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Goel N, D’ Souza Z, Tripathi A, Dey A, Sen A, Majumdar B, Thounaojam S, Roy R, Saurabh K. Concomitant paracentral acute middle maculopathy and acute macular neuroretinopathy in eyes post-blunt trauma. Indian J Ophthalmol 2023; 71:2789-2795. [PMID: 37417122 PMCID: PMC10491048 DOI: 10.4103/ijo.ijo_254_23] [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: 01/27/2023] [Revised: 03/02/2023] [Accepted: 05/03/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose To analyze the imaging characteristics and the clinical course of patients showing concomitant paracentral acute middle maculopathy (PAMM) and acute macular neuroretinopathy (AMN) post-blunt trauma. Methods PAMM and AMN lesions post-blunt trauma diagnosed on enhanced depth imaging optical coherence tomography (EDI-OCT) were recruited for the study. Results : Thirteen eyes of 13 individuals with a history of blunt trauma were included in the study, of whom 11 (85%) were males. Mean age of the patients was 33.62 (range 16-67) years. Mean visual acuity at presentation and the last visit was 1.67 log of minimum angle of resolution (logMAR) and 0.82 logMAR, respectively. Mean interval between trauma and imaging was 5.08 (range 1-15) days. All patients had unilateral involvement, with the right eye being involved in 10 patients (77%). All patients had concomitant PAMM and AMN lesions. Conclusion : Presence of coincident PAMM and AMN suggests a common pathophysiologic etiology, but the description of concomitant PAMM and AMN in the setting of blunt trauma to eye is hitherto unreported. Identifying AMN in a setting of PAMM requires meticulous examination of the OCT and OCTA images. It can be a cause of suboptimal visual recovery in such eyes.
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Affiliation(s)
- Nikita Goel
- Department of VitreoRetina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M. Bypass, Kolkata, West Bengal, India
| | - Zubin D’ Souza
- Department of VitreoRetina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M. Bypass, Kolkata, West Bengal, India
| | - Abhishek Tripathi
- Department of VitreoRetina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M. Bypass, Kolkata, West Bengal, India
| | - Amrita Dey
- Department of VitreoRetina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M. Bypass, Kolkata, West Bengal, India
| | - Ahana Sen
- Department of VitreoRetina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M. Bypass, Kolkata, West Bengal, India
| | - Bristi Majumdar
- Department of VitreoRetina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M. Bypass, Kolkata, West Bengal, India
| | - Sanatombi Thounaojam
- Department of VitreoRetina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M. Bypass, Kolkata, West Bengal, India
| | - Rupak Roy
- Department of VitreoRetina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M. Bypass, Kolkata, West Bengal, India
| | - Kumar Saurabh
- Department of VitreoRetina, BB Eye Foundation VIP, Shree Tower, RAA – 36, II, VIP Road, Raghunathpur, Rajarhat, Kolkata, West Bengal, India
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Foveal photoreceptor disruption in ocular diseases: An optical coherence tomography-based differential diagnosis. Surv Ophthalmol 2023:S0039-6257(23)00046-2. [PMID: 36934831 DOI: 10.1016/j.survophthal.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
Fovea centralis, located at the center of the macula, is packed with cone photoreceptors and is responsible for central visual acuity. Isolated foveal photoreceptor disruption may occur in a variety of hereditary, degenerative, traumatic, and toxic chorioretinal diseases. These have been known previously by multiple synonyms including macular microhole, foveal spot, and outer foveal microdefects. A common clinical feature underlying these conditions is the presence of apparently normal fovea or subtle hypopigmented lesion at the foveal or juxtafoveal area. A detailed history along with high-resolution optical coherence tomography is often helpful to derive a conclusive diagnosis in majority of these cases. Focal photoreceptor disruption usually involves loss or rarefaction of ellipsoid/interdigitation zone, either in isolation or associated with external limiting membrane or retinal pigment epithelium disruption in the fovea. Vitreomacular interface (VMI) disorders including vitreomacular traction, posterior vitreous detachment, epiretinal membrane, and impending macular hole possibly remain the most common cause. Retinal dystrophies such as cone dystrophy, occult macular dystrophy, and achromatopsia may present with diminution of vision and normal appearing fundus in a younger age group. Other causes include photic retinopathy (e.g., from a history of sun gazing, or laser pointer exposure), blunt trauma, drug exposure (e.g., poppers maculopathy or tamoxifen retinopathy), and acute retinal pigment epitheliopathy (ARPE). Visual prognosis depends on the underlying etiology with complete recovery common in the subset of patients with VMI, and ARPE, whereas persistent outer retinal defects are the rule in other conditions. We discuss the differential diagnoses that lead to isolated foveal photoreceptor defects. Identifying and understanding the underlying disease processes that cause foveal photoreceptor disruption may help predict visual prognosis.
