Association between visual function and the integrity of residual ellipsoid zone in resolved central serous chorioretinopathy

OCT Biomarkers in Ocular CLN2 Disease in Patients Treated With Intraventricular Enzyme Replacement Therapy

Purpose

Bilateral progressive, symmetrical loss of central retinal thickness (CRT) has been described in neuronal ceroid lipofuscinosis type 2 (CLN2) disease. This study details the pattern of morphological changes underlying CRT loss and disease progression in patients receiving intracerebroventricular (ICV) enzyme replacement therapy (ERT) with cerliponase alfa.

Methods

Spectral-domain optical coherence tomography macular cube scans were collected from 16 patients with classic CLN2 disease receiving ICV ERT. Detailed retinal structure analyses were performed on manually segmented horizontal B-scans through the fovea to determine the thickness of six retinal parameters and the extent of ellipsoid zone (EZ) loss.

Results

Anatomical changes primarily occurred in photoreceptor (PR)-related retinal parameters and correlated with ocular disease severity. Retinal degeneration began with initial focal parafoveal EZ discontinuities signaling the onset of rapid PR degeneration in a predictable pattern: parafoveal PR involvement with foveal sparing followed by profound parafoveal and foveal PR loss with additional thinning beyond the central retina. PR degeneration began with outer segment loss and progressed to outer nuclear layer (ONL) involvement. Longitudinal analyses confirmed these observations. The rate of PR loss was fastest at the fovea at ∼58 mm per year and became slower at locations farther away from the fovea.

Conclusions

Retinal degeneration in CLN2 disease is primarily associated with PR loss in a predictable pattern, with EZ disruption signaling early PR stress. CRT, ONL thickness, and PR layer thickness are useful anatomical biomarkers for understanding disease progression and treatment efficacy in CLN2. Studies using en face images will further clarify CLN2-related retinal degeneration.

In-Depth Analysis of Preoperative OCT Markers as Prognostic Factors for Lamellar Macular Holes and Epiretinal Membrane Foveoschisis

OBJECTIVE

To identify preoperative OCT markers that correlate with postoperative visual acuity (VA) changes in eyes with lamellar macular hole (LMH) and epiretinal membrane foveoschisis (ERMF) after pars plana vitrectomy (PPV).

DESIGN

Cross-sectional retrospective study.

SUBJECTS

Patients seen at the Wilmer Eye Institute between 2011 and 2021 with an International Classification of Diseases, Ninth Revision, or International Classification of Diseases, 10th Revision, code for "macular hole" that underwent PPV, and demonstrated all OCT criteria present for either LMH or ERMF based on the Hubschman et al (2020) classification.

METHODS

OCT markers including hole dimensions, retinal layer continuity, and ellipsoid zone (EZ) convexity and pixelated intensity were quantified. Visual acuity immediately before PPV and at the last follow-up date available were both recorded.

MAIN OUTCOME MEASURES

Preoperative OCT variables that are correlated with postoperative changes in VA.

RESULTS

Forty-two eyes from 42 patients with LMH (n = 11) and ERMF (n = 31) that underwent PPV were identified. Visual acuity in the ERMF cohort significantly improved at last follow-up compared with preoperative VA (P < 0.001), whereas VA in the LMH cohort did not (P = 0.14). In the LMH cohort, retinal layer continuity at the hole edge was positively correlated with change in VA at final follow-up, whereas hole height was negatively correlated with VA. In the ERMF cohort, preoperative VA was negatively correlated with change in VA at final follow-up.

CONCLUSIONS

Retinal layer continuity at the hole and hole height are novel preoperative markers that predict postoperative VA change in LMH. After identifying the type of macular lesion, surgeons should consider using these preoperative OCT markers when counseling patients on potential postoperative VA outcomes and when managing patient expectations.

FINANCIAL DISCLOSURE(S)

The authors have no proprietary or commercial interest in any materials discussed in this article.

Evaluation and comparison of microperimetry and optical coherence tomography findings in patients with Behçet uveitis

PURPOSE

To evaluate and compare the findings of MP and OCT in patients with inactive Behçet's uveitis (BU).

METHODS

Sixty-five eyes of 38 patients were included in this retrospective study. Ophthalmologic examination findings and OCT and MP results were recorded. The relationship between best corrected visual acuity (BCVA), duration of uveitis, central macular thickness (CMT), presence of photoreceptor zone (PZ), and/or retinal pigment epithelium (RPE) damage, macular integrity index, mean threshold and fixation stability was analyzed.

RESULTS

There was a positive correlation between BCVA and CMT (p < 0.001). The eyes with PZ and/or RPE damage had significantly lower visual acuity (p < 0.001). There was a negative correlation between BCVA and macular integrity index (p = 0.005). BCVA showed positive correlations with mean threshold and fixation stability [(BCVA vs. mean threshold, p < 0.001), (BCVA vs. P1, p < 0.001), and (BCVA vs. P2, p < 0.001)]. While there was no significant correlation between CMT and macular integrity index (p = 0.08), both mean threshold and fixation stability were significantly positively correlated with CMT [(CMT vs. mean threshold, p = 0.01), (CMT vs. P1, p = 0.008), and (CMT vs. P2, p = 0.005)]. Mean threshold and fixation stability (P1 and P2) were significantly lower in the eyes with PZ and/or RPE damage (p = 0.008, p = 0.02, and p = 0.01, respectively).

