Macular Ganglion Cell-Inner Plexiform Layer as a Marker of Cognitive and Sensory Function in Midlife.

BACKGROUND: Neurodegenerative diseases are public health challenges in aging populations. Early identification of people at risk for neurodegeneration might improve targeted treatment. Noninvasive, inexpensive screening tools are lacking but are of great potential. Optical coherence tomography (OCT) measures the thickness of nerve cell layers in the retina, which is an anatomical extension of the brain and might be indicative of common underlying neurodegeneration. We aimed to determine the association of macular ganglion cell-inner plexiform layer (mGCIPL) thickness with cognitive and sensorineural function in midlife. METHOD: This cross-sectional study included 1,880 Beaver Dam Offspring Study participants (aged 27-93 years, mean 58) who participated in the 10-year follow-up examination. We assessed cognitive function and impairment, hearing sensitivity thresholds and impairment, central auditory processing, visual impairment, and olfactory impairment. We measured mGCIPL using the Cirrus 5000 HD-OCT Macular Cube Scan. Multivariable linear and logistic regression models adjusted for potential confounders were used to determine associations between mGCIPL thickness and cognitive and sensorineural functions, as well as for comparing participants with a thin mGCIPL (1 SD below average) to the remainder in those functions. RESULTS: Thinner mGCIPL was associated with worse cognitive function, worse central auditory function, and visual impairment. We found an association of mGCIPL thickness with hearing sensitivity in women only and no association with impairment in hearing, olfaction, and cognition. Results on the thin group comparisons were consistent. CONCLUSIONS: mGCIPL thickness is associated with cognitive and sensorineural function and has the potential as a marker for neurodegeneration in middle-aged adults.

Retinal axonal degeneration in Niemann-Pick type C disease.

OBJECTIVE: Niemann-Pick disease type C1 (NPC1) is a rare autosomal-recessive lysosomal storage disorder presenting with a broad clinical spectrum ranging from a severe infantile-onset neurovisceral disorder to late-onset neurodegenerative disease. Optical coherence tomography (OCT) is established to detect retinal degeneration in vivo. We examined NPC1-patients (NPC1-P), clinically asymptomatic NPC1-mutation carriers (NPC1-MC), and healthy controls (HC) to (1) identify retinal degeneration in NPC1-disease and (2) to investigate possible subclinical retinal degeneration in NPC1-MC. METHODS: Fourteen NPC1-P, 17 NPC1-MC, and 31 age-matched HC were examined using spectral-domain OCT. Neurological examinations, clinical scales [modified Disability Rating Scale (mDRS); Scale for the Rating and Assessment of Ataxia (SARA); Spinocerebellar Ataxia Functional Index (SCAFI)], and video-oculography (VOG) were correlated with OCT data. RESULTS: Macular retinal nerve fiber layer and volumes of combined ganglion cell and inner plexiform layer were significantly lower in NPC1-P compared to HC [mRNFL (µm):0.13 ± 0.01 vs. 0.14 ± 0.02; p = 0.01; GCIPL (mm3):0.60 ± 0.05 vs. 0.62 ± 0.04; p = 0.04]. No significant differences were found in NPC1-MC in comparison to HC. In NPC1-P, the amplitude of upward vertical saccades showed positive associations with peripapillary RNFL (ρ = 0.645; p < 0.05), and thinned GCIP (ρ = 0.609; p < 0.05), but not in NPC1-MC. In NPC1-P correlations between combined outer plexiform layer and outer nuclear layer (OPONL) with mDRS (r = - 0.617; p < 0.05) and GCIP with SARA (r = - 0.622; p < 0.05) were observed. Furthermore, in NPC1-MC, motor scores were negatively associated with pRNFL (ρ = - 0.677; p < 0.01). CONCLUSIONS: Using OCT, we showed retinal degeneration in NPC1-P and significant correlation between retinal neuroaxonal degeneration with clinical measurements. We observed a non-significant trend of retinal degeneration in NPC1-MC correlating with subclinical motor abnormalities. Based on these preliminary data, OCT may be an important marker of neurodegeneration in NPC1-disease after onset of clinical symptoms.

Systematic ultrastructural comparison of swept-source and full-depth spectral domain optical coherence tomography imaging of diabetic macular oedema.

