Influence of sleep quality on macula and retinal nerve fiber layer in caucasian healthy adolescents: A cross-sectional assessment with optical coherence tomography / Influência da qualidade do sono na mácula e na camada de fibras nervosas da retina de adolescentes caucasianos saudáveis: uma avaliação transversal por tomografia de coerência ótica

Abstract Objective: Poor sleep quality have affect on neuronal structure in central nervous system. We aimed to investigate the effects of sleep quality on the thickness of retinal nerve fiber layer (RNFL), macula, and ganglion cell complex (GCC) obtained by optical coherence tomography (OCT) in healthy Caucasian adolescents. Methods: In this prospective cross-sectional study,100 healthy adolescents were evaluated for determining of sleep quality score by the Pittsburgh sleep quality index(PSQI) and were monitored for detection of sleep efficiency(%) by Sense Wear PRO3 Armband mobile monitor(SWA). The sleep quality is evaluated based on the PSQI score and PSQI ≤5 was defined as "good sleep", and a score >5 was defined as "poor sleep". All subjects were scanned by spectral-domain OCT for the thicknesses of RNFL, GCC, and macular subfields. Results: Thirty nine of the subjects (39%) have poor sleep quality while 61 of them (61%) have good sleep. Inner superior (P=0.017), inner nasal (P=0.007), inner inferior (P=0.025), outer nasal (P= 0.011), and outer inferior (P=0.007) segments of macular thicknesses in the subjects with poor sleep are significantly thicker than those of the subjects with good sleep, whereas average RNFL of the adolescents with poor sleep is significantly thinner (P=0.02). All these parameters and central macular thickness have significant correlations with sleep efficiency and PSQI score (P<0.05). Conclusion: Sleep quality may have effects on macula and the nerve fiber layer of retina in adolescents and poor sleep may be related to decrease in the thickness of retinal nerve fiber layer.

Resumo Objetivo: A má qualidade do sono afeta a estrutura neuronal do sistema nervoso central. O objetivo do presente estudo foi investigar os efeitos da qualidade do sono sobre a espessura da camada de fibras nervosas da retina (CFNR), a mácula e o complexo de células ganglionares (CCG) de adolescentes caucasianos saudáveis submetidos a tomografia de coerência ótica (TCO). Metodologia: O presente estudo transversal prospectivo avaliou 100 adolescentes saudáveis a fim de determinar o escore de qualidade do sono através do índice da qualidade do sono de Pittsburgh (PSQI); os participantes foram monitorados através do monitor móvel Sense Wear PRO3 Armband (SWA) a fim de detectar a eficiência do seu sono (%). A qualidade do sono foi avaliada com base no escore do PSQI; PSQI ≤ 5 foi definido como "sono de boa qualidade" e valores > 5 foram definidos como "sono de qualidade ruim". Todos os participantes foram submetidos a TCO no domínio espectral para avaliar a espessura dos subcampos CFNR, CCG e macular. Resultados: Trinta e nove participantes (39%) apresentaram sono de qualidade ruim, enquanto 61 (61%) apresentaram sono de boa qualidade. Os segmentos interno superior (P = 0,017), nasal interno (P = 0,007), inferior interno (P = 0,025), nasal externo (P = 0,011) e inferior externo (P = 0,007) de espessuras maculares dos indivíduos com sono de qualidade ruim foram significativamente mais espessos do que os de indivíduos com sono de boa qualidade, enquanto a CFNR média dos adolescentes com sono de qualidade ruim foi significativamente mais fina (P = 0,02). Todos esses parâmetros e a espessura macular central apresentaram correlações significativas com a eficiência do sono e com o escore do PSQI (P < 0,05). Conclusão: A qualidade do sono pode ter efeitos sobre a mácula e a camada de fibras nervosas da retina de adolescentes; além disso, o sono de qualidade ruim pode estar relacionado à diminuição da espessura da camada de fibras nervosas da retina.

Evaluation of toxic retinopathy caused by antimalarial medications with spectral domain optical coherence tomography / Avaliação da frequência de retinopatia por antimaláricos com o exame tomografia de coerência óptica de domínio espectral

ABSTRACT Purpose: To investigate the frequency of toxic retinopathy in patients with lupus erythematosus and rheumatoid arthritis with long-term use of chloroquine diphosphate or hydroxychloroquine through spectral domain optical coherence tomography and the outcomes of ophthalmological exams (visual acuity - Snellen's table, color vision test - Ishihara's table, fundoscopy, and retinography - red-free). Methods: A cross-sectional study was carried out involving the ophthalmologic evaluation of patients using regular chloroquine diphosphate or hydroxychloroquine for a period of 1 year or longer. The patients completed a questionnaire on their opinions and treatment regularity. The same patients underwent ophthalmologic examination and spectral domain optical coherence tomography. Results: The prevalence of toxic retinopathy caused by antimalarials was 4.15% (9 of 217 patients), 7.4% (4 of 54 patients) following chloroquine diphosphate usage, and 0.82% (1 of 121 patients) following hydroxychloroquine usage. Only patients with advanced stage maculopathy presented abnormalities during the ophthalmologic exam: the color vision test was altered in 11.1%, and visual acuity and fundoscopy were altered in 33.3%. Identification of early toxic retinopathy, detected in six patients, was possible using spectral domain optical coherence tomography. The mean duration of antimalarial drug usage among patients with toxic retinopathy was 10.4 years. Only 31% of the patients reported some symptoms during treatment, and although 24% were afraid to use the medication, they did so as prescribed. Conclusion: Use of spectral domain optical coherence tomography was essential for the diagnosis of early-stage antimalarial toxic retinopathy in patients with the following characteristics: asymptomatic, antimalarial use 7 days a week for a period of more than 5 years, and normal clinical ophthalmologic examination.