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Gong Y, Xia H, Zhang A, Chen LJ, Chen H. Optical coherence tomography biomarkers of photoreceptor degeneration in retinitis pigmentosa. Int Ophthalmol 2021; 41:3949-3959. [PMID: 34304340 DOI: 10.1007/s10792-021-01964-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Several parameters on optical coherence tomography (OCT) have been suggested as biomarkers for photoreceptor degeneration in retinitis pigmentosa (RP). This study is to compare the spatial distribution of the changes of OCT biomarkers in RP patients. METHODS OCT line scans of the horizontal meridian were conducted in 22 eyes of 22 RP patients and 30 eyes of 30 healthy controls. Longitudinal reflectance profiles were obtained using ImageJ at every 5 pixels. The following parameters on OCT were quantitatively measured: (1) relative optical intensity (ROI) of ellipsoid zone (EZ) and interdigitation zone (IZ); (2) thickness of outer nuclear layer (ONLT), photoreceptor (PRT), inner segment (IST) and outer segment (OST). The variations of these parameters across different regions were analyzed. RESULTS From fovea to perifoveal region, all the OCT biomarkers declined before disappeared, except IST and IZ-ROI. There was no identifiable declining zone for the IST and IZ-ROI between the normal and disappeared zones in some patients. The most central biomarker was the reduction of OST and IZ-ROI, followed by the PRT, EZ-ROI, then IST and finally ONLT. All these biomarkers had significant correlations with best-corrected visual acuity, except ONLT. CONCLUSION In retinitis pigmentosa, EZ-ROI, IZ-ROI, PRT, OST, IST and ONLT are valuable biomarkers of photoreceptor degeneration. Changes of OST and IZ-ROI are located most centrally and may be the early biomarkers.
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Affiliation(s)
- Yuting Gong
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China
| | - Honghe Xia
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China
| | - Anlin Zhang
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Haoyu Chen
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China.