BACKGROUND/AIMS: Optical coherence tomography (OCT) is commonly used to diagnose and assess diabetic macular oedema (DME). Swept-source OCT (SS-OCT) promises improved imaging depth and more independence from media opacities. Heidelberg Spectralis full-depth imaging (FDI) combines details at different depths to one representation. The aim of this study was to determine the comparability of the imaging methods concerning DME ultrastructure. METHODS: Two graders assessed the presence of typical DME phenomena in eyes with centre-involving DME on Topcon Atlantis SS-OCT and Heidelberg Spectralis FDI spectral-domain OCT (SD-OCT) B-scans. Retinal layer segmentation was corrected and choroidal layers were manually segmented. Graders measured cyst and subretinal fluid (SRF) diameters and counted hyper-reflective foci (HRF). Findings were recorded and statistically analysed. RESULTS: Statistically significant systematic biases (Spectralis-Atlantis) were found for the HRF count (outside the central mm, -6.39, p=0.0338), chorioretinal thickness (central mm: -35.45 µm, p=0.00034), choroidal thickness (central mm: -60.97 µm, p=0.00004) and Sattler's layer thickness (-42.69 µm, p=0.0001). Intergrader agreement was excellent or very good for posterior vitreous detachment, vitreomacular attachment (central mm) and SRF presence in both devices. Manually delineated Sattler's layer thickness showed an intraclass correlation of 0.85 with FDI SD-OCT but 0.26 with SS-OCT (p=0.003). CONCLUSION: Prominent aspects such as cysts in the outer nuclear layer and SRF can be identified with comparable confidence, while a significant systematic bias underlies chorioretinal, choroidal and Sattler's layer thickness and HRF count. Specialists should use the same device at every examination during longitudinal clinical consideration or cross-sectional evaluation of these ultrastructural biomarkers.

Progressive Changes in the Retinal Structure of Patients with Parkinson's Disease.

BACKGROUND: Many optical coherence tomography (OCT) studies have reported alterations in the retinal nerve fiber layer (RNFL) in Parkinson's disease (PD) and other neurodegenerative diseases. However, whether retinal alterations are a biomarker for PD is still controversial. OBJECTIVE: To investigate potential correlations between PD and morphological changes in retina using OCT and to determine its usefulness as a biomarker of disease progression in PD. METHODS: We performed a cross-sectional study on patients with PD (N = 37) and age-matched controls (N = 42), followed by a longitudinal study of the PD patients (N = 22) over approximately 2.5 years. RESULTS: The average retinal nerve fiber layer (RNFL) thickness (p < 0.001), total macular thickness (p = 0.001), and macular volume (p = 0.001) were decreased in PD patients compared to controls and had further decreased at the follow-up visit (p < 0.05 for all). The average RNFL thickness and the total thickness of macular were negatively correlated with age in PD patients at baseline. Linear regression analysis revealed that age (p = 0.002, p = 0.003, respectively) and LEDD (p = 0.011, p = 0.013, respectively) were correlated to total thickness and volume of macular in 22 PD patients in the follow-up study. However, no correlation was found between RNFL and other parameters. CONCLUSIONS: PD progression is associated with pronounced retinal structure changes, which can be quantified by OCT. Patterns of RNFL and macular damage detected by the noninvasive technology of OCT can be a useful biomarker for evaluating the progression of PD.

The Combination of Trypan Blue and Brilliant Blue G-Assisted Vitrectomy for Macular Pucker: Histopathological Findings.

PURPOSE: To report on the combined use of trypan blue (TB) and brilliant blue G (BBG) for staining the epiretinal membrane (ERM) and internal limiting membrane (ILM) during vitrectomy and to describe the histopathological findings. METHODS: 10 surgical specimens were removed from 10 eyes with macular pucker during vitrectomy using a commercially available combination of TB and BBG for ERM and ILM staining and peeling. Specimens were evaluated using light and transmission electron microscopy. RESULTS: In all cases the combination of TB and BBG was useful for identifying and delineating ERM and ILM. No complications related to the use of the dye were observed during or after surgery. Glial cells were present in all specimens. Hyalocytes were observed in 6 cases and myofibroblasts in 3 of them. In 7 cases native vitreous collagen fibrils were found on the ILM, while in 5 specimens newly formed collagen was present. No clinical evidence of toxicity was observed during the 3-month follow-up. CONCLUSION: The combined use of TB and BBG appeared to be very useful intraoperatively to improve the visualization of ERM and ILM, thus facilitating their complete removal. Anatomical and histopathological findings demonstrated the safety and the efficacy of this vital dye.

