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Current Neurology and Neuroscience... Mar 2024Papilledema refers to optic disc swelling caused by raised intracranial pressure. This syndrome arises from numerous potential causes, which may pose varying degrees of... (Review)
Review
PURPOSE OF REVIEW
Papilledema refers to optic disc swelling caused by raised intracranial pressure. This syndrome arises from numerous potential causes, which may pose varying degrees of threat to patients. Manifestations of papilledema range from mild to severe, and early diagnosis is important to prevent vision loss and other deleterious outcomes. The purpose of this review is to highlight the role of optical coherence tomography (OCT) in the diagnosis and management of syndromes of raised intracranial pressure associated with papilledema.
RECENT FINDINGS
Ophthalmoscopy is an unreliable skill for many clinicians. Optical coherence tomography is a non-invasive ocular imaging technique which may fill a current care gap, by facilitating detection of papilledema for those who cannot perform a detailed fundus examination. Optical coherence tomography may help confirm the presence of papilledema, by detecting subclinical peripapillary retinal nerve fiber layer (pRNFL) thickening that might otherwise be missed with ophthalmoscopy. Enhanced depth imaging (EDI) and swept source OCT techniques may identify optic disc drusen as cause of pseudo-papilledema. Macular ganglion cell inner plexiform layer (mGCIPL) values may provide early signs of neuroaxonal injury in patients with papilledema and inform management for patients with syndromes of raised intracranial pressure. There are well-established advantages and disadvantages of OCT that need to be fully understood to best utilize this method for the detection of papilledema. Overall, OCT may complement other existing tools by facilitating detection of papilledema and tracking response to therapies. Moving forward, OCT findings may be included in deep learning models to diagnose papilledema.
Topics: Humans; Papilledema; Optic Disk; Tomography, Optical Coherence; Retinal Ganglion Cells; Nerve Fibers; Intracranial Hypertension
PubMed: 38261144
DOI: 10.1007/s11910-023-01327-6 -
Comparative Medicine Aug 2023Chronic asymptomatic and acute symptomatic anterior uveitis are forms of ocular inflammation associated with juvenile idiopathic arthritis (JIA) Chronic JIA-associated...
Chronic asymptomatic and acute symptomatic anterior uveitis are forms of ocular inflammation associated with juvenile idiopathic arthritis (JIA) Chronic JIA-associated uveitis is characterized by young age of onset, female predilection, oligoarthritis, and antinuclear antibody (ANA) positivity. Acute JIA-associated uveitis predominantly affects older male juveniles who also develop enthesitis. A type I collagen-derived peptide (melanin-associated antigen [MAA]) induces anterior uveitis in rodents. In this study, we evaluated MAA-induced uveitis in rats as a potential model for JIA-uveitis. We characterized MAA-induced uveitis by assessing its relationship to age and sex; tracking the occurrence of arthritis, enthesitis, and ANA positivity; and measuring vitreous fluid inflammatory biomarkers. Juvenile and adult and male and female Lewis rats () were inoculated with MAA. Slit-lamp biomicroscopy, indirect ophthalmoscopy, and joint examinations were performed 3 times weekly. Rats were euthanized at 4 wk after MAA inoculation, and plasma ANA testing, vitreous inflammatory biomarker assays, and globe histopathology assessments were conducted. Uveitis, arthritis, ANA status, levels of inflammatory biomarkers, histopathology, and joint tomographic images were assessed in relation to age and sex and compared with nonuveitic controls. All MAA-immunized rats developed uveitis characterized by anterior chamber fibrin, iridal vessel dilation, and miosis, and uveal and choroidal lymphocytic infiltration. Levels of the vitreous fluid biomarker CCL5 were higher in uveitic rats compared with control rats. Time to uveitis onset, clinical uveitis scores, and biomarker levels did not differ based on age or sex. None of the MAA-exposed rats had arthritis, enthesitis, or ANA. None of the rats inoculated with MAA that had been treated with matrix metallopeptidase 1 had clinical, histologic, or immunohistochemical evidence of ocular inflammation. In contrast to JIA-associated uveitis in humans, MAA-induced uveitis in rats is not associated with age or sex predilections and MAA is not arthritogenic.
Topics: Humans; Male; Female; Rats; Animals; Child; Arthritis, Juvenile; Collagen Type I; Rats, Inbred Lew; Uveitis; Uveitis, Anterior; Biomarkers; Inflammation
PubMed: 37550056
DOI: 10.30802/AALAS-CM-22-000129 -
Retina (Philadelphia, Pa.) Nov 2023To study the status of retinal pigment epithelium in nonexudative and active choroidal neovascularization (CNV) in neovascular age-related macular degeneration.
PURPOSE
To study the status of retinal pigment epithelium in nonexudative and active choroidal neovascularization (CNV) in neovascular age-related macular degeneration.
METHODS
Only treatment-naïve neovascular age-related macular degeneration patients were enrolled in this prospective case-control study, including 17 eyes with nonexudative CNV (6 males and 11 females, 74.9 ± 10.0 years) and 28 eyes with active CNV (8 males and 20 females, 69.3 ± 6.8 years). All patients received a comprehensive ophthalmic examination, optical coherence tomography, dark-field scanning laser ophthalmoscopy, and fundus autofluorescence. The status of the retinal pigment epithelium was assessed with ImageJ software as the brightness of the CNV region on transillumination optical coherence tomography, dark-field scanning laser ophthalmoscopy, and fundus autofluorescence images. