- Irkutsk Branch of S.N. Fedorov National Medical Research Center "MNTK "Eye microsurgery", Irkutsk, Russia
| | - A G Shchuko
- Irkutsk Branch of S.N. Fedorov National Medical Research Center "MNTK "Eye microsurgery", Irkutsk, Russia
- Irkutsk Branch of Russian Medical Academy of Continuing Professional Education, Irkutsk, Russia
- Irkutsk State Medical University, Irkutsk, Russia
| | - A V Grigoryeva
- Irkutsk Branch of S.N. Fedorov National Medical Research Center "MNTK "Eye microsurgery", Irkutsk, Russia
| | - D Yu Samsonov
- Irkutsk Branch of S.N. Fedorov National Medical Research Center "MNTK "Eye microsurgery", Irkutsk, Russia
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15
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Molina Martín JC, Piñero DP, García Conca V, Desco MC, Mataix-Boronat J, Balboa Alonso M. Changes in the Hyperreflective Bands of Outer Retinal Layers after Idiopathic Epiretinal Membrane Surgical Removal. Curr Eye Res 2022; 47:1609-1614. [PMID: 36189946 DOI: 10.1080/02713683.2022.2132513] [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: 01/27/2023]
Abstract
Purpose: The purpose of this study was to describe the relationship between the outer retinal hyperreflective bands and visual acuity recovery after idiopathic epiretinal macular membrane (ERM) surgical removal.Methods: A prospective longitudinal non-comparative study was conducted that included a total of 68 patients with idiopathic ERM, who underwent consecutive 23 G pars plana vitrectomy (PPV) at San Juan University Hospital (Alicante, Spain) from January 2019 to January 2021. All patients underwent a complete preoperative standard ophthalmic examination, including measurement of best corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) examination. This protocol was repeated at 1 and 3 months after surgery.Results: Mean preoperative decimal BCVA was 0.30 ± 0.13 and disruption of the first, second, third and fourth outer retinal hyperreflective bands was observed by SD-OCT in 9 (27.9%), 27 (39.7%), 33 (48.5%) and 17 patients (25%), respectively. BCVA improved after ERM peeling at 1 and 3 months in all patients, regardless of the presence of disruption in any hyperreflective band. Significantly larger improvement of BCVA was found at 3 months after surgery in patients not showing disruption of hyperreflective bands 1 and 4 (p = 0.048 and 0.001, respectively).Conclusions: The integrity of the outer retinal hyperreflective bands by SD-OCT in patients with idiopathic ERM is a valuable tool to determine the visual prognosis of the surgical treatment of this condition. A successful recovery of hyperreflective bands 1 and 4 with ERM surgery may be a potential biomarker of the visual improvement achieved due to their important anatomical relation with cone photoreceptors at the foveal level.
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Affiliation(s)
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, San Vicente del Raspeig, Spain
| | - Victor García Conca
- Department of Ophthalmology, University Hospital San Juan de Alicante, Sant Joan d'Alacant, Spain
| | | | | | - María Balboa Alonso
- Department of Ophthalmology, University Hospital San Juan de Alicante, Sant Joan d'Alacant, Spain
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16
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Li M, Ma L. Learning Asymmetric and Local Features in Multi-Dimensional Data Through Wavelets With Recursive Partitioning. IEEE TRANSACTIONS ON PATTERN ANALYSIS AND MACHINE INTELLIGENCE 2022; 44:7674-7687. [PMID: 34495829 DOI: 10.1109/tpami.2021.3110403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Effective learning of asymmetric and local features in images and other data observed on multi-dimensional grids is a challenging objective critical for a wide range of image processing applications involving biomedical and natural images. It requires methods that are sensitive to local details while fast enough to handle massive numbers of images of ever increasing sizes. We introduce a probabilistic model-based framework that achieves these objectives by incorporating adaptivity into discrete wavelet transforms (DWT) through Bayesian hierarchical modeling, thereby allowing wavelet bases to adapt to the geometric structure of the data while maintaining the high computational scalability of wavelet methods-linear in the sample size (e.g., the resolution of an image). We derive a recursive representation of the Bayesian posterior model which leads to an exact message passing algorithm to complete learning and inference. While our framework is applicable to a range of problems including multi-dimensional signal processing, compression, and structural learning, we illustrate its work and evaluate its performance in the context of image reconstruction using real images from the ImageNet database, two widely used benchmark datasets, and a dataset from retinal optical coherence tomography and compare its performance to state-of-the-art methods based on basis transforms and deep learning.
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17
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Haverkamp S, Reinhard K, Peichl L, Mietsch M. No evidence for age-related alterations in the marmoset retina. Front Neuroanat 2022; 16:945295. [PMID: 36120100 PMCID: PMC9479465 DOI: 10.3389/fnana.2022.945295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/13/2022] [Indexed: 12/19/2022] Open
Abstract
The physiological aging process of the retina is accompanied by various and sometimes extensive changes: Macular degeneration, retinopathies and glaucoma are the most common findings in the elderly and can potentially lead to irreversible visual disablements up to blindness. To study the aging process and to identify possible therapeutic targets to counteract these diseases, the use of appropriate animal models is mandatory. Besides the most commonly used rodent species, a non-human primate, the common marmoset (Callithrix jacchus) emerged as a promising animal model of human aging over the last years. However, the visual aging process in this species is only partially characterized, especially with regard to retinal aberrations. Therefore, we assessed here for the first time potential changes in retinal morphology of the common marmoset of different age groups. By cell type specific immunolabeling, we analyzed different cell types and distributions, potential photoreceptor and ganglion cell loss, and structural reorganization. We detected no signs of age-related differences in staining patterns or densities of various cell populations. For example, there were no signs of photoreceptor degeneration, and there was only minimal sprouting of rod bipolar cells in aged retinas. Altogether, we describe here the maintenance of a stable neuronal architecture, distribution and number of different cell populations with only mild aberrations during the aging process in the common marmoset retina. These findings are in stark contrast to previously reported findings in rodent species and humans and deserve further investigations to identify the underlying mechanisms and possible therapeutic targets.
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Affiliation(s)
- Silke Haverkamp
- Department of Computational Neuroethology, Max Planck Institute for Neurobiology of Behavior—Caesar, Bonn, Germany
| | - Katja Reinhard
- Retinal Circuits and Optogenetics, Centre for Integrative Neuroscience, University of Tübingen, Tübingen, Germany
| | - Leo Peichl
- Institute of Clinical Neuroanatomy, Dr. Senckenbergische Anatomie, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Matthias Mietsch
- Laboratory Animal Science Unit, German Primate Center, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
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18
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He Y, Chen X, Tsui I, Vajzovic L, Sadda SR. Insights into the developing fovea revealed by imaging. Prog Retin Eye Res 2022; 90:101067. [PMID: 35595637 DOI: 10.1016/j.preteyeres.2022.101067] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 11/17/2022]
Abstract
Early development of the fovea has been documented by histological studies over the past few decades. However, structural distortion due to sample processing and the paucity of high-quality post-mortem tissue has limited the effectiveness of this approach. With the continuous progress in high-resolution non-invasive imaging technology, most notably optical coherence tomography (OCT) and OCT angiography (OCT-A), in vivo visualization of the developing retina has become possible. Combining the information from histologic studies with this novel imaging information has provided a more complete and accurate picture of retinal development, and in particular the developing fovea. Advances in neonatal care have increased the survival rate of extremely premature infants. However, with enhanced survival there has been an attendant increase in retinal developmental complications. Several key abnormalities, including a thickening of the inner retina at the foveal center, a shallower foveal pit, a smaller foveal avascular zone, and delayed development of the photoreceptors have been described in preterm infants when compared to full-term infants. Notably these abnormalities, which are consistent with a partial arrest of foveal development, appear to persist into later childhood and adulthood in these eyes of individuals born prematurely. Understanding normal foveal development is vital to interpreting these pathologic findings associated with prematurity. In this review, we first discuss the various advanced imaging technologies that have been adapted for imaging the infant eye. We then review the key events and steps in the development of the normal structure of the fovea and contrast structural features in normal and preterm retina from infancy to childhood. Finally, we discuss the development of the perifoveal retinal microvasculature and highlight future opportunities to expand our understanding of the developing fovea.
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Affiliation(s)
- Ye He
- Department of Ophthalmology, University of California - Los Angeles, Los Angeles, CA, USA; Doheny Eye Institute, Pasadena, CA, USA; Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, China
| | - Xi Chen
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
| | - Irena Tsui
- Department of Ophthalmology, University of California - Los Angeles, Los Angeles, CA, USA; Doheny Eye Institute, Pasadena, CA, USA
| | - Lejla Vajzovic
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
| | - Srinivas R Sadda
- Department of Ophthalmology, University of California - Los Angeles, Los Angeles, CA, USA; Doheny Eye Institute, Pasadena, CA, USA.
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19
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Gabrielle PH. Lipid metabolism and retinal diseases. Acta Ophthalmol 2022; 100 Suppl 269:3-43. [PMID: 36117363 DOI: 10.1111/aos.15226] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/24/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The retina has enormous lipids demands and must meet those needs. Retinal lipid homeostasis appears to be based on the symbiosis between neurons, Müller glial cells (MGC), and retinal pigment epithelium (RPE) cells, which can be impacted in several retinal diseases. The current research challenge is to better understand lipid-related mechanisms involved in retinal diseases, such as age-related macular degeneration (AMD) and glaucoma. RESULTS In a first axis, in vitro and focus on Müller glial cell, we aimed to characterize whether the 24S-hydroxycholesterol (24S-OHC), an overexpressed end-product of cholesterol elimination pathway in neural tissue and likely produced by suffering retinal ganglion cells in glaucoma, may modulate MGC membrane organization, such as lipid rafts, to trigger cellular signalling pathways related to retinal gliosis. We have found that lipid composition appears to be a key factor of membrane architecture, especially for lipid raft microdomain formation, in MGC. However, 24S-OHC did not appear to trigger retinal gliosis via the modulation of lipid or protein composition within lipid rafts microdomains. This study provided a better understanding of the complex mechanisms involved in the pathophysiology of glaucoma. On a second clinical ax, we focused on the lipid-related mechanisms involved in the dysfunction of aging RPE and the appearance of drusenoid deposits in AMD. Using the Montrachet population-based study, we intend to report the frequency of reticular pseudodrusen (RPD) and its ocular and systemic risk factors, particularly related to lipid metabolisms, such as plasma lipoprotein levels, carotenoids levels, and lipid-lowering drug intake. Our study showed that RPD was less common in subjects taking lipid-lowering drugs. Lipid-lowering drugs, such as statins, may reduce the risk of RPD through their effect on the production and function of lipoproteins. This observation highlights the potential role of retinal lipid trafficking via lipoproteins between photoreceptors and retinal pigment epithelium cells in RPD formation. Those findings have been complemented with preliminary results on the analysis of plasma fatty acid (FA) profile, a surrogate marker of short-term dietary lipid intake, according to the type of predominant drusenoid deposit, soft drusen or RPD, in age-related maculopathy. CONCLUSION Further research on lipid metabolism in retinal diseases is warranted to better understand the pathophysiology of retinal diseases and develop new promising diagnostic, prognostic, and therapeutic tools for our patients.
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Affiliation(s)
- Pierre-Henry Gabrielle
- Eye and Nutrition Research Group, Center for Taste and Feeding Behaviour, AgroSup Dijon, CNRS, INRAe, The University Bourgogne Franche-Comté, Dijon, France.,Department of Ophthalmology, Dijon University Hospital, Dijon, France.,The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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20
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Srinivasan VJ, Kho AM, Chauhan P. Visible Light Optical Coherence Tomography Reveals the Relationship of the Myoid and Ellipsoid to Band 2 in Humans. Transl Vis Sci Technol 2022; 11:3. [PMID: 36053140 PMCID: PMC9440607 DOI: 10.1167/tvst.11.9.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose We employ visible light optical coherence tomography (OCT) to investigate the relationship between the myoid, ellipsoid, and band 2 in the living human retina. Rather than refute existing theories, we aim to reveal new bands and better delineate the structures at hand. Methods An upgraded spectral/Fourier domain visible light OCT prototype, with 1.0-µm axial resolution, imaged 13 eyes of 13 young adult human subjects (23–40 years old) without a history of ocular pathology. The external limiting membrane (band 1) and band 2 edges were segmented. Reflectivity was examined along the inner segment (IS), defined as extending from band 1 to the band 2 center, and within band 2 itself. Results Images highlight a nearly continuously resolved extrafoveal internal limiting membrane, the peripheral single-cell thick ganglion cell layer, and the peripheral photoreceptor axonal fiber layer, a peripheral division of band 2 into bands 2a and 2b, and a reflectivity-based division of the IS into “m” and “e” zones. Discussion Topography and transverse intensity variations of the outermost band 2b suggest an association with rods. The “m” and “e” zone border is consistent with the myoid–ellipsoid boundary, even recapitulating the well-documented distribution of mitochondria throughout the IS at the foveal center. Theories of outer retinal reflectivity in OCT must adequately explain these observations. Translational Relevance Findings support that band 2 does partially overlap with the ellipsoid in transversally averaged OCT images due to photoreceptor IS length dispersion but argue that the inner ellipsoid must be inner to band 2, as suggested by prior quantitative measurements.
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Affiliation(s)
- Vivek J Srinivasan
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA.,Department of Radiology, NYU Langone Health, New York, NY, USA.,Tech4Health Institute, NYU Langone Health, New York, NY, USA.,Department of Biomedical Engineering, University of California, Davis, CA, USA
| | - Aaron M Kho
- Department of Biomedical Engineering, University of California, Davis, CA, USA
| | - Pooja Chauhan
- Department of Radiology, NYU Langone Health, New York, NY, USA.,Tech4Health Institute, NYU Langone Health, New York, NY, USA
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21
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Maloca PM, Freichel C, Hänsli C, Valmaggia P, Müller PL, Zweifel S, Seeger C, Inglin N, Scholl HPN, Denk N. Cynomolgus monkey's choroid reference database derived from hybrid deep learning optical coherence tomography segmentation. Sci Rep 2022; 12:13276. [PMID: 35918392 PMCID: PMC9346135 DOI: 10.1038/s41598-022-17699-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/29/2022] [Indexed: 11/18/2022] Open
Abstract
Cynomolgus monkeys exhibit human-like features, such as a fovea, so they are often used in non-clinical research. Nevertheless, little is known about the natural variation of the choroidal thickness in relation to origin and sex. A combination of deep learning and a deterministic computer vision algorithm was applied for automatic segmentation of foveolar optical coherence tomography images in cynomolgus monkeys. The main evaluation parameters were choroidal thickness and surface area directed from the deepest point on OCT images within the fovea, marked as the nulla with regard to sex and origin. Reference choroid landmarks were set underneath the nulla and at 500 µm intervals laterally up to a distance of 2000 µm nasally and temporally, complemented by a sub-analysis of the central bouquet of cones. 203 animals contributed 374 eyes for a reference choroid database. The overall average central choroidal thickness was 193 µm with a coefficient of variation of 7.8%, and the overall mean surface area of the central bouquet temporally was 19,335 µm2 and nasally was 19,283 µm2. The choroidal thickness of the fovea appears relatively homogeneous between the sexes and the studied origins. However, considerable natural variation has been observed, which needs to be appreciated.
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Affiliation(s)
- Peter M Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), 4031, Basel, Switzerland. .,Department of Ophthalmology, University Hospital Basel, 4031, Basel, Switzerland. .,Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK.
| | - Christian Freichel
- Pharma Research and Early Development (pRED), Pharmaceutical Sciences (PS), Roche, Innovation Center Basel, 4070, Basel, Switzerland
| | - Christof Hänsli
- Berner Augenklinik Am Lindenhofspital and University of Bern, Bern, Switzerland
| | - Philippe Valmaggia
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), 4031, Basel, Switzerland
| | - Philipp L Müller
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK.,Department of Ophthalmology, University of Bonn, Bonn, Germany.,Makulazentrum Augsburg, Fachärzte Augenheilkunde, Augsburg, Germany
| | - Sandrine Zweifel
- University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland.,University of Zurich, Rämistrasse 71, 8006, Zürich, Switzerland
| | - Christine Seeger
- Pharma Research and Early Development (pRED), Pharmaceutical Sciences (PS), Roche, Innovation Center Basel, 4070, Basel, Switzerland
| | - Nadja Inglin
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), 4031, Basel, Switzerland
| | - Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), 4031, Basel, Switzerland.,Department of Ophthalmology, University Hospital Basel, 4031, Basel, Switzerland
| | - Nora Denk
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), 4031, Basel, Switzerland.,Pharma Research and Early Development (pRED), Pharmaceutical Sciences (PS), Roche, Innovation Center Basel, 4070, Basel, Switzerland
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22
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Chauhan P, Kho AM, FitzGerald P, Shibata B, Srinivasan VJ. Subcellular Comparison of Visible-Light Optical Coherence Tomography and Electron Microscopy in the Mouse Outer Retina. Invest Ophthalmol Vis Sci 2022; 63:10. [PMID: 35943734 PMCID: PMC9379865 DOI: 10.1167/iovs.63.9.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose We employed in vivo, 1.0-µm axial resolution visible-light optical coherence tomography (OCT) and ex vivo electron microscopy (EM) to investigate three subcellular features in the mouse outer retina: reflectivity oscillations inner to band 1 (study 1); hyperreflective band 2, attributed to the ellipsoid zone or inner segment/outer segment (IS/OS) junction (study 2); and the hyperreflective retinal pigment epithelium (RPE) within band 4 (study 3). Methods Pigmented (C57BL/6J, n = 10) and albino (BALB/cJ, n = 3) mice were imaged in vivo. Enucleated eyes were processed for light and electron microscopy. Using well-accepted reference surfaces, we compared micrometer-scale axial reflectivity of visible-light OCT with subcellular organization, as revealed by 9449 annotated EM organelles and features across four pigmented eyes. Results In study 1, outer nuclear layer reflectivity peaks coincided with valleys in heterochromatin clump density (-0.34 ± 2.27 µm limits of agreement [LoA]). In study 2, band 2 depth on OCT and IS/OS junction depth on EM agreed (-0.57 ± 0.76 µm LoA), with both having similar distributions. In study 3, RPE electron dense organelle distribution did not agree with reflectivity in C57BL/6J mice, with OCT measures of RPE thickness exceeding those of EM (2.09 ± 0.89 µm LoA). Finally, RPE thickness increased with age in pigmented mice (slope = 0.056 µm/mo; P = 6.8 × 10-7). Conclusions Visible-light OCT bands arise from subcellular organization, enabling new measurements in mice. Quantitative OCT-EM comparisons may be confounded by hydration level, particularly in the OS and RPE. Caution is warranted in generalizing results to other species.