CONCLUSION

MP showed results consistent with visual acuity and morphological findings by OCT in patients with inactive BU. Although MP is promising for patient follow-up, controlled prospective studies are needed.

Retinal sensitivity and fundus autofluorescence in adult-onset foveomacular vitelliform dystrophy

The present study aimed to compare retinal sensitivity (RS) at each stage and to evaluate the relationship between RS and fundus autofluorescence (FAF) pattern in adult-onset foveomacular vitelliform dystrophy (AOFVD). We retrospectively reviewed 17 eyes of 13 patients with AOFVD. In addition to best-corrected visual acuity (VA), RS within the affected lesion and optical coherence tomography (OCT) measurements were carried out in each participant. All the examined eyes were classified into 4 stages and 3 FAF patterns. RS was superimposed on OCT fundus image and RS within the affected lesion was calculated in each eye. The relationships between visual functions (VA and RS within the affected lesion) and stages and also FAF patterns were analyzed using the linear mixed model. As a result, RS within the affected lesion was significantly associated with FAF pattern, but not with stage. In contrast, VA was correlated with neither stages nor FAF patterns. Our current result suggested that RS within the affected lesion was related to FAF patterns but this was not the case with VA in eyes with AOFVD, demonstrating the usefulness of measuring RS, not only VA, to comprehend the disease status in AOFVD.

Prediction of visual impairment in retinitis pigmentosa using deep learning and multimodal fundus images

BACKGROUND

The efficiency of clinical trials for retinitis pigmentosa (RP) treatment is limited by the screening burden and lack of reliable surrogate markers for functional end points. Automated methods to determine visual acuity (VA) may help address these challenges. We aimed to determine if VA could be estimated using confocal scanning laser ophthalmoscopy (cSLO) imaging and deep learning (DL).

METHODS

Snellen corrected VA and cSLO imaging were obtained retrospectively. The Johns Hopkins University (JHU) dataset was used for 10-fold cross-validations and internal testing. The Amsterdam University Medical Centers (AUMC) dataset was used for external independent testing. Both datasets had the same exclusion criteria: visually significant media opacities and images not centred on the central macula. The JHU dataset included patients with RP with and without molecular confirmation. The AUMC dataset only included molecularly confirmed patients with RP. Using transfer learning, three versions of the ResNet-152 neural network were trained: infrared (IR), optical coherence tomography (OCT) and combined image (CI).

RESULTS

In internal testing (JHU dataset, 2569 images, 462 eyes, 231 patients), the area under the curve (AUC) for the binary classification task of distinguishing between Snellen VA 20/40 or better and worse than Snellen VA 20/40 was 0.83, 0.87 and 0.85 for IR, OCT and CI, respectively. In external testing (AUMC dataset, 349 images, 166 eyes, 83 patients), the AUC was 0.78, 0.87 and 0.85 for IR, OCT and CI, respectively.

CONCLUSIONS

Our algorithm showed robust performance in predicting visual impairment in patients with RP, thus providing proof-of-concept for predicting structure-function correlation based solely on cSLO imaging in patients with RP.

Analysis of retinal sensitivity between acute and recurrent central serous chorioretinopathy by microperimetry

PURPOSE

To evaluate the retinal sensitivity of macular region in acute and recurrent central serous chorioretinopathy (CSCR) using microperimetry.

METHODS

This was a retrospective observational study. Twenty-five eyes of 25 subjects diagnosed with either acute or recurrent CSCR without any previous treatment were included in this study. All subjects underwent complete ophthalmological examinations, including central retinal thickness (CRT) using spectral domain OCT and the retinal sensitivity assessments of macular region using microperimeter MP-3. The mean global macular sensitivity (GMS) of 64 loci in the 20° central macular area and the local macular sensitivity (LMS) of the test locations in affected region of serous retinal detachment (SRD) were analyzed.

RESULTS

Twelve eyes of 12 subjects with acute CSCR (Group A) and 13 eyes of 13 subjects with recurrent CSCR (Group R) were enrolled. Clinical parameters, including age, duration, mean LogMAR best-corrected visual acuity and CRT, were not statistically significant (p =0.688, 0.080, 0.222, 0.394, respectively) between Group A and Group R. There were significant differences in the GMS and LMS between the two groups. Compared to group A (24.9±1.6dB), the mean GMS of group R was significantly (p = 0.018) lower (23.0±2.0dB). Furthermore, the mean LMS of group R (20.8 ± 3.4dB) was also significantly lower (p = 0.026) than that of group A (22.3 ± 3.1dB).

CONCLUSIONS

Recurrent CSCR often show worse retinal function in focal areas of the affected macular areas than in acute CSCR. Microperimetry may be a promising method for distinguish between the acute and recurrent CSCR.