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Liu Z, Tao QQ, Li XR, Zhang XM. Disorganization of the retinal inner layers as a predictor of visual acuity in eyes with macular edema secondary to uveitis. Int J Ophthalmol 2021; 14:725-731. [PMID: 34012888 DOI: 10.18240/ijo.2021.05.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/26/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the correlation between disorganization of the retinal inner layers (DRIL) and best-corrected visual acuity (BCVA) in patients with uveitis and macular edema (UME) who underwent systemic treatment using optical coherence tomography (OCT). METHODS A retrospective clinical study of 23 patients (30 eyes) with DRIL and 23 patients (31 eyes) without DRIL secondary to UME were included. All patients underwent comprehensive ophthalmic examinations at baseline, 3, 6, and 12mo after local and systemic treatment. The OCT-based parameters included foveal center point thickness (FCPT), mean thickness (MT), and diameters of DRIL in horizontal and vertical directions. BCVA and OCT-based parameters were compared between the two groups. The relationship between each OCT parameter and BCVA was evaluated using linear correlation and regression analysis. RESULTS At the initial visit, the mean baseline FCPT was 441.03±128.68 µm in the eyes with DRIL and 337.26±99.31 µm in the eyes without DRIL (P=0.001). No significant differences were observed in MT (P=0.357). The mean size of transverse and vertical diameters of DRIL was 684.07±267.51 and 267.07±104.61 µm at baseline, respectively. There was significant improvement in BCVA and OCT-based parameters at 3, 6, and 12mo in all cases (P<0.001 for each timepoint). In addition, significant differences were detected in BCVA and OCT parameters between eyes with and without DRIL at each time point (P<0.01 for each timepoint). A greater DRIL range at baseline was associated with a worse baseline BCVA (transverse diameter of DRIL: r=0.875, P<0.001; vertical diameter of DRIL: r=0.622, P<0.001). The transverse diameter of baseline DRIL was found to be significantly correlated with the final BCVA (P=0.003). CONCLUSION The improvement in BCVA is associated with DRIL in patients with UME. DRIL is an easy-to-determine and robust imaging biomarker that could help predict BCVA prognosis in eyes with UME.
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Affiliation(s)
- Zheng Liu
- 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, Tianjin 300384, China.,Shanxi Eye Hospital, Taiyuan 030002, Shanxi Province, China
| | - Qing-Qin Tao
- 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, Tianjin 300384, China
| | - Xiao-Rong Li
- 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, Tianjin 300384, China
| | - Xiao-Min Zhang
- 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, Tianjin 300384, China
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Crahay FX, Rampat R, Tonglet M, Rakic JM. Drones' side effect: facial and ocular trauma caused by an aerial drone. BMJ Case Rep 2021; 14:e238316. [PMID: 33731403 PMCID: PMC7978067 DOI: 10.1136/bcr-2020-238316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/03/2022] Open
Abstract
An adult man was struck in the face by his own aerial drone. The propellers hit the upper face region leading to forehead and eyelid lacerations, a partial scleral laceration, conjunctival laceration, hyphaema, traumatic iritis and forward displacement of one haptic of the intraocular lens from a previous cataract surgery. In the last decade, drone use has significantly increased and drone-related injuries have become an emerging cause of trauma. Our case raises awareness of the risks and highlights the need for improvement in regulation of drone use.
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Affiliation(s)
| | - Radhika Rampat
- Cornea and External Disease Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Martin Tonglet
- Emergency Medicine Department, CHU de Liège, Liège, Belgium
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Vicini G, Nicolosi C, Bacherini D, Sodi A. Swept source optical coherence tomography findings in a severe traumatic maculopathy following firework ocular injury. Am J Ophthalmol Case Rep 2020; 19:100776. [PMID: 32566801 PMCID: PMC7298391 DOI: 10.1016/j.ajoc.2020.100776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/26/2020] [Accepted: 06/06/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Giulio Vicini
- Corresponding author. Largo Brambilla, 3, 50134, Florence, Italy.
