Prospective study to evaluate incidence and indicators for early detection of ethambutol toxicity

2020 ◽  
pp. bjophthalmol-2020-316897
Author(s):  
Sohini Mandal ◽  
Rohit Saxena ◽  
Rebika Dhiman ◽  
Anant Mohan ◽  
Srikanta Kumar Padhy ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Contrast Sensitivity ◽  
Optic Neuropathy ◽  
Plexiform Layer ◽  
Retinal Nerve Fibre Layer ◽  
Significant Loss ◽  
Field Analysis ◽  
Inner Plexiform Layer ◽  
Visual Evoked Response ◽  
Subclinical Toxicity

AimsTo evaluate incidence of toxic optic neuropathy in patients receiving ethambutol (EMB) for 6 months and to identify its early indicators.MethodsWe included 50 patients on anti-tubercular therapy (ATT) including EMB (HRE regimen) based on total body weight for 6 months. Best-corrected visual acuity (ETDRS), colour vision (Ishihara pseudo-isochromatic plates), contrast sensitivity (Pelli-Robson chart), Humphrey visual field analysis (HVF 30-2 SITA FAST), pattern visual evoked response (VER) and spectral-domain optical coherence tomography (SDOCT) for ganglion cell inner plexiform layer (GCIPL) and retinal nerve fibre layer (RNFL) analysis were assessed at baseline and at 2, 4 and 6 months after starting ATT.ResultsMean age of the patients was 36.5±14.7 years with male:female ratio of 2.5:1. Mean daily dosage of EMB was 17.5±1.3 mg/kg/day. No significant change was observed in visual acuity, contrast sensitivity, color vision and mean or pattern SD on HVF at 6 months. Significant increase in VER latency of >2 SD (>125 ms) was observed in 46% eyes on follow-up indicating subclinical toxicity. Significant loss of mean RNFL (from 100.79±16.05 μm to 89.96±13.79 μm) and GCIPL thickness (from 83.1±5.60 μm to 79.85±6.45 μm) was observed at 6 months (p=0.001 for both). Patients with subclinical toxicity had significantly greater damage in temporal RNFL quadrant, supero-nasal and infero-nasal GCIPL sectors compared with others.ConclusionThe incidence of clinical EMB optic neuropathy was <2%, though subclinical damage in the form of increase in VER latency, and decrease in RNFL and GCIPL on OCT was seen in 46% eyes.

Diagnostic value of ganglion cell-inner plexiform layer for early detection of ethambutol-induced optic neuropathy

2018 ◽  
Vol 103 (3) ◽  
pp. 379-384 ◽  
Author(s):  
Ju-Yeun Lee ◽  
Jinu Han ◽  
Jeong Gi Seo ◽  
Kyung-Ah Park ◽  
Sei Yeul Oh
Keyword(s):  
Early Detection ◽  
Ganglion Cell ◽  
Optic Neuropathy ◽  
Plexiform Layer ◽  
Diagnostic Value ◽  
Retinal Nerve Fibre Layer ◽  
Field Pattern ◽  
Control Group ◽  
Inner Plexiform Layer ◽  
Minimum Thickness

AimTo evaluate the diagnostic value of macular ganglion cell-inner plexiform layer (mGCIPL) thickness versus peripapillary retinal nerve fibre layer (pRNFL) thickness for the early detection of ethambutol-induced optic neuropathy (EON).MethodsTwenty-eight eyes of 15 patients in the EON group and 100 eyes of 53 healthy subjects in the control group were included. All patients with EON demonstrated the onset of visual symptoms within 3 weeks. Diagnostic power for pRNFL and mGCIPL thicknesses measured by Cirrus spectral-domain optical coherence tomography was assessed by area under the receiver operating characteristic (AUROC) curves and sensitivity.ResultsAll of the mGCIPL thickness measurements were thinner in the EON group than in the control group in early EON (p<0.001). All of pRNFL thicknesses except inferior RNFL showed AUROC curves above 0.5, and all of the mGCIPL thicknesses showed AUROC curves above 0.5. The AUROC of the average mGCIPL (0.812) thickness was significantly greater than that of the average pRNFL (0.507) thickness (p<0.001). Of all the mGCIPL-related parameters considered, the minimum thickness showed the greatest AUROC value (0.863). The average mGCIPL thickness showed a weak correlation with visual field pattern standard deviations (r2=0.158, p<0.001).ConclusionsIn challenging cases of EON, the mGCIPL thickness has better diagnostic performance in detecting early-onset EON as compared with using pRNFL thickness. Among the early detection ability of mGCIPL thickness, minimum GCIPL thickness has high diagnostic ability.