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Affiliation(s)
- Pooja Chauhan
- Department of Radiology, NYU Langone Health, New York, New York, United States
| | - Aaron M. Kho
- Department of Biomedical Engineering, University of California Davis, Davis, California, United States
| | - Paul FitzGerald
- Department of Cell Biology and Human Anatomy, University of California Davis, Davis, California, United States
| | - Bradley Shibata
- Biological Electron Microscopy Facility, University of California Davis, Davis, California, United States
| | - Vivek J. Srinivasan
- Department of Radiology, NYU Langone Health, New York, New York, United States
- Department of Biomedical Engineering, University of California Davis, Davis, California, United States
- Department of Ophthalmology, NYU Langone Health, New York, New York, United States
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23
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Multi-modal and multi-scale clinical retinal imaging system with pupil and retinal tracking. Sci Rep 2022; 12:9577. [PMID: 35688890 PMCID: PMC9187716 DOI: 10.1038/s41598-022-13631-1] [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: 10/28/2021] [Accepted: 05/17/2022] [Indexed: 11/08/2022] Open
Abstract
We present a compact multi-modal and multi-scale retinal imaging instrument with an angiographic functional extension for clinical use. The system integrates scanning laser ophthalmoscopy (SLO), optical coherence tomography (OCT) and OCT angiography (OCTA) imaging modalities and provides multi-scale fields of view. For high resolution, and high lateral resolution in particular, cellular imaging correction of aberrations by adaptive optics (AO) is employed. The entire instrument has a compact design and the scanning head is mounted on motorized translation stages that enable 3D self-alignment with respect to the subject's eye by tracking the pupil position. Retinal tracking, based on the information provided by SLO, is incorporated in the instrument to compensate for retinal motion during OCT imaging. The imaging capabilities of the multi-modal and multi-scale instrument were tested by imaging healthy volunteers and patients.
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24
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Optical coherence tomography in the diagnosis and monitoring of congenital and juvenile glaucoma. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.2.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Optical coherence tomography (OCT) in everyday routine practice is the method of choice for the instrumental diagnosis of glaucoma in adults. As a non-invasive and safe method of visualizing structural changes in the retina and the optic nerve, the method is of particular value in pediatric practice. At the same time, OCT diagnostics in children is associated with certain difficulties, both during the study and when interpreting the scan results.This review summarizes the data from the literature and our own research in the diagnosis and monitoring of congenital and juvenile glaucoma from the standpoint of our own long-term clinical experience in using optical coherence tomography. We consider the physiological changes of the retina and optic nerve, attention is focused on the need to create a pediatric regulatory database of retinal thickness, the factors that determine the normal range of the data obtained and allow distinguishing physiological processes from pathological ones are identified. Clinical cases confirming the value of OCT in combined pathology are presented as examples.
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25
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McKay BR, Bansal A, Kryshtalskyj M, Wong DT, Berger A, Muni RH. Evaluation of Subretinal fluid Drainage Techniques during Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment - ELLIPSOID study. Am J Ophthalmol 2022; 241:227-237. [PMID: 35597323 DOI: 10.1016/j.ajo.2022.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare visual acuity and photoreceptor integrity following vitrectomy (PPV) with drainage from the peripheral retinal break(s) (PRB) vs. posterior retinotomy (PR) vs. perfluorocarbon liquid (PFCL) for macula-off rhegmatogenous retinal detachment (RRD). DESIGN Retrospective consecutive interventional comparative clinical study. METHODS 300 consecutive patients (300 eyes) with primary macula-off RRD underwent 23-gauge PPV with SRF drainage through 1) PRB (n=100), 2) PR (n=100), or 3) with PFCL (n=100). Visual acuity and SD-OCT were performed preoperatively and at 3, 6, and 12 months postoperatively. Primary outcomes were visual acuity and discontinuity of the external limiting membrane, ELM; ellipsoid zone, EZ; interdigitation zone, IDZ; and retinal pigment epithelium, RPE at 1-year. RESULTS Baseline characteristics were similar. Single-operation reattachment rates were: PRB 86%; PR 85%; PFCL 83%,p=0.9. Mean(±SD) logMAR visual acuity at 1-year was greater with PRB and PR compared to PFCL (PRB=0.6±0.5;PR=0.7±0.6;PFCL=0.9±0.6,p=0.002). There was an association between drainage technique and discontinuity of the ELM (PRB 26%,PR 24%,PFCL 44%,p=0.001), EZ (PRB 29%,PR 31%,PFCL 49%,p<0.001) and IDZ (PRB 43%,PR 39%,PFCL 56%, p=0.004). There was an association between drainage technique and risk of cystoid macular edema (CME) (PRB 28%,PR 39%,PFCL 46%,p=0.003) and ERM (PRB 64%,PR 90%,PFCL 61%,P<0.001). CONCLUSIONS PFCL-assisted drainage is associated with worse visual acuity and greater risk of outer retinal band discontinuity and CME compared with PRB or PR. PR had a greater risk of ERM compared with PRB and PFCL. PRB had the best outcomes overall. Drainage technique may impact long-term anatomic and functional outcomes.
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26
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J. Steptoe P, Guly CM, Dick AD. Ocular Toxoplasmosis Associated Dark Without Pressure. Ocul Immunol Inflamm 2022; 31:624-626. [PMID: 35499545 DOI: 10.1080/09273948.2022.2037658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Paul J. Steptoe
- Bristol Eye Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Catherine M. Guly
- Bristol Eye Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Andrew D. Dick
- Bristol Eye Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Medical School, University of Bristol, Bristol, UK
- Institute of Ophthalmology, University College London, London, UK
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27
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Mischi E, Soukup P, Harman CD, Oikawa K, Kowalska ME, Hartnack S, McLellan GJ, Komáromy AM, Pot SA. Outer retinal thickness and visibility of the choriocapillaris in four distinct retinal regions imaged with spectral domain optical coherence tomography in dogs and cats. Vet Ophthalmol 2022; 25 Suppl 1:122-135. [PMID: 35611616 PMCID: PMC9246961 DOI: 10.1111/vop.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the outer retinal band thickness and choriocapillaris (CC) visibility in four distinct retinal regions in dogs and cats imaged with spectral domain optical coherence tomography (SD-OCT). To attempt delineation of a fovea-like region in canine and feline SD-OCT scans, aided by the identification of outer retinal thickness differences between retinal regions. METHODS Spectralis® HRA + OCT SD-OCT scans from healthy, anesthetized dogs (n = 10) and cats (n = 12) were analyzed. Scanlines on which the CC was identifiable were counted and CC visibility was scored. Outer nuclear layer (ONL) thickness and the distances from external limiting membrane (ELM) to retinal pigment epithelium/Bruch's membrane complex (RPE/BM) and ELM to CC were measured in the area centralis (AC), a visually identified fovea-like region, and in regions superior and inferior to the optic nerve head (ONH). Measurements were analyzed using a multilevel regression. RESULTS The CC was visible in over 90% of scanlines from dogs and cats. The ONL was consistently thinnest in the fovea-like region. The outer retina (ELM-RPE and ELM-CC) was thickest within the AC compared with superior and inferior to the ONH in dogs and cats (p < .001 for all comparisons). CONCLUSIONS The CC appears a valid, albeit less than ideal outer retinal boundary marker in tapetal species. The AC can be objectively differentiated from the surrounding retina on SD-OCT images of dogs and cats; a fovea-like region was identified in dogs and its presence was suggested in cats. These findings allow targeted imaging and image evaluation of these regions of retinal specialization.
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Affiliation(s)
- Elisa Mischi
- Ophthalmology Section, Equine Department, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Petr Soukup
- Ophthalmology Section, Equine Department, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Christine D. Harman
- Department of Small Animal Clinical Sciences, College of Veterinary MedicineMichigan State UniversityEast LansingMichiganUSA
| | - Kazuya Oikawa
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Malwina E. Kowalska
- Ophthalmology Section, Equine Department, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
- Section of Epidemiology, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Sonja Hartnack
- Section of Epidemiology, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Gillian J. McLellan
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - András M. Komáromy
- Department of Small Animal Clinical Sciences, College of Veterinary MedicineMichigan State UniversityEast LansingMichiganUSA
| | - Simon A. Pot
- Ophthalmology Section, Equine Department, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
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28
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Schurer-Waldheim S, Seebock P, Bogunovic H, Gerendas BS, Schmidt-Erfurth U. Robust Fovea Detection in Retinal OCT Imaging using Deep Learning. IEEE J Biomed Health Inform 2022; 26:3927-3937. [PMID: 35394920 DOI: 10.1109/jbhi.2022.3166068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The fovea centralis is an essential landmark in the retina where the photoreceptor layer is entirely composed of cones responsible for sharp, central vision. The localization of this anatomical landmark in optical coherence tomography (OCT) volumes is important for assessing visual function correlates and treatment guidance in macular disease. In this study, the "PRE U-net" is introduced as a novel approach for a fully automated fovea centralis detection, addressing the localization as a pixel-wise regression task. 2D B-scans are sampled from each image volume and are concatenated with spatial location information to train the deep network. A total of 5586 OCT volumes from 1,541 eyes was used to train, validate and test the deep learning method. The test data is comprised of healthy subjects and patients affected by neovascular age-related macular degeneration (nAMD), diabetic macula edema (DME) and macular edema from retinal vein occlusion (RVO), covering the three major retinal diseases responsible for blindness. Our experiments demonstrate that the PRE U-net significantly outperforms state-of-the-art methods and improves the robustness of automated localization, which is of value for clinical practice.
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29
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Kim TH, Ma G, Son T, Yao X. Functional Optical Coherence Tomography for Intrinsic Signal Optoretinography: Recent Developments and Deployment Challenges. Front Med (Lausanne) 2022; 9:864824. [PMID: 35445037 PMCID: PMC9013890 DOI: 10.3389/fmed.2022.864824] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Intrinsic optical signal (IOS) imaging of the retina, also termed as optoretinogram or optoretinography (ORG), promises a non-invasive method for the objective assessment of retinal function. By providing the unparalleled capability to differentiate individual retinal layers, functional optical coherence tomography (OCT) has been actively investigated for intrinsic signal ORG measurements. However, clinical deployment of functional OCT for quantitative ORG is still challenging due to the lack of a standardized imaging protocol and the complication of IOS sources and mechanisms. This article aims to summarize recent developments of functional OCT for ORG measurement, OCT intensity- and phase-based IOS processing. Technical challenges and perspectives of quantitative IOS analysis and ORG interpretations are discussed.