Multifocal Electroretinography Changes over 12 Months after Resolution of Central Serous Chorioretinopathy: Prospective Observational Study

INTRODUCTION

This prospective observational study aimed to evaluate the changes in retinal function after the anatomical resolution of central serous chorioretinopathy by multifocal electroretinography.

METHODS

Thirty-two eyes of 32 patients with unilaterally resolved central serous chorioretinopathy were prospectively studied. Serial multifocal electroretinography examinations were performed at the initial visit for active central serous chorioretinopathy, the time of anatomical resolution (resolved central serous chorioretinopathy), and 3, 6, and 12 months after resolution. The peak amplitudes of the first kernel responses were analysed and compared with those in 27 age-matched normal controls.

RESULTS

Compared with controls, the N1 amplitudes of rings 1-4 and P1 amplitudes of rings 1-3 showed statistically significant reductions at 12 months after the resolution of central serous chorioretinopathy (p < 0.05). The multifocal electroretinography amplitude substantially increased at the time of resolution and gradually improved until 3 months after the resolution of central serous chorioretinopathy.

CONCLUSION

Serial examinations with multifocal electroretinography showed that retinal responses increased mostly after the resolution of central serous chorioretinopathy, and this improvement slowly progressed until 3 months; however, the multifocal electroretinography amplitudes remained statistically reduced 12 months after the anatomical resolution of central serous chorioretinopathy, indicating the residual functional deficits detected by multifocal electroretinography.

Changes of microstructure of central serous chorioretinopathy on OCT and its relationship with prognosis

PURPOSE

To quantitatively evaluate the relationship between retinal microstructure and prognosis in patients with central serous chorioretinopathy(CSC) using optical coherence tomography(OCT).

METHODS

398 affected eyes of patients with central serous chorioretinopathy who visited Zhongshan Ophthalmic Centre(ZOC) from 2015 to 2018 were included in this retrospective study. The optical coherence tomography images of all patients in their first visit were analyzed, and logistic regression analysis were performed with 11 independent variables, and subretinal fluid absorption in 3 months after therapy as well as recur in 6 months after therapy as dependent variable respectively. The correlation between shortage of ellipsoid baseline and height of foveal subretinal fluid, width of foveal subretinal fluid were analyzed respectively. The difference of duration and baseline logMAR visual acuity in eyes with and without double layer sign or subretinal hyper-reflective materials were analyzed respectively. The difference of therapeutic outcome among different therapeutic methods was also analyzed in eyes with double-layer sign and subretinal hyper-reflective materials respectively.

RESULTS

In the regression analysis with subretinal fluid absorption in 3 months after therapy as dependent variable, shortage of ellipsoid zone was statistically significant(P<0.0001,B=1.288).In the regression analysis with recur in 6 months as dependent variable, no independent variable was statisically significant. There is no correlation between shortage of ellipsoid zone and width or height of subretinal fluid. Duration of disease in eyes with double layer sign or subretinal hyper-reflective materials was longer than those without these features. In the eyes with double-layer sign or subretinal hyper-reflective material, the difference of logMAR visual acuity 3 months after treatment between 2 therapeutic methods was not statistically significant.

CONCLUSIONS

When using optical coherence tomography to quantitatively evaluate change microstructure in eyes with central serous chorioretinopathy, we found that subretinal fluid was easier to absorb completely in eyes with less shortage of ellipsoid zone. Double layer sign and subretinal hyper-reflective materials are easier to exist in eyes with longer duration of disease.

Trends in research related to ophthalmic microperimetry from 1992 to 2022: A bibliometric analysis and knowledge graph study

Background

Microperimetry is a novel technology to assess macular function. The aim of the study was to explore the global research status and trends in microperimetry.

Methods

Documents related to microperimetry in ophthalmology from 1992 to 2022 were extracted from the Science Citation Index Expanded (SCI-E) database of the Web of Science Core Collection (WOSCC). Raw data were analyzed using the VOSviewer and CiteSpace software. Bibliometric parameters included annual publication quantity, countries, authors, journals, international cooperation, and keywords.

Results

A total of 1,217 peer-reviewed documents were retrieved. Annual research output has increased significantly since 2005, especially since 2013. Holz F, Rubin G, and Guymer R contributed most to the number of articles published about microperimetry. Rubin G, Fitzke F, and Holz F, respectively, received the most citations for their study. The countries publishing most were the USA, Italy, and the UK, while the USA, the UK, and Germany received the most citation frequency. Univ Bonn, UCL, and Moorfields Eye Hosp were the top three productive institutions for microperimetry research in the world. The top three journals that publish articles about microperimetry were Retina-The Journal of Retinal and Vitreous Diseases, Investigative Ophthalmology and Visual Science, and the American Journal of Ophthalmology. The top 10 common keywords included microperimetry, optical coherence tomography, eye, retinal sensitivity, macular degeneration, fundus autofluorescence, scanning laser ophthalmoscope, visual acuity, sensitivity, and degeneration. Keywords "optical coherence tomography angiography," "retinitis pigmentosa," and "internal limiting membrane" burst in the last 3 years.