scholarly journals Association between individual retinal layer thickness and visual acuity in patients with epiretinal membrane: a pilot study

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e9481
Author(s):  
Jing Zou ◽  
Wei Tan ◽  
Wenlong Huang ◽  
Kangcheng Liu ◽  
Fangling Li ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Layer Thickness ◽  
Epiretinal Membrane ◽  
Linear Regression Analysis ◽  
Plexiform Layer ◽  
Surgical Patients ◽  
Retinal Layer ◽  
Inner Plexiform Layer ◽  
Post Surgery ◽  
Visual Improvement

Purpose We investigated the correlation between visual acuity (VA) and individual retinal layer thickness in the foveal, parafoveal, and perifoveal regions of patients with an idiopathic epiretinal membrane (ERM). Methods One hundred and five subjects presenting with unilateral idiopathic ERM were included in this study. We segmented each patient’s optical coherence tomography (OCT) image into seven layers and calculated the mean layer thickness in the foveal, parafoveal, and perifoveal regions using the Iowa Reference Algorithm. In 105 patients with ERM, we detected correlations between their macular regions’ individual retinal layer thickness and their best corrected VA. Thirty-one of the 105 patients with ERM underwent vitrectomy and completed six months of follow-up. We then compared the 31 surgical patients’ preoperative and postoperative individual retinal layer thickness in each macular region. Additionally, the association between preoperative individual retinal layer thickness in each macular region and VA six months post-surgery in patients with ≥ two Snellen lines of visual improvement was determined. Results Multiple linear regression analysis showed that the inner nuclear layer (INL) thickness in the foveal, parafoveal, and perifoveal region were all associated with VA in the 105 patients (R2 = 0.344, P < 0.001; R2 = 0.427, P < 0.001; and R2 = 0.340, P < 0.001, respectively). Thirty-one surgical patients 6 months post-surgery showed significantly decreased thicknesses (P ≤ 0.012) of the foveal INL, inner plexiform layer (IPL), and outer nuclear layer (ONL); the parafoveal retina nerve fiber layer (RNFL), IPL, INL, and ONL; and the perifoveal RNFL, IPL, INL, ganglion cell layer (GCL), outer plexiform layer (OPL), and photoreceptor layer (PRL). We found a weak correlation between postoperative VA and preoperative foveal and perifoveal RNFL thickness (r = 0.404 and r = 0.359, respectively), and a moderate correlation between postoperative VA and preoperative foveal and parafoveal INL thickness (r = 0.529 and r = 0.583, respectively) in the 31 surgical patients (P ≤ 0.047). The preoperative INL thickness in the foveal, parafoveal, and perifoveal regions showed a moderate to strong correlation (r = 0.507, 0.644, and 0.548, respectively), with postoperative VA in patients with ≥ 2 lines of visual improvement (P ≤ 0.038). Conclusion We detected a correlation between retinal damage and VA in the parafoveal, perifoveal, and foveal regions. Our results suggest that INL thickness in all macular regions may be a prognostic factor for postoperative VA in ERM patients.

Contrast Sensitivity and Visual-Field Thresholds in Patients with Thyroid Optic Neuropathy

Perception ◽  
1997 ◽  
Vol 26 (1_suppl) ◽  
pp. 194-194
Author(s):  
J Jankauskiene ◽  
R Lukauskiene ◽  
B Mickiene
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Contrast Sensitivity ◽  
Optic Neuropathy ◽  
Control Group ◽  
Ophthalmological Examination ◽  
Threshold Test ◽  
Spatial Frequencies ◽  
Snellen Visual Acuity ◽  
The Mean

Thyroid optic neuropathy is one of the most troubling complications of endocrine ophthalmopathies. It is related to the degree of extraocular muscle swelling in the apex of the orbit. The purpose of this study was to investigate contrast sensitivity and visual-field thresholds in patients with thyroid optic neuropathy. We examined twenty-two patients aged 29 – 63 years (mean 45.3 years). The control group consisted of fifteen healthy persons of similar age. Contrast sensitivity was measured by means of Volkov's charts (sinusoidal gratings) at eight spatial frequencies from 17.5 to 0.46 cycles deg−1. The visual field was investigated with a static automatic perimeter (Allgan Humphrey Field Analyzer) by means of the central 30-2 threshold test. All patients underwent a complete ophthalmological examination including best corrected Snellen visual acuity, fundus copy, and proptosis measurement with the Hertel exophthalmometer. The mean proptosis of patients was 19.4 mm. Fifteen of the patients had decreased visual acuity. Contrast sensitivity at low spatial frequencies was significantly reduced in the patients. It was established that a reduction of visual-field threshold accompanies the decrease of visual acuity. Our results show that contrast sensitivity and visual-field threshold testing are very sensitive at detecting early optic neuropathy and may be a useful means of following patients after treatment.