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Affiliation(s)
- Tae-Hoon Kim
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States
| | - Guangying Ma
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States
| | - Taeyoon Son
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States
| | - Xincheng Yao
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, United States
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30
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Li KV, Flores-Bellver M, Aparicio-Domingo S, Petrash C, Cobb H, Chen C, Canto-Soler MV, Mathias MT. A Surgical Kit for Stem Cell-Derived Retinal Pigment Epithelium Transplants: Collection, Transportation, and Subretinal Delivery. Front Cell Dev Biol 2022; 10:813538. [PMID: 35252183 PMCID: PMC8895272 DOI: 10.3389/fcell.2022.813538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/20/2022] [Indexed: 12/04/2022] Open
Abstract
Transplantation of stem cell-derived retinal pigment epithelium (RPE) cells is a promising potential therapy for currently incurable retinal degenerative diseases like advanced dry age-related macular degeneration. In this study, we designed a set of clinically applicable devices for subretinal implantation of RPE grafts, towards the overarching goal of establishing enabling technologies for cell-based therapeutic approaches to regenerate RPE cells. This RPE transplant kit includes a custom-designed trephine for the production of RPE transplants, a carrier for storage and transportation, and a surgical device for subretinal delivery of RPE transplants. Cell viability assay confirmed biocompatibility of the transplant carrier and high preservation of RPE transplants upon storage and transportation. The transplant surgical device combines foldable technology that minimizes incision size, controlled delivery speed, no fluid reflux, curved translucent tip, usability of loading and in vivo reloading, and ergonomic handle. Furthermore, the complementary design of the transplant carrier and the delivery device resulted in proper grasping, loading, and orientation of the RPE transplants into the delivery device. Proof-of-concept transplantation studies in a porcine model demonstrated no damage or structural change in RPE transplants during surgical manipulation and subretinal deployment. Post-operative assessment confirmed that RPE transplants were delivered precisely, with no damage to the host retina or choroid, and no significant structural change to the RPE transplants. Our novel surgical kit provides a comprehensive set of tools encompassing RPE graft manufacturing to surgical implantation rendering key enabling technologies for pre-clinical and clinical phases of stem cell-derived RPE regenerative therapies.
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Affiliation(s)
- Kang V. Li
- CellSight Ocular Stem Cell and Regeneration Research Program, Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, United States
- *Correspondence: Marc T. Mathias, ; M. Valeria Canto-Soler, ; Kang V. Li,
| | - Miguel Flores-Bellver
- CellSight Ocular Stem Cell and Regeneration Research Program, Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, United States
| | - Silvia Aparicio-Domingo
- CellSight Ocular Stem Cell and Regeneration Research Program, Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, United States
| | - Carson Petrash
- CellSight Ocular Stem Cell and Regeneration Research Program, Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, United States
| | - Hannah Cobb
- CellSight Ocular Stem Cell and Regeneration Research Program, Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, United States
| | - Conan Chen
- CellSight Ocular Stem Cell and Regeneration Research Program, Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, United States
| | - M. Valeria Canto-Soler
- CellSight Ocular Stem Cell and Regeneration Research Program, Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, United States
- Charles C. Gates Center for Regenerative Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- *Correspondence: Marc T. Mathias, ; M. Valeria Canto-Soler, ; Kang V. Li,
| | - Marc T. Mathias
- CellSight Ocular Stem Cell and Regeneration Research Program, Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, United States
- *Correspondence: Marc T. Mathias, ; M. Valeria Canto-Soler, ; Kang V. Li,
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31
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Steptoe PJ, Pearce I, Beare NAV, Sreekantam S, Mohammed BR, Barry RJ, Steeples LR, Denniston AK, Murray PI. Proposing a Neurotropic Etiology for Acute Posterior Multifocal Placoid Pigment Epitheliopathy and Relentless Placoid Chorioretinitis. FRONTIERS IN OPHTHALMOLOGY 2022; 1:802962. [PMID: 38983970 PMCID: PMC11182168 DOI: 10.3389/fopht.2021.802962] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/20/2021] [Indexed: 07/11/2024]
Abstract
Purpose To reassess the underlying pathophysiology of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and relentless placoid chorioretinitis (RPC) through comparison with the non-inoculated eye of the von Szily animal model of neurotropic viral retinal infection. Methods Narrative review. Results Literature reports of isolated neurotropic viral entities and rising serological viral titers in APMPPE after presentation support a potential direct infective etiology. In general, viral transport along axons results in mitochondrial stasis and disruption of axoplasmic flow. Clinical manifestations of axoplasmic flow disruption in APMPPE/RPC may signify the passage of virus along the neuronal pathway. From a case series of 11 patients, we demonstrate a timely, spatial, and proportional association of optic disc swelling with APMPPE lesion occurrence. Signs within the inner retina appear to precede outer retinal lesions; and acute areas of outer nuclear layer (ONL) hyperreflectivity appear to be the result of coalescence of multiple hyperreflective foci resembling axonal spheroids (which occur as a consequence of axoplasmic disruption) and follow the Henle fiber layer neurons. Underlying areas of retinal pigment epithelium (RPE) hyper-autofluorescence follow ONL hyperreflectivity and may signify localized infection. Areas of apparent choriocapillaris hypoperfusion mirror areas of RPE/Bruch's membrane separation and appear secondary to tractional forces above. Increases in choroidal thickness with lesion occurrence and focal areas of choriocapillaris hypoperfusion are observed in both APMPPE/RPC and the von Szily model. Conclusions The neurotrophic infection model provides significant advantages over the existing primary choriocapillaris ischemia hypothesis to account for the range of imaging signs observed in APMPPE and RPC.
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Affiliation(s)
- Paul J Steptoe
- Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
| | - Ian Pearce
- St. Paul's Eye Unit, Liverpool University Hospitals National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom
| | - Nicholas A V Beare
- St. Paul's Eye Unit, Liverpool University Hospitals National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | | | - Robert J Barry
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Laura R Steeples
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Alastair K Denniston
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Ophthalmology Department, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Centre for Rare Diseases, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Philip I Murray
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Li S, Hua R, Jing Z, Huang L, Chen L. Correlation Between Retinal Microstructure Detected by Optical Coherence Tomography and Best Corrected Visual Acuity in Diabetic Retinopathy Macular Edema. Front Endocrinol (Lausanne) 2022; 13:831909. [PMID: 35721720 PMCID: PMC9198249 DOI: 10.3389/fendo.2022.831909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/14/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the correlation between best corrected visual acuity (BCVA) and retinal microstructural parameters detected by optical coherence tomography (OCT) in diabetic retinopathy macular edema (DRME). METHODS Thirty-nine patients (64 eyes) with DRME were enrolled in this study. These patients underwent OCT to measure the fracture distance of the external limiting membrane (ELM), junction between the inner and outer segments (IS/OS), central foveal thickness (CFT), and edema layer. The correlation between the above parameters and BCVA was discussed. RESULTS CFT and the fracture distances of the ELM and IS/OS layers were negatively correlated with BCVA (p<0.05 for all). There was significant difference in Logarithm of the minimum angle of resolution (LogMAR) BCVA among patients with inner retinal edema, outer retinal edema, and mixed retinal edema (F = 5.57, p = 0.01). The LogMAR BCVA of inner retinal edema was the lowest (p < 0.05), and the LogMAR BCVA of outer retinal edema and mixed retinal edema were comparable (p > 0.05). CONCLUSION In eyes with DRME, thin CFT, intact ELM and IS/OS layers, and edema in inner retina is closely correlated with good BCVA.
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Affiliation(s)
- Siying Li
- Department of Ophthalmology, The First Affiliated Hospital of Jiamusi University, Jiamusi, China
| | - Rui Hua
- Department of Ophthalmology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zuoqian Jing
- Department of Ophthalmology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Lele Huang
- Department of Ophthalmology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Lei Chen
- Department of Ophthalmology, The First Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Lei Chen,
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Yurtogullari S, Erbahceci IE. Inner and outer retina findings determined by optical coherence tomography in different subtypes of multiple sclerosis. Niger J Clin Pract 2022; 25:1069-1075. [DOI: 10.4103/njcp.njcp_1568_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mathis T, Vasseur V, Zuber K, Arej N, Loria O, Kodjikian L, Sennlaub F, Mauget‐Faÿsse M. Light-induced modifications of the outer retinal hyperreflective layers on spectral-domain optical coherence tomography in humans: an experimental study. Acta Ophthalmol 2021; 99:765-772. [PMID: 33393736 PMCID: PMC8596705 DOI: 10.1111/aos.14723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 11/14/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Numerous small hyperreflective dots (HRDs) can be seen within the hyporeflective layer between the ellipsoid zone (EZ) and the interdigitation zone (IZ) on C-scan spectral-domain optical coherence tomography (SD-OCT) with a yet unknown variation under light conditions. The aim of this study was to explore light-induced SD-OCT changes in these HRDs. METHODS The study subjects were randomly assigned to two groups: Group 1 experienced a dark adaptation protocol followed by intense retinal photobleaching, while Group 2, serving as the control group, was exposed to constant ambient light without any variation. The number of HRDs was automatically counted. RESULTS Twenty healthy volunteers were prospectively included. The number of HRDs differed significantly over time (p = 0.0013). They decreased in Group 1 after dark adaptation and retinal photobleaching before returning to baseline levels 30 min later; conversely, they remained relatively constant in Group 2 throughout the study (p < 0.001). Light-skinned subjects had less HRD than dark-skinned subjects. CONCLUSION We observed light-induced modifications in the space between the EZ and the IZ. We hypothesize that the HRDs visible in this zone correspond to melanosomes that are mobilized during the light stimulation protocol. Larger studies are recommended to further evaluate and confirm light-induced SD-OCT changes under physiological and pathological conditions.