Morphometric of the interface of the central retina in patients with retinal vein occlusion / Índices morfométricos da interface da retina central em pacientes com oclusão da veia retiniana

ABSTRACT Background: Systematization of characteristics and morphological changes in the retina, and understanding its role in occlusive diseases involving retinal vessels can contribute to research on the dynamic of the pathological process and to improved understanding of disease treatment. Objective: To research the basic morphometric and structural indicators of the macular region of the retina in patients with central retinal vein occlusion (CRVO). Settings and Design: Ufa Eye Research Institute, retrospective case series. Methods: The basic morphometric and structural indices of the macular region of the retina in 15 patients with CRVO were studied using the optical coherence tomography. Patients with CRVO (15 eyes) were included in Group I (study), and 10 patients with no retinal pathology (10 eyes) were included in Group II (control). Statistical analysis used: For the statistical analysis, the Statistica 6.1 program was used with a parametric method, the Student's test.To consider the probability of statistically significant differences, values beginning with up to p<0.05 were accepted. Results: In Group II, we determined the correct profile of the macula with fovea centralis and a range of retinal thickness from 221.4 ± 10.97 to 355.2 ± 12.17 µm, with an average value of - 299.01 ± 7.56 µm. In Group I mean retinal thickness at all points of the study area ranged from 247.86 ± 39.06 to 494.07 ± 40.22 µm with a gradual thickening of the periphery to the center, reaching a maximum at a distance of 893 µm from the center of the fovea. The average thickness of the retina as a result of edema increased by a multiple of 1.3 and amounted to - 386.97 ± 16.26 µm. Conclusions: The study indicated that the edema is the main morphological substrate, promoting structural changes in the central retina in retinal vein occlusion, and is cystic in nature. Increase in total retinal thickness (up to 386.97 ± 16.26 µm) in this pathology is largely due to the structural changes in zones, covering the îuter plexiform layer - the inner nuclear layer and the nerve fiber layer with the inner limiting membrane. Meanwhile a significant increase in the thickness of the outer plexiform with the inner nuclear layers (up to 94.94 ± 5.08 µm) and nerve fiber layers (up to 54.6 ± 3.26µm) was observed.

RESUMO Introdução: Sistematização característica e alterações morfológicas na retina, compreensão de sua arquitetura em doenças oclusivas de vasos retinianos para contribuir com a melhoria dos estudos sobre as regularidades da dinâmica do processo patológico, diagnóstico e tratamento da doença. Objetivo: Investigar a morfometria de base e indicadores estruturais da região macular da retina em pacientes com oclusão da veia central da retina (CRVO). Definições e design: Ufa Eye Research Institute, série de casos retrospectiva. Métodos: A análise morfométrica de base e índices estruturais da região macular da retina em quinze pacientes com CRVO. Foram estudados pacientes com CRVO (15 olhos), incluídos no Grupo I (em estudo), 10 pacientes com qualquer patologia da retina (10 olhos), incluídos no Grupo II (controle), com o uso da tomografia de coerência óptica. Para a análise estatística utilizou-se o programa Statistica 6.1 usando o método paramétrico - teste de Student. A probabilidade de diferenças estatisticamente significativas foram valores começando com até p <0,05. Resultados: No Grupo II, o perfil correcto da mácula com fovea centralis e uma gama de espessura da retina de 221,4 ± 10,97 a 355,2 ± 12,17µm, com um valor médio de - 299,01 ± 7,56 µm foram determinadas. No Grupo I, a espessura média da retina em todos os pontos da área de estudo variou de 247.86 ± 39.06 a 494,07 ± 40,22µm com um espessamento gradual da periferia para o centro, atingindo um máximo em um raio de 893µm a partir do centro da fóvea.A espessura média da retina, como resultado do edema aumentado em 1,3 vezes e elevou se a - 386,97 ± 16,26 µm. Conclusões: O estudo indicou que o edema é cístic por natureza e é o principal substrato morfológico responsável por mudanças estruturais que promovem a oclusão da veia central da retina. O aumento na espessura total da retina (de 386.97 ± 16.26 µm) nesta patologia deve-se às mudanças estruturais nas zonas que vão da camada plexiforme - nucleo interno, camada de fibras do nervo óptico e membrana limitante Foi observado ainda um aumento significativo da esessura do plexiforme externo com cas camadas nucleaes internas (de 94.94 ± 5.08 µm) e camadas de fibras do nervo óptico (de 54.6 ± 3.26µm).

Vitreomacular Attachment Ultrastructure and Histopathological Correlation.