scholarly journals A Normative Database of A-Scan Data Using the Heidelberg Spectralis Spectral Domain Optical Coherence Tomography Machine

2021 ◽  
Author(s):  
Joos Meyer ◽  
Roshan Karri ◽  
Helen Danesh-Meyer ◽  
Kate Drummond ◽  
Andrew Symons
Keyword(s):  
Optical Coherence Tomography ◽  
Reference Values ◽  
Age Groups ◽  
Plexiform Layer ◽  
Retinal Nerve Fibre Layer ◽  
Inner Plexiform Layer ◽  
Optical Coherence ◽  
Cross Sectional ◽  
Normative Database ◽  
The Mean

AbstractPurposeDevelop the first normative database of macular and circumpapillary scans with reference values at the level of the A-scan using the Heidelberg Spectralis Optical Coherence Tomography (OCT) machine.MethodsThis study is a retrospective cross sectional analysis of macular and circumpapillary OCT scans of healthy individuals. All participants had a full ophthalmic examination, including best corrected visual acuity, intraocular pressure, biomicroscopy, posterior segment examination and OCT scan. The volume and thickness of each of the nine Early Treatment Diabetic Retinopathy zones at the macula were analysed for the total retinal thickness, retinal nerve fibre layer (RNFL), ganglion cell layer (GCL) and inner plexiform layer (IPL). The thickness of the circumpapillary RNFL was analysed at the disc. De-identified A-scans were extracted from the OCT machine as separate tab-separated text file and made available according to the data sharing statement.ResultsTwo-hundred eyes from 144 participants were included of which 98 (49%) were female. The mean age (SD) was 48.52 (17.52). Participants were evenly distributed across four age groups and represented nine broad ethnic groups in proportions comparable to the local distribution. All the macular scans were 20° x 20° (5.9 mm x 5.9 mm), with a total scan density between 12,800 and 49,152 A-scans. The peripapillary scans were all 12° (3.5 mm), at a scan density of 768 A-scans. The mean retinal, GCL and IPL volumes were significantly greater in males than females. Age and total retinal volume (r = –0.2561), GCL volume (– 0.2911) and IPL volume (–0.3194) were negatively correlated. No significant correlation was found between the RNFL and age.ConclusionThis study provides a normative database of macular and circumpapillary scans with reference values at the level of the A-scan using the Heidelberg Spectralis Optical Coherence Tomography (OCT) machine.

scholarly journals Combined multi-modal assessment of glaucomatous damage with electroretinography and optical coherence tomography/angiography

2020 ◽  
Author(s):  
Khaldoon O. Al-Nosairy ◽  
Gokulraj Prabhakaran ◽  
Konstantinos Pappelis ◽  
Hagen Thieme ◽  
Michael B. Hoffmann
Keyword(s):  
Layer Thickness ◽  
Diagnostic Performance ◽  
Plexiform Layer ◽  
Pattern Electroretinogram ◽  
Retinal Nerve Fibre Layer ◽  
Photopic Negative Response ◽  
Inner Plexiform Layer ◽  
Structural Measure ◽  
Diagnostic Modalities ◽  
And Function

AbstractPurposeTo compare the diagnostic performance and to evaluate the interrelationship of electroretinographical and structural and vascular measures in glaucoma.MethodsFor 14 eyes of 14 healthy controls and 15 eyes of 12 patients with glaucoma ranging from preperimetric to advanced stages OCT, OCT-A and electrophysiological measures [multifocal photopic negative response ratio (mfPhNR) and steady state pattern electroretinogram (ssPERG)] were applied to assess changes in retinal structure, microvasculature, and function, respectively. The diagnostic performance was assessed via area-under-curve (AUC) measures obtained from ROC analyses. The interrelation of the different measures was assessed with correlation analyses.ResultsmfPhNR and ssPERG amplitudes, parafoveal (pfVD) and peripapillary vessel density (pVD), macular ganglion cell inner plexiform layer thickness (mGCIPL) and peripapillary retinal nerve fibre layer thickness (pRNFL) were significantly reduced in glaucoma. The AUC for mfPhNR was highest among diagnostic modalities (AUC: 0.88, 95%-CI: 0.75-1.0, P< 0.001), albeit not statistically different from that for macular (mGCIPL: 0.76, 0.58-0.94, P< 0.05; pfVD: 0.81, .65-.97, P< 0.01) or peripapillary imaging (pRNFL: 0.85, 0.70-1.0, P< 0.01; pVD: 0.82, 0.68-0.97, P < 0.01). Combined functional/vascular measures yielded the highest AUC (mfPhNR-pfVD: 0.94, 0.85-1.0, P<0.001). The functional/structural measure correlation (mfPhNR-mGCIPL correlation coefficient (rs): 0.58, P = 0.001; mfPhNR-pRNFL rs: 0.66, P < 0.0001) was stronger than the functional-vascular correlation (mfPhNR-pfVD rs: 0.29, P = 0.13; mfPhNR-pVD rs: 0.54, P = 0.003).ConclusionsThe combination of ERG measures and OCT-A improved diagnostic performance in glaucoma. Combing ERG, structural and OCT-A parameters provides an enhanced understanding of the pathophysiology of glaucoma.

