Foveal structure in nanophthalmos and visual acuity

Abstract Purpose To evaluate the fovea in nanophthalmic eyes using spectral domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA), and to investigate the relationship between the macular microstructure and visual acuity. Methods This is a retrospective case series of five nanophthalmic patients. The foveal avascular zone (FAZ) area was measured in superficial and deep vascular layers with OCTA. The thickness of the inner retinal layer (IRL) was measured with SD-OCT. The ratio of the foveal and parafoveal IRL thickness (fIRL/pIRL ratio) was calculated. The relationship between these parameters and visual acuity was then investigated. Results Eight eyes were identified as nanophthalmic with a mean axial length of 17.19 ± 1.44 mm (range: 15.71 to 19.88 mm). The mean best-corrected visual acuity (BCVA) in the logarithm of the minimum angle of resolution (logMAR) was 0.12 ± 0.18 (range: − 0.18 to 0.40). OCTA showed that FAZs were either absent or undeveloped in the superficial and deep capillary plexuses. Two patients did not show any visual impairments despite small FAZ and a shallow foveal depression. Although the BCVA was significantly correlated with the deep FAZ size, it did not correlate with the superficial FAZ size, axial length, or fIRL/pIRL ratio. However, the refractive error, axial length, and deep FAZ size were all significantly correlated with the fIRL/pIRL ratio. Conclusions The FAZs were commonly found to be small in the superficial and deep capillary plexuses. Although the deep FAZ size correlated with visual acuity, it is unclear whether the retinal microstructure and the FAZ size are responsible for the visual impairments observed in the same individuals.

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Comparison of Retinal Layer Thickness and Capillary Vessel Density in the Patients with Spontaneously Resolved Acute Central Serous Chorioretinopathy

Journal of Clinical Medicine ◽

10.3390/jcm10010045 ◽

2020 ◽

Vol 10 (1) ◽

pp. 45

Author(s):

Kyu Jin Han ◽

Hyeong Ju Kim ◽

Je Moon Woo ◽

Jung Kee Min

Keyword(s):

Visual Acuity ◽

Layer Thickness ◽

Central Serous Chorioretinopathy ◽

Subretinal Fluid ◽

Vessel Density ◽

Foveal Avascular Zone ◽

Retinal Layer ◽

Healthy Controls ◽

Retrospective Case ◽

Capillary Vessel

We investigate retinal layer thickness and capillary vessel density (VD) in the patients with central serous chorioretinopathy (CSC) who recovered spontaneously and evaluate the correlation between the changes in these values and visual outcomes using swept-source optical coherence tomography (SS-OCT) and OCT angiography (OCTA). This retrospective case–control study included 34 eyes of 34 patients with spontaneously resolved acute CSC. The changes in retinal layer thickness and capillary VD were examined using SS-OCT and OCTA after complete resolution of subretinal fluid (SRF). The fellow eyes and 34 healthy eyes were used as controls. In the eyes with CSC, the outer retinal layer was significantly thinner than in the eyes of fellow and healthy controls. The foveal avascular zone area and VDs in the superficial and deep capillary plexus in the eyes with CSC were not significantly different from those in the eyes of fellow and healthy controls. The VD of the choriocapillaris in the eyes with CSC was significantly lower than that in the eyes of fellow and healthy controls. Correlation analyses revealed that the outer retinal layer thickness and initial visual acuity were positively correlated with the final visual acuity. Furthermore, the initial SRF area and height were negatively correlated with the outer retinal layer thickness after SRF resolution. Attenuation of outer retinal layer thickness and decreased VD of the choriocapillaris were observed in the eyes with spontaneously resolved acute CSC. The outer retinal layer thickness could be an important visual predictor of CSC.

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Association of foveal avascular zone with the metamorphopsia in epiretinal membrane

Scientific Reports ◽

10.1038/s41598-020-74190-x ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Hideki Shiihara ◽

Hiroto Terasaki ◽

Shozo Sonoda ◽

Naoko Kakiuchi ◽

Hidetaka Yamaji ◽

...