Conclusion

The bibliometric and knowledge graph analysis of research status and trends in microperimetry provided global researchers with valuable information to propose future cooperation and track cutting-edge progress.

Foveal microstructure and visual function in patients with lamellar macular hole, epiretinal membrane foveoschisis or macular pseudohole

PURPOSE

To compare the foveal microstructures, such as the prevalence of epiretinal proliferation (EP) and residual ellipsoid zone (EZ), in eyes with lamellar macular hole (LMH), epiretinal retinal membrane (ERM) foveoschisis and macular pseudohole (MPH), and to investigate the association of the foveal microstructure with visual functions.

METHOD

In addition to the prevalence of EP, we calculated the residual EZ index within 1mm and 3 mm (rEZ1 and rEZ3) in all examined eyes. Comparisons were conducted to baseline characteristics (logMAR visual acuity [logMAR VA], metamorphopsia score [Mave], central retinal thickness [CRT], the prevalence of EP, rEZ1 and rEZ3) between MPH, ERM foveoschisis and LMH subgroups. The relationships (1) between logMAR VA and each of age, type (MPH, ERM foveoschisis and LMH), the prevalence of EP, rEZ1, rEZ3, spherical equivalent (SE) and CRT and (2) between Mave and each of variables were investigated.

RESULTS

Fifty-one eyes of 48 patients were enroled. The mean age was 65.2 ± 11.1 years. Ten eyes were diagnosed as LMH, 22 eyes as ERM foveoschisis and 19 eyes as MPH, respectively. There was a significant difference in CRT only between LMH and ERM foveoschisis (p = 0.023). There was a tendency toward significance in rEZ1 between LMH and ERM foveoschisis (p = 0.057), but not in rEZ3. The optimal model for logMAR VA included age, rEZ1, SE and CRT. On the other hand, the optimal model for Mave included the prevalence of EP, rEZ1 and SE.

CONCLUSION

Microstructural observations are useful to predict visual functions in LMH, ERM foveoshisis and MPH.

Quantitative analysis of choroidal vasculature in central serous chorioretinopathy using ultra-widefield swept-source optical coherence tomography angiography

We aimed to quantitatively compare the choroid blood flow and choroid thickness at the periphery among eyes with central serous chorioretinopathy (CSC), fellow eyes and healthy eyes using ultra-widefield swept-source optical coherence tomography angiography (UWF SS-OCTA). Retrospective analysis of 49 patients with CSC (98 eyes, including unaffected fellow eyes) and 49 age and sex matched controls were included. We obtained 3-dimensional data of vertical 20 mm × horizontal 24 mm × scan depth 6 mm, comprising 9 subfields (superotemporal, upper, superonasal, temporal, central, nasal, inferotemporal, lower, inferonasal regions). CSC eyes presented with greater density of large-vessel choroidal layer in all the 9 subfields compared with controls. Compared with normal eyes, CSC eyes had greater choroidal thickness (superotemporal, upper, superonasal, temporal, central, nasal, inferotemporal, and inferonasal subfields) and choroidal volume (superotemporal, upper, superonasal, temporal, central, and nasal subfields). Compared with control eyes, the choriocapillaris density in the superotemporal, inferotemporal and inferonasal subfields was greater in patients with CSC. Our study may provide further evidence for the congestion of vortex vein in the pathogenesis of CSC. UWF SS-OCTA can be used to evaluate the abnormalities of the choroidal structures even at the periphery in eyes with CSC.

Widefield Choroidal Thickness of Eyes with Central Serous Chorioretinopathy Examined by Swept-Source OCT

PURPOSE

To examine widefield (WF) changes in the choroidal thickness of eyes with central serous chorioretinopathy (CSC).

DESIGN

An observational study.

PARTICIPANTS

Twenty-two patients (20 men and 2 women) with treatment-naïve unilateral CSC and 28 normal eyes of 28 age-matched, healthy participants (21 men and 7 women).

METHODS

We performed enhanced depth imaging of swept-source (SS) OCT with a viewing angle of vertical 20 mm × horizontal 23 mm. Moreover, we developed a grid consisting of 9 subfields, with diameters of 3, 9, and 18 mm; the inner and outer rings were enclosed by circles with diameters of 3 and 9 mm and 9 and 18 mm, respectively, which were divided into 4 subfields-superotemporal, inferotemporal, superonasal, and inferonasal.

MAIN OUTCOME MEASURES

Widefield changes in choroidal thickness.

RESULTS

The mean duration from the presumed onset of CSC was 6.8 ± 3.1 months during the examination. Compared with that in normal eyes, the choroidal thickness in eyes of patients with CSC was significantly greater in all subfields (P < 0.020 for fellow eyes; P < 0.001 for eyes with CSC). Compared with that in fellow eyes, the choroidal thicknesses in eyes of patients with CSC were significantly greater, except for the outer superotemporal and inferonasal subfields (P < 0.001 for all inner subfields; P < 0.001 for the outer superonasal and inferotemporal subfields). In areas with dilated vortex veins, choroidal thickening was observed from the vicinity of the vortex vein ampulla to the macula along the course of the veins. Choroidal thickening on the dominant side was significantly greater than that on the nondominant side (P = 0.015 for the nasal subfield of the inner ring; P = 0.003 and P < 0.001 for the temporal subfields of the inner and outer rings, respectively).