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Affiliation(s)
- Thibaud Mathis
- Department of OphthalmologyCroix‐Rousse University HospitalHospices Civils de LyonUniversity of Medicine Lyon 1LyonFrance
- UMR‐CNRS 5510 MatéisLyon 1 UniversityLyonFrance
- INSERMCNRSInstitut de la VisionSorbonne UniversityParisFrance
| | - Vivien Vasseur
- Department of OphthalmologyRothschild FoundationParisFrance
| | - Kevin Zuber
- Department of OphthalmologyRothschild FoundationParisFrance
| | - Nicolas Arej
- Department of OphthalmologyRothschild FoundationParisFrance
| | - Olivier Loria
- Department of OphthalmologyCroix‐Rousse University HospitalHospices Civils de LyonUniversity of Medicine Lyon 1LyonFrance
- UMR‐CNRS 5510 MatéisLyon 1 UniversityLyonFrance
| | - Laurent Kodjikian
- Department of OphthalmologyCroix‐Rousse University HospitalHospices Civils de LyonUniversity of Medicine Lyon 1LyonFrance
- UMR‐CNRS 5510 MatéisLyon 1 UniversityLyonFrance
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Trinh M, Khou V, Kalloniatis M, Nivison-Smith L. Location-Specific Thickness Patterns in Intermediate Age-Related Macular Degeneration Reveals Anatomical Differences in Multiple Retinal Layers. Invest Ophthalmol Vis Sci 2021; 62:13. [PMID: 34661608 PMCID: PMC8525852 DOI: 10.1167/iovs.62.13.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To examine individual retinal layers’ location-specific patterns of thicknesses in intermediate age-related macular degeneration (iAMD) using optical coherence tomography (OCT). Methods OCT macular cube scans were retrospectively acquired from 84 iAMD eyes of 84 participants and 84 normal eyes of 84 participants propensity-score matched on age, sex, and spherical equivalent refraction. Thicknesses of the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer + Henle's fiber layer (ONL+HFL), inner- and outer-segment layers (IS/OS), and retinal pigment epithelium to Bruch's membrane (RPE-BM) were calculated across an 8 × 8 grid (total 24° × 24° area). Location-specific analysis was performed using cluster(normal) and grid(iAMD)-to-cluster(normal) comparisons. Results In iAMD versus normal eyes, the central RPE-BM was thickened (mean difference ± SEM up to 27.45% ± 7.48%, P < 0.001; up to 7.6 SD-from-normal), whereas there was thinned outer (OPL, ONL+HFL, and non-central RPE-BM, up to −6.76% ± 2.47%, P < 0.001; up to −1.6 SD-from-normal) and inner retina (GCL and IPL, up to −4.83% ± 1.56%, P < 0.01; up to −1.7 SD-from-normal) with eccentricity-based effects. Interlayer correlations were greater against the ONL+HFL (mean |r| ± SEM 0.19 ± 0.03, P = 0.14 to < 0.0001) than the RPE-BM (0.09 ± 0, P = 0.72 to < 0.0001). Conclusions Location-specific analysis suggests altered retinal anatomy between iAMD and normal eyes. These data could direct clinical diagnosis and monitoring of AMD toward targeted locations.
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Affiliation(s)
- Matt Trinh
- Centre for Eye Health, University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Vincent Khou
- Centre for Eye Health, University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Abstract
PURPOSE To describe the clinical and multimodal imaging features of bacillary layer detachment (BD), and its response to intravitreal anti-vascular endothelial growth factor therapy, in eyes with macular neovascularization. METHODS Retrospective, observational case series of 14 eyes (14 patients, 7 men) imaged with eyes (14 patients, 7 men) were imaged with spectral-domain optical coherence tomography, and either fluorescein angiography or optical coherence tomography angiography. Therapeutic response was monitored with serial imaging and best-corrected visual acuity assessments. RESULTS The mean age was 75 ± 13 (range: 45-96) years, with mean follow-up duration of 27 ± 21 (range: 1-56) months. Neovascular age-related macular degeneration was found in 71% (10/14) eyes. Type 2 macular neovascularization lesions were associated with BD in all 14 eyes. Subretinal hemorrhage was noted in 79% (11/14) eyes. BD promptly resolved after intravitreal antivascular endothelial growth factor therapy in all eyes. The baseline best-corrected visual acuity improved from logarithm of the minimum angle of resolution 0.84 ± 0.32 (Snellen equivalent 20/138) to logarithm of the minimum angle of resolution 0.48 ± 0.31 (Snellen equivalent 20/60) at the last follow-up, with treatment of the macular neovascularization. CONCLUSION Type 2 macular neovascularization and subretinal hemorrhage are associated with BDs, which may be due to a rapid influx of exudative fluid into the potential space between the external limiting membrane and ellipsoid zone. Intravitreal antivascular endothelial growth factor therapy results in rapid resolution of BDs and visual improvement in most eyes.
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REVISED CLASSIFICATION OF THE OPTICAL COHERENCE TOMOGRAPHY OUTER RETINAL BANDS BASED ON CENTRAL SEROUS CHORIORETINOPATHY ANALYSIS. Retina 2021; 41:181-188. [PMID: 32271277 DOI: 10.1097/iae.0000000000002792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the optical coherence tomography (OCT) imaging findings in recent onset neurosensory retinal detachments induced by central serous chorioretinopathy and to attempt to corroborate these findings with proposed anatomical correlates. METHODS Retinal detachments due to central serous chorioretinopathy of less than 3 months' duration and the surrounding area were scanned with OCT. The imaging of the outer retinal bands was evaluated according to proposals by Cuenca et al and the IN•OCT Consensus classification. RESULTS Optical coherence tomography findings in 11 eyes (11 patients) with CSC showed that all hyperreflective bands above Band 4 were variably continuous within the outer portion of the serous detachment. We then attempted to reconcile inconsistencies in current explanations for the outer retinal bands to propose changes to the outer retinal OCT nomenclature. CONCLUSION Our patients' OCT findings support the current standard that Band 3 is an outer retinal structure and that Band 4 represents the retinal pigment epithelium/Bruch complex. Confusion exists regarding whether the interdigitation zone extends halfway up or for the full length of the outer segments, and the hyporeflective band between Bands 3 and 4 has yet to receive an appropriate term. We therefore propose a modification to the IN•OCT Consensus classification by renaming the trilaminar hyporeflective, hyperreflective, and hyporeflective bands between Bands 2 and 4 as the outer segment-interdigitation zone complex consisting of the inner, middle, and outer segment-interdigitation zone, respectively.
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Masri RA, Weltzien F, Purushothuman S, Lee SCS, Martin PR, Grünert U. Composition of the Inner Nuclear Layer in Human Retina. Invest Ophthalmol Vis Sci 2021; 62:22. [PMID: 34259817 PMCID: PMC8288061 DOI: 10.1167/iovs.62.9.22] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [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 measure the composition of the inner nuclear layer (INL) in the central and peripheral human retina as foundation data for interpreting INL function and dysfunction. Methods Six postmortem human donor retinas (male and female, aged 31–56 years) were sectioned along the temporal horizontal meridian. Sections were processed with immunofluorescent markers and imaged using high-resolution, multichannel fluorescence microscopy. The density of horizontal, bipolar, amacrine, and Müller cells was quantified between 1 and 12 mm eccentricity with appropriate adjustments for postreceptoral spatial displacements near the fovea. Results Cone bipolar cells dominate the INL a with density near 50,000 cells/mm2 at 1 mm eccentricity and integrated total ∼10 million cells up to 10 mm eccentricity. Outside central retina the spatial density of all cell populations falls but the neuronal makeup of the INL remains relatively constant: a decrease in the proportion of cone bipolar cells (from 52% at 1 mm to 37% at 10 mm) is balanced by an increasing proportion of rod bipolar cells (from 9% to 15%). The proportion of Müller cells near the fovea (17%) is lower than in the peripheral retina (27%). Conclusions Despite large changes in the absolute density of INL cell populations across the retina, their proportions remain relatively constant. These data may have relevance for interpreting diagnostic signals such as the electroretinogram and optical coherence tomogram.
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Affiliation(s)
- Rania A Masri
- The University of Sydney, Faculty of Medicine and Health, Save Sight Institute and Discipline of Clinical Ophthalmology, Sydney, Australia.,Australian Research Council Centre of Excellence for Integrative Brain Function, The University of Sydney, Sydney, Australia
| | - Felix Weltzien
- The University of Sydney, Faculty of Medicine and Health, Save Sight Institute and Discipline of Clinical Ophthalmology, Sydney, Australia
| | - Sivaraman Purushothuman
- The University of Sydney, Faculty of Medicine and Health, Save Sight Institute and Discipline of Clinical Ophthalmology, Sydney, Australia
| | - Sammy C S Lee
- The University of Sydney, Faculty of Medicine and Health, Save Sight Institute and Discipline of Clinical Ophthalmology, Sydney, Australia.,Australian Research Council Centre of Excellence for Integrative Brain Function, The University of Sydney, Sydney, Australia
| | - Paul R Martin
- The University of Sydney, Faculty of Medicine and Health, Save Sight Institute and Discipline of Clinical Ophthalmology, Sydney, Australia.,Australian Research Council Centre of Excellence for Integrative Brain Function, The University of Sydney, Sydney, Australia
| | - Ulrike Grünert
- The University of Sydney, Faculty of Medicine and Health, Save Sight Institute and Discipline of Clinical Ophthalmology, Sydney, Australia.,Australian Research Council Centre of Excellence for Integrative Brain Function, The University of Sydney, Sydney, Australia
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Nair U, Sheth JU, Indurkar A, Soman M. Intraretinal Cysts in Macular Hole: A Structure-Function Correlation Based on En Face Imaging. Clin Ophthalmol 2021; 15:2953-2962. [PMID: 34285461 PMCID: PMC8285276 DOI: 10.2147/opth.s321594] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/01/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To characterize retinal micromorphic changes on en face optical coherence tomography (OCT) and to determine their role in pathogenesis and visual outcomes in macular hole (MH) surgery. Patients and Methods This is a retrospective, interventional, consecutive case series of 28 eyes undergoing successful MH surgery. Pre- and post-operative en face OCT were manually segmented, and the correlation between parameters such as MH basal diameter and minimal inlet area, area of cyst in inner plexiform layer (IPL) and outer plexiform layer (OPL), percentage of cyst in IPL and OPL, and amount of ellipsoid zone (EZ) defect and external limiting membrane (ELM) defect was performed. Their relationship with visual acuity (VA) outcomes (Group 1: ≥20/60; 14 eyes; Group 2: <20/60; 14 eyes) was also evaluated. Results A significant positive correlation was noted between the cyst area in OPL and IPL (r=0.768; p<0.001), which in turn were positively correlated with the basal diameter of the MH in all eyes. The cyst area was significantly more in IPL as compared to OPL in all eyes (p=0.049) and in group 2 (p=0.03) but not in group 1 (p=0.62). As compared to group 2, eyes in group 1 had significantly better pre- and post-operative VA, and significantly smaller basal diameter, minimal inlet area, area of cyst in IPL and OPL, and amount of defect in the ELM (postoperative) and EZ (pre- and post-operative), respectively. Conclusion An increase in the basal diameter of the MH is associated with a simultaneous congruous enlargement of the area of cyst in IPL and OPL. Based on these imaging findings, we propose that the possible rationale for the origin of these intraretinal cysts could be a breakdown in the physiological retinal pigment epithelium (RPE) pump due to the anatomical separation of the neurosensory retina from the underlying RPE, ie, "RPE contact loss" theory.
