Effect of digital ocular massage on intraocular pressure and Schlemm's canal dimensions.

Digital ocular massage has been reported to temporarily lower intraocular pressure (IOP). This could be related to an enhanced aqueous humor outflow; however, the mechanism is not clearly understood. Using anterior segment optical coherence tomography, the Schlemm's canal (SC) and trabecular meshwork (TM) can be imaged and measured. Here, 66 healthy adults underwent digital ocular massage for 10 min in their right eyes. The IOP and dimensions of the SC and TM were measured before and after ocular massage. All subjects demonstrated IOP reduction from 15.7 ± 2.5 mmHg at baseline to 9.6 ± 2.2 mmHg immediately after, and median of 11.6 mmHg 5-min after ocular massage (Friedman's test, p < 0.001). There was significant change in SC area (median 10,063.5 µm2 at baseline to median 10,151.0 µm2 after ocular massage, Wilcoxon test, p = 0.02), and TM thickness (median 149.8 µm at baseline to 144.6 ± 25.3 µm after ocular massage, Wilcoxon test, p = 0.036). One-third of the subjects demonstrated collapse of the SC area (-2 to -52%), while two-thirds showed expansion of the SC area (2 to 168%). There were no significant changes in SC diameter (270.4 ± 84.1 µm vs. 276.5 ± 68.7 µm, paired t-test, p = 0.499), and TM width (733.3 ± 110.1 µm vs. 733.5 ± 111.6 µm, paired t-test, p = 0.988). Eyes with a higher baseline IOP demonstrated a greater IOP reduction (Pearson correlation coefficient r = -0.521, p < 0.001). Eyes with smaller SC area at baseline showed greater SC area expansion (Pearson correlation coefficient = -0.389, p < 0.001). Greater IOP reduction appeared in eyes with greater SC area expansion (Pearson correlation coefficient r = -0.306, p = 0.01). Association between change in IOP and change in TM thickness was not significant (Spearman's ρ = 0.015, p = 0.902). Simple digital ocular massage is an effective method to lower IOP values, and change in the SC area was significantly associated with IOP changes.

Case of persistent corneal epithelial damage after cataract surgery leading to diagnosis of vitamin A deficiency.

PURPOSE: To report our findings of reduced full-field electroretinograms (ff-ERGs) and abnormal optical coherence tomographic (OCT) images in a patient with poor visual acuity after cataract surgery who was eventually diagnosed with vitamin A deficiency (VAD). METHODS: This was a clinical study of a patient who complained of blurred vision after cataract surgery. To determine the cause of the reduced vision, we recorded full-field electroretinograms (ff-ERGs) to determine the scotopic and photopic status of the retina. We also performed optical coherence tomography to assess the changes in the retinal structure. Serological tests were performed. RESULTS: A 74-year-old man presented with persistent corneal epithelial damages and reduced vision that developed after conventional cataract surgery. OCT showed an interrupted ellipsoid zone, and fundus autofluorescence (FAF) showed a severe hypofluorescence in the retina of the left eye. The scotopic ff-ERGs were severely reduced, and the photopic ff-ERGs were mildly reduced. Serological examinations revealed a vitamin A concentration < 7 IU/dL (normal, 97-316 IU/dL). Based on these findings, we diagnosed the patient with VAD and started treatment with oral vitamin A supplements. After three months, his visual acuity, ff-ERGs, and OCT findings recovered to normal levels. The amplitudes and implicit times of the RETeval flicker ERGs increased to be within the normal range, and the hypofluorescence of the left eye disappeared. The length of the photoreceptor outer segments increased after the vitamin A supplementation. CONCLUSION: Our findings indicate that the ERGs are helpful for diagnosing patients with VAD associated with persistent corneal epithelial damages.

Effect of Bergmeister papilla on disc parameters in spectral domain optical coherence tomography.