Keyword(s):

Visual Acuity ◽

Superficial Layer ◽

University Hospital ◽

Foveal Avascular Zone ◽

Service Unit ◽

Corrected Visual Acuity ◽

Avascular Zone ◽

The Mean ◽

The Relationship ◽

Best Corrected Visual Acuity

Abstract This study was to investigate the relationship between the metamorphopsia and foveal avascular zone (FAZ) parameter in eyes with epiratinal membrane (ERM). We studied patients with an ERM visited retinal service unit at the Kagoshima University Hospital or Shirai Hospital. The best-corrected visual acuity (BCVA), and the degree of metamorphopsia by M -CHARTS™ were evaluated. The 3 × 3 mm optical coherence tomography angiography (OCTA) images of the superficial layer were obtained. Area (mm2), the circularity, eigen value were calculated using ImageJ software. The relationship between visual function, such as best corrected visual acuity (BCVA) and metamorphopsia, and FAZ parameters were studied by Pearson’s correlational coefficient. Fifty-four eyes of 51 patients (24 men and 27 women) with an ERM were studied. The mean age of the patients was 69.6 ± 8.20 years. The mean BCVA and metamorphopsia score was 0.31 ± 0.29 logMAR units and 0.49 ± 0.42. There was no significant relationship between BCVA and FAZ parameters. While, metamorphopsia score was significantly and negatively correlated with all of FAZ parameters (area R = − 0.491, P < 0.001; circularity R = − 0.385, P = 0.004; eigenvalue ratio R = − 0.341; P = 0.012). Multiple regression analysis showed the FAZ area was solely and significantly correlated with metamorphopsia score (β − 0.479, P < 0.001). The size but not the shape of the FAZ was significantly correlated with the degree of metamorphopsia suggesting that it could be an objective parameter of metamorphopsia in ERM patients.

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Magnification Effect of Foveal Avascular Zone Measurement Using Optical Coherence Tomography Angiography

Biomedicine Hub ◽

10.1159/000507501 ◽

2020 ◽

Vol 5 (2) ◽

pp. 1-8

Author(s):

Mika Suda ◽

Yuji Yoshikawa ◽

Gaku Terauchi ◽

Soiti Matsumoto ◽

Takuhei Shoji ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Axial Length ◽

Optical Coherence Tomography Angiography ◽

Foveal Avascular Zone ◽

Optical Coherence ◽

En Face ◽

Avascular Zone ◽

The Mean ◽

The Relationship ◽

Magnification Effect

Purpose: The aim of this study was to evaluate the foveal avascular zone (FAZ) of healthy subjects and examine the magnification effect. Methods: A total of 33 healthy volunteers were enrolled and all subjects were eligible for analysis. Optical coherence tomography angiography (OCTA) examination scanned 3 × 3 mm of the macular area. The FAZ area was measured on the superficial OCTA en face image with and without correction by axial length. The relationship between changes in the FAZ area after correction with the axial length was examined. Results: The mean age was 21.9 ± 0.6 years. The mean axial length was 24.87 ± 1.17 mm and mean spherical equivalent (SE) value was –3.64 ± 2.83 diopters (D). The FAZ area was 0.26 ± 0.10 mm2 before the axial length correction and 0.27 ± 0.10 mm2 after the correction. In the eyes that had an axial length longer than or equal to 26 mm or SE less than or equal to –6 D, the FAZ area after correction was significantly larger than that before correction (p < 0.01). The change of FAZ area after correction with axial length was significantly correlated with the axial length (R2 = 0.88, p < 0.01) or SE value (R2 = 0.55, p < 0.01). Conclusion: FAZ areas were comparable to previous reports. In high myopic cases, the magnification effect needs to be considered when evaluating the FAZ area.

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Incidence, Risk, and Visual Outcomes after Repositioning of Acute Non-Traumatic Flap Dislocations Following Femtosecond-Assisted LASIK

Journal of Clinical Medicine ◽

10.3390/jcm10112478 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2478

Author(s):

Majid Moshirfar ◽

David G. West ◽

Chase M Miller ◽

William B. West ◽

Shannon E. McCabe ◽

...

Keyword(s):