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Affiliation(s)
- Unnikrishnan Nair
- Vitreoretinal Services, Chaithanya Eye Hospital and Research Institute, Trivandrum, Kerala, India.,Department of Research, Chaithanya Innovation in Technology and Eyecare (Research), Trivandrum, Kerala, India
| | - Jay U Sheth
- Vitreoretinal Services, Chaithanya Eye Hospital and Research Institute, Trivandrum, Kerala, India.,Department of Research, Chaithanya Innovation in Technology and Eyecare (Research), Trivandrum, Kerala, India
| | - Asmita Indurkar
- Vitreoretinal Services, Chaithanya Eye Hospital and Research Institute, Trivandrum, Kerala, India
| | - Manoj Soman
- Vitreoretinal Services, Chaithanya Eye Hospital and Research Institute, Trivandrum, Kerala, India.,Department of Research, Chaithanya Innovation in Technology and Eyecare (Research), Trivandrum, Kerala, India
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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.].
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Etheridge T, Liu Z, Nalbandyan M, Cleland S, Blodi BA, Mares JA, Bailey S, Wallace R, Gehrs K, Tinker LF, Gangnon R, Domalpally A. Association of Macular Thickness With Age and Age-Related Macular Degeneration in the Carotenoids in Age-Related Eye Disease Study 2 (CAREDS2), An Ancillary Study of the Women's Health Initiative. Transl Vis Sci Technol 2021; 10:39. [PMID: 34003924 PMCID: PMC7910637 DOI: 10.1167/tvst.10.2.39] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the relationship of retinal layer thickness with age and age-related macular degeneration (AMD) in the Carotenoids in Age-Related Eye Disease Study 2. Methods Total retinal thickness within the macular area, and individual layer thickness was determined for CAREDS2 participants (n = 906 eyes, 473 women) from the Women's Health Initiative using Heidelberg optical coherence tomography (OCT). Mean measurements within the OCT grid were compared across age tertiles (69–78, 78–83, and 83–101 years) and AMD outcomes. Results Mean retinal thickness in the central circle, inner ring, and outer ring were 277 ± 34 µm, 326 ± 20 µm, and 282 ± 15 µm, respectively. Thickness did not vary by age in the central circle, but decreased with age in the inner and outer circles (P ≤ 0.004). Specifically, ganglion cell (GCL), inner plexiform, and outer nuclear (ONL) layer thickness decreased with age (P ≤ 0.003). Age-adjusted retinal thickness in all three circles did not vary by AMD outcomes (486 without AMD and 413 with AMD). However, individual layers showed changes with GCL and photoreceptor thinning and retinal pigment epithelial thicknening in eyes with late AMD. After controlling for age and AMD, higher ONL thickness was associated with better visual acuity. Conclusions In this cohort of older women, a decrease in perifoveal thickness was associated with increasing age, particularly in the inner retinal layers. Variabilty in thickness in AMD eyes was primarily due to outer retinal layers. Among all retinal layers, the ONL plays an important role in preserving visual acuity. Translational Relevance The study provides a deeper understanding of age related changes to the retinal layers and their effect on visual loss.
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Affiliation(s)
- Tyler Etheridge
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Zhe Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Marine Nalbandyan
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Spencer Cleland
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Barbara A Blodi
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Julie A Mares
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Steven Bailey
- Oregon Health Sciences University Casey Eye Institute, Portland, OR, USA
| | - Robert Wallace
- University of Iowa, College of Public Health, Department of Epidemiology, Iowa City, IA, USA
| | - Karen Gehrs
- University of Iowa, Department of Ophthalmology, University of Iowa, Iowa City, IA, USA
| | - Lesley F Tinker
- Cancer Research Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ronald Gangnon
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Yao X, Son T, Kim TH, Le D. Interpretation of anatomic correlates of outer retinal bands in optical coherence tomography. Exp Biol Med (Maywood) 2021; 246:2140-2150. [PMID: 34111984 DOI: 10.1177/15353702211022674] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
By providing the sectioning capability to differentiate individual retinal layers, optical coherence tomography (OCT) is revolutionizing eye disease diagnosis and treatment evaluation. A better understanding of the hyper- and hypo-reflective bands in retinal OCT is essential for accurate interpretation of clinical outcomes. In this article, we summarize the interpretations of clinical OCT and adaptive optics (AO) OCT (AO-OCT) of the outer retina in the human eye, and briefly review OCT investigation of the outer retina in animal models. Quantitative analysis of outer retinal OCT bands is compared to established parameters of retinal histology. The literature review and comparative analysis support that both inner/outer segment (IS/OS) junction and IS ellipsoid zone nonexclusively contribute to the second band; and OS, OS tips, and retinal pigment epithelium apical processes contribute to the third band in conventional OCT. In contrast, AO-OCT might predominantly detect the IS/OS junction and OS tip signals at the second and third bands due to its improved sectioning capability and possible AO effect on the sensitivities for recording ballistic and diffusive photons from different regions of the outer retina.
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Affiliation(s)
- Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA.,Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Taeyoon Son
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Tae-Hoon Kim
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - David Le
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
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Muni RH, Felfeli T, Sadda SR, Juncal VR, Francisconi CLM, Nittala MG, Lindenberg S, Gunnemann F, Berger AR, Wong DT, Altomare F, Giavedoni LR, Kohly RP, Kertes PJ, Sarraf D, Hillier RJ. Postoperative Photoreceptor Integrity Following Pneumatic Retinopexy vs Pars Plana Vitrectomy for Retinal Detachment Repair: A Post Hoc Optical Coherence Tomography Analysis From the Pneumatic Retinopexy Versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial. JAMA Ophthalmol 2021; 139:620-627. [PMID: 33885738 DOI: 10.1001/jamaophthalmol.2021.0803] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Pneumatic retinopexy (PnR) is associated with superior visual acuity and reduced vertical metamorphopsia compared with pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD). It is important to determine postoperative photoreceptor integrity with both surgical techniques. Objective To compare photoreceptor integrity on spectral domain-optical coherence tomography (SD-OCT) between PnR and PPV at 12 months postoperatively. Design, Setting, and Participants Post hoc analysis of the Pneumatic Retinopexy Versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) conducted between August 2012 and May 2017 at St Michael's Hospital, Toronto, Ontario, Canada. Primary RRDs with specific criteria were included. Data were analyzed between April and August 2020. Intervention Randomization to PnR vs PPV stratified by macular status. Main Outcomes and Measures Difference in proportion of patients with discontinuity of the ellipsoid zone (EZ) and external limiting membrane (ELM) between groups assessed independently by 2 masked graders at an external masked image reading center. Results A total of 150 participants completed the 12-month follow-up visit. A total of 145 patients (72 PPV and 73 PnR) had gradable spectral-domain optical coherence tomography at 12 months. Analysis of the central 3-mm (foveal) scans found that 24% (n = 17 of 72) vs 7% (n = 5 of 73) displayed EZ discontinuity (difference, 17%; odds ratio [OR], 4.204; 95% CI, 1.458-12.116; P = .005) and 20% (n = 14 of 71) vs 6% (n = 4 of 73) displayed ELM discontinuity (difference, 14%; OR, 4.237; 95% CI, 1.321-13.587; P = .01) in the PPV and PnR groups, respectively. Analysis of the 6-mm (foveal and nonfoveal) scans revealed that EZ and ELM discontinuity was greater in the PPV vs PnR groups (EZ, 32% [n = 23 of 72] vs 11% [n = 8 of 73]; difference, 21%; OR, 3.814; 95% CI, 1.573-9.249; P = .002; ELM, 32% [n = 23 of 71] vs 18% [n = 13 of 73]; difference, 14%; OR, 2.211; 95% CI, 1.015-4.819; P = .04). Conclusions and Relevance Discontinuity of the EZ and ELM was more common at 12 months postoperatively following PPV vs PnR for RRD repair. The findings of this post hoc analysis suggest that less discontinuity of the EZ and ELM may provide an anatomic basis for the previously reported superior functional outcomes with PnR, although the analysis does not prove a cause-and-effect relationship. Trial Registration ClinicalTrials.gov Identifier: NCT01639209.