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Inter- and Intra-individual Variations in Foveal Outer Nuclear Layer Thickness and Their Associations with Clinical Characteristics in a Healthy Chinese Population. J Ophthalmol 2020; 2020:7967393. [PMID: 32566269 PMCID: PMC7267860 DOI: 10.1155/2020/7967393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/23/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate foveal outer nuclear layer (ONL) thickness and the difference thereof between bilateral eyes and their possible associations with clinical characteristics in a healthy Chinese population. Materials and Methods Normal subjects were enrolled. Generalized linear models were used to assess the associations of foveal ONL thickness with sex, age, and spherical equivalents (SEs) and the associations of the difference in foveal ONL thickness between bilateral eyes with sex, age, and difference in SEs between bilateral eyes. Results Totally, 304 subjects were included. The average foveal ONL thickness was 103.19 ± 14.25 (range 70-151) μm in the right eye and 103.90 ± 14.63 (range 69-155) μm in the left eye. The mean difference in foveal ONL thickness between right and left eyes was -0.71 ± 4.36 (range -13 to +12) μm. Men had slightly greater foveal ONL thickness values in both right and left eyes compared with women (both P < 0.05); however, some women had a thicker foveal ONL than that of men (85/198 vs. 46/106 in the right eye; 79/198 vs. 52/106in the left eye). Age and SEs were not associated with foveal ONL thickness in either eye (all P > 0.05). Sex, age, and difference in SEs between bilateral eyes were not associated with the difference in foveal ONL thickness between bilateral eyes (all P > 0.05). Conclusions Foveal ONL thickness showed wide variation in a normal Chinese population but little difference between bilateral eyes. Both these parameters could not be adjusted by sex, age, SEs, or the SEs difference between bilateral eyes. Thus, in those diseases involving only one eye, the difference or ratio of foveal ONL thickness between the affected eye and normal fellow eye may reflect the actual degree of the disease, rather than the foveal ONL thickness in the affected eye alone.
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Reduced photoreceptor outer segment layer thickness in mild commotio retinae without ellipsoid zone disruption. Graefes Arch Clin Exp Ophthalmol 2020; 258:1437-1442. [PMID: 32314032 DOI: 10.1007/s00417-020-04678-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/28/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To quantitatively investigate the reflectivity and structure of the outer retinal layers on spectral-domain optical coherence tomography (SD-OCT) in commotio retinae. METHODS Nineteen patients with acute macular commotio retinae and 19 age-matched normal controls were examined using SD-OCT. Longitudinal reflectance profiles (LRP) were obtained using Image J. The reflectivity of outer retinal layers was measured at the fovea, 1 mm nasal to fovea and 1 mm temporal to fovea. The reflectivity ratios of outer retinal layers divided by the outer nuclear layer (ONL) were calculated for normalization. Photoreceptor outer segment layer thickness was also measured. The results were compared between the patients and controls. RESULTS The reflectivity ratio of ellipsoid zone/ONL and outer segment/ONL was higher in commotio retinae than in controls only at fovea (12.66 ± 4.73 vs 9.67 ± 3.34, p = 0.041; 7.70 ± 2.20 vs 3.73 ± 1.63, p < 0.001, respectively) but not at 1 mm nasal or temporal to the fovea. Photoreceptor outer segment layer thickness was significantly shorter in commotio retinae compared to controls at all three locations (19.64 ± 3.05 vs 25.16 ± 3.53, 16.95 ± 4.02 vs 20.00 ± 3.00, and 15.42 ± 3.22 vs 20.05 ± 2.48, respectively, all p < 0.05). CONCLUSIONS Quantitative measurement of SD-OCT images revealed that shortening of photoreceptor outer segment is an additional, and potentially better, biomarker for commotio retinae on top of increased reflectivity.