Risk Factors ◽

Visual Acuity ◽

High Myopia ◽

Case Series ◽

Retrospective Case ◽

Visual Outcomes ◽

Uncorrected Distance Visual Acuity ◽

Incidence Risk ◽

Mechanical Devices

Although the use of femtosecond lasers instead of mechanical devices has decreased the incidence of flap complications following laser-assisted in situ keratomileusis (LASIK), dislocations and striae still occur. Flap repositioning is an effective intervention to improve visual outcomes after acute flap complications in both microkeratome-assisted and femtosecond-assisted LASIK. This retrospective case series included patients undergoing flap repositioning secondary to acute flap dislocation and/or visually significant striae within the first two weeks following femtosecond LASIK (FS-LASIK) from 2015 to 2020 at a single institution. Preoperative, intraoperative, and postoperative de-identified data were analyzed for incidence, risk factors, and visual acuity outcomes. The incidence of flap repositioning was 0.35% in 21,536 eyes (n = 70). Indications for repositioning included acute flap dislocation (35.7%) and visually significant striae (64.3%). High myopia (OR = 3.04, p = 0.001) and patient age over 50 years (OR = 3.69, p = 0.001) were the strongest risk factors for these complications. Prior to flap repositioning, uncorrected distance visual acuity (UDVA) of 20/20 or better and 20/40 or better occurred in 19% and 57% of eyes, respectively. After repositioning, a final UDVA of 20/20 or better and 20/40 or better occurred in 78% and 98% of eyes, respectively. After repositioning, one line of UDVA was lost in two eyes (2.8%) and two lines were lost in one eye (1.4%). Risk factors for acute flap dislocation included high myopia and age over 50 years. Flap repositioning was effective in salvaging visual outcomes.

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Inverted Internal Limiting Membrane Flap Technique for Extra Large Macular Holes

Current Trends in Ophthalmology ◽

10.18314/ctoy.v1i1.371 ◽

2018 ◽

Vol 1 (1) ◽

pp. 07-13

Author(s):

Ogugua Ndubuisi Okonkwo ◽

Adekunle Olubola Hassan ◽

Olufemi Oderinlo

Keyword(s):

Visual Acuity ◽

Case Series ◽

Functional Results ◽

Internal Limiting Membrane ◽

Vital Role ◽

Symptom Duration ◽

Flap Technique ◽

Macular Holes ◽

Snellen Visual Acuity ◽

Sd Oct

Aim: To investigate the outcome of the inverted Internal Limiting Membrane (ILM) flap technique for extra large idiopathic macular holes (MHs).Methods: A retrospective non-comparative surgical case series of seven eyes of 7 patients with MHs (base diameter of at least 1000 ?m) was conducted. All the MHs were treated using pars plana vitrectomy and brilliant blue G (BBG)-assisted inverted ILM flap technique. Spectral Domain- Optical Coherence Tomography (SD-OCT) images were used to assess the anatomical outcomes of surgery including the macular microstructure, while Best Corrected Snellen Visual Acuity (BCSVA) was used to evaluate the functional outcomes.Results: The average MH size was 1241microns and average symptom duration was nineteen months. All eyes achieved successful anatomical closure and there was no occurrence of a flat open type closure. SD-OCT microstructural study revealed a reconstruction of the Ellispod Zone (EZ) and External Limiting Membrane (ELM), in only 3 eyes. There was an improvement in visual acuity in 5 eyes, while 2 eyes maintained the same as pre operative vision. The largest increase in post operative visual acuity gain was a 4-line improvement in Best Corrected Snellen Visual Acuity (BCSVA) noted in one of the 3 eyes with reconstructed EZ and ELM. The 3 months symptom duration in this patient was the shortest in this series.Conclusion: Inverted ILM flap technique is a safe and effective approach for the management of extra large chronic idiopathic MHs with demonstrably good anatomical and limited functional results in a majority of cases. Postoperative reconstruction of the microstructure is however seen only in a minority of eyes. Despite an absence of the outer retina (EZ and ELM), some eyes still experience an improvement in vision. The symptom duration may play a vital role in functional outcome in this subset of extra large chronic MHs.

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Combined Pars Plana Glaucoma Drainage Device Placement and Vitrectomy Using a Vitrectomy Sclerotomy Site for Tube Placement: A Case Series

10.21203/rs.3.rs-92136/v1 ◽

2020 ◽

Author(s):

Enchi Kristina Chang ◽

Sanchay Gupta ◽

Marika Chachanidze ◽

John B. Miller ◽

Ta Chen Chang ◽

...

Keyword(s):