OBJECTIVES: To investigate the morphological characteristics of Bergmeister papilla (BMP), a persistent hyaloid remnant tissue, and its effects on the measurements and repeatability of spectral-domain optical coherence tomography (OCT). SUBJECTS/METHODS: The subjects of this prospective cross-sectional study including 83 patients with BMP and 76 unaffected individuals, all had open-angle structures. Images, including a 5-line raster and three consecutive optic disc cube scans centred on the optic disc, were acquired using the Cirrus high-definition OCT. BMP's structural characteristics were classified based on the raster scan images, and repeatability of acquiring optic nerve head and retinal nerve fibre layer parameters acquisition was analysed by calculating the test-retest standard deviation (Sw), coefficient of variance (CV), and intraclass correlation coefficient. RESULTS: BMPs (n = 83) were categorised into lifting edge (LE) type (63.9%, n = 53), which partially covers the edge of the optic nerve head, and covering disc (CD) type (36.1%, n = 30), which completely covers the cupping area like a cap. The average cup-to-disc ratio (0.58 ± 0.21), vertical cup-to-disc ratio (0.55 ± 0.21), and cup volume (0.22 ± 0.22) of the CD type were lower than those of the LE type (0.66 ± 0.13, 0.64 ± 0.13, and 0.4 ± 0.27, respectively; all P < 0.05). Tolerability indices for repeatability of cup volume (Sw = 0.40 and CV = 0.36) and inferonasal (4 o'clock) retinal nerve fibre layer (Sw = 0.27 and CV = 0.25) in LE-type BMPs exceeded the cut-off value (0.22) and demonstrated stronger correlation with BMP location than that of the controls. CONCLUSION: Caution should be exercised when interpreting OCT findings in eyes with BMP, as BMP can introduce a pitfall in OCT imaging.

Late-Onset Chronic Corneal Fistula Following Phototherapeutic Keratectomy: A Case Report and Importance of Early Detection.

BACKGROUND We report a case of late-onset chronic fistula in a decompensated cornea after multiple ocular surgeries and a recent phototherapeutic keratectomy (PTK). CASE REPORT A 73-year-old woman presented to our service with a past ocular history of bilateral chronic angle closure glaucoma and pseudophakic bullous keratopathy in the left eye. Given a history of long-term uncontrolled glaucoma with advanced disc cupping and poor visual potential, the patient underwent multiple palliative procedures, including, most recently, a PTK. Few years later she presented with a spontaneous late onset of slowly appearing corneal leak on fluorescein staining upon routine clinical examination. Corrected distance visual acuity was hand motion and intraocular pressure (IOP) was 40 mmHg in the affected eye. Serial anterior segment optical coherence tomography (AS-OCT) sections were obtained, which aided in understanding the current presentation and revealed distinctive multilayer corneal changes during the healing process. The patient was successfully managed with cyanoacrylate corneal gluing and ocular hypotensive medications, which halted the corneal leak. CONCLUSIONS We report a case of a rare finding of corneal fistula in an eye with multiple previous ocular surgeries, and provide an explanation of the possible etiopathogenesis. We also highlight the pivotal role of AS-OCT for evaluating such cases and stress the importance of early detection of similar subtle leaks in the setting of a formed anterior chamber, which can often be missed, carrying a risk of infection.

Early effects of cardiopulmonary bypass surgery on retinal nerve fiber layer and ganglion cell layer.

PURPOSE: To determine the effects of cardiopulmonary bypass surgery on retinal nerve fiber layer, ganglion cell layer, and macula by optic coherens tomography (OCT). METHOD: Sixty-six eyes of 33 patients aged between 44 and 74 who were indicated for cardiopulmonary bypass surgery in the cardiovascular surgery clinic were included in the study. Routine ophthalmologic examinations of all patients were performed before and 1 week after surgery. In addition, 3D(H) Macula+5 Line Cross 12 × 9 mm mod and Peripapilar 3D Disk 6 × 6 mm mod data were analyzed with OCT (Topcon, Triton Swept Source-OKT, Tokyo, Japan) device. Peripapillary total, superior, inferior retinal nerve fiber layer (RNFL), optic disc cavity volume, cup-to-disc ratio, macular ganglion cell layer (GCL), macular thickness were compared before and after surgery. RESULTS: After cardiopulmonary bypass surgery, thickening was detected in the total RNFL (p<0.001), superior RNFL (p = 0.01) and inferior RNFL (p<0.001) layers. There was no change in the values of GCL, macular thickness, optic disc cupping volume, cup-to-disc ratio after surgery (p>0.05). There was a positive correlation (r = 0.392 p<0.05) between the patients' blood oxygen (PO2) values during bypass surgery with their post-surgical GCL+ values, and a negative correlation between optic disc cup volumes (r=-0.349 p<0.05). CONCLUSION: RNFL thickening has been detected in patients undergoing cardiopulmonary bypass surgery. This thickening may occur secondary to ischemic edema that occurs during surgery. Considering the late complications of ischemic edema in the RNFL, oxygen levels should be kept at an optimum level during surgery and long-term ophthalmologic follow-ups should be performed.