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9
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Babiuch AS, Han M, Conti FF, Wai K, Silva FQ, Singh RP. Association of Disorganization of Retinal Inner Layers With Visual Acuity Response to Anti-Vascular Endothelial Growth Factor Therapy for Macular Edema Secondary to Retinal Vein Occlusion. JAMA Ophthalmol 2019; 137:38-46. [PMID: 30286219 DOI: 10.1001/jamaophthalmol.2018.4484] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Disorganization of retinal inner layers (DRIL) has demonstrated significant correlations with visual acuity (VA) in center-involved diabetic macular edema. In patients with retinal vein occlusion (RVO) and secondary macular edema, DRIL may be a useful biomarker in determining VA outcomes. Objective To examine whether DRIL at baseline and after treatment is associated with VA in RVO. Design, Setting, and Participants A retrospective review of records of 147 patients 18 years or older with treatment-naive branch RVO (BRVO), central RVO (CRVO), or hemispheric RVO (HRVO), with a minimum of 12 months of follow-up, who presented to a tertiary ophthalmic center from December 1, 2010, to January 1, 2016, was conducted. Data collection continued through January 2017. Exclusion criteria included active confounding retinal or ocular disease, history of pars plana vitrectomy, or prior intravitreal injections. Two masked graders calculated a DRIL score based on DRIL presence in 3 predefined regions on spectral-domain optical coherence tomography at baseline, 6 months, and 12 months. A third masked grader was used for discrepancies. Exposures Anti-vascular endothelial growth factor (AVF) therapy (ranibizumab, aflibercept, or bevacizumab) determined by the treating physician. Main Outcomes and Measures The DRIL score at baseline for determining VA outcomes and correlation of VA with changes in DRIL burden in response to AVF therapy. Results In the 147 patients (mean [SD] age, 68.9 [13.1] years; 75 [51.0%] female), baseline DRIL was seen in 91 eyes (61.9%). In the BRVO group but not the CRVO group, baseline DRIL was associated with lower baseline Early Treatment Diabetic Retinopathy Study (ETDRS) score (score of 66.7 for no DRIL vs 54.6 for DRIL, P = .002). Absence of DRIL at baseline in the CRVO/HRVO group correlated with greater VA gains at 6 months, adjusting for baseline VA (score change of 19.50 for no DRIL vs 12.72 for DRIL; P = .04). During 12 months, continued DRIL presence in BRVO was associated with less VA gain up to 6 months (score change of 6.2 for the DRIL increase group vs 18.6 for the DRIL decrease group vs 2.9 for the DRIL stable group; P = .02). Increasing DRIL scores in CRVO/HRVO were associated with reduced VA improvement at 6 months (score change of -0.12 for the DRIL increase group vs 16.90 for the DRIL decrease group vs 8.45 for the DRIL stable group; P = .002) and 12 months (score change of -1.91 for the DRIL increase group vs 17.83 for the DRIL decrease group vs 6.97 for the DRIL stable group; P < .001). Conclusions and Relevance Baseline DRIL presence and DRIL burden changes with AVF therapy for macular edema secondary to RVO may be useful biomarkers of ETDRS score improvements.
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Affiliation(s)
- Amy S Babiuch
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael Han
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Felipe F Conti
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Karen Wai
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Rishi P Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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Blegen HMJ, Santamaria JA, Mehta A, Reed DS, Drayna PM, Davies B. Patterns and prognosis of commotio retinae in orbital wall fractures. Ther Adv Ophthalmol 2019; 11:2515841419862133. [PMID: 31321382 PMCID: PMC6628538 DOI: 10.1177/2515841419862133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/14/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose: Orbital wall fractures are a significant cause of ocular injury in trauma and
are associated with posterior segment pathology. This study aims to
characterize patterns and prognosis of commotio retinae following orbital
wall fracture. Methods: This study is a retrospective analysis of 294 orbital wall fractures
diagnosed by computed tomography imaging from August 2015 to October 2016 at
a Level 1 trauma center. Dilated funduscopic exams were assessed for acute
posterior segment pathology, focusing specifically on commotio retinae
(N = 38). These were compared with patients with no
traumatic retinal findings (N = 253) to indicate
statistically significant differences in the mechanism of injury, fracture
pattern, subjective symptoms, radiologic and exam findings, and acute
interventions. Results: Commotio was most commonly associated with assault (60.5%,
p = 0.004) in a younger patient population, whereas normal
retinal exams were more likely after falls from standing (24.1%,
p = 0.022). Half of all commotio was found inferiorly
and most commonly occurred in medial or inferior wall fracture. Patients
with commotio were more likely to have motility deficits (29.7%,
p = 0.049) with clinical evidence of entrapment (13.2%,
p < 0.001), requiring acute operative repair (15.8%,
p = 0.005). Inferior wall fracture was associated with
19.4% surgical intervention in commotio as compared with those with normal
funduscopic exams (6.1%, p = 0.012). All patients with
follow-up had resolution of commotio and best-corrected visual acuity of
20/25 or better. Conclusion: Retinal pathology is not infrequent in orbital wall fractures. Inferior wall
fracture was associated with 19.4% surgical intervention in commotio as
compared to those with normal funduscopic exams (6.1%,
p = 0.012). A high index of suspicion and thorough
investigation is warranted in evaluating these patients.
