Retinal Neurovascular Structural Changes in Optical Coherence Tomography and the Relationship between These Changes and White Matter Hyperintensities in Patients with Migraine

2021 ◽  
pp. 1-12
Author(s):  
Erman Altunisik ◽  
Burak Oren
Keyword(s):  
Optical Coherence Tomography ◽  
White Matter ◽  
Structural Changes ◽  
White Matter Hyperintensities ◽  
Control Group ◽  
Inner Plexiform Layer ◽  
Optical Coherence ◽  
Significant Difference ◽  
Migraine Group ◽  
The Relationship

<b><i>Introduction:</i></b> This study aimed to reveal whether retinal nerve fiber layer (RNFL), ganglion cell layer (GCL) inner plexiform layer, and choroidal layer (CL) thicknesses differed in patients with migraine. Optical coherence tomography (OCT) was used to measure these neurovascular structural changes and determine the relationship between these structures and cranial white matter hyperintensities (WMHs). <b><i>Methods:</i></b> This retrospective comparative registry study included a total of 155 individuals aged 18–55 (mean, 33.50 ± 8.34), consisting of 110 migraine patients and 45 healthy controls. <b><i>Results:</i></b> RNFLs were thinner in the migraine group than the control group but not to a statistically significant degree. However, in both eyes, peripapillary RNLF thickness in some specific quadrants was found to be significantly thinner in the patient group than the control group. GCLs were significantly thinner in the migraine group than the control group. CLs were significantly thicker in the migraine group than in the control group. There was no significant difference between the OCT parameters of patients with and without WMH. An inverse correlation was found between disease duration and CL thickness. CLs were significantly thicker in patients in attack periods than those in attack-free periods. There was no significant difference between the OCT parameters of the migraine with aura and migraine without aura subgroups. <b><i>Discussion/Conclusions:</i></b> Retinal neural and vascular structures might be affected in migraine sufferers, including those in subgroups. Rebound vasodilation may cause alterations in CL thickness during a migraine attack. Factors other than hypoperfusion may contribute to the pathophysiology responsible for the formation of WMH.

scholarly journals Increased Subfoveal Choroidal Thickness and Retinal Structure Changes on Optical Coherence Tomography in Pediatric Alport Syndrome Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Seda Karaca Adıyeke ◽  
Gamze Ture ◽  
Fatma Mutlubaş ◽  
Hasan Aytoğan ◽  
Onur Vural ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Alport Syndrome ◽  
Structural Changes ◽  
Early Period ◽  
Enhanced Depth Imaging ◽  
Control Group ◽  
Optical Coherence ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Objective. To evaluate optical coherence tomography (OCT) findings of pediatric Alport syndrome (AS) patients with no retinal pathology on fundus examination. Materials and Methods. Twenty-one patients being followed up with the diagnosis of AS (Group 1) and 24 age- and sex-matched healthy volunteers (Group 2) were prospectively evaluated. All participants underwent standard ophthalmologic examination, retinal nerve fibre layer (RNFL) analysis, and horizontal and vertical scan macula enhanced depth imaging OCT (EDI-OCT). Statistical analysis of the data obtained in this study was performed with SPSS 15.0. Results. Macula thickness was significantly decreased in the temporal quadrant in Group 1 compared to those of the control group (p=0.013). RNFL measurements revealed statistically significant thinning in the temporal, superior, inferotemporal, and inferonasal quadrants and in average thicknesses in cases with AS compared to the controls (p<0.001, p<0.001, p=0.022, p=0.016, p<0.001, respectively). The mean subfoveal coronial thickness (SCT) was 362.2 ± 77.8 μm in Group 1 and 256,18 ± 71.7 μm in Group 2. There was a statistically significant difference between the two groups in terms of mean CT (p<0.001). Conclusion. OCT provides valuable information in identifying the structural changes and evaluation of ocular findings in patients with AS. Even if no pathological retinal findings were found in the clinical examination, structural changes in the OCT examination begin in early period of AS.