[Ocular complications in intense pulsed light therapy (case study)]. / Glaznye oslozhneniya intensivnoi fototerapii (klinicheskoe nablyudenie).

A 24-year-old female patient with photophobia, discoria, redness and dryness in her right eye after intense pulsed light (IPL) therapy applied for posttraumatic subcutaneous hemorrhage received a comprehensive ophthalmic examination including optical coherence tomography (OCT) and OCT angiography of the anterior eye segment. Her best corrected visual acuity was 20/20 in both eyes. Medically induced mydriasis revealed discoria with paresis of pupil dilatator in the left eye (pupil size 4.2 mm and 6.6 mm in the right and left eye, respectively). Anterior segment OCT showed anterior chamber cytosis and increased iris vascularity. The patient was prescribed topical 1.0% tropicamide 2 times per day and 1.0% dexamethasone 4 times per day for two weeks. Examination performed after 3 months showed no restoration of pupil dilatator function in the left eye. The case demonstrates potential ocular complications of IPL therapy, which may include iris burn with iritis and persistent pupil dilatator dysfunction.

Parapapillary choroidal microvasculature dropout in eyes with primary open-angle glaucoma.

The purpose of this study was to evaluate how various parameters are related to microvasculature dropout (MvD) area measured using optical coherence tomography angiography (OCTA). We measured the area of MvD in 55 patients with primary open-angle glaucoma (POAG). Using OCTA, MvD area and peripapillary choroidal atrophy (PPA) area were assessed in a 4.5 mm × 4.5 mm region. The following were examined: circumpapillary nerve fiber layer (cpRNFL) thickness, optic disc area, optic disc cupping area, optic disc rim area, Humphrey Field Analyzer (HFA) 24/10-2 mean deviation (MD), and pattern standard deviation (PSD). The relationship between MvD area and each parameter was evaluated using Spearman's rank correlation coefficient analysis. Mean MvD area and PPA area were 0.18 ± 0.17 mm2 and 1.13 ± 0.72 mm2, respectively. MvD area was significantly correlated with optic disc rim area (p = 0.0017), cpRNFL (p = 0.0027), HFA 24/10-2 MD, and PSD (p < 0.001). In eyes with POAG, MvD area indicates the severity of glaucoma, which might be associated with structural changes in the peripapillary vasculature around the optic disc.

Analysis of the Macular Region Following Panretinal Photocoagulation for the Treatment of Diabetic Retinopathy Using Optical Coherence Tomography.

Background: Diabetic retinopathy (DR) is the most prevalent microvascular complication of diabetes. Panretinal photocoagulation (PRP) is the established treatment for mitigating severe visual impairment resulting from proliferative DR. Objective: This study aims to investigate the impact of PRP on the macular region in patients with DR, utilizing optical coherence tomography (OCT) for assessment. Design: An experimental study was meticulously designed, implementing PRP as the primary intervention. Setting: The investigation was conducted within the Department of Ophthalmology at the Affiliated Huaian No.1 People's Hospital, Huai'an, Jiangsu, China. Participants: A total of 120 participants diagnosed with DR and undergoing treatment at our hospital were enrolled in the study. Interventions: The participants were randomly assigned to either the control group (CG, n = 60) or the study group (SG, n = 60). The CG received conventional drug treatment involving oral iodized lecithin, while the SG received PRP. OCT was employed to monitor changes in macular fovea volume and macular retinal thickness. Primary Outcome Measures: Evaluation criteria encompassed clinical efficacy, macular fovea volume, macular retinal thickness, IL-6 and VEGF levels, incidence of adverse reactions, and quality of life in both groups. Results: The study resulted in a higher total effective rate in the SG (96.67%) compared to the CG (80.00%) (χ2 = 8.09, P < .05). Post-treatment, reductions were observed in macular fovea volume and macular retinal thickness, with significantly lower SG values than CG values (P < .05). Both serum IL-6 and VEGF levels exhibited reductions in both groups after treatment, with the SG displaying a more significant decrease compared to the CG (P < .05). The occurrence of adverse reactions significantly decreased in the SG relative to the CG (P < .05). Quality of life scores for the SG was notably elevated compared to the CG (P < .05). Conclusions: PRP emerges as a highly valuable approach in the management of DR. It contributes to retinal thickness improvement within the macular region and inflammation reduction, and also enhances therapeutic outcomes, minimizes adverse reactions, and optimizes patients' quality of life. These findings warrant further clinical adoption and widespread promotion.