PURPOSE: The ultrastructural anatomy of the vitreomacular interface in young human donor eyes and animal eyes is explored using scanning electron microscopy (SEM) to determine its relationship with the formation of the perimacular ridge from abusive head trauma, as well as macular hole formation, vitreomacular traction syndrome, and preretinal hemorrhage. MATERIALS AND METHODS: SEM is used to image the posterior poles of 23 human donor eyes, as well as several cow, dog, monkey, pig, and rabbit eyes for vitreomacular interface anatomy. We examined autopsy eyes from abusive head trauma histopathologically. RESULTS: Two rings of thick, circumferential, vitreous attachment at the area centralis are found. An inner ring at the fovea, R1, and an outer ring at the perifoveal region, R2, are both observed in eyes from donors < 30 years of age; comparatively, in eyes from donors > 30 years, only R2 is present (p<0.001). R2 is found with unique elliptical shape in Cynomolgus monkey. Macula, R1, and R2 are not detected in cow, dog, pig, or rabbit eyes. CONCLUSIONS: The vitreomacular ring attachments found in donor eyes correspond anatomically with the perimacular ridge found histopathologically in abusive head trauma, and likely correlates with the macular hole, vitreomacular traction syndrome, and preretinal hemorrhage. Vitreomacular interface anatomy in the monkey, but not the cow, dog, pig, or rabbit, demonstrates some anatomical similarity to that of the human, consistent with species differences regarding the area centralis.

Effect of internal limiting membrane abrasion on retinal tissues in macular holes.

PURPOSE: The purpose of this study was to identify the structural and histological effects of a Tano diamond-dusted membrane scraper (DDMS) on the retinal surface after internal limiting membrane (ILM) abrasion in macular hole surgery. METHODS: Institutional experimental study was performed in 11 eyes. All eyes underwent ILM abrasion in the operating room with a DDMS for macular hole repair as an alternative to traditional ILM peeling. Three human donor eyes underwent an identical procedure in the laboratory. Retinal tissues were removed by ILM abrasion with a DDMS during vitrectomy for macular hole repair and retinal tissues remaining in human donor eyes. Main outcome measures were microscopic and immunohistological characteristics of instrument tip tissues and retinal structure after ILM abrasion. RESULTS: The tips of the Tano DDMS showed evidence of cellular membranes and ILM removal. The retinas showed distinct areas of lamellar ILM removal without penetration of the retinal nerve fiber layer (RNFL). CONCLUSIONS: Application of the Tano DDMS instrument is sufficient to remove membranes from the surface of the ILM and layers of the ILM without disruption of the underlying RNFL. Internal limiting membrane abrasion can be a useful and effective alternative to complete ILM removal for macular surgery.

[The vitreous and the macula].

The macula is a site where various vitreoretinal disorders occur. In 1983 we started to observe the retinal surface of postmortem eyes with a scanning electron microscope (SEM). We investigated the anatomy of the vitreous in postmortem eyes by slit lamp biomicroscopy. The novel anatomy of the premacular vitreous led us to conduct a clinical study of vitreomacular interface diseases. In 1997, time domain optical coherence tomography(OCT) became available which facilitated visualization of the vitreoretinal interface. Swept source OCT which was introduced in 2012 can depict liquefied lacunae in the vitreous. It enabled us to elucidate the mechanism of vitreoretinal diseases. I. SEM revealed the remnants of vitreous cortex at fovea with high incidence (44%), which suggests strong vitreoretinal attachment at the fovea and vitreous cortex origin of the epiretinal membrane. II. We studied the anatomy of the vitreous in postmortem eyes. The vitreous of bisected eye balls was stained by fluorescein and immersed in water and observed by slit-lamp biomicroscopy. We discovered a "posterior precortical vitreous pocket (PPVP)" in adult eyes without posterior vitreous detachment (PVD). III. We performed clinical study in various vitreoretinal diseases based on the novel vitreous anatomy and explained their mechanism. 1. In diabetic retinopathy, ring shaped fibrovascular tissue surrounding the macula is formed along the outer margin of the PPVP. Although PVD progresses outside the PPVP, its posterior wall remains attached to the retina, which causes macular traction or cystoid macular edema. 2. In eyes with idiopathic epimacular membrane (IEM), detached vitreous cortex had an oval defect corresponding to the IEM. Posterior wall of the PPVP that is premacular vitreous cortex appeared to be the framework of IEM. 3. During vitrectomy for macular hole, premacular round defect appears when PVD is created. The residual cortex on the macula is fibrous membrane with elasticity. The tangential contraction of premacular cortex may generate anterior traction to the fovea, which leads to macular hole. IV. Using time domain OCT, we demonstrated the evolution of macular hole, myopic foveoschisis and lamellar macular hole. After 2007, we investigated age related changes of vitreoretinal interface by spectral domain OCT V. We demonstrated whole structure of the PPVP using swept source OCT. PPVP is a boat shaped premacular liquefied space which has a connecting channel to Cloquet's canal. PPVP develops during childhood. Visualization of vitreous structure proved that our previous assumptions are reasonable. Although the physiological function of the PPVP is unclear, we speculate that the aqueous flows into the PPVP though Cloquet's canal and the connecting channel.