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Affiliation(s)
- Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Kensington Vision and Research Centre, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science/Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Srinivas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California.,Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles
| | - Verena R Juncal
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Carolina L M Francisconi
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Frederic Gunnemann
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California.,Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles
| | - Alan R Berger
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - David T Wong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Filiberto Altomare
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Louis R Giavedoni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Radha P Kohly
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Kensington Vision and Research Centre, University of Toronto, Toronto, Ontario, Canada.,The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Kensington Vision and Research Centre, University of Toronto, Toronto, Ontario, Canada.,The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David Sarraf
- Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles
| | - Roxane J Hillier
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, England.,Institute of Translational and Clinical Research, Newcastle University, Newcastle upon Tyne, England
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44
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Gao S, Li Y, Bissig D, Cohen ED, Podolsky RH, Childers KL, Vernon G, Chen S, Berkowitz BA, Qian H. Functional regulation of an outer retina hyporeflective band on optical coherence tomography images. Sci Rep 2021; 11:10260. [PMID: 33986362 PMCID: PMC8119672 DOI: 10.1038/s41598-021-89599-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/27/2021] [Indexed: 12/30/2022] Open
Abstract
Human and animal retinal optical coherence tomography (OCT) images show a hyporeflective band (HB) between the photoreceptor tip and retinal pigment epithelium layers whose mechanisms are unclear. In mice, HB magnitude and the external limiting membrane-retinal pigment epithelium (ELM-RPE) thickness appear to be dependent on light exposure, which is known to alter photoreceptor mitochondria respiration. Here, we test the hypothesis that these two OCT biomarkers are linked to metabolic activity of the retina. Acetazolamide, which acidifies the subretinal space, had no significant impact on HB magnitude but produced ELM-RPE thinning. Mitochondrial stimulation with 2,4-dinitrophenol reduced both HB magnitude and ELM-RPE thickness in parallel, and also reduced F-actin expression in the same retinal region, but without altering ERG responses. For mice strains with relatively lower (C57BL/6J) or higher (129S6/ev) rod mitochondrial efficacy, light-induced changes in HB magnitude and ELM-RPE thickness were correlated. Humans, analyzed from published data captured with a different protocol, showed a similar light-dark change pattern in HB magnitude as in the mice. Our results indicate that mitochondrial respiration underlies changes in HB magnitude upstream of the pH-sensitive ELM-RPE thickness response. These two distinct OCT biomarkers could be useful indices for non-invasively evaluating photoreceptor mitochondrial metabolic activity.
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Affiliation(s)
- Shasha Gao
- Department of Ophthalmology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Visual Function Core, National Eye Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Yichao Li
- Visual Function Core, National Eye Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - David Bissig
- Department of Neurology, University of California Davis, Sacramento, CA, USA
| | - Ethan D Cohen
- Division of Biomedical Physics, Office of Science and Engineering Labs, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
| | - Robert H Podolsky
- Beaumont Research Institute, Beaumont Health, Royal Oak, MI, 48073, USA
| | | | - Gregory Vernon
- Visual Function Core, National Eye Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Sonia Chen
- Visual Function Core, National Eye Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Bruce A Berkowitz
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Haohua Qian
- Visual Function Core, National Eye Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
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45
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Sura AA, Chen L, Messinger JD, Swain TA, McGwin G, Freund KB, Curcio CA. Measuring the Contributions of Basal Laminar Deposit and Bruch's Membrane in Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2021; 61:19. [PMID: 33186466 PMCID: PMC7671869 DOI: 10.1167/iovs.61.13.19] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose Basal laminar deposit (BLamD) is a consistent finding in age-related macular degeneration (AMD). We quantified BLamD thickness, appearance, and topography in eyes of aged donors with and without AMD and evaluated its relationship to other components of the retinal pigment epithelium-basal lamina/Bruch's membrane (RPE-BL-BrM) complex. Methods Donor eyes (n = 132) were classified as normal (n = 54), early to intermediate AMD (n = 24), geographic atrophy (GA; n = 13), and neovascular AMD (NV; n = 41). In high-resolution histology, we assessed RPE, BLamD, and BrM thicknesses and phenotypes at 3309 predefined locations in the central (foveal and perifovea) and superior (perifoveal) sections. Pre-mortem optical coherence tomography (OCT) imaging of a 90-year-old woman was compared to postmortem histopathology. Results In non-atrophic areas of AMD eyes, the RPE-BLamD is thick (normal = 13.7 µm, early-intermediate = 16.8 µm, GA = 17.4 µm, NV = 18.7 µm), because the BLamD is thick (normal = 0.3 µm, early-intermediate = 5.5 µm, GA = 4.1 µm, NV = 5.3 µm). RPE layer thickness is similar across these stages. Disease-associated variants of BLamD (thick, late, basal mounds) cluster subfoveally. A thick BLamD is visible on OCT as a hyporeflective split in the RPE-BL-BrM complex. BrM is thin (3.5 µm) in NV (normal = 4.2 µm, early to intermediate = 4.4 µm, and GA = 4.2 µm). Conclusions The RPE-BL-BrM complex is thick in AMD, driven by the accumulation and expansion of BLamD rather than expansion of either three-layer BrM, RPE-BL, or RPE. BLamD is clinically appreciable by OCT in some patients as a non-neovascular "split RPE-BL-BrM complex" or "double-layer sign." BLamD may contribute toward the formation and progression of high-risk drusen yet also exhibit protective properties.
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Affiliation(s)
- Amol A Sura
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Ling Chen
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States.,The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, China
| | - Jeffrey D Messinger
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Thomas A Swain
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States.,Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Gerald McGwin
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States.,Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye Ear and Throat Hospital, New York, New York, United States.,Department of Ophthalmology, NYU Langone School of Medicine, New York, New York, United States.,Columbia University College of Physicians and Surgeons, Harkness Eye Institute, New York, New York, United States
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
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46
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Ma G, Son T, Kim TH, Yao X. In vivo optoretinography of phototransduction activation and energy metabolism in retinal photoreceptors. JOURNAL OF BIOPHOTONICS 2021; 14:e202000462. [PMID: 33547871 PMCID: PMC8240094 DOI: 10.1002/jbio.202000462] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/09/2021] [Accepted: 02/02/2021] [Indexed: 05/05/2023]
Abstract
The objective of this study is to verify the anatomic correlate of the second (2nd) outer retina band in optical coherence tomography (OCT), and to demonstrate the potential of using intrinsic optical signal (IOS) imaging for concurrent optoretinography (ORG) of phototransduction activation and energy metabolism in stimulus activated retinal photoreceptors. A custom-designed OCT was employed for depth-resolved IOS imaging in mouse retina activated by a visible light flicker stimulation. The spatiotemporal properties of the IOS changes at the photoreceptor outer segment (OS) and inner segment (IS) were quantitatively evaluated. Rapid IOS change was observed at the OS almost right away, and the IOS at the IS was relatively slow. Comparative analysis indicates that the OS-IOS reflects transient OS deformation caused by the phototransduction activation, and IS-IOS might reflect the energy metabolism caused by mitochondria activation in retinal photoreceptors. The consistency of the distribution of the IS-IOS and the 2nd OCT band supports the IS ellipsoid (ISe), which has abundant mitochondria, as the signal source of the 2nd OCT band of the outer retina.
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Affiliation(s)
- Guangying Ma
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
| | - Taeyoon Son
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
| | - Tae-Hoon Kim
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
| | - Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
- Correspondence: Xincheng Yao, Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA.
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47
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Albertos-Arranz H, Sánchez-Sáez X, Martínez-Gil N, Pinilla I, Coco-Martin RM, Delgado J, Cuenca N. Phenotypic Differences in a PRPH2 Mutation in Members of the Same Family Assessed with OCT and OCTA. Diagnostics (Basel) 2021; 11:diagnostics11050777. [PMID: 33925984 PMCID: PMC8146155 DOI: 10.3390/diagnostics11050777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/15/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
Choroidal dystrophies comprise a group of chorioretinal degenerations. However, the different findings observed among these patients make it difficult to establish a correct clinical diagnosis. The objective of this study was to characterize new clinical findings by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in these patients. Four family members with a PRPH2 gene mutation (p.Arg195Leu) were included. OCT was performed at the macula, and the thickness of the outer and inner retina, total retina, and choroid was measured. The features of the vascular network were analyzed by OCTA. Patients showed a decreased outer nuclear layer in the avascular area compared with the controls. Two patients presented greater foveal and parafoveal degeneration of the outer retina, whereas the most degenerated area in the rest was the perifovea. Disruption of the third outer band at the foveola is one of the first-altered outer bands. Slow blood flow areas or capillary dropout were main signs in the deep capillary plexus. Microaneurysms were frequently observed in less degenerated retinas. Vascular loops and intraretinal microvascular abnormalities (IRMAs) were present in the superficial plexus. Extensive degeneration of the choriocapillaris was detected. Phenotypic differences were found between patients: two showed central areolar choroidal dystrophy and the rest had extensive chorioretinal atrophy. These signs observed in OCT and OCTA can help to more appropriately define the clinical disease in patients with choroidal dystrophies.