RESUMO Objetivo: Investigar a frequência da retinopatia tóxica em pacientes com lúpus eritematoso e artrite reumatóide com uso crônico de difosfato de cloroquina ou hidroxicloroquina, através de tomografia de coerência óptica de domínio espectral e os resultados dos exames oftalmológicos (acuidade visual - tabela de Snellen, teste de visão de cor - tabela de Ishihara, fundoscopia e retinografia - red free). Métodos: Foi realizado um estudo transversal envolvendo a avaliação oftalmológica de pacientes em uso regular de difosfato de cloroquina ou hidroxicloroquina por um período de um ano ou mais. Os pacientes responderam a um questionário sobre a sua opinião e regularidade do tratamento. Os mesmos pacientes realizaram exame oftalmológico clínico e tomografia de coerência óptica de domínio espectral. Resultados: A prevalência de retinopatia tóxica por antimaláricos foi de 4,15% (9 dos 217 pacientes), 7,4% (4 de 54 pacientes) após uso de difosfato de cloroquina e 0,82% (1 de 121 pacientes) após uso de hidroxicloroquina. Apenas os pacientes com maculopatia em fase avançada apresentaram alterações durante os exames clínicos: teste de visão de cores alterado em 11,1%, e a acuidade visual e fundoscopia foram alteradas em 33,3%. A identificação de retinopatia tóxica precoce, detectada em seis pacientes, foi possível por meio da tomografia de coerência óptica de domínio espectral. A duração média do tempo de uso de drogas antimaláricas entre os pacientes com retinopatia tóxica foi de 10,4 anos. Apenas 31% dos pacientes relataram algum sintoma durante o tratamento e apesar de 24% terem medo de usar a medicação, eles o fizeram conforme prescrito. Conclusão: O uso da tomografia de coerência óptica de domínio espectral foi essencial para o diagnóstico de retinopatia tóxica antimalárica em estágio inicial em pacientes com as seguintes características: uso assintomático, antimalárico 7 dias por semana por um período maior que cinco anos e exame oftalmológico clínico normal.

Normative values for optical coherence tomography parameters in healthy children and interexaminer agreement for choroidal thickness measurements / Valores normativos de parâmetros de tomografia de coerência óptica em crianças saudáveis e concordância interexaminador de medidas de espessura coroidal

ABSTRACT Purpose: To (a) determine the normative values for optical coherence tomography (OCT) parameters such as central macular thickness, retinal nerve fiber layer thickness, and choroidal thickness in healthy children; (b) investigate the relationships of these parameters with axial length, central corneal thickness, refractive errors, and intraocular pressure; and (c) determine interexaminer agreement for choroidal thickness measurements. Methods: In this cross-sectional study, 120 healthy children aged 8-15 years underwent detailed ophthalmological examination and OCT measurements. Choroidal thickness was measured at three separate locations by two independent examiners. Results: The mean global retinal nerve fiber layer thickness was 98.75 ± 9.45 μm (79.0-121.0). The mean central macular thickness was 232.29 ± 29.37 μm (190.0-376.0). The mean subfoveal choroidal thickness obtained by examiner 1 was 344.38 ± 68.83 μm and that obtained by examiner 2 was 344.04 ± 68.92 μm. Interexaminer agreement was between 99.6%-99.8% for choroidal thickness at three separate locations. Central macular thickness increased with axial length (r=0.245, p=0.007). Choroidal thickness increased with age (r=0.291, p=0.001) and decreased with axial length (r=-0.191, p=0.037). Global retinal nerve fiber layer thickness decreased with axial length (r=-0.247, p=0.007) and increased with central corneal thickness (r=0.208, p=0.022). Global retinal nerve fiber layer thickness positively correlated with choroidal thickness (r=0.354, p<0.001). Global retinal nerve fiber layer thickness (r=0.223, p=0.014) and choroidal thickness (r=0.272, p=0.003) increased with the spherical equivalent (D). Conclusions: Optical coherence tomography parameters showed a wide range of variability in children. Retinal nerve fiber layer thickness, central macular thickness, and choroidal thickness were found to be either inter-related or correlated with age, central corneal thickness, axial length, and refractive errors. Furthermore, manual measurements of choroidal thickness showed high interexaminer agreement. Because normative values for optical coherence tomography parameters differed in children, the measurements should be interpreted according to an age-appropriate database.