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Affiliation(s)
- Halward M J Blegen
- Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX 78215, USA
| | | | - Aditya Mehta
- Brooke Army Medical Center, San Antonio, TX, USA
| | | | | | - Brett Davies
- Brooke Army Medical Center, San Antonio, TX, USA
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Joltikov KA, Sesi CA, de Castro VM, Davila JR, Anand R, Khan SM, Farbman N, Jackson GR, Johnson CA, Gardner TW. Disorganization of Retinal Inner Layers (DRIL) and Neuroretinal Dysfunction in Early Diabetic Retinopathy. Invest Ophthalmol Vis Sci 2019; 59:5481-5486. [PMID: 30452602 PMCID: PMC6735648 DOI: 10.1167/iovs.18-24955] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To elucidate the relationship between disorganization of retinal inner layers (DRILs) and retinal function in diabetic patients without diabetic retinopathy (DR) and with nonproliferative DR, but without diabetic macular edema (DME). Methods Fifty-seven participants with diabetes mellitus (DM) and 18 healthy controls underwent comprehensive ophthalmic examination, fundus photography, and spectral-domain optical coherence tomography. Scans of the fovea were evaluated for the presence of DRIL. Retinal function was evaluated using Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity, the quick contrast sensitivity function (qCSF) on the AST Sentio Platform, short-wavelength automated perimetry (SWAP), standard automated perimetry (SAP), and frequency doubling perimetry (FDP). ANOVA and Kruskal-Wallis were used to compare retinal function in subjects with and without DRIL. Tukey-Kramer test and Wilcoxon were used for post hoc analysis. Results DRIL was identified in 9 of 57 diabetic subjects. DRIL subjects had higher body mass index and longer diabetes duration compared to diabetic subjects without DRIL (P = 0.03 and P = 0.009, respectively). Subjects with DRIL had reduced ETDRS visual acuity (P = 0.003), contrast sensitivity function (P = 0.0003), and SAP performance (PSD, P < 0.0001) compared to controls and diabetic subjects without DRIL. Structural analysis revealed inner retinal thinning, and some outer retinal thinning, associated with DRIL. Conclusions Diabetic subjects with DRIL have reduced retinal function compared to those without DRIL, and defective retinal lamination may be an early cellular consequence of diabetes responsible for this in some patients. Following further longitudinal studies, DRIL may be a readily available and reliable structural biomarker for reduced retinal function in early diabetic neuroretinal disease.