A comparison of some organizational characteristics of the mouse central retina and the human macula.

Mouse models have greatly assisted our understanding of retinal degenerations. However, the mouse retina does not have a macula, leading to the question of whether the mouse is a relevant model for macular degeneration. In the present study, a quantitative comparison between the organization of the central mouse retina and the human macula was made, focusing on some structural characteristics that have been suggested to be important in predisposing the macula to stresses leading to degeneration: photoreceptor density, phagocytic load on the RPE, and the relative thinness of Bruch's membrane. Light and electron microscopy measurements from retinas of two strains of mice, together with published data on human retinas, were used for calculations and subsequent comparisons. As in the human retina, the central region of the mouse retina possesses a higher photoreceptor cell density and a thinner Bruch's membrane than in the periphery; however, the magnitudes of these periphery to center gradients are larger in the human. Of potentially greater relevance is the actual photoreceptor cell density, which is much greater in the mouse central retina than in the human macula, underlying a higher phagocytic load for the mouse RPE. Moreover, at eccentricities that correspond to the peripheral half of the human macula, the rod to cone ratio is similar between mouse and human. Hence, with respect to photoreceptor density and phagocytic load of the RPE, the central mouse retina models at least the more peripheral part of the macula, where macular degeneration is often first evident.

Vestibular dysfunction, altered macular structure and trait localization in A/J inbred mice.

A/J mice develop progressive hearing loss that begins before 1 month of age and is attributed to cochlear hair cell degeneration. Screening tests indicated that this strain also develops early onset vestibular dysfunction and has otoconial deficits. The purpose of this study was to characterize the vestibular dysfunction and macular structural pathology over the lifespan of A/J mice. Vestibular function was measured using linear vestibular evoked potentials (VsEPs). Macular structural pathology was evaluated using light microscopy, scanning electron microscopy, transmission electron microscopy, confocal microscopy and Western blotting. Individually, vestibular functional deficits in mice ranged from mild to profound. On average, A/J mice had significantly reduced vestibular sensitivity (elevated VsEP response thresholds and smaller amplitudes), whereas VsEP onset latency was prolonged compared to age-matched controls (C57BL/6). A limited age-related vestibular functional loss was also present. Structural analysis identified marked age-independent otoconial abnormalities in concert with some stereociliary bundle defects. Macular epithelia were incompletely covered by otoconial membranes with significantly reduced opacity and often contained abnormally large or giant otoconia as well as normal-appearing otoconia. Elevated expression of key otoconins (i.e., otoconin 90, otolin and keratin sulfate proteoglycan) ruled out the possibility of reduced levels contributing to otoconial dysgenesis. The phenotype of A/J was partially replicated in a consomic mouse strain (C57BL/6J-Chr 17(A/J)/NaJ), thus indicating that Chr 17(A/J) contained a trait locus for a new gene variant responsible to some extent for the A/J vestibular phenotype. Quantitative trait locus analysis identified additional epistatic influences associated with chromosomes 1, 4, 9 and X. Results indicate that the A/J phenotype represents a complex trait, and the A/J mouse strain presents a new model for the study of mechanisms underlying otoconial formation and maintenance.

[Efficacy of topical ketorolac for improving visual function after photocoagulation in diabetic patients with focal macular edema]. / Eficacia del ketorolaco tópico para mejorar la función visual después de la fotocoagulación, en diabéticos con edema macular focal.

BACKGROUND: Photocoagulation reduces the incidence of visual loss in diabetic patients with focal macular edema, but it can induce it for Efficacy of topical ketorolac for improving visual function after photocoagulation in diabetic patients with focal macular edema 6 weeks after treatment and produces visual improvement in some cases. Topical ketorolac may reduce the inflammation caused by photocoagulation and improve visual outcome. PURPOSE: To determine the efficacy of topical ketorolac for improving visual function after photocoagulation in diabetic patients with focal macular edema. METHODS: An experimental, comparative, prospective, longitudinal study in diabetic patients with focal macular edema was conducted. Eyes were randomized into two groups of topical treatment for 3 weeks after photocoagulation (A: ketorolac, B: placebo). Best corrected visual acuity before and after treatment was compared in each group (paired t test), and the proportion of eyes with visual improvement was compared between groups (χ(2)). The evaluation was repeated after stratifying for initial visual acuity (≥ 0.5, < 0.5). RESULTS: There were 105 eyes included. In group A (n= 46) mean visual acuity changed from 0.50 to 0.58 (p= 0.003), and from 0.55 to 0.55 in group B (n= 59, p= 0.83); mean percent change was 22.3% in group A and 3.5% in group B (p= 0.03). Visual improvement was identified in 25 eyes from group A (54.3%) and 19 from group B (32.2%, p= 0.019, RR 1.65); the difference only persisted when initial visual acuity was ≥ 0.5 (10 [40%], group A, 5 [14.7%], group B, p= 0.02, RR 2.72). CONCLUSION: Topical ketorolac was more effective than placebo to improve best corrected visual acuity in diabetic patients with focal macular edema.