scholarly journals Glaucomatous Macular Vasculature: A Quantitative Analysis

2020 ◽  
Vol 9 (3) ◽  
pp. 185-197
Author(s):  
Pedro Arede ◽  
Joanna Przezdziecka-Dolyk ◽  
Fabian Debowy ◽  
Jacek Olszewski ◽  
Carla Fernandes ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Structural Changes ◽  
Open Angle Glaucoma ◽  
Major Axis ◽  
Foveal Avascular Zone ◽  
Control Group ◽  
Equivalent Diameter ◽  
Optical Coherence ◽  
Fiber Layer ◽  
Avascular Zone

Background: The aim of this study was to evaluate the characteristics of the macular vessel density (VD) and the foveal avascular zone (FAZ) in glaucoma quantitatively using the optical coherence tomography angiography (OCT-A). Methods: Twenty-five eyes of 13 patients with primary open angle glaucoma (POAG) and 12 eyes of 6 healthy participants were enrolled retrospectively. Functional visual field (VF) and structural Spectral-Domain optical coherence tomography (SD-OCT) Retinal Nerve Fiber Layer Thickness (RNFLT) were assessed in all participants. OCT-A was performed on a fovea centered, 15x10 degrees, macular region. OCT-A scans were processed with MATLAB software and automatically graded to define FAZ parameters. The parafoveal VD in the superficial and deep retinal vascular plexus (SVP and DVP) was analyzed by quadrant and circular segmented zones. Results: Foveal Avascular Zone -Major Axis Length (p=0.02), Area (p=0.04), Equivalent Diameter (p=0.04) and Perimeter (p=0.04) were significantly larger in glaucoma than the control group. Regarding SVP and DVP, the average macular total VD were lower in glaucoma patients compared to the control group (p<0.01; p<0.01). Additionally, the inner circular region (p=0.04; p<0.01 respectively for SVP and DVP) and all quadrants except for North had a lower VD in glaucoma group compared to the control group. Assessment of the total VD successfully predicted RNFLT (p<0.001) and was significantly associated with the probability of glaucoma (p=0.009). Conclusion: OCT-A parameters, namely the FAZ morphology and the macular VD, were associated with glaucomatous functional and structural changes. The macular VD showed a considerable diagnostic value. It may be a modern biomarker, representing microvascular network disruption of the macular perfusion in glaucoma.

OCT Angiography of the Central Macular Capillary Network in Glaucoma Patients and Healthy Controls

2018 ◽  
Vol 235 (04) ◽  
pp. 436-444
Author(s):  
Olena Müller ◽  
Margarita G. Todorova ◽  
Torsten Schlote
Keyword(s):  
Optical Coherence Tomography ◽  
Structural Changes ◽  
Ganglion Cells ◽  
Retinal Nerve Fibre Layer ◽  
Vessel Density ◽  
Healthy Controls ◽  
Optical Coherence ◽  
Significant Difference ◽  
Nerve Fibre Layer ◽  
And Control

Abstract Purpose We aimed to investigate central macular microvasculature by optical coherence tomography angiography (OCTA) and to analyse its relation to alterations in classical parameters of optical coherence tomography (OCT) in glaucoma patients. Methods Using OCTA (Avanti incl. AngioVue; Optovue, Inc., Fremont, CA), the superficial flow (SF) and the superficial non-flow (SNF) area of the macula, as well as the S-ETDRS (based on Early Treatment Diabetic Retinopathy charts). and S-grid vessel density (zones 1 – 9) of the macula, were evaluated in 27 glaucoma patients (49 eyes) and compared to those of 27 age-matched healthy controls (50 eyes; p = 0.253). The interactions between OCTA parameters representing macular microvasculature and classical OCT measurements of the circumpapillary retinal nerve fibre layer (RNFL) and macular ganglion cells (mGCC) were analysed within groups (linear mixed-effects model). Results SF, SNF, and S-ETDRS vessel density exhibited no significant difference between the glaucoma and control groups (all p ≥ 0.158). However, within the glaucoma group, decreased RNFL and mGCC thickness correlated significantly with decreased S-ETDRS density (zones 1; 2 – 9, p ≤ 0.033). The same held true for the interactions between the RNFL and mGCC thickness with S-grid density (zones 1 – 3; 6 – 9; p ≤ 0.033). For perimetric glaucoma patients, subgroup analyses demonstrated significantly reduced density maps of superficial foveal flow as well as significant interactions between OCT and OCTA parameters; this was not the case within the preperimetric group. Conclusions Even if the central macular microvasculature, as measured by SF and SNF, is found preserved in glaucoma, the strong positive relation between the central microvascular and structural changes in OCTA and OCT indicates that there are alterations in central macular microvasculature in subclinical glaucoma.

scholarly journals Peripapillary microvasculature in patients with diabetes mellitus: An optical coherence tomography angiography study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Yong-Il Shin ◽  
Ki Yup Nam ◽  
Seong Eun Lee ◽  
Min-Woo Lee ◽  
Hyung-Bin Lim ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Optical Coherence Tomography ◽  
Optical Coherence Tomography Angiography ◽  
Plexiform Layer ◽  
Control Group ◽  
Diabetic Patients ◽  
Inner Plexiform Layer ◽  
Optical Coherence ◽  
Regression Analyses ◽  
Fiber Layer

Abstract To evaluate changes in peripapillary microvascular parameters in diabetes mellitus (DM) patients using optical coherence tomography angiography (OCTA). Seventy-one diabetic patients (40 in the no diabetic retinopathy [DR] group and 31 in the non-proliferative DR [NPDR] group) and 50 control subjects. OCTA (Zeiss HD-OCT 5000 with AngioPlex) 6 × 6 mm scans centered on the optic disc were analyzed. Peripapillary vessel density (VD), perfusion density (PD) in superficial capillary plexus (SCP) were automatically calculated. The average macular ganglion cell-inner plexiform layer (mGC-IPL) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses of the no DR and NPDR groups were significantly thinner than those of the control group. The no DR and NPDR groups showed lower peripapillary VD and PD in SCP compared with the control group. Using univariate regression analyses, the average mGC-IPL thickness, the pRNFL thickness, the no DR group and NPDR group were significant factors that affected the peripapillary VD and PD in SCP. Multivariate regression analyses showed that the grade of DR was a significant factor affecting the peripapillary VD and PD in SCP. OCTA revealed that peripapillary microvascular parameters in the no DR and NPDR groups were lower than those of normal controls. The peripapillary VD and PD in SCP were correlated with the mGC-IPL thickness, the pRNFL thickness, and the no DR and NPDR groups. Changes in peripapillary OCTA parameters may help with understanding the pathophysiology of DM and evaluating a potentially valuable biomarker for patients with subclinical DR.

scholarly journals Relationship of Migraine and Body Mass Index (BMI)

2016 ◽  
Vol 6 (2) ◽  
pp. 80-87
Author(s):  
Mohammed Momenuzzaman Khan ◽  
Md Nazmul Huda ◽  
Manabendra Bhattacharjee ◽  
Md Jalal Uddin ◽  
Mustofa Kamal Uddin Khan
Keyword(s):  
Social Life ◽  
Overweight And Obesity ◽  
Control Group ◽  
P Value ◽  
Case Group ◽  
Increased Risk ◽  
Significant Difference ◽  
Associated Symptoms ◽  
Migraine Group ◽  
The Relationship