RESUMO Objetivo: Determinar valores normativos para parâmetros de tomografia de coerência óptica consistindo em espessura macular central, espessura da camada de fibra nervosa da retina e espessura coroidal em crianças saudáveis, para investigar suas relações com o comprimento axial, espessura corneana central, erros refractivos e pressão intraocular e determinar a concordância interexaminador para medidas de espessura coroidal. Métodos: um total de 120 crianças saudáveis com idade entre 8 e 15 anos foram submetidas a exame oftalmológico detalhado e a medições de tomografia de coerência óptica em uma configuração de estudo transversal. A espessura coroide foi medida por dois examinadores independentes em 3 pontos distintos. Resultados: A espessura global media da camada de fibra nervosa da retina foi de 98.75 ± 9.45 μm (79.0-121.0). A espessura macular central media foi de 232.29 ± 29.37 μm (190.0-376.0). A espessura coroidea subfoveal media foi de 344.38 ± 68.83 μm medida pelo examinador 1 e 344.04 ± 68.92 μm medida pelo examinador 2. A concordância foi entre 99.6-99.8% para a espessura coroidal em 3 pontos distintos. Verificou-se que a espessura macular central aumentava com o comprimento axial (r=0.245, p=0.007). A espessura da coroide aumentou com a idade (r=0.291, p=0.001) e diminuiu com o comprimento axial (r=-0.191, p=0.037). A espessura global da camada de fibras nervosas da retina diminuiu com o comprimento axial (r=-0.247, p=0.007) e aumenta com a espessura central da córnea (r=0.208, p=0.022). A espessura global da camada de fibras nervosas da retina foi correlacionada positivamente com a espessura coroidal (r=0.354, p<0.001). A espessura global da camada de fibras nervosas da retina (r=0.223, p=0.014) e a espessura coroide (r=0.272, p=0.003) aumentaram com o equivalente esférico (D). Conclusões: os parâmetros de tomografia de coerência óptica parecem mostrar uma ampla gama de variabilidade em crianças. A espessura da camada de fibra nervosa da retina, a espessura macular central, a espessura coroidea estão inter-relacionadas ou correlacionadas com a idade, espessura corneana central, comprimento axial e erros refractivos. Além disso, as medidas manuais da espessura coroidea apresentaram alta concordância entre examinadores. Deve-se ter em mente que os valores normativos dos parâmetros da tomografia de coerência óptica diferem em crianças, portanto, as medidas devem ser interpretadas de acordo com uma determinada base de dados apropriada para idade.

Age-associated changes in the inner macular thickness and peripapillary retinal nerve fiber layer thickness / 中华实验眼科杂志

Objective To determine the difference of macular ganglion cell-inner plexiform layer (mGCIPL) thickness and peripapillary retinal nerve fiber layer (pRNFL) thickness using Cirrus HD-OCT between older and young people in order to provide information for glaucomatous progressive analysis.Methods A prospective case series study was adopted.Sixty-seven old persons (114 eyes) aged 60-80 years old were selected from retired staff of an institution who underwent routine physical examinations between June and July 2016 in Beijing Tongren Hospital as older group and 24 young persons(42 eyes) aged (20-40 years old) who underwent routine physical examination at the same period were selected as young group.The total superior,superonasal,inperonasal,inferior,inferotemporal and superotemporal mGCIPL thickness and PRNFL thickness were measured by Cirrus HD-OCT.The research followed the Declaration of Helsinki.The ethics committee of the Tongren Eye Center approved the study and all participants provided an informed consent.Results There were statistical differences in all measurement parameters (mGCIPL and pRNFL) between older and young people (all at P＜0.05) except nasal pRNFL thickness.Minimum mGCIPL thickness was significantly different between older and young group [(74.02±11.01) pm vs.(82.74 ±3.94) μm;t =-7.290,P＜0.001],while in the pRNFL parameters,temporal pRNFL thickness was siginicantly changed between older and young group [(70.83 ± 12.30) μm vs.(82.10 ± 17.02) μm;t =-3.930,P ＜ 0.001].The nasal pRNFL thickness showed no significant difference between the two groups.Conclusions All mGCIPL and most pRNFL parameters in older people were obviously thinner than young people except nasal pRNFL,age factor should be considered seriously in the progression analysis of glaucomatous neuropathy.

En face and OCT angiography findings in macular retinoschisis

Abstract The diagnosis of macular retinoschisis is often complex and demands complementary exams to be confirmed. This is the report of a case of a 27 years old man diagnosed with macular retinoschisis, in which En face OCT and OCT angiography were used to identify and demonstrate the typical patterns of the disease, as well as distinguish them from the findings of cystoid macular edema.

Large colloid drusen analyzed with structural en face optical coherence tomography / Análise de drusas grandes coloidais através de OCT en face estrutural

ABSTRACT Drusen are extracellular deposits between the basal lamina of the retinal pigment epithelium (RPE) and the inner collagenous layer of Bruch's membrane. Large colloid drusen (LCD) are located below the RPE and are characterized by multiple, large, dome-shaped RPE detachments, with marked attenuation of the ellipsoid zone overlaying the drusen. This report presents the structural en face optical coherence tomography (OCT) findings of LCD and relates them to findings from fluorescein and indocyanine green angiography. We describe the case of a 55-year-old woman who presented with the chief complaint of a 5-year history of progressively worsening vision. Her best-corrected visual acuities were 20/40 and 20/400 in the right eye and the left eye, respectively. Fundus examination showed large bilateral, symmetrical, sub-retinal, yellowish lesions compatible with LCD. We describe the structural en face OCT characteristics and angiographic findings from this patient.

RESUMO Drusas são depósitos extracelulares localizados entre a lâmina basal do epitélio pig mentado da retina (RPE) e a camada colágena interna da membrana de Bruch. Drusas grandes coloidais (LCD) estão localizadas abaixo do EPR, e são caracterizadas por múltiplos descolamentos cupuliformes do EPR com atenuação da zona elipsoide sobrejacente às drusas. O objetivo deste relato é apresentar os achados de tomografia de coerência óptica (OCT en face estrutural em uma paciente com LCD, bem como correlacioná-los com angiografia fluoresceínica e angiografia com indocianina verde. Descrevemos o caso de uma paciente do sexo feminino, 55 anos, que referiu baixa acuidade visual em ambos os olhos há 5 anos. Sua acuidade visual corrigida era de 20/40 no olho direito e 20/400 no olho esquerdo. Ao exame fundoscópico a paciente apresentava lesões compatíveis com drusas grandes coloidais. As características tomográficas e angiográficas também são descritas neste relato de caso.