Antecedentes: la fotocoagulación reduce la incidencia de pérdida visual en diabéticos con edema macular focal, aunque puede inducirla durante 6 semanas; la mejoría visual después del tratamiento es excepcional. El ketorolaco tópico puede limitar la inflamación causada por la fotocoagulación, y mejorar el desenlace visual. Objetivo: determinar la eficacia del ketorolaco tópico en la mejoría de la función visual después de la fotocoagulación, en diabéticos con edema macular focal. Material y métodos: estudio experimental, comparativo, prospectivo, longitudinal efectuado en diabéticos con edema macular focal, asignados al azar a dos grupos de tratamiento tópico durante 3 semanas después de la fotocoagulación (A: ketorolaco, B: placebo). En cada grupo se comparó la agudeza visual antes y después del tratamiento (t pareada) y entre grupos la proporción de ojos con mejoría visual (χ2). La evaluación se repitió con estratificación por agudeza visual inicial (≥ 0.5, < 0.5). Resultados: se analizaron 105 ojos; en el grupo A (n= 46) el promedio de agudeza visual cambió de 0.50 a 0.58 (p= 0.003), en el B (n= 59) de 0.55 a 0.55 (p= 0.83); el promedio del cambio porcentual fue 22.3% en el grupo A y 3.5% en el B (p= 0.03). Hubo mejoría visual en 25 ojos del grupo A (54.3%) y 19 del B (32.2%, p= 0.019, RR 1.65); la diferencia persistió cuando la agudeza visual inicial era ≥ 0.5 (10 [40%], grupo A, 5 [14.7%], grupo B, p= 0.02, RR 2.72). Conclusiones: el ketorolaco fue más eficaz que el placebo para mejorar la agudeza visual en pacientes diabéticos con edema macular focal.

[Safety and efficacy of subconjunctival triamcinolone injections in the management of uveitic macular edema: retrospective study of thirty-one cases]. / Efficacité et tolérance des injections sous-conjonctivales de triamcinolone dans la prise en charge des œdèmes maculaires uvéitiques : étude rétrospective sur trente et un cas.

Triamcinolone acetonide (Kenacort) is a corticosteroid that can be administrated by subconjunctival injection, with an extended release for up to three months. Our retrospective study aims to analyze safety and efficacy of subconjunctival triamcinolone injections in the treatment of uveitic macular edema. We included 31 eyes of 30 patients, who had one or several injections. We studied the progression of visual acuity, central macular thickness by optical coherence tomography (OCT), intraocular pressure, and presence or absence of cataract, on the day of injection (T0), and at 1, 3, 6 and 12 months after injection. Twenty-one patients had only one injection; 10 patients had 2. The 12-month follow-up showed an improvement in visual acuity with an initial mean of 0.36 ± 0.27 logMAR to 0.23 ± 0.33 logMAR at 3 months of follow-up (P<0.0004), and to 0.24 ± 0.21 logMAR at 12 months (P=0.0371), for a two-line improvement. A decrease in mean central macular thickness was measured by OCT, from a mean of 444 ± 112 µm (0.24 ± 0.11 logSD-OCT) at T0 to 355 ± 103 µm (0.14 $ ± 0.10 logSD-OCT) at 3 months (P=0.0002). We did not find a significant increase in intraocular pressure, and we diagnosed one cataract during follow-up but this occurred in the uninjected eye as well. Subconjunctival injection of triamcinolone acetonide is a safe and effective treatment of macular edema related to uveitis. Initial clinical monitoring is necessary to detect iatrogenic events.

Macular microstructures and prognostic factors in myopic subretinal hemorrhages.