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Affiliation(s)
- Henar Albertos-Arranz
- Department of Physiology, Genetics and Microbiology, University of Alicante, 03690 Alicante, Spain; (H.A.-A.); (X.S.-S.); (N.M.-G.)
| | - Xavier Sánchez-Sáez
- Department of Physiology, Genetics and Microbiology, University of Alicante, 03690 Alicante, Spain; (H.A.-A.); (X.S.-S.); (N.M.-G.)
| | - Natalia Martínez-Gil
- Department of Physiology, Genetics and Microbiology, University of Alicante, 03690 Alicante, Spain; (H.A.-A.); (X.S.-S.); (N.M.-G.)
| | - Isabel Pinilla
- Department of Ophthalmology, Aragon Health Science Institute (IIS Aragón), Lozano Blesa University Hospital, 50009 Zaragoza, Spain;
- National Institute of Health Carlos III (ISCIII), (RETICS) Cooperative Health Network for Research in Ophthalmology (Oftared), 28040 Madrid, Spain;
| | - Rosa M. Coco-Martin
- National Institute of Health Carlos III (ISCIII), (RETICS) Cooperative Health Network for Research in Ophthalmology (Oftared), 28040 Madrid, Spain;
- Institute of Applied Ophthalmobiology (IOBA), Medical School, University of Valladolid, 47011 Valladolid, Spain
| | | | - Nicolás Cuenca
- Department of Physiology, Genetics and Microbiology, University of Alicante, 03690 Alicante, Spain; (H.A.-A.); (X.S.-S.); (N.M.-G.)
- National Institute of Health Carlos III (ISCIII), (RETICS) Cooperative Health Network for Research in Ophthalmology (Oftared), 28040 Madrid, Spain;
- San Vicente del Raspeig Campus, Ramón Margalef Institute, University of Alicante, 03690 Alicante, Spain
- Correspondence: ; Tel.: +34-965-909-916
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48
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Aleman TS, O'Neil EC, O'Connor K, Jiang YY, Aleman IA, Bennett J, Morgan JIW, Toussaint BW. Bardet-Biedl syndrome-7 ( BBS7) shows treatment potential and a cone-rod dystrophy phenotype that recapitulates the non-human primate model. Ophthalmic Genet 2021; 42:252-265. [PMID: 33729075 DOI: 10.1080/13816810.2021.1888132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To provide a detailed ophthalmic phenotype of two male patients with Bardet-Biedl Syndrome (BBS) due to mutations in the BBS7 geneMethods: Two brothers ages 26 (Patient 1, P1) and 23 (P2) underwent comprehensive ophthalmic evaluations over three years. Visual function was assessed with full-field electroretinograms (ffERGs), kinetic and chromatic perimetry, multimodal imaging with spectral domain optical coherence tomography (SD-OCT), fundus autofluorescence (FAF) with short- (SW) and near-infrared (NIR) excitation lights and adaptive optics scanning light ophthalmoscopy (AOSLO).Results: Both siblings had a history of obesity and postaxial polydactyly; P2 had diagnoses of type 1 Diabetes Mellitus, Addison's disease, high-functioning autism-spectrum disorder and -12D myopia. Visual acuities were better than 20/30. Kinetic fields were moderately constricted. Cone-mediated ffERGs were undetectable, rod ERGs were ~80% of normal mean. Static perimetry showed severe central cone and rod dysfunction. Foveal to parafoveal hypoautofluorescence, most obvious on NIR-FAF, co-localized with outer segment shortening/loss and outer nuclear layer thinning by SD-OCT, and with reduced photoreceptors densities by AOSLO. A structural-functional dissociation was confirmed for cone- and rod-mediated parameters. Worsening of the above abnormalities was documented by SD-OCT and FAF in P2 at 3 years. Gene screening identified compound heterozygous mutations in BBS7 (p.Val266Glu: c.797 T > A of maternal origin; c.1781_1783delCAT, paternal) in both patients.Conclusions: BBS7-associated retinal degeneration may present as a progressive cone-rod dystrophy pattern, reminiscent of both the murine and non-human primate models of the disease. Predominantly central retinal abnormalities in both cone and rod photoreceptors showed a structural-functional dissociation, an ideal scenario for gene augmentation treatments.
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Affiliation(s)
- Tomas S Aleman
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Ophthalmology of the Children's Hospital of Philadelphia, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erin C O'Neil
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Ophthalmology of the Children's Hospital of Philadelphia, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Keli O'Connor
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yu You Jiang
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Isabella A Aleman
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jean Bennett
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica I W Morgan
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian W Toussaint
- Christiana Care Health System, Wilmington, Delaware, USA.,Department of Ophthalmology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
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49
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Rakocz N, Chiang JN, Nittala MG, Corradetti G, Tiosano L, Velaga S, Thompson M, Hill BL, Sankararaman S, Haines JL, Pericak-Vance MA, Stambolian D, Sadda SR, Halperin E. Automated identification of clinical features from sparsely annotated 3-dimensional medical imaging. NPJ Digit Med 2021; 4:44. [PMID: 33686212 PMCID: PMC7940637 DOI: 10.1038/s41746-021-00411-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/26/2021] [Indexed: 12/30/2022] Open
Abstract
One of the core challenges in applying machine learning and artificial intelligence to medicine is the limited availability of annotated medical data. Unlike in other applications of machine learning, where an abundance of labeled data is available, the labeling and annotation of medical data and images require a major effort of manual work by expert clinicians who do not have the time to annotate manually. In this work, we propose a new deep learning technique (SLIVER-net), to predict clinical features from 3-dimensional volumes using a limited number of manually annotated examples. SLIVER-net is based on transfer learning, where we borrow information about the structure and parameters of the network from publicly available large datasets. Since public volume data are scarce, we use 2D images and account for the 3-dimensional structure using a novel deep learning method which tiles the volume scans, and then adds layers that leverage the 3D structure. In order to illustrate its utility, we apply SLIVER-net to predict risk factors for progression of age-related macular degeneration (AMD), a leading cause of blindness, from optical coherence tomography (OCT) volumes acquired from multiple sites. SLIVER-net successfully predicts these factors despite being trained with a relatively small number of annotated volumes (hundreds) and only dozens of positive training examples. Our empirical evaluation demonstrates that SLIVER-net significantly outperforms standard state-of-the-art deep learning techniques used for medical volumes, and its performance is generalizable as it was validated on an external testing set. In a direct comparison with a clinician panel, we find that SLIVER-net also outperforms junior specialists, and identifies AMD progression risk factors similarly to expert retina specialists.
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Affiliation(s)
- Nadav Rakocz
- Department of Computer Science, University of California, Los Angeles, CA, USA
| | - Jeffrey N Chiang
- Department of Computational Medicine, University of California, Los Angeles, CA, USA
| | | | - Giulia Corradetti
- Doheny Eye Institute, Los Angeles, CA, USA.,Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Liran Tiosano
- Doheny Eye Institute, Los Angeles, CA, USA.,Faculty of Medicine, Hebrew University of Jerusalem, Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Michael Thompson
- Department of Computer Science, University of California, Los Angeles, CA, USA
| | - Brian L Hill
- Department of Computer Science, University of California, Los Angeles, CA, USA
| | - Sriram Sankararaman
- Department of Computer Science, University of California, Los Angeles, CA, USA.,Department of Computational Medicine, University of California, Los Angeles, CA, USA.,Department of Human Genetics, University of California, Los Angeles, CA, USA
| | - Jonathan L Haines
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Margaret A Pericak-Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dwight Stambolian
- Department of Ophthalmology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Srinivas R Sadda
- Doheny Eye Institute, Los Angeles, CA, USA.,Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Eran Halperin
- Department of Computer Science, University of California, Los Angeles, CA, USA. .,Department of Computational Medicine, University of California, Los Angeles, CA, USA. .,Faculty of Medicine, Hebrew University of Jerusalem, Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. .,Department of Anesthesiology, University of California, Los Angeles, CA, USA. .,Institute of Precision Health, University of California, Los Angeles, CA, USA.
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50
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Zhang T, Kho AM, Yiu G, Srinivasan VJ. Visible Light Optical Coherence Tomography (OCT) Quantifies Subcellular Contributions to Outer Retinal Band 4. Transl Vis Sci Technol 2021; 10:30. [PMID: 34003965 PMCID: PMC7998011 DOI: 10.1167/tvst.10.3.30] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/17/2021] [Indexed: 01/07/2023] Open
Abstract
Purpose To use visible light optical coherence tomography (OCT) to investigate subcellular reflectivity contributions to the outermost (4th) of the retinal hyperreflective bands visualized by current clinical near-infrared (NIR) OCT. Methods Visible light OCT, with 1.0 µm axial resolution, was performed in 28 eyes of 19 human subjects (21-57 years old) without history of ocular pathology. Two foveal and three extrafoveal hyperreflective zones were consistently depicted within band 4 in all eyes. The two outermost hyperreflective bands, occasionally visualized by NIR OCT, were presumed to be the retinal pigment epithelium (RPE) and Bruch's membrane (BM). RPE thickness, BM thickness, and RPE interior reflectivity were quantified topographically across the macula. Results A method for correcting RPE multiple scattering tails was found to both improve the Gaussian goodness-of-fit for the BM intensity profile and reduce the coefficient of variation of BM thickness in vivo. No major topographical differences in macular BM thickness were noted. RPE thickness decreased with increasing eccentricity. Visible light OCT signal intensity in the RPE was weighted to the apical side and attenuated more across the RPE in the fovea than peripherally. Conclusions Morphometry of the presumed RPE and BM bands is consistent with known anatomy. Weighting of RPE reflectivity toward the apical side suggests that melanosomes are the predominant contributors to RPE backscattering and signal attenuation in young eyes. Translational Relevance By enabling morphometric analysis of the RPE and BM, visible light OCT deciphers the main reflectivity contributions to outer retinal band 4, commonly visualized by commercial OCT systems.
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Affiliation(s)
- Tingwei Zhang
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
| | - Aaron M. Kho
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
| | - Glenn Yiu
- Department of Ophthalmology and Vision Science, University of California Davis, Davis School of Medicine, Sacramento, California, USA
| | - Vivek J. Srinivasan
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
- Department of Ophthalmology and Vision Science, University of California Davis, Davis School of Medicine, Sacramento, California, USA
- Department of Ophthalmology, New York University Langone Health, New York, New York, USA
- Department of Radiology, New York University Langone Health, New York, New York, USA
- Tech4Health Institute, New York University Langone Health, New York, New York, USA
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