Evaluation of inner segment/outer segment junctions in different types of epiretinal membranes / Avaliação da junção segmento interno/segmento externo em diferentes graus de membranas epirretinianas

ABSTRACT Purpose: This study was conducted to evaluate the relationships of inner/outer segment (IS/OS) junction disruption, macular thickness, and epiretinal membrane (ERM) grade with best-corrected visual acuity (BCVA), as well as the relationship between IS/OS junction disruption and ERM grade. Methods: Fifty-four eyes of 54 patients with different grades of ERM were retrospectively reviewed. Patients were classified into three groups by ERM grade according to retinal striae and vessel distortion: grade/group 1, visible membranes without retinal striae or vessel distortion; grade/group 2, mild to moderate macular striae or vessel straightening; and grade/group 3, moderate to severe striae and vascular straightening. Correlations of BCVA with age, central retinal thickness, ERM grade, and IS/OS disruption as well as of IS/OS disruption, central macular thickness, and BCVA with ERM grade were evaluated. Results: Twenty-nine (53.7%) eyes exhibited IS/OS junction disruption. Groups 1 and 2 differed significantly with respect to BCVA (p=0.038), but groups 2 and 3 did not (p=0.070). Central macular thickness was significantly greater in group 2 than in group 1 (p=0.031) and in group 3 than in group 2 (p=0.033). Groups 1 and 2 differed significantly in terms of IS/OS disruption (p=0.000), but groups 2 and 3 did not (p=0.310). Conclusions: The IS/OS junction appears to be disrupted during the early stages of ERM. Grade 3 ERM is associated with a significantly higher incidence of IS/OS disruption.

RESUMO Objetivo: Este estudo foi realizado para avaliar a relação entre a interrupção da junção segmento interno/segmento externo (IS/OS), espessura macular e grau de membrana epirretiniana (ERM), com a melhor acuidade visual corrigida (BCVA), e a relação entre a interrupção da junção IS/OS com a severidade da ERM. Métodos: Cinquenta e quatro olhos de 54 pacientes com diferentes graus de ERM foram avaliados retrospectivamente. ERMs foram classificadas, de acordo com as estrias de retina e a distorção dos vasos, em 3 grupos: grupo 1 foram membranas visíveis sem estrias retinianas ou distorção dos vasos, grupo 2 membranas com estrias maculares discretas a moderadas ou retificação dos vasos, e grupo 3 membranas com estrias moderadas a graves e retificação vascular. A correlação da BCVA com a idade, espessura central da retina, severidade da ERM e interrupção da junção IS/OS foram avaliadas. A relação de interrupção da junção IS/OS, a espessura macular central e acuidade visual com a severidade da ERM também foram avaliadas. Resultados: Vinte e nove olhos (53,7%) apresentavam interrupção da junção IS/OS. A BCVA foi diferente entre ERMs grupo 1 e grupo 2 (p=0,038), a diferença entre o grupos 2 e 3 não foi estatisticamente significativa (p=0,070). A espessura macular central foi estatisticamente maior no grupo 2, quando comparado ao grupo 1 (p=0,031) e maior no grupo 3 quando comparado ao grupo 2 (p=0,033). A diferença entre o grupo 1 e grupo 2 em relação à interrupção da junção IS/OS foi estatisticamente significativa (p=0,000), ao passo que a diferença entre o grupo 2 e do grupo 3 não foi estatisticamente significativa (p=0,310). Conclusões: As junções IS/OS parecem estar interrompidas nos estágios iniciais da ERM. O grau 3 de ERM têm uma maior incidência significativa de interrupção da junção IS/OS.

A study of the vitreoretinal interface in patients with age-related macular degeneration / Estudo da interface vitreorretiniana em pacientes com degeneração macular relacionada à idade

ABSTRACT Purpose: To assess whether hyaloid adhesion is more prevalent in patients with age-related macular degeneration (AMD) than in control patients and to evaluate whether it is more prevalent in exudative AMD than in non-exudative AMD. Methods: This was a cross-sectional, controlled analytical study. Patients from the Ophthalmology Department of the Public Service Hospital of the State of São Paulo were included if they were diagnosed with AMD that was confirmed by fundus biomicroscopy and fluorescein angiography. Patients were divided into three groups: patients without a vitreoretinal disease (controls), patients with exudative AMD, and patients with non-exudative AMD. For the optimal study of the vitreoretinal interface, all patients were subjected to spectral-domain optical coherence tomography (SD-OCT; Cirrus HD-OCT, version 4000; Carl Zeiss Meditec) and ultrasonography (UltraScan®, Alcon). Results with p values of ≤0.05 were considered statistically significant. Results: We assessed 75 eyes of 23 patients with AMD (14 women and nine men) and 15 the control patients (11 women and four men). In total, 33 eyes had AMD that was consistent with the inclusion criteria, of which 11 had the non-exudative form (non-atrophic) and 22 had the exudative form (11 active and 11 disciform scars). Adherence was observed in eight eyes in the control group (26.67%), in seven eyes with exudative AMD (31.82%), and in five eyes with non-exudative AMD (45.45%). Conclusion: Patients with exudative and non-exudative forms of AMD did not present with higher vitreoretinal adhesion than control patients as assessed by SD-OCT and ultrasound. Moreover, patients with exudative AMD (neovascular membrane and disciform scar) did not reveal a higher adherence than those with non-exudative AMD when evaluated by the same methods.