CONCLUSIONS

Enhanced depth imaging of SS-OCT facilitated the analysis of WF changes in choroidal thickness in both healthy patients and patients with CSC. The local factors of the affected vortex vein and systemic risk factors may be involved in the pathogenesis of CSC.

Structural-vascular-functional correlation in type 2 non-proliferative macular telangiectasia

PURPOSE

To correlate the structural-vascular-functional changes in type 2 non-proliferative macular telangiectasia (MacTel) using optical coherence tomography (OCT) angiography (OCTA).

METHODS

In this retrospective study, OCTA and enface OCT image analysis of eyes with confirmed diagnosis of non-proliferative type 2 MacTel was performed. The 'MacTel area' was calculated by marking the outer boundary of an area affected by MacTel on superficial (SCP) and deep capillary plexus (DCP) on OCTA images and photoreceptor layer (PRL) on enface OCT scan. At every follow-up OCTA scan visit, best-corrected visual acuity, MacTel area and stage of disease was documented. Analyses between disease stage, MacTel area and logMAR visual acuity was carried out.

RESULTS

In total, 38 single-visit OCTA scans of 22 patients were included. The mean age was 58.9 ± 10.98 years. An increase in disease severity stage correlated positively with MacTel area in SCP segmentations slab (r = 0.334; p = 0.04) and logMAR visual acuity (r = 0.338; p = 0.038). No correlation in the DCP area or PRL area (p > 0.05) was noted with disease stage. A statistically significant positive correlation was noted between the structural changes in PRL layer with vascular changes in SCP (p = 0.021) but not in DCP (p = 0.199). No correlation of visual acuity with changes in SCP, DCP or PRL was noted (p > 0.05).

CONCLUSION

OCTA is a useful adjunct for determining disease severity in type 2 non-proliferative MacTel by assessing the structural-vascular changes. Further longitudinal studies need to be considered in future for understanding the pathomechanism of retinal damage in type 2 MacTel.

Predicting retinal sensitivity using optical coherence tomography parameters in central serous chorioretinopathy

PURPOSE

To predict changes in retinal sensitivity using optical coherence tomography (OCT) in eyes with central serous chorioretinopathy (CSC).

METHODS

Twenty-three eyes in 23 patients with CSC were enrolled. Retinal sensitivity was measured twice using microperimetry in all the examined eyes. Spectral domain OCT measurements were simultaneously conducted. The relationship between retinal sensitivity and the thicknesses of (i) the retinal nerve fiber layer plus the ganglion cell layer (RNFL + GCL), (ii) the inner nuclear layer (INL), (iii) the outer nuclear layer (ONL), and (iv) the serous retinal detachment height (SRDH) were investigated in a point-wise manner. The associations between the change in retinal sensitivity and the OCT parameters at baseline were also investigated.

RESULTS

The mean age of the participants was 49.8 ± 10.7 years. The mean SRDH was significantly lower (p < 0.001), and the mean retinal sensitivity (p < 0.001) was significantly higher at the second examination, compared with the first; however, the logMAR visual acuity (VA) did not differ significantly between the two examinations (p = 0.063). The logMAR VA was associated with retinal sensitivity at both the first and second examinations (p < 0.001). The retinal sensitivity at the second examination was significantly correlated with the retinal sensitivity, RNFL + GCL, INL, ONL, and SRDH at the first examination and with the improvement in SRDH.

CONCLUSIONS

Retinal sensitivity was associated with the retinal structure in eyes with CSC; these parameters could be useful for predicting the change in visual function prior to treatment.

Clinical classification, visual outcomes, and optical coherence tomographic features of 48 patients with posterior sympathetic ophthalmia

Background

To investigate the clinical manifestations, visual outcomes and optical coherence tomographic (OCT) features of patients with posterior sympathetic ophthalmia (PSO).

Methods

We performed a retrospective review of 48 patients diagnosed with PSO between January 2013 and December 2019. We compared the clinical and OCT features among different clinical types of PSO.

Results

PSO could be classified into two types according to whether the fundus exhibited serous retinal detachment (SRD) or multifocal choroiditis (MFC). There were 41 patients (85.4%) with SRD and 7 patients (14.6%) with MFC. The latent period of patients with MFC was significantly longer than that of patients with SRD (P = 0.002). The final visual acuity of patients with MFC was significantly worse than that of patients with SRD (P = 0.0001). In patients with acute SRD, OCT revealed that the mean height of retinal detachment in the fovea was 528.8 ± 437.5 μm. After treatment, the retina reattached in all patients and the band structures of the outer retina were restored in most patients (92.7%). In patients with acute MFC, the OCT images revealed inflammatory lesions on the retinal pigment epithelium layer. After treatment, the OCT images showed hyperreflective fibrosis of the lesions and loss of the outer retinal band structures in all patients.

Conclusions

We found that PSO could be classified according to the presence of SRD or MFC. The visual prognosis differed significantly between these types of PSO. OCT imaging is useful for clinical classification and monitoring of retinal changes after treatment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13023-022-02258-0.