Efficacy and safety of iodized lecithin tablets versus spironolactone in alleviating central serous retinopathy among Chinese patients with uncontrolled diabetes.

To compare the effectiveness and safety of spironolactone versus lecithin-bound iodine in patients with central serous retinopathy (CSR). Chinese diabetes patients aged>18 years with CSR with persistent increased level of subretinal fluid (SRF) were enrolled. Subjects were randomized to receive either oral lecithin-bound iodine (390µg/kg/day) or oral spironolactone (50mg/day) for 6 months. A total of 200 patients were randomized and completed the study. Compared to spironolactone group, patients treated with lecithin-bound iodine had greater proportion of eye with complete resolution (87% vs 81%, p>0.005). Higher improvement in height of SRF was observed in lecithin-bound iodine-treated patients as compared with Spironolactone-treated patients (91.2[87.5] vs 142.5 [121.1]; p>0.005). However, no statistically significant difference was observed on none of comparisons. Compared to Spironolactone, the patients treated with lecithin-bound iodine had greater improvement in lesion size, central macular thickness and best-corrected visual acuity. However, no statistically significant difference was observed in any of parameter assessed. (p>0.005). The results of the present study suggested that the lecithin-bound iodine was found more effective (nnumerically) than spironolactone in Chinese diabetes patients with CSR.

Ocular posterior segment microstructural and microvascular morphological changes in protein supplement-consuming bodybuilders.

BACKGROUND: To determine the effects of protein supplement (whey protein powder (PP)) on retinal, choroidal and optic nerve head (ONH) microstructure and microvascular morphology in healthy bodybuilders. METHODS: This cross-sectional study included 23 male adults (consumers, 23 right eyes) who had been routinely consuming whey PP for bodybuilding purposes for ≥ 3 months, and 21 age- and gender-matched healthy volunteers (non-consumers, 21 right eyes) who also attended the gym but did not consume any nutritional supplements. Participants underwent standard ocular exams, enhanced depth imaging optical coherence tomography (EDI OCT), and optical coherence tomography angiography (OCTA) after ≥ 8 h of rest and fasting. RESULTS: Whey PP was consumed for a median of 9.5 (6-12) months. Whey PP consumers had a median age of 22 (21-22) years, while non-consumers had 21 (20-22) years (p = 0.067). Whey PP consumers had greater microstructural thickness than non-consumers, with subfoveal choroidal thickness (301.40 ± 38.91 versus 278.12 ± 33.58 µm; p = 0.035) being significantly different but not central macular thickness (270.55 ± 24.60 versus 265.85 ± 12.44 µm; p = 0.402). Despite a non-significant difference in superficial and deep capillary plexus vascular densities (VDs), whey PP consumers had relatively lower VDs than non-consumers in all macular regions (p > 0.05). Despite this, whey PP consumers displayed greater ONH VDs, as well as higher global RNFL thickness (116.75 ± 10.41 versus 114.50 ± 11.70 µm) than non-consumers (p > 0.05). CONCLUSION: Protein supplements, particularly whey PPs, appear to be associated with different changes in the retina and choroid, as well as ONH microstructural and microvascular morphology, implying that paying attention to these clinical aspects when performing ocular tests in bodybuilders who consume nutritional supplements could be critical.

Characterization of peripheral blood inflammatory indicators and OCT imaging biological markers in diabetic retinopathy with or without nephropathy.