PURPOSE: To investigate microstructural changes and visual prognosis in myopic subretinal hemorrhages (mSH) without choroidal neovascularization (CNV). METHODS: In this retrospective, observational case series, 13 consecutive eyes with mSH were followed for 6 months. The medical records, fluorescein angiography (FA), and spectral-domain optical coherence tomography (OCT) were reviewed. Fluorescein angiography confirmed the absence of CNV. The baseline and 6-month findings/parameters were investigated, including the maximal hemorrhagic height, intraretinal hyperscattering signal across the retina at 6 months (i.e., intraretinal hyperreflective sign), and integrity of the photoreceptor inner and outer segment (IS/OS) and external limiting membrane (ELM) lines. RESULTS: The final visual acuity (VA) improved significantly (P = 0.001), and the hemorrhages resolved in 12 (92.3%) eyes by 6 months. The tops of the hemorrhages reached the outer nuclear layer (ONL) in three eyes (23.1%), internal limiting membrane (ILM) in five (38.5%), and between the two layers in five (38.5%). The intraretinal hyperreflective sign in all eyes extended into the ONL in five eyes (38.5%), to the ILM in four (30.8%), and between the two layers in four (30.8%). The location of the hyperreflective signs at 6 months coincided with the ruptured retinal layers at baseline in all eyes. The IS/OS line and the ELM were each intact in six (46.2%) eyes. The final VA was associated significantly with the IS/OS (P < 0.05) and ELM (P < 0.01) integrity. CONCLUSIONS: The intraretinal hyperreflective sign, presumed to be scarring that enters through the disrupted outer retina, is correlated closely with photoreceptor function.

[Normal macular thickness and volume using spectral domain optical coherence tomography in a reference population]. / Espesor y volumen macular normal, mediante tomografía de coherencia óptica de dominio espectral, en nuestra población de referencia.

OBJECTIVE: To establish normal values of macular thickness and volume obtained by the Cirrus SD-OCT (Carl ZeissMeditec, Dublin, CA, U.S.A.). Secondly, to assess the association between macular thickness and volume, sex and age. MATERIAL AND METHODS: A prospective study was conducted on patients who were seen in a hospital Retina Unit, and who only had retinal disease in one eye. All the Macular Cube 512 × 128 scan protocols were performed by the same operator. Only the healthy eye was scanned in each patient. RESULTS: A total of 100 eyes of 100 patients were analysed. The mean central foveal thickness was 261.31 ± 17.67 microns, and was significantly (P<.05) higher in males (267.74 ± 16.98 microns) than in females (255.60 ± 16.40 microns). The mean obtained for the volume of the cube was 10.09 ± 0.37mm 3, and the mean thickness of 280.33 ± 10.34 cube um, with no statistically significant differences between gender being found (P<.05). The mean macular thickness is less at central level, increases in the inner perifoveal ring, and then decreases in the outer perifoveal ring. Furthermore, of all quadrants the greatest thickness was the nasal (328.27 ± 12.96 microns), followed by the upper (326.27 ± 11.89 microns), lower (322.53 ± 12.37mm) sectors, with the temporal sector being the thinnest (313.35 ± 14.20 microns). The mean age of the patients was 60.86 ± 14 years. CONCLUSION: The mean central foveal thickness and the thickness of the inner perifoveal ring are significantly higher in men than in women. Both the mean volume and thickness of the cube, as well as nasal and inner superior sectors decrease with age, being significantly only in women.

The microstructural and functional changes in the macula of heavy habitual smokers.

To investigate whether heavy habitual smoking affects microstructures and functions of the macula, 45 age- (20-39 years old) and sex-matched adult smokers (≥1 box/day for ≥5 years) and 45 nonsmokers (controls) were enrolled in this case-control study. Central macular thickness (CMT), macular autofluorescent pigment density (MAPD), macular electroretinogram (ERG), and photostress recovery time (PRT) measurements were performed. The mean age of smokers and nonsmokers was 32.9 ± 3.9 and 33.1 ± 4.1 years, respectively (p = 0.43), and smoking duration was 11 ± 5.6 years. CMT in smokers (220 ± 28 µm) and nonsmokers (217.2 ± 31 µm; p = 0.57) was similar. Smokers had lower MAPD values (124.6) than nonsmokers (138.2) (p = 0.010). Multifocal ERG parameters in the central (6°) hexagon were similar in both groups (p > 0.05 for latency and amplitudes of P1 and N1). PRT in smokers and nonsmokers was similar (7.2 ± 1.2 and 7.4 ± 1.9 min, respectively; p = 0.33); however, foveal threshold value (FTV) at the first minute after photostress was statistically higher in smokers (36.1 ± 1.04 dB) than nonsmokers (34.8 ± 1.05 dB) (p = 0.011). We conclude that decreased MAPD and altered response to photostress may be indicative of early nicotine toxicity in microstructurally sound macula of adult chronic smokers.

Macular ultrastructural features in amblyopia using high-definition optical coherence tomography.