Assessment of Scleral Contour Changes in High Myopia by Optical Coherence Tomography

Purpose

This study aimed to establish and validate optical coherence tomography (OCT) based diagnostic criteria of high myopia.

Methods

This was a cross-sectional study including 100 eyes of high myopia with axial length larger than 26.5 mm and 100 control eyes, which were examined by spectral-domain OCT. Vertical and horizontal OCT of 9 mm scanning across fovea were analyzed. OCT characteristics including mirror artifact, scleral sink due to steep inclination of posterior sclera, scleral visibility, abnormality of outer retinal layer, foveoschisis, and dome-shaped macula were assessed in each group.

Results

The mean axial length was 28.65 ± 2.07 mm (range, 26.51–34.59 mm) in high myopia group and 23.79 ± 0.99 mm (range, 21.26–25.94 mm) in control group. Among the OCT characteristics noted at high frequency in the eyes with high myopia, three criteria achieving high sensitivity and specificity were determined: scleral sink over 500 μm, scleral visibility over 100 μm, and dome-shaped macula. Under conditions of presence of any of three criteria in either horizontal or vertical OCT scanning, the diagnostic sensitivity, specificity, positive predictive value, and negative predictive value for high myopia were found to be 95.0%, 98.0%, 98.0%, and 95.1%, respectively. In a new set of OCT images from 50 eyes with high myopia and 50 eyes of nonhigh myopia cases, the OCT-based criteria also proved similar level of diagnostic validity.

Conclusions

The OCT-based criteria, which directly addressed posterior scleral contour changes, may lead to an intuitive and accurate diagnosis of high myopia. Also, the criteria may contribute to early detection and monitoring of eyes that cannot be defined as high myopia but can progress. OCT may be useful for monitoring high myopia patients as OCT can detect myopia-associated retinal pathologies as well as scleral contour changes.

Assessment of macular function in patients with non-vascularized pigment epithelial detachment

Non-vascularized pigment epithelial detachments (PED) are usually associated with dry age-related macular degeneration (AMD). In this study, we aimed to investigate the correlation between visual function and morphologic parameters. Seventeen eyes of eleven patients with non-vascularized AMD were enrolled. In addition to conventional optical coherence tomography (OCT), polarization-sensitive optical coherence tomography (PS-OCT) measurements were performed by evaluating the regularity of retinal pigment epithelium (RPE) entropy within the PED area. Retinal sensitivity was measured with MP-3 microperimetry, and retinal sensitivities within (RSin) and outside (RSout) the PED area were calculated. The relationship between OCT parameters and visual function was analyzed. As a result, there was a significant difference between the RSin and RSout (p < 0.001, Wilcoxon signed rank test). Moreover, RSin was significantly related to logMAR VA (p = 0.033, linear mixed model). The regularity of RPE entropy was significantly related to visual acuity and RSin (p = 0.00038, p = 0.031, linear mixed model), although neither the height nor area of PED correlated with visual function. Our results suggest that retinal sensitivity is significantly deteriorated within the PED area and RPE entropy measured with PS-OCT was closely related to visual function in eyes with non-vascularized PED.

Applications of Multimodal Imaging in Central Serous Chorioretinopathy Evaluation

Central serous chorioretinopathy (CSCR) is a macular disease characterized by serous retinal detachment commonly involving the macular region. CSCR has a wide spectrum of clinical presentations. Although a significant proportion of CSCR cases are self-limiting, patients can suffer from persistent or recurrent disease, sometimes complicated with choroidal neovascularization, resulting in permanent visual loss. Multimodal imaging, including fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and optical coherence tomography, has advanced the diagnosis and classification of CSCR cases. Evolution of new imaging techniques including optical coherence tomography angiography, wide-field imaging, and en face reconstruction imaging has also contributed to better understandings of the pathophysiology of CSCR. This review article summarizes the features of multimodal imaging for CSCR and discusses the application of such features in evaluating the disease.

Directional Reflectivity of the Ellipsoid Zone in Dry Age-Related Macular Degeneration

BACKGROUND AND OBJECTIVE

Ellipsoid zone (EZ) reflectivity on optical coherence tomography (OCT) is affected by the orientation of the scanning beam. The authors sought to determine how directional reflectivity changes in dry age-related macular degeneration (AMD).

PATIENTS AND METHODS

Retrospective image analysis included 17 control and 20 dry AMD subjects. Directional OCT (D-OCT) was performed using multiple displaced pupil entrance positions. EZ pixel values and apparent incidence angles were measured.

RESULTS

EZ reflectivity decreased in off-axis scans in controls (P < .001), AMD areas between drusen (P < .001), and AMD areas overlying drusen (P < .001). The magnitude of decrement in EZ reflectivity was significantly higher when incidence angles exceeded 10° in controls than in AMD areas between drusen (P = .024).

CONCLUSION

EZ reflectivity in dry AMD may vary by incident angle of light less than in controls, possibly indicating alteration of photoreceptor orientation or integrity. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:145-152.].