scholarly journals Correlation of retinal layer changes with vision gain in diabetic macular edema during conbercept treatment

2019 ◽  
Author(s):  
Yupeng Xu ◽  
Yuan Qu ◽  
Yan Suo ◽  
Jian Gao ◽  
Xia Chen ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Outer Nuclear Layer ◽  
Plexiform Layer ◽  
Retinal Layer ◽  
Central Field ◽  
Inner Plexiform Layer ◽  
Clinically Significant ◽  
Sd Oct

Abstract Purpose To assess the changes in individual retinal layer thickness and visual function associated with gains in visual acuity after an intravitreal conbercept injection in the diabetic macular edema (DME) on spectral domain optical coherence tomography (SD-OCT) and microperimetry during 1-year follow-up. Methods Retrospective observational study. Twenty patients with clinically significant DME in the study eye were imaged by SD-OCT every three months and MP1 microperimeter in the third month while receiving anti-VEGF (conbercept) treatment. In each patient, seven retinal layers were segmented in 98 scans covering a 6mm×6mm area of the macula at baseline and during 1 year of treatment. An automatic, full-threshold microperimetry of the central field (10°×10°, 40 stimulated points) with the MP1 microperimeter. Thickness and microperimetry changes were quantitatively measured and evaluated for their correlation with increases in visual acuity. Results Although thicknesses of the inner nuclear layer (INL) and the outer nuclear layer (ONL) were reduced the most after treatment (p< 0.05), decreases of the ganglion cell layer (GCL) (r = 0.591, p= 0.006) and inner plexiform layer (IPL) (r= 0.663, p= 0.001) in central subfield area was associated with BCVA gain, and had the best estimation of BCVA gain (adjust R2=0.544). Mean macular sensitivity in the central subfield was also well correlated with BCVA gain (r=0.531, p=0.016). Conclusions Neural recovery occurred after the resolution of edema during conbercept treatment, due to the decreases in GCL and IPL associating with gains in vision and improved microperimetry.

Effect of baseline test selection on glaucoma progression detection by optical coherence tomography-guided progression analysis

2020 ◽  
pp. bjophthalmol-2019-315715
Author(s):  
Dong Hyun Kang ◽  
Young Hoon Hwang
Keyword(s):  
Optical Coherence Tomography ◽  
Plexiform Layer ◽  
Retinal Nerve Fibre Layer ◽  
Inner Plexiform Layer ◽  
Optical Coherence ◽  
Average Thickness ◽  
Test Selection ◽  
Glaucoma Progression ◽  
Rnfl Thickness ◽  
Baseline Test

PurposeTo evaluate the effect of baseline test selection on progression detection of circumpapillary retinal nerve fibre layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) in glaucomatous eyes by optical coherence tomography (OCT)-guided progression analysis (GPA).MethodsA total of 53 eyes with either RNFL or GCIPL progression determined using OCT-GPA were included. Three different baseline conditions were created by dividing eight serial OCT tests from each eye into three sets. Specifically, these sets presented baseline tests at exams 1–2 (1st set), 2–3 (2nd set) and 3–4 (3rd set), respectively. Agreement on progression detection was defined as the presence of ‘Possible Loss’ or ‘Likely Loss’ in the 2nd or 3rd sets at the same location in the 1st set.ResultsThe proportion of eyes with agreement on progression detection was 47.1%, 20.0% and 31.0% for RNFL ‘thickness map progression’, ‘thickness profiles progression’ and ‘average thickness progression’, respectively. In GCIPL ‘thickness map progression’ and ‘average thickness progression’, 53.8% and 62.8% of eyes showed agreement, respectively. Eyes with disagreement showed a greater change in thickness (slope of change in the 3rd set−1st set) compared to the eyes with agreement (p<0.05), with the exception of RNFL ‘thickness profiles progression’ (p=0.064).ConclusionGlaucoma progression detection by OCT-GPA was affected by baseline test selection, especially in eyes with a greater reduction in progression. GCIPL thickness was less influenced by baseline test selection compared to RNFL thickness.

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