Objective: To observe the distribution characteristics of peripheral blood inflammatory indexes and retinal macular area optical coherence tomography (OCT) imaging biomarkers in patients with diabetic retinopathy (DR) with or without diabetic nephropathy (DN), in order to seek clinical biomarkers that can predict the development of DR and DN. Methods: A total of 169 inpatients with DR who visited the ophthalmology department of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from October 2020 to June 2022 and had complete clinical data were collected, and the patients with DR were divided into two major groups, DR and DR/DN, according to whether they had DN, and then further divided into four subgroups, Non-proliferative DR(NPDR), proliferative DR(PDR), NPDR/DN and PDR/DN, according to the stage of DR. The distribution characteristics of peripheral blood inflammatory indexes [Neutrophil to lymphocyte ratio(NLR) and Platelet to neutrophil ratio(PLR)], renal function indexes [Cystatin-C(CYS-C), Creatinine(Crea), Uric acid(UA)and Urinary albumin to creatinine ratio(UACR)] and OCT imaging indexes [Hyperreflective foci(HRF), Disorgnization of retinal inner layers(DRIL), Outer retinal tubulations(ORTs), Central retinal thickness(CRT), Retinal nerve fiber layer(RNFL) and Ganglion cell layer(GCL)] were analyzed between the above subgroups. Results: There was no difference between DR and DR/DN groups in terms of gender, family history of diabetes, duration of diabetes and Body mass index(BMI) (P>0.05), the mean age of the DR/DN group was significantly lower than that of the DR group (P<0.05), and the proportion of the DR/DN group with a history of hypertension was significantly higher than that of the DR group (P<0.05); there was no significant difference in hemoglobin A1C(HbA1c) between DR and DR/DN groups (P>0.05). (P>0.05), Hemoglobin(HGB) was significantly higher in the DR group than in the DR/DN group (P <0.05), NLR, PLR, Crea, UA and CYS-C were significantly higher in the DR/DN group than in the DR group (P<0.05); there was no significant difference in the comparison of HRF, DRIL, ORTs positive rate and CRT between the DR and DR/DN groups (P>0.05). RNFL and GCL thickness were significantly lower in the DR/DN group than in the DR group (P<0.05); history of hypertension (OR=2.759), NLR (OR=1.316), PLR (OR=1.009), Crea (OR=1.018), UA (OR=1.004), CYS-C (OR=3.742) were the independent (OR=0.951), age (OR=0.951), HGB (OR=0.976), RNFL (OR=0.909) and GCL (OR=0.945) were independent protective factors for DR/DN; RNFL (OR=0.899) and GCL (OR=0.935) were independent protective factors for NPDR/DN, RNFL (OR=0.852) and GCL (OR=0.928) were independent protective factors for PDR/DN. ROC curve analysis showed that the area under the curve (AUC) for CYS-C, PLR, Crea, UA and the combination of the four indicators to predict DR/DN were 0.717, 0.625, 0.647, 0.616 and 0.717, respectively. Conclusions: (1) Low age combined with hypertension HGB, NLR, PLR, CYS-C, Crea and UA may be serum biological markers for predicting DN in DR; meanwhile, PLR, CYS-C, Crea, UA and the combination of the four indicators can be used for risk assessment and adjunctive diagnosis of DN in DR combined with hypertension. (2) The RNFL and GCL thickness in the temporal aspect of the central macular sulcus may be imaging biological markers for predicting DN in DR; meanwhile, GCL thickness may have important value for risk prediction and diagnosis of DN in combination with DR.

Melanin-dependent tissue interactions induced by a 755-nm picosecond-domain laser: complementary visualization by optical imaging and histology.

Fractional picosecond-domain lasers (PSL) induce optical breakdown, which correlates histologically to vacuolization in the epidermis and dermis. In this ex vivo porcine study, we sought to establish a framework for the investigation of laser-tissue interactions and their dependence on melanin density. Light- (melanin index: 24.5 [0-100]), medium- (58.7), and dark-pigmented (> 98) porcine skin samples were exposed to a 755-nm fractional PSL and examined with dermoscopy, line-field confocal optical coherence tomography (LC-OCT), conventional OCT, and subsequently biopsied for digitally stained ex vivo confocal microscopy (EVCM) and histology, using hematoxylin and eosin (HE) and Warthin-Starry (WS) melanin staining. Dermoscopy showed focal whitening in medium- and dark-pigmented skin. Similarly, LC-OCT and OCT visualized melanin-dependent differences in PSL-induced tissue alterations. Vacuoles were located superficially in the epidermis in dark-pigmented skin but at or below the dermal-epidermal junction in medium-pigmented skin; in light-pigmented skin, no vacuoles were observed. Histology confirmed the presence of vacuoles surrounded by areas void of WS staining and disrupted stratum corneum in darker skin. The combined use of optical imaging for multiplanar visualization and histological techniques for examination of all skin layers may mitigate the effect of common artifacts and attain a nuanced understanding of melanin-dependent laser-tissue interactions.

Paracentral acute middle maculopathy in a fasting patient after cataract surgery and its response to hyperbaric oxygen therapy.