Comparison of the efficacy and safety between subthreshold micropulse laser, standard-fluence and low-fluence photodynamic therapy for chronic central serous chorioretinopathy

PURPOSE

To compare the efficacy and safety of subthreshold micropulse laser treatment (SML), standard-fluence photodynamic therapy (PDT) and low-fluence PDT in patients with chronic central serous chorioretinopathy (cCSC).

METHODS

This retrospective study included 52 eyes of 46 patients with chronic CSC who were treated with 577nm SML (n=23), standard-fluence PDT (verteporfin 6mg/m² and light energy 50J/cm²) (n=13), or low-fluence PDT (verteporfin 6mg/m² and light energy 25J/cm²) (n=16). The mean changes in best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) parameters, including central retinal thickness (CRT), subretinal fluid (SRF) height, and ellipsoid zone (EZ) disruption, over the follow-up period were evaluated.

RESULTS

The mean follow-up period was 8.42±3.34 months. In the SML group, the SRF resolution time was longer than the other groups. At 1 month, the SML group's mean CRT was higher than the other groups. The BCVA improvement was statistically significant in all groups (P<0.05), but in the SML group, it was slower than the other groups. Three eyes in the low-fluence and one eye in the standard-fluence PDT group received a second PDT treatment. The mean number of SML treatments was 2.48±1.08. If the EZ was intact, the rate of complete resolution of SRF was higher than if the EZ was disrupted or lost.

CONCLUSION

SML, standard-fluence PDT, and low-fluence PDT can all improve visual acuity in cCSC. Standard-fluence and low-fluence PDT induced a more rapid reabsorption of the fluid, improvement of BCVA, and equal safety compared with SML. More treatment sessions of SML were required than with the other treatment modalities.

Quantification of residual ellipsoid zone and its correlation with visual functions in patients with cone-rod dystrophy

Cone-rod dystrophy (CORD) is one of the inherited retinal diseases that result in central visual field deterioration and decreased visual acuity (VA). In CORD patients, impaired photoreceptor cells are observed as the disruption of ellipsoid zone (EZ) on optical coherence tomography (OCT) images. In the present study, we calculated the index of residual EZ (rEZ) to quantify the function of photoreceptor cells and investigated the correlation between rEZ index and visual functions. Twenty-six eyes of 13 patients with clinical suspicion of CORD were examined. Visual field was tested with the Humphrey Visual Field Analyzer (HFA 10-2 program). We simultaneously obtained OCT images and calculated the area of decreased EZ intensity (EZa). Using the binarized OCT images, the percentage of the rEZ in a 3 × 3 mm area surrounding the macula was analyzed. To clarify interrator reproducibility, intraclass correlation coefficient (ICC) was calculated. Moreover, we investigated the association between OCT parameters and VA as well as the mean deviation (MD) value measured with HFA. The mean age of the patients was 48.5 ± 16.9 years. The mean central retinal thickness was 122.7 ± 73.2 μm. The mean EZa and rEZ were 22.2 ± 23.6 μm² and 0.35 ± 0.31, respectively. The ICC of each rEZ index was 0.91 (95% CI: 0.89 < ICC < 0.93). Multivariate analysis indicated rEZ was significantly related to logMAR VA (p = 0.05) and rEZ and EZa were associated with the MD value (p = 0.014 and p = 0.009, linear mixed model). Furthermore, rEZ was also associated with photopic a- and b-wave amplitudes (p = 0.027 and p = 0.0024, respectively, linear mixed model). Taken together, the current results suggested the usefulness of rEZ quantification for predicting visual functions in CORD patients.

Dynamic changes and correlation analysis of outer retinal microstructure in macular area of central serous chorioretinopathy patients during restoration period

PURPOSE

To investigate the dynamic changes and possible affecting variables of outer retinal microstructure in macular area of central serous chorioretinopathy (CSC) patients.

METHODS

This was a retrospective study. The data of optical coherence tomography (OCT) and autofluoroscopy (AF) of 36 CSC patients admitted to our hospital from February 2012 to February 2013 were included. Dynamic variations and possible correlated variables of central retinal thickness (CRT), subretinal fluid diameter (SRFD), ellipsoid zone (EZ), interdigitation zone (IZ) and/or hyperautofluorescent spot (HAS) were analyzed.

RESULTS

The outer retinal microstructure was gradually restored along with the subretinal fluid absorption during the follow-up. EZ in 94.4% (34/36) and the IZ in 100% (36/36) eyes were completely disappeared at baseline and restored (completed or incomplete) in 88.9% (8/9) and 44.4% (4/9) eyes, respectively, after 6-month follow-up. HAS was evident in 25% eyes (8/32 eyes) at baseline, and the density was initially increased and then declined during follow-up. Correlation analysis demonstrated that the restoration of EZ and IZ was correlated with the restoration period and subretinal fluid absorption.

CONCLUSION

The outer retinal microstructure was restored during the subretinal fluid absorption in CSC patients, with EZ restored earlier than IZ. The restoration period and the absorption of subretinal fluid were two closely correlated variables of macular microstructure restoration.

