Morphometric analysis of fovea with spectral-domain optical coherence tomography and visual outcome postsurgery for retinal detachment

Purpose:

The purpose of this study was to correlate the postoperative best-corrected visual acuity (BCVA) with spectral-domain optical coherence tomography (SD-OCT) findings in fovea involving rhegmatogenous retinal detachment (RRD) surgery.

Materials and Methods:

Thirty eyes with preoperative fovea-involving RRD, who underwent scleral buckling (SB) (6 eyes) and pars plana vitrectomy (PPV) (19 eyes) and combined SB and PPV (5 eyes) were recruited. Patients underwent clinical examination and SD-OCT scan of fovea preoperatively and at 30 days and 90 days postoperatively. The correlations between SD-OCT findings and BCVA were analyzed.

Results:

Inner segment/outer segment (IS/OS) junction integrity was the indicator of better BCVA at 30 days and 90 days (P = 0.0002 and P = 0.0003, respectively) whereas outer retinal corrugation (ORC) was related to worse BCVA at 30 days and 90 days (P = 0.001). External limiting membrane did not have a co-relation with visual outcome, but cystoid macular edema showed co-relation at 90 days (P = 0.047). All eyes of SB and 3 eyes of PPV had a minimal subfoveal fluid at 30 days follow-up that had no effect on visual acuity. All retinas were attached at final follow-up.

Conclusion:

IS/OS junction integrity and ORC may be important predictors of postoperative visual outcome after anatomically successful RRD surgery.     

比较应用SD-OCT检测青光眼患者黄斑区节细胞与视盘周围视网膜神经纤维层的改变

目的:通过节细胞内网状层(GCIPL)评估中度和重度青光眼的损伤程度并比较其与视盘周围视网膜神经纤维层(PRNFL)的诊断效能,包括敏感性与特异性及ROC曲线下面积(AUC).方法:前瞻性研究.共210眼(包括中度青光眼患者30例54眼,重度青光眼患者34例59眼和正常人50例97眼)纳入本研究.所有参与者均接受全面眼科检查,包括视野检查、3D-OCT视盘检查和3D-OCT黄斑部垂直扫描.记录并比较所有参与者的GCIPL和PRNFL的AUC、敏感性与特异性.结果:在中度和重度青光眼组中,上部、下部及整体GCIPL和PRNFL厚度明显变薄(P＜0.001).在中度青光眼组中,GCIPL的敏感度与特异性高于PRNFL(仅上半部分敏感性相同).重度青光眼组,上部、下部及整体GCIPL的敏感度均低于PRNFL.整体GCIPL的特异性低于PRNFL.上部GCIPL的特异性高于PRNFL.下部GCIPL的特异性与PRNFL相同.结论:对于区分中度和重度青光眼,黄斑GCIPL参数的功能远高于PRNFL.两者联合在病情分析中效果最优,能够提供更准确的损伤程度评估.     

The Relationship Between Macula Retinal Ganglion Cell Density and Visual Function in the Nonhuman Primate

PurposeLoss of ganglion cell inner plexiform layer (GCIPL) and visual sensitivity in the macula region are known to occur at all stages of glaucoma. While both are dependent on the underlying retinal ganglion cells (RGCs), the relationship between structure and function is modest. We hypothesize that the imprecise relationship is due to a lack of direct correspondence between in vivo measures and RGC counts, as well as the relatively large stimulus size used by standard perimetry, which exceeds spatial summation.MethodsThe relationship between optical coherence tomography (OCT)–derived GCIPL thickness and corresponding inner cell density from retinal flat mounts was determined for four nonhuman primates with varying stages of neuropathy. Normative data for 10-2 threshold using Goldman size I to V stimuli were established for 10 animals, 4 of which were then followed longitudinally with OCT and perimetry. The relationship between GCIPL volume, which incorporated stimulus size after removal of residual thickness, and differential light sensitivity was determined for both experimental glaucoma and healthy eyes.ResultsPeak inner retinal cell density was 63,052 ± 9238 cells/mm² in the healthy eye. Cell density was related to both GCIPL thickness and eccentricity (R² = 0.74, P < .01). For all 10-2 eccentricities, size III stimuli were greater than the critical area (P < 0.01). Based on the structural and histologic relationship, the critical area corresponds to approximately 156 RGCs.ConclusionsThe relationship between cell density and GCIPL thickness is dependent on retinal eccentricity. For 10-2 perimetry, perimetric loss, especially at earlier stages of neuropathy, may best be detected using size II or smaller stimuli.     