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Affiliation(s)
- Katherine A Joltikov
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Christopher A Sesi
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Vinícius M de Castro
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - José R Davila
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Rohit Anand
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Sami M Khan
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Neil Farbman
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | | | - Chris A Johnson
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Thomas W Gardner
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
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Braza ME, Young J, Hammeke TA, Robison SE, Han DP, Warren CC, Carroll J, Stepien KE. Assessing photoreceptor structure in patients with traumatic head injury. BMJ Open Ophthalmol 2018; 3:e000104. [PMID: 30539149 PMCID: PMC6257382 DOI: 10.1136/bmjophth-2017-000104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/29/2018] [Accepted: 10/11/2018] [Indexed: 11/17/2022] Open
Abstract
Objective Previous work using adaptive optics scanning light ophthalmoscopy (AOSLO) imaging has shown photoreceptor disruption to be a common finding in head and ocular trauma patients. Here an expanded trauma population was examined using a novel imaging technique, split-detector AOSLO, to assess remnant cone structure in areas with significant disruption on confocal AOSLO imaging and to follow photoreceptor changes longitudinally. Methods and Analysis Eight eyes from seven subjects with head and/or ocular trauma underwent imaging with spectral domain optical coherence tomography, confocal AOSLO and split-detector AOSLO to assess foveal and parafoveal photoreceptor structure. Results Confocal AOSLO imaging revealed hyporeflective foveal regions in two of eight eyes. Split-detector imaging within the hyporeflective confocal areas showed both remnant and absent inner-segment structure. Both of these eyes were imaged longitudinally and showed variation of the photoreceptor mosaic over time. Four other eyes demonstrated subclinical regions of abnormal waveguiding photoreceptors on multimodal AOSLO imagery but were otherwise normal. Two eyes demonstrated normal foveal cone packing without disruption. Conclusion Multimodal imaging can detect subtle photoreceptor abnormalities not necessarily detected by conventional clinical imaging. The addition of split-detector AOSLO revealed the variable condition of inner segments within confocal photoreceptor disruption, confirming the usefulness of dual-modality AOSLO imaging in assessing photoreceptor structure and integrity. Longitudinal imaging demonstrated the dynamic nature of the photoreceptor mosaic after trauma. Multimodal imaging with dual-modality AOSLO improves understanding of visual symptoms and photoreceptor structure changes in patients with head and ocular trauma.
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Affiliation(s)
- Matthew E Braza
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonathon Young
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas A Hammeke
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Scott E Robison
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dennis P Han
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Clinton C Warren
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joseph Carroll
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kimberly E Stepien
- Department of Ophthalmology and Visual Sciences, University of WI - Madison, Madison, Wisconsin, USA
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13
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Cham KM, Di pasquale DN, Jaworski A. A case of commotio retinae following champagne cork injury. Clin Exp Optom 2018; 101:140-142. [DOI: 10.1111/cxo.12515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/10/2016] [Accepted: 11/15/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kwang Meng Cham
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Victoria, Australia,
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14
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Zhu W, Chen H, Zhao H, Tian B, Wang L, Shi F, Xiang D, Luo X, Gao E, Zhang L, Yin Y, Chen X. Automatic Three-dimensional Detection of Photoreceptor Ellipsoid Zone Disruption Caused by Trauma in the OCT. Sci Rep 2016; 6:25433. [PMID: 27157473 PMCID: PMC4860566 DOI: 10.1038/srep25433] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 04/18/2016] [Indexed: 12/03/2022] Open
Abstract
Detection and assessment of the integrity of the photoreceptor ellipsoid zone (EZ) are important because it is critical for visual acuity in retina trauma and other diseases. We have proposed and validated a framework that can automatically analyse the 3D integrity of the EZ in optical coherence tomography (OCT) images. The images are first filtered and automatically segmented into 10 layers, of which EZ is located in the 7th layer. For each voxel of the EZ, 57 features are extracted and a principle component analysis is performed to optimize the features. An Adaboost classifier is trained to classify each voxel of the EZ as disrupted or non-disrupted. Finally, blood vessel silhouettes and isolated points are excluded. To demonstrate its effectiveness, the proposed framework was tested on 15 eyes with retinal trauma and 15 normal eyes. For the eyes with retinal trauma, the sensitivity (SEN) was 85.69% ± 9.59%, the specificity (SPE) was 85.91% ± 5.48%, and the balanced accuracy rate (BAR) was 85.80% ± 6.16%. For the normal eyes, the SPE was 99.03% ± 0.73%, and the SEN and BAR levels were not relevant. Our framework has the potential to become a useful tool for studying retina trauma and other conditions involving EZ integrity.
