Purpose
The purpose of this study was to describe morphological changes in lamina cribrosa (LC), prelaminar tissue thickness (PTT) and Bruch’s membrane opening (BMO) in eyes affected by papilledema ...and correlate them with trans-LC-pressure difference (TLCD).
Methods
This was a prospective study, including twelve eyes newly diagnosed of papilledema. Eyes underwent scanning with Spectralis-OCT with enhanced depth imaging to compare BMO, anterior LC surface position (LC depth-LCD-) and PTT before and after oedema resolution. Correlation analysis between these parameters and TLCD was performed.
Results
TLCD inversely correlated with LCD at baseline and directly with LC reversal movement after lowering cerebrospinal fluid pressure (CSFP) (ρ
Spearman:
−0.739,
p
= 0.006; ρ
Spearman:
0.844,
p
= 0.001 respectively). At onset, RNFL thickening and BMO were significantly larger in eyes with TLCD > −9.2 mmHg (group 2) compared with TLCD < −9.2 mmHg (group 1)
p
= 0.007,
p
= 0.041 respectively. A significant RNFL and BMO shrinking were observed, but they were significantly larger in group 2. The magnitude of LC displacement following oedema resolution was significantly larger and in the opposite direction in group 2 vs group 1 (−68.7 μm vs 19.5 μm,
p
= 0.016). TLCD correlated with RNFL thickening at baseline (ρ
Spearman:
0.667,
p
= 0.018) and with RNFL thinning at last visit (ρ
Spearman:
0.673,
p
= 0.017). TLCD correlated with mean deviation (MD) (ρ
Spearman:
0.712,
p
= 0.014) and visual field index (VFI) (ρ
Spearman:
−0.657,
p
= 0.028) at onset. MD and VFI were worse in group 2.
Conclusions
LC position was significantly related to TLCD in papilledema. Eyes with higher TCLD showed significantly larger backward LC movement, BMO shrinking and RNFL thinning after lowering CSFP compared with eyes with lower TLCD, where LC movement occurred in the opposite direction.
Introduction:
To report the first case of bilateral ocular decompression retinopathy after uneventful non-perforating deep sclerectomy with mitomycin C in a child with tubulointerstitial nephritis ...and uveitis syndrome.
Case description:
An 8-year-old girl affected by tubulointerstitial nephritis and uveitis syndrome developed ocular hypertension (45 mmHg in the right eye and 42 mmHg in the left eye) associated with recurrent episodes of uveitis and chronic use of steroids despite maximum hypotensive medical treatment. Bilateral non-perforating deep sclerectomy with mitomycin C (0.2 mg/mL, 1 min) was performed under general anesthesia without complications. The first postoperative day, the visual acuity was reduced to 0.6 in the right eye and 0.05 in the left eye and the intraocular pressure was 3 mmHg in both eyes. Fundoscopy revealed bilateral optic nerve swelling and diffuse retinal hemorrhages, some of them with scattered-white centers. About 2 months after surgery, the visual acuity was normal and the fundus examination showed complete resolution.
Conclusion:
The ocular decompression retinopathy is an uncommon complication after non-perforating deep sclerectomy. This is the first case of bilateral ocular decompression retinopathy reported after non-perforating deep sclerectomy in a child with ocular hypertension secondary to recurrent uveitis and chronic use of steroids associated with tubulointerstitial nephritis and uveitis syndrome.
Purpose To evaluate the accuracy of 3 spectral-domain (SD) optical coherence tomography (OCT) devices (Topcon 3D-1000 Topcon; Cirrus HD Carl Zeiss Meditec, Inc, and Spectralis OCT Heidelberg ...Engineering) before and after mydriasis for the diagnosis of diabetic macular edema. Design Cross-sectional study. Methods Sixty-two eyes of 62 consecutive patients with diabetes without recent loss of vision referred for retinal control were assessed. Two scans were performed for each SD OCT instrument. Central retinal thickness was measured before and after pupil dilation. Pupil dynamic was studied using pMetrics pupillometer (iVIS Technologies), and lens opacity was measured by Pentacam densitometry (Oculus). The diagnostic accuracy of SD OCT devices was assessed by sensitivity, specificity, and area under the receiver operating characteristic curve. Logistic regression analysis was used to assess the effect of pupil size and lens opacity on the reliability of SD OCT in the acquisition of adequate images. Results The area under the receiver operating characteristic curve for the Topcon 3D OCT device was 0.84, that for the Cirrus HD OCT device was 0.93, and that for the Spectralis OCT device was 0.91. Significant differences in area under the receiver operating characteristic curve before and after pupillary dilatation were not found. Sensitivity and specificity associated with the cutoff value for the best performance were 82% and 74% for the Topcon 3D OCT device, 90% and 87% for the Cirrus HD OCT device, and 90% and 84% for the Spectralis OCT device, respectively. The Topcon 3D OCT device had an 11.3% segmentation algorithm failure rate for the central millimeter of the fovea, and the nuclear lens density was significantly greater in these eyes than in those without failure (17.1 ± 1.1 mm vs 10.4 ± 0.2 mm; P < .05). Conclusions SD OCT is a useful tool to detect and to measure diabetic macular edema without the need for pupil dilatation.
Optical coherence tomography is a valuable tool for evaluating patients with neuro-ophthalmic disorders. In the acute phase of anterior optic neuritis (ON), peripapillary retinal nerve fiber layer ...(pRNFL) measurements can underestimate the amount of damage as axonal swelling could mask the true degree of RNFL loss. Contrary to pRNFL evaluation, we hypothesize that macular ganglion cell layer analysis could detect true neuronal loss before swelling resolution in anterior ON. We describe 4 patients with anterior ON in whom ganglion cell layer and inner plexiform layer (GCIPL) thinning was detected earlier than pRNFL loss. GCIPL analysis may provide more accurate information than pRNFL thickness and serve as an early structural indicator of irreversible neuronal loss.
