Macular Cone Abnormalities in Behçet's Disease Detected by Adaptive Optics Scanning Light Ophthalmoscope

Uveitis in Behçet disease - an update

PURPOSE OF REVIEW

Uveitis is a major manifestation of Behçet disease (BD) and potentially has a high morbidity. This article reviews recently published data on BD uveitis.

RECENT FINDINGS

A set of classification criteria and a diagnostic algorithm have been developed for BD uveitis. Recent reports have confirmed male predominance and posterior segment inflammation in the majority of BD uveitis patients. A high uveitis attack severity score, fluorescein angiographic leakage at the posterior pole, and disruption of outer retinal layers on optical coherence tomography (OCT) predict poor visual outcome. OCT-angiography studies have suggested subclinical changes of retinal capillaries in patients with or without ocular involvement. In a randomized controlled trial, interferon-α was superior to cyclosporine. Favorable outcomes were reported with earlier initiation, optimization, and withdrawal of infliximab after remission. Adalimumab as first-line was superior to conventional therapy.

SUMMARY

Classification criteria will be used to select a homogeneous group of patients for research and the diagnostic algorithm may help ophthalmologists predict the probability of BD uveitis based on ocular findings. Fluorescein angiography and OCT are the routine imaging modalities. Clinical relevance of OCT-angiography is unclear. Interferon-α, infliximab, and adalimumab have proven superior efficacy compared to conventional therapy.

In-vivo visualization of the photoreceptors using Spectralis High Magnification Module imaging in central serous chorioretinopathy

Purpose

To visualize photoreceptors using the Spectralis High Magnification Module (HMM) in a case of central serous chorioretinopathy (CSCR) and to correlate the findings with those of optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A).

Observations

A 35-year-old Caucasian male presenting with chronic CSCR in the left eye was examined using HMM, OCT and OCT-A. The photoreceptors mosaic was assessed both in diseased and apparently uninvolved areas. A partial topographic correlation between the loss of photoreceptors on HMM images and an altered reflectivity of the photoreceptor layer on en-face OCT was noted. Interestingly, a correlation between the photoreceptor damage on HMM and choriocapillaris flow-void areas on OCT-A was seen.

Conclusions and Importance

HMM is a non-invasive imaging modality, allowing the in-vivo visualization of photoreceptor damage in a diseased retina. A focal abnormal perfusion of the choriocapillaris might influence the integrity of the overlying photoreceptors in CSCR.

Human Foveal Cone and Müller Cells Examined by Adaptive Optics Optical Coherence Tomography

Purpose

The purpose of this study was to image and investigate the foveal microstructure of human cone and Müller cells using adaptive optics-optical coherence tomography.

Methods

Six healthy subjects underwent the prototype adaptive optics-optical coherence tomography imaging, which allowed an axial resolution of 3.4 µm and a transverse resolution of approximately 3 µm. The morphological features of the individual retinal cells observed in the foveola were qualitatively and quantitatively evaluated.

Results

In the six healthy subjects, the image B-scans showed hyper-reflective dots that were densely packed in the outer nuclear layer. The mean number, diameter, and density of hyper-reflective dots in the foveola were 250.8 ± 59.6, 12.7 ± 59.6 µm, and 6966 ± 1833/mm2, respectively. These qualitative and quantitative findings regarding the hyper-reflective dots were markedly consistent with the morphological features of the foveal cone cell nuclei. Additionally, the images showed the funnel-shaped hyporeflective bodies running vertically and obliquely between the inner and external limiting membranes, illustrating the cell morphology of the foveal Müller cells.

Conclusions

Using adaptive optics, we succeeded in visualizing cross-sectional images of the individual cone and Müller cells of the human retina in vivo.

Translational Relevance

Adaptive optics-optical coherence tomography would help to improve our understanding of the pathogenesis of macular diseases.