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Affiliation(s)
- Weifang Zhu
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Haoyu Chen
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, 515041, China.,Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Shatin N.T., Hong Kong, 999077, China
| | - Heming Zhao
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Bei Tian
- Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Lirong Wang
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Fei Shi
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Dehui Xiang
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Xiaohong Luo
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, 515041, China
| | - Enting Gao
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Li Zhang
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Yilong Yin
- School of Computer Science and Technology, Shandong University, Jinan, Shandong, 250100, China
| | - Xinjian Chen
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu, 215006, China
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15
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Nicholson L, Ramu J, Triantafyllopoulou I, Patrao NV, Comyn O, Hykin P, Sivaprasad S. Diagnostic accuracy of disorganization of the retinal inner layers in detecting macular capillary non-perfusion in diabetic retinopathy. Clin Exp Ophthalmol 2015; 43:735-41. [PMID: 25998983 DOI: 10.1111/ceo.12557] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 05/18/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Disorganization of the retinal inner layers (DRIL) on optical coherence tomography (OCT) is thought to represent retinal capillary non-perfusion (CNP) in eyes with diabetic retinopathy. This study was designed to evaluate the ability of DRIL to accurately predict CNP. DESIGN Retrospective masked reliability and diagnostic accuracy study performed in the National Institute for Health Research (NIHR) Moorfields Biomedical Research Centre, London, UK SAMPLES: Retinal images of patients with diabetic retinopathy METHODS The OCT images from 90 separate areas of angiographically confirmed perfused and non-perfused areas of the macula from 37 eyes of 31 patients were anonymized and coded. Two masked graders independently graded these OCT scans for the presence or absence of DRIL to determine the intergrader reliability. The diagnostic accuracy of DRIL in identifying CNP was evaluated from the results obtained. MAIN OUTCOME MEASURES Sensitivity and specificity of DRIL in accurately detecting CNP RESULTS: The intergrader agreement was high with a Cohen's kappa of 0.909. DRIL was present in 84.4% (38/45) of non-perfused retina and none in perfused retina (0/45). The sensitivity and specificity of DRIL in detecting angiographic evidence of CNP was 84.4% and 100%, respectively. The positive predictive value was 100% and the negative predictive value was 86.5%. CONCLUSIONS The presence of DRIL is a reliable predictor of areas of macular CNP. However, DRIL is not a universal finding of non-perfusion, with some cases exhibiting absence of DRIL despite angiographic CNP.
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Affiliation(s)
- Luke Nicholson
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
| | - Jayashree Ramu
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
| | | | | | - Oliver Comyn
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
| | - Philip Hykin
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
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16
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Abstract
PURPOSE To evaluate outer retinal structural abnormalities in patients with visual deficits after closed-globe blunt ocular trauma. METHODS Nine subjects with visual complaints after closed-globe blunt ocular trauma were examined between 1 month after trauma and 6 years after trauma. Spectral domain optical coherence tomography was used to assess the outer retinal architecture, whereas adaptive optics scanning light ophthalmoscopy was used to analyze the photoreceptor mosaic integrity. RESULTS Visual deficits ranged from central scotomas to decreased visual acuity. Spectral domain optical coherence tomography defects included focal foveal photoreceptor lesions, variable attenuation of the interdigitation zone, and mottling of the outer segment band, with one subject having normal outer retinal structure. Adaptive optics scanning light ophthalmoscopy revealed disruption of the photoreceptor mosaic in all subjects, variably manifesting as foveal focal discontinuities, perifoveal hyporeflective cones, and paracentral regions of selective cone loss. CONCLUSION We observe persistent outer retinal disruption in subjects with visual complaints after closed-globe blunt ocular trauma, albeit to a variable degree. Adaptive optics scanning light ophthalmoscopy imaging allows the assessment of photoreceptor structure at a level of detail not resolvable using spectral domain optical coherence tomography or other current clinical imaging tools. Multimodal imaging seems to be useful in revealing the cause of visual complaints in patients after closed-globe blunt ocular trauma. Future studies are needed to better understand how photoreceptor structure changes longitudinally in response to various traumas.
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