RESUMO Objetivo: Avaliar se a adesão hialoidea é mais prevalente em pacientes com degeneração macular relacionada a idade (DMRI) (exsudativa e não exsudativa) comparado ao grupo controle e avaliar se a prevalência é maior na forma exsudativa comparada a forma não exsudativa. Métodos: Trata-se de um estudo transversal, analítico, de grupo controle, com os pacientes atendidos no Departamento de Retina do Serviço de Oftalmologia do Hospital do Servidor Público Estadual de São Paulo (HSPE), que tiveram o diagnóstico de DMRI confirmado após a biomicroscopia de fundo e angiofluoresceinografia. Os pacientes foram divididos em três grupos, um composto por pacientes sem doenças vitreorretinianas (30 olhos), outro pacientes com DMRI exsudativa (22 olhos) e o terceiro grupo por pacientes com DMRI não exsudativa (11 olhos). Para melhor estudo da interface vitreorretiniana, todos os pacientes foram submetidos aos exames de SD-TCO (Cirrus HD-TCO, versão 4000; Carl Zeeis Meditec) e ultrassonografia (UltraScan®, Alcon). Foram considerados significativos os resultados com valor de p≤0,05. Resultados: Foram avaliados 75 olhos de 23 pacientes com DMRI e 15 no grupo controle, sendo que apenas 33 olhos que apresentavam DMRI obedeciam aos critérios de inclusão, sendo 11 pertencentes à forma seca (nenhuma forma atrófica) e 22 à forma exsudativa (11 de forma ativa e 11 disciforme). A adesão foi encontrada em oito olhos no grupo controle (26,67%), em sete olhos com DMRI exsudativa (31,82%) e em cinco olhos no grupo DMRI não exsudativa (45,45%). Conclusão: Neste estudo, pacientes com DMRI (formas exsudativa e não exsudativa) não apresentaram maior adesão vitreorretiniana quando comparados ao grupo controle, ao serem avaliados através SD-TCO (Cirrus HD-TCO, versão 4000; Carl Zeeis Meditec) e ultrassonografia (UltraScan®, Alcon). Neste estudo, pacientes com DMRI exsudativa (ativa e disciforme) não apresentaram maior adesão quando comparados à forma seca, ao serem avaliados pelos mesmos métodos.

Repeatability and reproducibility of manual measurements to peripapillary choroidal thickness in healthy children using enhanced depth imaging OCT / 中华实验眼科杂志

Background Current researches of choroidal structure changes primarily focus on macular choroidal thickness in adolescents and children,but there are few studies on peripapillary choroidal thickness in children with enhanced depth imaging (EDI)-OCT.In addition,the reliability of manual measurements to peripapillary choroidal thickness is an important factor for the estimation of EDI-OCT.Objective This study was to determine the repeatability and reproducibility of manual measurements of peripapillary choroidal thickness in children by EDI-OCT.Methods A reliability evaluation of diagnosis test was performed.EDI-OCT technology was used to image the peripapillary choroidal thickness in 49 children aged 7-14 years in Eye Hospital of Wenzhou Medical University from February to March 2015 under the informed consent of their custodians.An annular scanning was carried out surrounding optical disc by the same ophthalmologist with Spectralis OCT,and the peripapillary choroidal thickness was manually measured at global,temporal,superotemporal,superonasal,nasal,inferonasal and inferotemporal zones.The intraclass and interclass repeatability and reducibility of measuring values from intraobserver,inter-observer and intra-session were evaluated with intraclass correlation coefficients (ICC),and BlandAltman agreement analysis was used to assess the consistency of repeated measurements.Results The average age in the subjects was (9.9 ± 1.3) years.No significant difference was found in the mean difference of reduplicative measured peripapillary choroidal thickness at each zone (all at P＞0.05).The ICCs of intra-observer,inter-observer and intra-session were 0.971-0.993,0.827-0.952 and 0.974-0.991,respectively,and the 95％ limit of agreement of global peripapillary choroidal thickness were-12.4-9.7 μm,-15.2-11.6 μm and-16.3-19.1 μm,respectively.Conclusions The repeatability,reproducibility and consistency are favorable in manually measured values of peripapillary choroidal thickness from EDI-OCT image.EDI-OCT appears a good application in the assessment of peripapillary choroidal thickness in children.

Agreement in optic disc measurements between Cirrus HD-OCT and Heidelberg retinal tomograph Ⅱ in myopic eyes / 中华实验眼科杂志