PURPOSE: To study macular morphology in amblyopic eyes using high-definition spectral domain optical coherence tomography (SD-OCT) and to compare the findings with fellow eyes. METHODS: This was a prospective institutional study of patients ≥6 years of age with unilateral amblyopia. Enhanced high-definition single line macular scans of amblyopic eyes were obtained using SD-OCT and compared with fellow eyes. Scans were evaluated qualitatively for structural differences. Central foveal thickness was measured and areas of the different retinal layers were computed within 500 µm from the foveal centre nasally and temporally. RESULTS: Forty-five patients with unilateral amblyopia were included: 25 with strabismic and 20 with anisometropic amblyopia with a mean age of 24.8 years. Qualitatively, the bulge in the inner segment/outer segment junction of the central fovea was noted to be attenuated or absent in 60% of amblyopic eyes compared with 29% of normal eyes, p=0.02. Also, amblyopic eyes demonstrated a shallow foveal pit compared with normal fellow eyes. Mean foveal thickness was significantly increased in amblyopic (228.56 µm) versus fellow eyes (221.72 µm), p=0.03. Upon exploring different retinal layers, the temporal inner nuclear layer area was increased (p=0.04) while the outer nuclear layer area was decreased (p=0.04) in amblyopic eyes compared with fellow eyes. CONCLUSIONS: Using enhanced high-definition SD-OCT, amblyopic eyes demonstrated qualitative and quantitative differences in macular features, possibly representing signs of immaturity compared with normal fellow eyes.

[Macular morphology and peripapillary retinal nerve fiber layer thickness in children with regressed retinopathy of prematurity]. / Morfologia siatkówki w plamce i grubosc warstwy wlókien nerwowych tarczy nerwu wzrokowego u dzieci z przebyta retinopatia wczesniaków.

PURPOSE: morphobiometric evaluation of macula and peripapillary retinal nerve fiber layer thickness with the use of high-resolution optical coherence tomography in children with a history of regressed retinopathy or prematurity. MATERIALS AND METHODS: 18 patients at the age of 8 to 14 years with a history of spontaneously regressed retinopathy of prematurity were studied prospectively. For statistical purposes a control group of 21 matched subjects at the age of 8 to 15 years was used. Ophthalmic examination and optical coherence tomography were performed in each patient. Peripapillary nerve fibre layer thickness, foveal and parafoveal thickness ratio, total macular volume and subfoveal choroidal thickness were measured in both groups. RESULTS: in the optical coherence tomography, the foveal thickness in children with retinopathy of prematurity was significantly higher [269.5 µm (232-321)] compared to the controls [224.5 µm (207-267)]. The macular volume in the study group was also higher (8.68 mm³). The subfoveal choroidal thickness was reduced in study group [321 µm (112-365)] compared to the control group [337 µm (294-358)]. There was no statistical significant difference in total peripapillary nerve fibre layer thickness between the two groups. CONCLUSION: The morphobiometric macular changes in eyes with a history of regressed retinopathy of prematurity are possibly related to the developmental abnormalities, which retinopathy of prematurity is due to the presence of the abnormal foveal structure across all retinal layers.

Disparity between foveal thickness and macular volume in diabetic macular edema.

BACKGROUND: Optical coherence tomography (OCT) quantifies changes of foveal thickness and macular volume after photocoagulation in diabetic macular edema. Macular volume evaluates the whole macula, but it may underestimate changes in foveal thickness induced by photocoagulation. We undertook this study to evaluate the concordance between macular volume and foveal thickness for identifying clinically significant changes of retinal thickness after photocoagulation for diabetic macular edema. METHODS: We carried out an observational, retrospective, longitudinal, analytical study. Center point thickness (CPT), central subfield mean thickness (CSMT) and macular volume were measured with OCT before photocoagulation and 3 weeks after in diabetic patients with focal macular edema (January 2006--January 2010). Concordance among variables to detect clinically significant changes (CPT >17%, CSMT >11%, macular volume >3%) was identified using the kappa test. RESULTS: Sixty eight eyes were included; 47 eyes had nonproliferative retinopathy (69.1%). CPT increased significantly in 14.7% of the sample; CSMT in 8.8%, and macular volume in 11.8%. CPT decreased significantly in 4.4%, CSMT in 8.8%, and macular volume in 42.6%. Concordance was regular for CPT and CSMT increased (57%). Concordance was good for CPT and CSMT decreased (64%). Concordance was regular for CSMT and macular volume decreased in eyes with center involvement (43%). The remaining concordances were poor. DISCUSSION: Two independent events happen after focal photocoagulation: involution of the original thickening and increase in CPT. In order to detect both events, evaluation of either foveal thickness alone or macular volume alone is insufficient. CONCLUSION: Identifying the efficacy and safety of treatments for diabetic macular edema requires simultaneous measurement of CPT and macular volume.