Optical coherence tomography parameters as predictors of treatment response to a 577-nm subthreshold micropulse laser in chronic central serous chorioretinopathy

To determine the relation between retinal microstructural changes and the response to 577-nm subthreshold micropulse laser (SML) treatment in chronic central serous chorioretinopathy (cCSC). This retrospective study included 39 eyes of 39 patients with cCSC, treated with the 577-nm SML. The eyes were evaluated in three groups: complete remission, partial remission, and failure groups. The presence of some baseline retinal microstructural changes, thickness of the outer nuclear layer (ONL), status of the ellipsoid zone (EZ), and retinal pigment epithelium (RPE) were evaluated. The changes in central macular thickness (CMT), subretinal fluid (SRF) height, and best-corrected visual acuity (BCVA) were calculated. There were 14, 13, and 12 eyes in the complete remission, partial remission, and failure group, respectively. The baseline EZ and RPE were found intact in 71.4% and 64.3% of the eyes in the complete remission group, respectively; however, these rates were respectively 25% and 16.7% in the failure group (p < 0.05). Extrafoveal foci were present in 35.7% of the eyes in the complete remission group, but none was found in the failure group (p < 0.05). Although there was no statistically significant difference, the baseline ONL thickness was higher, and the hyperreflective dots, retinal bumps, subretinal fibrinous exudates, and PEDs were seen less in the complete remission group. The changes of the BCVA were not significant in any of the groups at the last visit (p > 0.05). The presence of baseline intact EZ and RPE, and extrafoveal foci can potentially be used as predictors of the SML treatment success in cCSC.

Central serous chorioretinopathy imaging biomarkers

PURPOSE

To identify the factors predicting the visual and anatomical outcomes in eyes with central serous chorioretinopathy (CSCR) through 12 months.

METHODS

Patients with diagnosis of CSCR, either acute or chronic, were included in this multicentric, retrospective study. Demographic factors; systemic risk factors; central macular thickness (CMT), subfoveal choroidal thickness (SFCT), linear extent of ellipsoid zone (EZ) and interdigitation zone damage on optical coherence tomography; details of leak on fluorescein angiography and indocyanine green angiography were included as predictors of anatomical and visual outcomes. Regression analysis was performed to correlate the changes in best corrected visual acuity (BCVA) and resolution of disease activity.

RESULTS

A total of 231 eyes of 201 patients with a mean age (49.7±11.8 years) were analysed. A total of 97 and 134 eyes were classified as acute and chronic CSCR. BCVA (0.35±0.31 to 0.24±0.34; p<0.001), baseline optical coherence tomography (OCT) parameters including CMT (p<0.001), subretinal fluid (SRF) height (p<0.001) and SFCT (p=0.05) showed a significant change through 12 months. Multivariate regression analysis showed change in CMT (p≤0.01) and SRF height at baseline (p=0.05) as factors predictive of good visual outcome. Logistic regression analysis revealed changes in both CMT (p=0.009) and SFCT (p=0.01) through 12 months to correlate with the resolution of disease.

CONCLUSION

OCT parameters such as changes in both CMT and SFCT along with subfoveal EZ damage can be predictive of disease resolution whereas changes in CMT and baseline SRF height correlate well with changes in BCVA through 12 months.

Long-Term Effects of Half-Time Photodynamic Therapy on Retinal Sensitivity in Eyes with Chronic Central Serous Chorioretinopathy

The purpose of this study was to evaluate the long-term effects of half-time photodynamic therapy (PDT) on the retinal sensitivity in eyes with chronic central serous chorioretinopathy (CSC). Twenty-two eyes of 22 patients with chronic CSC were studied. PDT was applied with full-dose verteporfin and half-time laser duration. The best-corrected visual acuity (BCVA) and retinal sensitivity in the central 2 and 10 degrees were evaluated at the baseline, and at 12 and 24 months after the half-time PDT. The retinal sensitivity was determined by Macular Integrity Assessment microperimetry (MAIA, Centervue, Padova, Italy). The results showed that the mean retinal sensitivities in the central 2 and 10 degrees were significantly improved at 12 months (25.6 ± 2.79 dB, median; 26.11 dB, 25.6 ± 2.25 dB, median; 25.65 dB, respectively; P < 0.001) and at 24 months (26.3 ± 2.62 dB, median; 27.38 dB, 26.6 ± 2.21 dB, median; 27.45 dB, respectively; P < 0.001) after the treatment compared to that at the baseline (19.2 ± 3.93 dB, median; 19.34 dB, 20.9 ± 2.92 dB, median; 20.9 dB, respectively). The BCVA was also significantly improved from 0.18 ± 0.19 median; 0.15 logarithm of the minimum angle of resolution (logMAR) units at the baseline to 0.07 ± 0.15 median; 0 logMAR units at 12 months (P < 0.001) and to 0.049 ± 0.16 median; -0.039 logMAR units at 24 months (P < 0.001). We conclude that half-time PDT results in a significant improvement of the mean central retinal sensitivity for at least 24 months in eyes with chronic CSC. Thus, half-time PDT is beneficial in resolving chronic CSC for a relatively long period.