BACKGROUND:Retrograde transsynaptic degeneration (RTSD) of the retinal ganglion cells and retinal nerve fiber layer after postgeniculate injury has been well documented, but to the best of our ...knowledge, associated retinal microvascular changes have not been examined. The purpose of our study was to assess vessel density (VD) at macular and peripapillary regions in patients with RTSD.
METHODS:Cross-sectional study including 16 patients with homonymous visual field defects secondary to unilateral postgeniculate visual pathway injury and 18 age-matched controls. All participants were examined with AngioVue optical coherence tomography angiography to measure the peripapillary vessel density and macular vessel density (pVD/mVD) as well as the peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell complex (GCC) thicknesses. The pRNFL and macular ganglion cell–inner plexiform layer (GCIPL) thicknesses also were evaluated using Cirrus OCT. A normalized asymmetry score (NAS) was calculated for GCIPL and GCC thickness, and mVD.
RESULTS:Average pRNFL and macular GCIPL/GCC thicknesses were significantly thinner in both eyes of patients compared with control eyes (all P ≤ 0.05). Eight patients (50%), who showed a RTSD of the GCIPL map, had a relative thinning of the GCIPL/GCC ipsilateral to the brain lesion in both eyes (represented by a positive GCIPL-NAS/GCC-NAS). The mean pVD and mVD also were significantly reduced in patients (all P ≤ 0.05). There was a strong correlation between GCIPL-NAS/GCC-NAS and mVD-NAS index in both eyes (all r > 0.7, P = 0.001). Furthermore, there was a similar spatial pattern of damage for the macular GCC thickness and VD values.
CONCLUSIONS:We demonstrated a significant VD decrease in peripapillary and macular areas of patients with RTSD because of postgeniculate lesions. The structural and microvascular asymmetry indexes were significantly correlated. These findings provide new insights regarding transsynaptic degeneration of the visual system.
Purpose To evaluate the agreement of retinal nerve fiber layer (RNFL) color codes among Stratus, Cirrus, and Spectralis optical coherence tomography (OCT) in patients with relapsing-remitting ...multiple sclerosis. Design Prospective cohort study. Methods In 140 eyes from 70 patients having relapsing-remitting multiple sclerosis from January 2011 to September 2011, peripapillary RNFL thickness was measured using the fast RNFL program by Stratus, the optic disc cube protocol by Cirrus, and the N-site axonal analysis by Spectralis. Results Overall, a moderate to good RNFL color code agreement was found (0.435-0.884), except for the nasal quadrant. The temporal quadrant was the most abnormal color coding by both Cirrus (64.7%) and Spectralis (61.7%) in both the optic neuritis (ON) and non-ON group and by Stratus (58.8%) in the ON group. Abnormal temporal RNFL color-code rate was significantly higher in ON eyes than non-ON eyes by Cirrus ( P < .001), Stratus ( P < .001), and Spectralis ( P = .030). Overall, Cirrus significantly displayed abnormal findings while both Stratus and Spectralis displayed normal results for the inferior quadrant ( P < .05). On the other hand, Spectralis OCT showed a significantly higher rate of abnormal findings while Cirrus displayed normal results for the temporal quadrant in non-ON eyes ( P < .001). Conclusions We found a substantial color-code disagreement among devices in patients with relapsing-remitting multiple sclerosis regarding the ON antecedent. In non-ON eyes, Spectralis yielded a significantly higher thinning for temporal quadrant than Cirrus, suggesting that N-site axonal analysis could define axonal damage in relapsing-remitting multiple sclerosis patients earlier than conventional RNFL analysis.
Purpose:
To assess the changes in peripapillary and macular choroidal thickness, and in the lamina cribrosa position following deep sclerectomy.
Methods:
Prospective study, including 39 eyes with ...open-angle glaucoma following deep sclerectomy. Choroidal thickness was automatically measured using swept-source optical coherence tomography at four peripapillary locations (superior, temporal, inferior, and nasal) and at the macular area in nine fields plotted with Early Treatment Diabetic Retinopathy Study grid. Optic nerve head was evaluated by Spectralis optical coherence tomography with enhanced depth imaging technology. All measurements were performed preoperatively and at 1 week and 2 months after surgery.
Results:
The mean intraocular pressure significantly decreased 1 week and 2 months after surgery (p < 0.001). A significant peripapillary choroidal thickening was observed at all locations 1 week postoperatively (p ≤ 0.002) and in the temporal quadrant 2 months after surgery (p = 0.027). There was a significant thickening in all macular choroidal thickness measurements at 1 week (p < 0.001) and 2 months (p < 0.05), except at subfoveal and inner nasal locations. The mean peripapillary and macular choroid thickness was 22.8% and 19.7% at 1 week and 6.2% and 7.8% at 2 months, respectively. A significant forward lamina cribrosa displacement occurred at every postoperative stage (p < 0.001). Multivariate analysis showed a significant correlation between the magnitude of intraocular pressure reduction and the anterior lamina cribrosa movement (0.623, p = 0.000) and a negative correlation between the intraocular pressure change and the mean peripapillary and macular choroidal thickening (−0.527, p = 0.002; −0.568, p = 0.002, respectively).
Conclusion:
There was a significant reversal lamina cribrosa displacement measured from Bruch’s membrane opening reference despite a significant peripapillary choroidal thickening following deep sclerectomy. Both findings were significantly correlated with the change in intraocular pressure
PDF