Background: Migraine is an important cause of headache and headache-related disabilities. It increases loss of working time, causes inability to carry out daily activities and disruption of family and social life. The pathophysiology of migraine is still poorly understood. On the other hand, the prevalence of obesity is constantly increasing worldwide. The consequence of overweight and obesity includes increased risk of diabetes mellitus, dyslipidemia, hypertension, cardiovascular disease and cancer.Objectives: This study was performed to assess the relationship between BMI and migraine by finding out the relationship between migraine frequency and duration in different BMI groups, comparing the socio-demographic variables in migraine and non-migraine patients and to find out the migraine related co-morbidities.Materials and Methods: This observational case-control study was conducted on 100 subjects aged 12–50 years in the Neurology Outpatient Department, Mymensingh Medical College Hospital, Mymensingh in the period of January 2011 to December 2012. Out of total subjects fifty migraine patients were selected as cases and fifty nonmigraineurs as controls. Subjects were then categorized in three groups based on BMI: <23, 23 to 25 and >25. Collected data were compiled and appropriate analyses were done by using computer based software, Statistical Package for Social Sciences (SPSS) version 16.0. For statistical analysis one way ANOVA tests were done for comparing means of quantitative data and Chi-square tests were done for qualitative data. A p value <0.05 was considered statistically significant.Results: In this study, majority (>95%) of the study subjects were between 10 and 35 years of age. Mean age of case group was found 25.55 ± 5.87 and that of control was 25.53 ± 4.22 years. Case group contained 10 (20%) males and 40 (80%) females whereas control group had 14 (28%) males and 36 (72%) females. Number of female cases and controls were higher than that of male. In control group 30 (60%) were unmarried and 20 (40%) were married. There was no significant difference in the financial condition between case and control groups. Students and housewives occupied the largest number of study subjects who were unemployed. Regarding residence, rural and urban patients were equal in case group and in control group 29 (58%) were urban and 21 (42%) rural. Mean duration of headache was 8.9 ± 7.5, 5.8 ± 6.7, 9.6 ± 14.3 years in different BMI groups (<23, 23–25, >25 respectively) in case group and 4.6 ± 5.3, 4.4 ± 3.4, 3.4 ± 1.4 years in control group respectively. There was significant difference in quality of headache. In migrainous group 58.6% in BMI <23, 30% in BMI 23–25, 36.4% in BMI >25 noted their headache as throbbing, in contrast most of the nonmigrainous described them as dull in nature. Mean frequency of headache per month was significantly higher in migraine group compared to non-migraine group (p=0.02). Regarding associated symptoms, nausea, vomiting, photophobia and phonophobia were observed significantly higher in migraine patients in BMI <23 group. Odd ratios (ORs) for vomiting, photophobia and phonophobia with 95% confidence interval (CI) were 23.385 (2.752–97.739), 16.500 (3.060– 88.971) and 13.000 (2.922–57.846) respectively. Smoking was found significantly higher in nonmigrainous group than migraine group in case of BMI <23.Conclusion: From the result of present study it can be concluded that there is statistically no significant relation of BMI with frequency of headache, but some relationship were observed for associated symptoms of migraine with low BMI.J Enam Med Col 2016; 6(2): 80-87

scholarly journals The quantitative measurements of choroidal thickness and volume in diabetic retinopathy using optical coherence tomography and optical coherence tomography angiography; correlation with vision and foveal avascular zone

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Fariba Ghassemi ◽  
Sahar Berijani ◽  
Ameneh Babeli ◽  
Houshang Faghihi ◽  
Alireza Gholizadeh ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Diabetic Retinopathy ◽  
Normal Control ◽  
Choroidal Thickness ◽  
Enhanced Depth Imaging ◽  
Foveal Avascular Zone ◽  
Control Group ◽  
Optical Coherence ◽  
Significant Difference ◽  
Avascular Zone

Abstract Background To represent choroidal thickness (CT) and choroidal volume (CV) databases in diabetic retinopathy (DR) patients and healthy control participants using optical coherence tomography (OCT) and enhanced depth imaging OCT (EDI-OCT). No study had evaluated CT at all main stages of diabetic retinopathy in a single study. Methods The study included 176 eyes from 93 patients (39–80 years old; 42% females) who were divided into three groups based on DR severity and normal control group: 39 eyes no DR, 64 eyes NPDR, 33 eyes PDR, and 40 eyes normal control. The CT and CV were measured and statistically analyzed. Intra-observer and inter-observer coefficients of repeatability were calculated. Results Subfoveal CT showed persistent thinning from normal group (322.50 ± 69.24) to no-diabetic retinopathy (NDR, 308.33 ± 74.45) to nonproliferative diabetic retinopathy (NPDR, 283.45 ± 56.50) group and then thickening as the patient progressed to proliferative diabetic retinopathy (PDR, 295.17 ± 95.69) (P = 0.087). A significant difference was found between the control group and the NDR, NPDR, and PDR groups in nearly all CT and CV of Early Treatment Diabetic Retinopathy Study macular subfields. Fasting blood sugar (FBS = 189.08 ± 51.3 mg/dl) and diabetes mellitus (DM) duration (13.6 ± 6.5 years) had no noticeable effect on CT. In patients with diabetes, the best-corrected visual acuity (BCVA), diabetic macular edema (DME), and foveal avascular zone (FAZ) were not affected by CT and CV. Conclusions The choroidal thickness decreases from the early stages of diabetic retinopathy up to the NPDR stage, with a subsequent modest rise in CT during the PDR stage. There was no correlation between FBS, diabetes duration, BCVA, DME, and FAZ, and CT.