Visual Acuity ◽

Statistical Tests ◽

Case Series ◽

Tube Placement ◽

Glaucoma Drainage Device ◽

Retrospective Case ◽

Tube Obstruction ◽

Pars Plana ◽

Sclerotomy Site

Abstract Background: The purpose of this study is to report the safety and efficacy of pars plana (PP) glaucoma drainage devices (GDDs) with pars plana vitrectomy (PPV) using one of the vitrectomy sclerotomy sites for tube placement in patients with refractory glaucoma.Methods: Retrospective case series of 28 eyes of 28 patients who underwent combined PP GDD and PPV between November 2016 and September 2019 at Massachusetts Eye and Ear. Main outcome measures were intraocular pressure (IOP), glaucoma medication burden, best corrected visual acuity (BCVA), and complications. Statistical tests were performed with R and included Kaplan-Meier analyses, Wilcoxon paired signed-rank tests, and Fisher tests.Results: Mean IOP decreased from 22.8 mmHg to 11.4 mmHg at 1.5 years (p = 0.009), and mean medication burden decreased from 4.3 to 1.7 at 1.5 years (p = 0.009). Both IOP and medication burden were significantly lower at all follow-up time points. The probability of achieving 5 ≤ IOP ≤ 18 mmHg with at least 20% IOP reduction from preoperative levels was 77.7% at 1 year and 45.8% at 1.5 years. At their last visit, four eyes (14.3%) achieved complete success with IOP reduction as above without medications, and 13 eyes (46.2%) achieved qualified success with medications. Visual acuity was unchanged or improved in 23 eyes (82.1%) at their last follow-up. Two patients had a visual acuity decrease of >2 lines. Two eyes required subsequent PPV for tube obstruction, and one eye had transient hypotony.Conclusions: The results of pars plana GDD and vitrectomy using one of the vitrectomy sclerotomy sites for tube placement are promising, resulting in significant IOP and medication-burden reductions through postoperative year 1.5 without additional risk of postoperative complications. Inserting GDDs into an existing vitrectomy sclerotomy site may potentially save surgical time by obviating the need to create another sclerotomy for tube placement and suture one of the vitrectomy ports.

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Changes of outer retinal thickness with increasing age in normal eyes

International Eye Research ◽

10.18240/ier.2020.02.08 ◽

2020 ◽

Vol 1 (2) ◽

pp. 108-112

Author(s):

Zi-Jing Li ◽

◽

Jian-Hui Xiao ◽

Peng Zeng ◽

Xiang Gao ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Outer Segment ◽

Retinal Thickness ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Retinal Layer ◽

External Limiting Membrane ◽

The Cost ◽

The Relationship ◽

Sd Oct

AIM: To comprehensively investigate the relationship between outer retinal layer thickness and age in normal eyes. METHODS: One hundred normal eyes of 100 subjects who underwent spectral-domain optical coherence tomography (SD-OCT) were included in this retrospective study. The distances between the external limiting membrane (ELM) line and the photoreceptor inner segment/outer segment (IS/OS) line (ELM-IS/OS), the IS/OS line and the cone outer segment tips (COST) line (IS/OS-COST), the COST line and the retinal pigment epithelium (RPE) complex (COST-RPE) and the full retinal thickness (RT) were measured at the fovea and on four quarters. The relationship between thickness and age or sex was then analysed. CONCLUSION: In normal eyes, the RT thickness on the nasal quarter and the ELM-IS/OS thickness were significantly and negatively correlated with age. The IS/OS-COST and COST-RPE thicknesses were not significantly correlated with age or sex.

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Relationship between Drug-Induced Sleep Endoscopy Findings, Tonsil Size, and Polysomnographic Outcomes of Adenotonsillectomy in Children

Otolaryngology ◽

10.1177/0194599819860777 ◽

2019 ◽

Vol 161 (3) ◽

pp. 507-513 ◽

Cited By ~ 6

Author(s):

Derek J. Lam ◽

Natalie A. Krane ◽

Ron B. Mitchell

Keyword(s):

Rating Scale ◽

Tertiary Care ◽

Case Series ◽

Apnea Hypopnea Index ◽

Strongly Correlated ◽

Sleep Endoscopy ◽

Retrospective Case ◽

Drug Induced ◽

Failure Assessment ◽

The Relationship

Objective (1) Determine the correlation of awake tonsil scores and preadenotonsillectomy (pre-AT) sleep endoscopy findings. (2) Assess the relationship between polysomnographic AT outcomes with awake tonsil scores and sleep endoscopy ratings of tonsil and adenoid obstruction. Study Design Retrospective case series with chart review. Setting Tertiary care children’s hospital. Subjects and Methods Children aged 1 to 18 years who underwent sleep endoscopy and AT from January 1, 2013, to August 30, 2016, were included. Pre-AT sleep endoscopy findings were scored with the Sleep Endoscopy Rating Scale. Awake tonsil scores and sleep endoscopy ratings were compared with Spearman correlation. Associations between changes in pre- and post-AT polysomnography parameters and (1) awake tonsil scoring and (2) sleep endoscopy scoring were assessed with 1-way analysis of variance and linear regression. Results Participants included 36 children (mean ± SD age, 6.8 ± 4.3 years; 68% male, 44% obese). Awake tonsil scores and sleep endoscopy ratings were strongly correlated ( R = 0.58, P = .003). Awake tonsil scores were not associated with changes in any polysomnography parameters after AT (all P > .05), while sleep endoscopy ratings of adenotonsillar obstruction were significantly associated (all P < .05, R2 = 0.16-0.35). Patients with minimal adenotonsillar obstruction during sleep endoscopy had less improvement than those with partial or complete obstruction (mean obstructive apnea-hypopnea index change: −8.2 ± 11.5 vs −15.9 ± 14.3, and −46.8 ± 31.3, respectively; P < .001). Conclusions In children at risk for AT failure, assessment of dynamic collapse with sleep endoscopy may better predict the outcome of AT than awake tonsil size assessment, thus helping to inform surgical expectations.