Retinal ganglion cell and inner plexiform layer thickness measurements in regions of severe visual field sensitivity loss in patients with glaucoma

Purpose

To better understand the effects of severe glaucoma on the thickness of the retinal ganglion cell (RGC) and inner plexiform (IP) layers measured with frequency-domain optical coherence tomography.

Methods

In experiment 1, macular cube scans were obtained in 11 patients with glaucoma and the thickness of both the RGC and IP layers were measured at locations corresponding to 3, 5, and 7° eccentricity. For patients, only locations with total deviation losses of −15 dB or worse on perimetry were included. In experiment 2, higher resolution, horizontal midline scans were obtained from 30 controls in order to obtain a precise measure of the thickness of the RGC and IP layers of the healthy retina.

Results

In regions of severe field loss (experiment 1), glaucoma decreased the thickness of both layers, leaving a residual layer. The residual thickness of the IP layer was larger than the residual thickness of the RGC layer. In healthy controls (experiment 2), the RGC layer was about 57% of the RGC+IP layer thickness at 3° as compared with only 36% at 10°, in agreement with a recent histological study.

Conclusion

Glaucomatous optic neuropathy, with severe losses in visual field sensitivity, decreases the thickness of both the RGC and IP layers, but leaves a residual thickness of both. The IP layer contributes slightly more than the RGC to this residual, even just outside the center of the fovea where the RGC layer thickness exceeds the IP layer thickness in controls.     

Association of outer retinal layer morphology with visual acuity in patients with retinal vein occlusion: SCORE Study Report 13

Purpose

To assess associations between visual acuity (VA) and the status of the photoreceptor inner segment–outer segment (IS–OS) junction in a subset of patients in the Standard Care vs COrticosteroid for REtinal Vein Occlusion (SCORE) Study.

Methodology

High-resolution time domain optical coherence tomography (OCT) scans of study eyes from a single site participating in the SCORE Study were evaluated. Integrity of the IS–OS junction in the central subfield was evaluated using a three-step scale: absent, abnormal or normal. Associations of the IS–OS status with ETDRS VA letter score and center point thickness (CPT) were investigated.

Results

Baseline OCTs of 42 eyes were evaluated. The IS–OS junction was absent in 30 (71%) and abnormal in 12 (29%). At month 12, the IS–OS junction was absent in 18 (43%), abnormal in 12 (28%), and normal in 12 (28%) eyes. At baseline, IS–OS status was significantly associated with CPT, but not with VA. At month 12, IS–OS status was significantly associated with CPT and VA, that is, absent or abnormal IS–OS was associated with increased CPT and worse VA. Change in IS–OS status was not associated with change in CPT (P=0.8). Worsening of IS–OS status was associated with loss of VA and improvement in IS–OS status to normal was associated with gain in VA (P=0.03).

Conclusion

In this data set with long-term follow-up of OCTs as part of the SCORE Study, there is a correlation between change in IS–OS status and VA. This supports further evaluation of outer retinal morphology in larger data sets.     