Background As myopia is a common ocular condition which has been reported as the risk factor of primary open angle glaucoma,it is of great importance to evaluate the optic disc morphology in myopic eyes.Objective This study was to evaluate the agreement of optic disc measurements between Cirrus high-density optical coherence tomography (HD-OCT) and Heidelberg retina tomograph (HRT) in myopic eyes;and to investigate the relationships between axial length (AL) and differences of optic disc parameters measured with the two devices.Methods One hundred and fifty myopic subjects were included in this prospective cross-sectional study.One eye from each subject was randomly selected for optic disc imaging by Cirrus HD-OCT and HRT2 in Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong from September to December in 2010 under the approval of Ethic Committee of this hospital and informed consent of each patient was received.Each subject received complete ophthalmic examinations including intraocular pressure (IOP) measurement,visual acuity,refraction,slit lamp,dilated fundus examination and perimetry.The subjects were divided into low (≤-3.00 D,35 eyes),moderate (-3.00 D＜SE＜-6.00 D,60 eyes) and high myopia (SE ≥-6.00 D,55 eyes) groups according to the refractive status.Measurement of axial length was performed with IOL master.Optic disc parameters including disc area,rim area,cup volume,vertical cup-to-disc ratio (VCDR) and average cup-to-disc area ratio (ACDR) were measured by Cirrus HD-OCT and HRT2,respectively.The OCT measurements were corrected for ocular magnification using the Littman's formula,and the results were compared between the instruments.The measurement agreement was evaluated using Bland-Altman plots.Pearson correlation analysis was used to evaluate the associations between AL and the measurement differences of the two instruments.Results The mean axial length and refraction were (25.62±1.10) mm and (-5.22±2.34) D,respectively.The corrected optic disc parameters were significantly larger than those without adjustment by using Cirrus HD-OCT (all at P＜ 0.001).In the high myopic group,the disc area measured by Cirrus HD-OCT was significantly larger than that by HRT2 (P＜0.001).In the moderate myopic group,the rim area measured by HRT2 was significantly larger than that by the Cirrus HD-OCT (P =0.040).The measurements of ACDR,VCDR and cup volume by Cirrus HD-OCT were all larger than those by HRT2 in the three myopic groups (all at P＜0.001).The 95％ limits of agreement (LoA) of disc area and rim area with the two devices were-0.64 to 0.74 and-0.74 mm to 0.62 mm2,respectively.The differences of disc area,rim area and cup volume measurements from the two devices were significantly and positively associated with axial length (r=0.158,0.148,0.156,all at P＜0.05).No significant correlation was detected between AL and the differences of ACDR and VCDR (r =0.012,0.093,both at P ＞ 0.05).Conclusions Optic disc parameters measured by Cirrus HD-OCT are affected by optical magnification in myopic eyes.Poor agreement is found across all of the disc measurements with Cirrus HD-OCT and HRT2.The two devices should not be used interchangeably for measurements of optic disc.Moreover,the differences between measurements of the two devices are significantly associated with AL.

Automated biometry of human ocular anterior segment based on spectral domain optical coherence tomography / 中华实验眼科杂志

Background Ultra-long scan depth OCT can achieve imaging of full range of human ocular anterior segment.However,the measurement of the dimension of anterior segment from the OCT image with high speed and precision is a challenge at present.The software of automatic data processing is still lack in analyzing spectral domain OCT.Objective This study was to perform the automatic biometry and data processing of human ocular anterior segment OCT image by using self-developed automatic detection software and evaluate the accuracy and repeatability of this method.Methods Twenty eyes of 10 normal subjects were included in Eye Hospital of Wenzhou Medical University from June to July 2013.The OCT image of anterior eye segments were obtained with custom-made ultra-long scan depth OCT under the informed consent.Anautomatic software algorithm was developed for the biometric measurement on these OCT images,including boundary segmentation,image registration and optical correction of OCT images.The boundary segmentation algorithm utilized the axial gradient information of OCT images and the shortest path search principal based on the dynamic programming to optimize edge finding.Central corneal thickness (CCT),anterior chamber depth (ACD),pupil diameter (PD),lens thickness (LT),radius of lens anterior curvatures (LAC) and radius of lens of posterior curvatures (LPC) were automatically and manually measured,and the validity of automatic detection algorithm was assessed by calculating the intraclass correlation coefficient (ICC) between the automatic and manual measurements,and the repeatability was validated by calculating the coefficient of repeatability (COR) between repeated measurement.This study was approved by the Ethic Committee of Wenzhou Medical University and informed consent was obtained from all subjects.Results There were no significant differences in the results of CCT,ACD,PD,LT,LAC and LPC between the automatic and manual measurements (P =0.205,0.167,0.285,0.127,0.102,0.074).The results were consistent between automatic and manual measurements (all at ICC＞0.75).The repeated measurement values were consistent in CCT,ACD and LT in both automatic and manual modes (all at ICC＞0.75).The reproducibilities of automatic biometry in PD and LAC (ICC =0.793,0.872;COR =2.90,5.79) were better than those of manual mode (ICC =0.631,0.579;COR =5.62,10.46);while the reproducibility of automatic biometry in LPC (ICC =0.663;COR =6.17) was lower than that of manual mode (ICC =0.794,COR =4.79).Conclusions Self-developed automatic detection software appears to be accurate and repeatable in measuring dimension of spectral domain OCT images.This automatic software algorithm can be used for the biometry and monitor of human ocular anterior segment.

Very Late Stent Thrombosis 11 Years after Implantation of a Drug-Eluting Stent.

Very late stent thrombosis is an infrequent yet potentially fatal complication associated with drug-eluting stents. We report the case of an 88-year-old man who sustained an ST-segment-elevation myocardial infarction 11 years after initial sirolimus-eluting stent implantation. Optical coherence tomograms of the lesion showed that the focal incomplete endothelialization of the stent struts was the likely cause; neointimal formation, neoatherosclerosis, and late stent malapposition might also have contributed. To our knowledge, this is the longest reported intervening period between stent insertion and the development of an acute coronary event secondary to very late stent thrombosis. The associated prognostic and therapeutic implications are considerable, because they illuminate the uncertainties surrounding the optimal duration of antiplatelet therapy in patients who have drug-eluting stents. Clinicians face challenges in treating these patients, particularly when competing medical demands necessitate the discontinuation of antiplatelet therapy. In addition to the patient's case, we discuss factors that can contribute to very late stent thrombosis.