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Comparative Assessment of Widefield Fundus Autofluorescence Patterns in Retinoschisis and Retinal Detachment

Journal of VitreoRetinal Diseases ◽

10.1177/2474126420907020 ◽

2020 ◽

Vol 4 (4) ◽

pp. 286-292

Author(s):

Jessica L. Cao ◽

Thais F. Conti ◽

Grant L. Hom ◽

Amy S. Babiuch ◽

Tyler Greenlee ◽

...

Keyword(s):

Retinal Detachment ◽

Imaging Modality ◽

Fundus Autofluorescence ◽

Case Series ◽

Comparative Assessment ◽

High Variability ◽

Retrospective Case ◽

Data Points ◽

Sd Oct

Purpose: This article characterizes widefield fundus autofluorescence (WF-FAF) patterns in retinoschisis (RS), retinal detachment (RD), and combined retinoschisis-detachment (RS/RD), and to correlate them with spectral-domain optical coherence tomography (SD-OCT) findings. Methods: A retrospective case series of 13 eyes with senile RS, RD, or RS/RD is presented. One eye underwent imaging of 2 areas within the retina, resulting in 14 data points. Independent, masked graders classified pathology on SD-OCT as RS, RD, or RS/RD and graded WF-FAF images for either hypoautofluorescent areas or mixed autofluorescence (AF) (hyper-AF, iso-AF, hyper-AF with hypo-AF, hyper-AF with iso-AF, or hypo-AF with iso-AF). Results: There was no statistically significant correlation between the autofluorescence pattern and the type of retinal abnormality ( P = .74). Conclusions: High variability was found in the characterization of WF-FAF in patients with RS and RD. SD-OCT remains the criterion-standard imaging modality in distinguishing RS from RD in clinically ambiguous cases.

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Broad internal limiting membrane peeling with adjunctive plasma–thrombin for repair of large macular holes

European Journal of Ophthalmology ◽

10.1177/1120672120920218 ◽

2020 ◽

pp. 112067212092021

Author(s):

Kyle A Bolo ◽

Stanley Chang

Keyword(s):

Case Series ◽

Internal Limiting Membrane ◽

Adjunctive Treatment ◽

Retinal Layer ◽

Retrospective Case ◽

Closure Rate ◽

Autologous Plasma ◽

Internal Limiting Membrane Peeling ◽

Membrane Peeling ◽

Macular Holes

Purpose To assess the potential efficacy of broad internal limiting membrane peeling with adjunctive plasma–thrombin instillation to treat large macular holes and to make qualitative comparisons to internal limiting membrane peeling without adjunctive treatment and internal limiting membrane peeling with inverted and free internal limiting membrane flaps. Methods A systematic literature review and a retrospective case series. Participants in the case series (N = 39) had idiopathic macular holes larger than 400 µm as measured on spectral-domain optical coherence tomography and underwent pars plana vitrectomy, internal limiting membrane peeling, placement of autologous plasma and bovine thrombin over the hole, and gas tamponade. Repeat imaging and clinical data were collected from 1, 2, 3, 6, and 12 months postoperatively. Results Macular hole closure rate was 97%; 82% had U-type closures. At 12 months, 11% had defects in the external limiting membrane and 22% in the ellipsoid zone. This closure rate is similar to prior studies of internal limiting membrane flaps, while the U-type closure rate and retinal layer restoration compare favorably to those reported for internal limiting membrane peeling alone and internal limiting membrane flaps; 75% experienced a three-line improvement in visual acuity by 6 months, which exceeds results by either method. Conclusion Plasma–thrombin instillation over macular holes may be a less-complicated alternative adjunct to internal limiting membrane flaps that can achieve similar outcomes when combined with internal limiting membrane peeling.

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