OCT 测量黄斑内层视网膜厚度在青光眼诊断中的研究进展

目前高分辨相干光断层扫描（optical coherence tomography,OCT）的扫描速度及轴向分辨率大幅度提高,尤其是视网膜层间算法的应用,使得黄斑内层视网膜厚度的测量成为可能。近些年来,许多研究关注于视网膜内层厚度在青光眼中改变,发现黄斑结构损害与功能丢失之间的对应关系,并通过多种分析方法,帮助临床医生提高青光眼的诊断效率。（国际眼科纵览,2016,40：150-155）     

Trans-synaptic Retrograde Degeneration Following Hemispherectomy in Childhood

Trans-synaptic retrograde degeneration (TRD) in the human visual system has been established. However there are few studies demonstrating macular thinning of the Retinal Ganglion cell Layer and/or Inner Plexiform layer (RGCL-IPL), corresponding to an acquired homonymous hemianopia. We report a 17 year old with a homonymous hemianopia, secondary to a hemispherectomy for intractable epilepsy. Three years following hemispherectomy, Optical Coherence Tomography (OCT) revealed evidence of TRD, corresponding to his complete homonymous hemianopia. Macular maps of the RGCL-IPL thickness provides useful additional information to measurements of optic nerve Retinal Nerve Fibre Layer Thickness (RNFL) in identifying TRD in acquired homonymous hemianopia.     

Peripapillary Retinal Nerve Fiber Layer and Ganglion Cell–Inner Plexiform Layer Thickness in Children with Familial Mediterranean Fever

Purpose: To evaluate the thickness of the peripapillary retinal nerve fiber layer (RNFL) and retinal ganglion cell-inner plexiform layer (GCIPL) in children with familial Mediterranean fever (FMF).

Methods: The study included 39 FMF patients and 36 healthy controls. After detailed ocular examination, the thickness of the peripapillary RNFL and GCIPL were measured by spectral domain optic coherence tomography (SD-OCT). All measurements were taken from the right eye of the patients and controls. According to their disease severity score (DSS), the patients were divided into two groups: patients with DSS ≤5 and those with DSS >5.

Results: There were no statistically significant differences in peripapillary RNFL and retinal GCIPL thickness between patients with FMF and controls.

Conclusion: It appears that FMF does not affect the RNFL and GCIPL thickness.     

【In Press】 Effect of infusion pressure during cataract surgery on ganglion cells measured using isolated-check visual evoked potential

AIM: To detect the relationship between infusion pressure and postoperative retinal visual function. METHOD: This prospective observational cohort study included sixty-one eyes that underwent uncomplicated cataract surgery. Patients were divided into two groups according to infusion time (IT) recorded using surgery equipment [Group A: IT>ITmean (27 eyes); Group B: IT相似文献   

Effect of infusion pressure during cataract surgery on ganglion cells measured using isolated-check visual evoked potential

AIM: To detect the relationship between infusion pressure and postoperative ganglion cells function. METHODS: This prospective observational cohort study included sixty-one eyes that underwent uncomplicated cataract surgery. Patients were divided into two groups according to infusion time (IT) recorded using surgery equipment [Group A: IT>ITmean (27 eyes); Group B: IT相似文献   

Arrested development: High-resolution imaging of foveal morphology in albinism

Albinism, an inherited disorder of melanin biosynthesis, disrupts normal retinal development, with foveal hypoplasia as one of the more commonly associated ocular phenotypes. However the cellular integrity of the fovea in albinism is not well understood - there likely exist important anatomical differences that underlie phenotypic variability within the disease and that also may affect responsiveness to therapeutic intervention. Here, using spectral-domain optical coherence tomography (SD-OCT) and adaptive optics (AO) retinal imaging, we obtained high-resolution images of the foveal region in six individuals with albinism. We provide a quantitative analysis of cone density and outer segment elongation demonstrating that foveal cone specialization is variable in albinism. In addition, our data reveal a continuum of foveal pit morphology, roughly aligning with schematics of normal foveal development based on post-mortem analyses. Different albinism subtypes, genetic mutations, and constitutional pigment background likely play a role in determining the degree of foveal maturation.     