INTRODUCTION: Paracentral acute middle maculopathy (PAMM) is a structural optical coherence tomography (OCT) sign secondary to ischemia in the intermediate and deep retinal vascular network, characterized by hyperreflectivity in the inner nuclear layer (INL). AIM: Our objective is to demonstrate PAMM development following uncomplicated cataract surgery, possibly triggered by fasting and dehydration. We also aim to emphasize the potential role of hyperbaric oxygen therapy in treating PAMM. CASE PRESENTATION: A 66-year-old man with a past medical history of Neurofibromatosis type 1 and cardiovascular disease underwent uncomplicated cataract surgery in the left eye. The patient was also fasting due to Ramadan. The patient complained of very low vision during the routine postoperative examination on the third day. His-best-corrected visual acuity (BCVA) was counting fingers at 1 meter. His-anterior and posterior segment examination was unremarkable. In infrared imaging, a large hyporeflective area was observed in the parafoveal region, and structural OCT also showed increased hyperreflectivity in the middle retinal layers corresponding to the junction of INL and outer plexiform layer (OPL) involving the entire INL which suggested PAMM. Following 14 sessions of hyperbaric oxygen therapy, the patient's BCVA increased to 0.9 on the 14th day of diagnosing PAMM. CONCLUSION: To the best of our knowledge, this is the first case representing a patient with  PAMM triggered by fasting and cataract surgery who responded positively to hyperbaric oxygen therapy. However, triggering of PAMM by fasting is entirely unproven and that this observation occurred in a highly complex case with many other possible contributing factors. Also, the triggering of PAMM by some manipulation during surgery is equally unproven.

Akimba Proliferative Diabetic Retinopathy Model: Understanding Molecular Mechanism and Drug Screening for the Progression of Diabetic Retinopathy.

As the prevalence of diabetes has reached epidemic proportions worldwide, diabetic retinopathy incidence is increasing rapidly. An advanced diabetic retinopathy (DR) stage can lead to a sight-threatening form. There is growing evidence showing diabetes causes a range of metabolic changes that subsequently lead to pathological modifications in the retina and retinal blood vessels. To understand the complex mechanism of the pathophysiology of DR, a precise model is not readily available. By crossbreeding the Akita and Kimba strains, a suitable proliferative DR model was acquired. This new Akimba strain manifests marked hyperglycemia and vascular changes, which resemble the early and advanced stage of DR.Here, we describe the breeding method, colony screening for experiments, and imaging techniques widely used to investigate the DR progression in this model. We elaborate step-by-step protocols to set up and perform fundus, fluorescein angiography, optical coherence tomography, and optical coherence tomography-angiogram to study retinal structural changes and vascular abnormalities. In addition, we show a method to label the leukocytes with fluorescence and laser speckle flowgraphy to examine the inflammation in the retina and retinal vessel blood flow speed, respectively. Lastly, we describe electroretinogram to evaluate the functional aspect of the DR transformations.

Longitudinal Assessment of Retinal Nerve Fiber Layer and Ganglion Cell Complex Thicknesses in Patients With Large Optic Disc Cups and Normal Intraocular Pressure and Visual Fields.

PRCIS: The thicknesses of the circumpapillary retinal nerve fiber layer (cpRNFL) and ganglion cell complex (GCC) did not change during 5 years in physiological large disc cupping. PURPOSE: We evaluated longitudinal changes in the thicknesses of the cpRNFL and GCC in large disc cupping with a normal intraocular pressure (IOP) (<21 mm Hg) and visual field. METHODS: This retrospective, consecutive case series study included 269 eyes of 269 patients with large disc cupping and normal IOP. We analyzed patient demographics, IOP, central corneal thickness, vertical cup-to-disc ratios using color fundus photography, the thicknesses of the cpRNFL and GCC using RTVue-100, and mean deviation using visual field examinations. RESULTS: The differences in IOP, vertical cup-to-disc ratios, and mean deviation between the baseline and each follow-up visit were not statistically significant. The baseline average and mean average at 60 months follow-up of the cpRNFL thickness were 106.5±8.5 and 105.1±9.3 µm, respectively; differences between the baseline and each follow-up visit were not statistically significant. The baseline average and mean average at 60 months follow-up of the GCC thickness were 82.8±9. and 81.5±9.2 µm, respectively; differences between baseline and each follow-up visit were not statistically significant. CONCLUSIONS: The thicknesses of the cpRNFL and GCC did not change in well-maintained optic nerve head findings with normal IOP and visual field during a 5-year follow-up period. Optical coherence tomography evaluations of the thicknesses of the cpRNFL and GCC help accurately diagnose physiological optic disc cupping.

Early diagnosis of retinal neurovascular injury in diabetic patients without retinopathy by quantitative analysis of OCT and OCTA.