Quantitative analysis of choroidal neovascularization by split spectrum amplitude decorrelation angiography OCT / 中华实验眼科杂志

Background Choroidal neovascularization (CNV) is a major cause of visual loss in many fundus diseases.Fundus angiography (FA) is essential for the diagnosis,location and treatment of CNV.However, FA is an invasive examination method.Split spectrum amplitude decorrelation angiography (SSADA) OCT can quickly and clearly provide vascular signals.However, whether SSADA-OCT is feasible in the evaluation of CNV remains unclear.Objective This study was to detect and quantify CNV using OCT angiography.Methods Thirteen patients with unilateral CNV were included in Beijing Tongren Eye Center from June 2014 to August 2014.All affected eyes of the subjects were scanned with a high-speed frequency domain OCT.The SSADA-OCT images were obtained by scanning of macula covered 6 mm×6 mm area.The CNV area and grey scale were computed from the en face OCT images of retinal layer and choroidal layer.This study followed the Helsinki Declaration and was approved by the Ethics Committee of Beijing Tongren Hospital,and written informed consent was obtain from each patient prior to any medical examination.Results SSADA-OCT angiogram revealed CNV area and location confirmed by fluorescein angiography,and the CNV blood flow information of internal limiting membrane,inner plexiform layer,retinal pigment epithelium,and choroid was exhibited by OCT angiography.All CNVs with different causes showed the well defined and hyperreflected signal in macular region.The average CNV area was (0.15 ±0.09)mm2 , and the average grey scale of CNV was 75.40±32.35 in the affected eyes,and that in the contralateral eyes was 26.99±22.87 in the 300 μm area,showing significant elevation in gray scale in the affected eyes compared with the contralateral eyes (t =6.946, P＜0.001).Conclusions OCT angiography is a noninvasive observation technique of retinal and choroidal blood flow.It can provide quantitative information and detailed images of CNV.

Comparison of central corneal thickness measurements using optical low-coherence reflectometry, Fourier domain optical coherence tomography, and Scheimpflug camera / Comparação entre medidas de espessura central da córnea com reflectometria óptica de baixa coerência, tomografia de coerência óptica de domínio Fourier, e câmera Scheimpflug

Purpose: To compare the results of central corneal thickness (CCT) measurements obtained using optical low-coherence reflectometry (OLCR), Fourier domain optical coherence tomography (FD-OCT), and a Scheimpflug camera (SC), combined with Placido corneal topography. Methods: A total of 25 healthy subjects were enrolled in the present study, and one eye of each subject was included. A detailed ophthalmic examination was performed in all cases following CCT measurements with OLCR, FD-OCT, and SC. The results were compared using an ANOVA test. Bland-Altman analysis was used to demonstrate agreement between methods. Intra-examiner repeatability was assessed by using intraclass correlation coefficients (ICCs). Results: Statistically significant differences were observed between the results of the CCT measurements obtained using the three different devices (p=0.009). Significant correlations were found between OLCR and FD-OCT (r=0.97; p<0.0001), FD-OCT and SC (r=0.91; p<0.0001), and OLCR and SC (r=0.95; p<0.0001). The 95% limits of agreement (LOA) obtained from Bland-Altman plots were from -7.2 μm to 28.7 μm for OLCR versus FD-OCT, from -19.2 μm to 30.4 μm for OLCR versus SC, and from -42.6 to 32.3 μm for FD-OCT versus SC. Intra-examiner repeatability was excellent for each method, with ICCs >0.98. Conclusion: Although the results of CCT measurements obtained from these three devices were highly correlated with one another and the mean differences between instruments were comparable with the reported diurnal CCT fluctuation, the measurements are not directly interchangeable in clinical practice because of the wide LOA values. .

Objetivo: Comparar os resultados de medições de espessura corneana central (CCT ) obtidos com reflectometria óptica de baixa coerência (OLCR), tomografia de coerência óptica de domínio Fourier (FD-OCT ), e uma câmera Scheimpflug (SC), combinada com topografia corneana de placido. Métodos: Um olho de cada de 25 indivíduos saudáveis foram incluídos neste estudo. Um exame oftalmológico detalhado foi realizado em todos os casos após as medidas de CCT com OLCR, FD-OCT, e SC. Os resultados foram comparados por meio do teste ANOVA. Análise de Bland-Altman foi utilizada para demonstrar concordância entre os métodos. A repetibilidade intra-examinador foi avaliada por meio de coeficientes de correlação intraclasse (ICCs). Resultados: Foram observadas diferenças estatisticamente significativas entre os resultados das medidas de CCT obtidas a partir de três dispositivos diferentes (p=0,009). Foram encontradas correlações significativas entre OLCR e FD-OCT (r=0,97, p<0,0001), FD-OCT e SC (r=0,91, p<0,0001), e OLCR e SC (r=0,95; p<0,0001). Os limites de 95% de confiança (LOA) obtidos a partir de gráficos de Bland-Altman foram de -7,2 a 28,7 μm para OLCR contra FD-OCT, de -19,2 a 30,4 μm para OLCR contra SC, e de -42,6 a 32,3 μm para FD-OCT contra SC. A repetibilidade intra-examinador foi excelente para cada método com ICCs>0,98. Conclusões: Apesar de os resultados das medições CCT obtidos a partir destes três dispositivos terem sido altamente correlacionados entre si e as diferenças médias entre os instrumentos serem comparáveis à flutuação relatado da CCT diurna, as medições não são diretamente intercambiáveis na prática clínica em razão da largura dos valores limites de confiança. .