Segmented retinal analysis in pituitary adenoma with chiasmal compression: A prospective comparative study

Purpose:The aim of this study was to determine the alteration in ganglion cell complex and its relationship with retinal nerve fiber layer (RNFL) thickness as measured by spectral-domain optical coherence tomography (OCT) in pituitary adenoma cases and also its correlation with visual field (VF).Methods:This is a prospective comparative study wherein detailed neuro-ophthalmic examination including perimetry, RNFL and ganglion cell layer inner plexiform layer (GCL-IPL) thickness were measured preoperatively in the cases of pituitary adenoma with chiasmal compression with visual symptoms and field changes who were planned for neuro-surgical intervention. These parameters were repeated 1 year after the surgery. GCL-IPL, RNFL parameters were compared with controls and were correlated with VF mean deviation (MD). The diagnostic power of GCL-IPL was tested using the receiver operating characteristic (ROC) curve. Healthy age and sex-matched controls without any ocular and systemic abnormality were taken for comparison.Results:Twenty-four patients qualified the inclusion criteria. A significant thinning of GCL-IPL (P = 0.002) and RNFL (P = 0.039) was noticed in the pituitary adenoma group. GCL-IPL (r = 0.780 P < 0.001) and RNFL (r = 0.669, P < 0.001) were significantly correlated with the MD. The ROC curve values of GCL-IPL were 0.859 (95% confidence interval 0.744% to 0.973) and of RNFL were 0.731 (95% confidence interval 0.585–0.877). The diagnostic ability of GCL-IPL was more as compared to the RNFL analysis, although it was statistically insignificant (P = 0.122).Conclusion:GCL-IPL measurements on the OCT are a sensitive tool to detect early anterior visual pathway changes in chiasmal compression for pituitary adenoma patients.     

Values of macular ganglion cell-inner plexiform layer and 10-2 visual field measurements in detecting and evaluating glaucoma

AIM: To assess the performance of macular ganglion cell-inner plexiform layer thickness (mGCIPLT) and 10-2 visual field (VF) parameters in detecting early glaucoma and evaluating the severity of advanced glaucoma. METHODS: Totally 127 eyes from 89 participants (36 eyes of 19 healthy participants, 45 eyes of 31 early glaucoma patients and 46 eyes of 39 advanced glaucoma patients) were included. The relationships between the optical coherence tomography (OCT)-derived parameters and VF sensitivity were determined. Patients with early glaucoma were divided into eyes with or without central 10° of the VF damages (CVFDs), and the diagnostic performances of OCT-derived parameters were assessed. RESULTS: In early glaucoma, the mGCIPLT was significantly correlated with 10-2 VF pattern standard deviation (PSD; with average mGCIPLT: β=-0.046, 95%CI, -0.067 to -0.024, P<0.001). In advanced glaucoma, the mGCIPLT was related to the 24-2 VF mean deviation (MD; with average mGCIPLT: β=0.397, 95%CI, 0.199 to 0.595, P<0.001), 10-2 VF MD (with average mGCIPLT: β=0.762, 95%CI, 0.485 to 1.038, P<0.001) and 24-2 VF PSD (with average mGCIPLT: β=0.244, 95%CI, 0.124 to 0.364, P<0.001). Except for the minimum and superotemporal mGCIPLT, the decrease of mGCIPLT in early glaucomatous eyes with CVFDs was more severe than that of early glaucomatous eyes without CVFDs. The area under the curve (AUC) of the average mGCIPLT (AUC=0.949, 95%CI, 0.868 to 0.982) was greater than that of the average circumpapillary retinal nerve fiber layer thickness (cpRNFLT; AUC=0.827, 95%CI, 0.674 to 0.918) and rim area (AUC=0.799, 95%CI, 0.610 to 0.907) in early glaucomatous eyes with CVFDs versus normal eyes. CONCLUSION: The 10-2 VF and mGCIPLT parameters are complementary to 24-2 VF, cpRNFLT and ONH parameters, especially in detecting early glaucoma with CVFDs and evaluating the severity of advanced glaucoma in group level.