AIMS: To quantitatively analyze and compare the differences in retinal neurovascular units (NVUs) between healthy individuals and patients with type 2 diabetes mellitus (DM) by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) techniques and to determine the value of this technique for the early diagnosis of retinal neurovascular damage in patients with diabetes mellitus without retinopathy (NDR). METHODS: This observational case‒control study was conducted from July 1, 2022, to November 30, 2022, at the outpatient ophthalmology clinic of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine. All subjects underwent baseline data entry and mean thickness of the peripapillary retinal nerve fiber layer (pRNFL), the thickness of each retinal layer in the macula 3 × 3 mm, and vascular density (VD) examination. RESULTS: The study included 35 healthy individuals and 48 patients with DM. The retinal VD as well as partial pRNFL, macular nerve fiber layer (NFL), and macular ganglion cell layer (GCL) thickness in DM patients exhibited significantly lower VD in the DM group than in the control group (p < 0.05). Age and disease duration of DM patients showed a negative trend with pRNFL thickness, macular NFL thickness, macular GCL thickness, and VD. However, a positive trend was observed between DM duration and partial inner nuclear layer (INL) thickness. Moreover, there was a positive correlation between macular NFL and GCL thickness and VD for the most part, while a negative correlation was shown between INL temporal thickness and DVC-VD. pRNFL-TI and GCL-superior thickness were screened as two variables in the analysis of the predictors of retinal damage in DM according to the presence or absence of DM. The AUCs were 0.765 and 0.673, respectively. By combining the two indicators for diagnosis, the model predicted prognosis with an AUC of 0.831. In the analysis of retinal damage indicators associated with the duration of DM, after regression logistic analysis according to the duration of DM within 5 years and more than 5 years, the model incorporated two indicators, DVC-VD and pRNFL-N thickness, and the AUCs were 0.764 and 0.852, respectively. Combining the two indicators for diagnosis, the AUC reached 0.925. CONCLUSIONS: Retinal NVU may have been compromised in patients with DM without retinopathy. Basic clinical information and rapid noninvasive OCT and OCTA techniques are useful for the quantitative assessment of retinal NVU prognosis in patients with DM without retinopathy.

Time course study of optical coherence tomography angiography in patients with methanol induced optic neuropathy.

INTRODUCTION: In countries where alcoholic beverages are legally prohibited, methanol toxicity usually occurs due to ingesting homemade alcoholic drinks. The initial ophthalmologic symptoms of methanol toxicity typically appear 6-48 h after ingestion, and the severity of symptoms varies widely from mild and painless decreased vision to no-light perception vision. METHODS: This prospective study examines 20 patients with acute methanol poisoning within 10 days of use. Patients underwent ocular examinations, BCVA (Best Corrected Visual Acuity) recording, and OCTA (Optical Coherence Tomography Angiography) of the macula and optic disc. BCVA measurement and imaging were repeated one month and three months after intoxication. RESULTS: There was a statistically significant reduction in superficial parafoveal vascular density (P-value = 0.026), inner retinal thickness (P-value = 0.022), RNFL (Retinal Nerve Fiber Layer) thickness (P-value = 0.031), and an increase in cup to disc ratio (P-value < 0.001), and central visual acuity (P-value = 0.002) in this time course. However, there was no statistically significant difference in FAZ (Foveal Avascular Zone) area (P-value = 0.309), FAZ perimeter (P-value = 0.504), FD-300 (Foveal density, vascular density within a 300 µm wide region of the FAZ) (P-value = 0.541), superficial vascular density (P-value = 0.187), deep foveal vascular density (P-value = 0.889), deep parafoveal vascular density (P-value = 0.830), choroidal flow area (P-value = 0.464), total retinal thickness (P-value = 0.597), outer retinal thickness (P-value = 0.067), optic disc whole image vascular density (P-value = 0.146), vascular density inside the disc (P-value = 0.864), or peripapillary vascular density (P-value = 0.680) at different times. CONCLUSION: Over time, methanol poisoning can cause changes in retinal layers thickness, vasculature, and optic nerve head. The most important changes include cupping of the optic nerve head, reduction in RNFL thickness, and inner retinal thickness.

Thinning of the Lamina Cribrosa and Deep Layer Microvascular Dropout in Patients With Open Angle Glaucoma and High Myopia.