scholarly journals Changes in the Retinal Microvasculature Measured Using Optical Coherence Tomography Angiography According to Age

2020 ◽  
Vol 9 (3) ◽  
pp. 883 ◽  
Author(s):  
Seung Hun Park ◽  
Heeyoon Cho ◽  
Sun Jin Hwang ◽  
Beomseo Jeon ◽  
Mincheol Seong ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Foveal Avascular Zone ◽  
Vascular Density ◽  
Inner Plexiform Layer ◽  
Optical Coherence ◽  
Cross Sectional ◽  
Swept Source ◽  
Age Related ◽  
Retinal Microvasculature ◽  
Significant Difference

In this cross-sectional study, we examined age-related changes in the retinal vessels of 100 healthy participants, aged from 5 to 80 years, and divided into four groups (G1, under 20 years of age; G2, from 20 to 39 years of age; G3, from 40 to 59 years of age; G4, age 60 years or older). All subjects underwent swept-source optical coherence tomography (SS-OCT) and OCT angiography (OCTA). The vascular density (VD) of the superficial (SCP) and deep capillary plexus (DCP), and choriocapillaris (CCP) were measured using OCTA. The vascular density of each capillary layer, foveal avascular zone (FAZ) area, ganglion cell-inner plexiform layer (GC-IPL) thickness, retinal thickness (RT), and choroidal thickness (CT) were compared between age groups. Most OCT variables were correlated with OCTA variables. The FAZ area; VD of the SCP, DCP, and CCP; GC-IPL thickness; RT; and CT showed significant difference (p < 0.001) between G1 + G2 and G3 + G4, except for central GC-IPL thickness (p = 0.14) and central RT (p = 0.25). Density of the retinal capillary vasculature reduced and FAZ area increased after age 40, which represents the onset of middle age.

scholarly journals A pilot study of scleral thickness in central serous chorioretinopathy using anterior segment optical coherence tomography

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yun Ji Lee ◽  
Yeon Jeong Lee ◽  
Jae Yeon Lee ◽  
Suhwan Lee
Keyword(s):  
Optical Coherence Tomography ◽  
Central Serous Chorioretinopathy ◽  
Anterior Segment ◽  
Venous Drainage ◽  
Enhanced Depth Imaging ◽  
Control Group ◽  
Study Group ◽  
Optical Coherence ◽  
Swept Source ◽  
Significant Difference

AbstractThe aim of this study is to compare the scleral thickness of central serous chorioretinopathy (CSC) eyes with controls using anterior segment optical coherence tomography (AS OCT). This prospective case control study included 15 patients (15 eyes) with CSC and 15 age and gender matched healthy subjects. All subjects underwent spectral domain OCT with enhanced depth imaging and swept source AS OCT of temporal sclera. We investigated difference in scleral thickness between the two groups and relationship between choroidal and scleral thickness. Among the 15 eyes in the study group, 1 eye had acute CSC, 4 had recurrent CSC, 7 had inactive CSC, and 3 had chronic CSC. There was no significant difference in terms of age, gender, axial length and spherical equivalent between the two groups. The choroidal and scleral thickness of the study group were significantly greater than those of the control group (P < 0.001, P = 0.034). Choroidal thickness was positively correlated with scleral thickness (P = 0.031). A thick sclera along with a thick choroid were demonstrated in CSC eyes using AS OCT. Scleral characteristics might be involved in the pathogenesis of CSC by affecting outflow resistance of venous drainage in choroidal circulation.

scholarly journals Choroidal Structural Changes Assessed with Swept-Source Optical Coherence Tomography after Cataract Surgery in Eyes with Diabetic Retinopathy