Applications of visual evoked potentials and Fourier-domain optical coherence tomography in Parkinson's disease: a controlled study / Potenciais evocados visuais e tomografia de coerência óptica com domínio de Fourier na doença de Parkinson: um estudo controlado

Purpose: The goal of this cross-sectional observational study was to quantify the pattern-shift visual evoked potentials (VEP) and the thickness as well as the volume of retinal layers using optical coherence tomography (OCT) across a cohort of Parkinson's disease (PD) patients and age-matched controls. Methods: Forty-three PD patients and 38 controls were enrolled. All participants underwent a detailed neurological and ophthalmologic evaluation. Idiopathic PD cases were included. Cases with glaucoma or increased intra-ocular pressure were excluded. Patients were assessed by VEP and high-resolution Fourier-domain OCT, which quantified the inner and outer thicknesses of the retinal layers. VEP latencies and the thicknesses of the retinal layers were the main outcome measures. Results: The mean age, with standard deviation (SD), of the PD patients and controls were 63.1 (7.5) and 62.4 (7.2) years, respectively. The patients were predominantly in the initial Hoehn-Yahr (HY) disease stages (34.8% in stage 1 or 1.5, and 55.8 % in stage 2). The VEP latencies and the thicknesses as well as the volumes of the retinal inner and outer layers of the groups were similar. A negative correlation between the retinal thickness and the age was noted in both groups. The thickness of the retinal nerve fibre layer (RNFL) was 102.7 μm in PD patients vs. 104.2 μm in controls. Conclusions: The thicknesses of retinal layers, VEP, and RNFL of PD patients were similar to those of the controls. Despite the use of a representative cohort of PD patients and high-resolution OCT in this study, further studies are required to establish the validity of using OCT and VEP measurements as the anatomic and functional biomarkers for the evaluation of retinal and visual pathways in PD patients. .

Objetivo: Este estudo observacional transversal controlado visou quantificar os potenciais evocados visuais com estímulo de padrões alternantes (PEV), a espessura e o volume das camadas retinianas com tomografia de coerência óptica (TCO) num grupo de pacientes com doença de Parkinson (DP). Métodos: Quarenta e três pacientes com DP e 38 controles. Procedimentos: pacientes e controles foram submetidos a exames neurológico e oftalmológico detalhados, sendo incluídos pacientes com DP idiopática e excluídos casos com glaucoma ou aumento da pressão intraocular. Todos os participantes foram estudados com PEV e TCO de Fourier, sendo quantificadas as latências de P100, a espessura e o volume das camadas retinianas interna e externa. Resultados: A média das idades e desvio-padrão dos pacientes com DP e controles foram respectivamente 63,1(7,5) e 62,4 (7,2) anos. Os pacientes com DP situaram-se predominantemente nos estágios iniciais de Hoehn-Yahr (34.8% no estágio 1 ou 1.5; 55.8 % no estágio 2). Não foram observadas diferenças entre os dois grupos quanto às latências dos PEV, a espessura e o volume das camadas retinianas. Observamos uma correlação negativa entre a espessura das camadas retinianas e a idade em ambos os grupos. Não se observou diferença significativa quanto à espessura da camada retiniana das fibras do nervo óptico (CRFNO), que foi de 102,7 μm nos pacientes e 104,2 μm nos controles. Conclusões: A espessura das camadas retinianas, os PEV e a espessura da CRFNO foi semelhante nos pacientes com DP e controles. Apesar desse grupo representativo de pacientes com DP e da alta resolução da TCO utilizada neste estudo, mais estudos são necessários para estabelecer o papel da TCO e dos PEV como biomarcadores anatômico e funcional na avaliação ...

Direct cyclopexy surgery for post-traumatic cyclodialysis with persistent hypotony: ultrasound biomicroscopic evaluation / Ciclopexia direta em ciclodiálise pós-traumática com hipotonia ocular persistente -acompanhamento por biomicroscopia ultrassônica (UBM)

Cyclodialysis is a relatively rare condition usually caused by ocular injury; however, it can also be caused iatrogenically during intraocular surgery. Hypotony maculopathy is the most important complication and the primary reason for visual loss. Clinical diagnosis using gonioscopy may be difficult, and ultrasound biomicroscopy (UBM) can be an alternative. There are different kinds of treatments, and the optimal one remains controversial. Here we describe a case of traumatic cyclodialysis with persistent ocular hypotony treated by direct cyclopexy, as illustrated by UBM performed before and after surgery.

Ciclodiálise é uma condição relativamente rara, geralmente devido a um trauma ocular, mas também pode ser causada iatrogenicamente como consequência de cirurgia intraocular. A maculopatia hipotônica é a complicação mais importante e a principal razão para a perda visual nessa situação. O diagnóstico clínico por gonioscopia pode ser difícil e a biomicroscopia ultrassônica (UBM) pode ser uma alternativa. Existem diferentes tipos de tratamentos e algumas controvérsias sobre a melhor opção. Neste relato, nós descrevemos um caso de ciclodiálise traumática com hipotonia ocular persistente tratado por cyclopexia direta avaliado por UBM antes e depois da cirurgia.