PRCIS: Lamina cribrosa (LC) thinning (thickness of ≤128.00 µm) helps to distinguish open angle glaucoma from high myopia, which was associated with the presence of microvasculature dropout and elevated intraocular pressure. PURPOSE: The purpose of this study was to analyze the factors associated with LC thickness in highly myopic eyes with and without open angle glaucoma. METHODS: In total, 240 highly myopic eyes with γ-zones (194 eyes without and 46 eyes with open angle glaucoma) were examined, and the LC center, externally oblique border, an abrupt change of scleral curvature (scleral step), deep layer microvasculature dropout and global retinal nerve fiber layer thickness were investigated on optical coherence tomography and optical coherence tomography angiography. RESULTS: LC were thinner in highly myopic open angle glaucoma compared with high myopia alone (107.76±9.86 vs. 137.07±18.51 µm, P <0.001), which was associated with deep layer microvasculature dropout and elevated intraocular pressure. The areas under the receiver operating characteristic curve for detecting open angle glaucoma from the LC thickness was 0.964, which was statistically higher ( P <0.05) than from the global retinal nerve fiber layer thickness (0.921) and vertical cup-to-disc ratio (0.902). A LC thickness cutoff value of 128 µm provided 100% sensitivity for detecting open angle glaucoma with 84% specificity. CONCLUSIONS: Highly myopic eyes with open angle glaucoma appear to have a thinner LC, which was associated with elevated intraocular pressure and deep layer microvasculature dropout. LC thinning (≤128.00 µm) helps distinguish open angle glaucoma from high myopia with an abnormal retinal nerve fiber layer thickness distribution and unclear shallow disc cupping.

An Ex Vivo Study of Filum Terminale in Children and Fetuses Based on Optical Coherence Tomography.

Objective: To distinguish ex vivo normal and abnormal filum terminale (FT) in pathology based on optical coherence tomography (OCT). Methods: A total of 14 ex vivo FTs, freshly imaged via OCT after being cut, were excised from the scanned region for histopathological examination (HPE). Qualitative analysis was performed by 2 blinded assessors. Results: We performed OCT imaging of all specimens and validated them qualitatively. In the fetal FTs, we observed large amounts of fibrous tissue scattered throughout with a few capillaries but no adipose tissue. In tight filum terminale syndrome (TFTS), adipose infiltration and capillaries were significantly increased, with obvious fibroplasia and disarrangement. OCT images showed increased adipose tissue in which the adipocytes were arranged in a grid-like pattern; dense, disordered fibrous tissue and vascular-like tissue were present. The diagnostic results of OCT and HPE were consistent (Kappa = 0.659; P = .009, <.01), and there was no statistically significant difference in diagnosing TFTS using a Chi-square test (P > .05). The area under the curve (AUC) for OCT (AUC = 0.966; 95% CI, 0.903 to 1.000) was better than magnetic resonance imaging (MRI) (AUC = 0.649; 95% CI, 0.403 to 0.896). Conclusion: OCT can quickly obtain clear images of FT's inner structure, contribute to diagnosing TFTS and will be an indispensable complement to MRI and HPE. More FT sample studies in vivo are needed to confirm the high accuracy rate of OCT.

Discriminating Between Compressive Optic Neuropathy With Glaucoma-Like Cupping and Glaucomatous Optic Neuropathy Using OCT and OCTA.

Purpose: To discriminate between compressive optic neuropathy with glaucoma-like cupping (GL-CON) and glaucomatous optic neuropathy (GON) by comparing the peripapillary retinal nerve fiber layer (pRNFL) thickness and retinal microvasculature using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Methods: In this retrospective cross-sectional study, OCT scans were performed on 28 eyes of GL-CON, 34 eyes of GON, and 41control eyes to determine the pRNFL thickness, ganglion cell complex thickness, and cup/disc ratio. OCTA scans were conducted for 12 eyes of GL-CON, 15 eyes of GON, and 15 control eyes to measure the vessel density of the peripapillary and macular areas. Analysis of covariance was used to perform the comparisons, and the area under the curve was calculated. Results: The GON eyes had a significantly thinner pRNFL in the inferior quadrant and greater vertical cup/disc ratio than the GL-CON eyes. In the radial peripapillary capillary segment, the vessel density of the GON in the inferior sectors was significantly lower than in the GL-CON. The superficial macular vessel density in the whole-image, peritemporal, perinasal, and peri-inferior sectors was significantly smaller in the GON group than in the GL-CON group. The best parameter for discriminating between GL-CON and GON was the superficial macular vessel density in the peritemporal sector. Conclusions: GL-CON eyes showed a characteristic pattern of pRNFL and retinal microvascular changes. Translational Relevance: GL-CON can be effectively distinguished from GON by detecting the alterations in the pRNFL and retinal microvasculature using OCT and OCTA.