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Huiping Yao ◽  
Sha Gao ◽  
Xiaoqing Liu ◽  
Yufeng Zhou ◽  
Yu Cheng ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Diabetic Retinopathy ◽  
Cataract Surgery ◽  
Structural Changes ◽  
Control Group ◽  
Optical Coherence ◽  
Diabetic Cataract ◽  
Swept Source ◽  
Choroidal Vasculature ◽  
The Difference

Objective. To determine the influence of phacoemulsification on choroidal vasculature in patients with diabetic retinopathy (DR) undergoing cataract surgery using swept-source optical coherence tomography (SS-OCT). Methods. The study was conducted in 23 eyes of 23 cataract patients with mild/moderate nonproliferative diabetic retinopathy (NPDR) without diabetic macular edema (DME) and 23 age-matched controls. Choroidal thickness (CT) and choroidal vascularity index (CVI) were measured at baseline and 1 week, 1 month, and 3 months after surgery. Results. The baseline CVI in the DR group was significantly lower than that in the control group ( P = 0.001 ). CVI in DR patients after surgery significantly increased compared with preoperative values (all P < 0.001 for 1 week, 1 month, and 3 months after surgery). Postoperative increase of CVI and CT in the DR group was more than in the control group, and the difference was significant 1 month and 3 months after surgery (all P < 0.05 ). Conclusion. Patients with mild/moderate NPDR have reduced CVI compared with nondiabetic patients at baseline; diabetic cataract surgery tended to induce more increase in CVI and CT as compared with nondiabetic patients. This trial is registered with NCT04499768.

scholarly journals Optic nerve and macular optical coherence tomography in recovered COVID-19 patients

2021 ◽  
pp. 112067212110010
Author(s):  
Barbara Burgos-Blasco ◽  
Noemi Güemes-Villahoz ◽  
Beatriz Vidal-Villegas ◽  
Jose Maria Martinez-de-la-Casa ◽  
Juan Donate-Lopez ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Optic Nerve ◽  
Demographic Data ◽  
Mean Difference ◽  
Control Group ◽  
Case Group ◽  
Inner Plexiform Layer ◽  
Ophthalmological Examination ◽  
Optical Coherence ◽  
Fiber Layer

Purpose: To investigate the peripapillary retinal nerve fiber layer thickness (RNFLT), macular RNFLT, ganglion cell layer (GCL), and inner plexiform layer (IPL) thickness in recovered COVID-19 patients compared to controls. Methods: Patients previously diagnosed with COVID-19 were included, while healthy patients formed the historic control group. All patients underwent an ophthalmological examination, including macular and optic nerve optical coherence tomography. In the case group, socio-demographic data, medical history, and neurological symptoms were collected. Results: One hundred sixty patients were included; 90 recovered COVID-19 patients and 70 controls. COVID-19 patients presented increases in global RNFLT (mean difference 4.3; CI95% 0.8 to 7.7), nasal superior (mean difference 6.9; CI95% 0.4 to 13.4), and nasal inferior (mean difference 10.2; CI95% 2.4 to 18.1) sectors of peripapillary RNFLT. Macular RNFL showed decreases in COVID-19 patients in volume (mean difference −0.05; CI95% −0.08 to −0.02), superior inner (mean difference −1.4; CI95% −2.5 to −0.4), nasal inner (mean difference −1.1; CI95% −1.8 to −0.3), and nasal outer (mean difference −4.7; CI95% −7.0 to −2.4) quadrants. COVID-19 patients presented increased GCL thickness in volume (mean difference 0.04; CI95% 0.01 to 0.07), superior outer (mean difference 2.1; CI95% 0.8 to 3.3), nasal outer (mean difference 2.5; CI95% 1.1 to 4.0), and inferior outer (mean difference1.2; CI95% 0.1 to 2.4) quadrants. COVID-19 patients with anosmia and ageusia presented an increase in peripapillary RNFLT and macular GCL compared to patients without these symptoms. Conclusions: SARS-CoV-2 may affect the optic nerve and cause changes in the retinal layers once the infection has resolved.

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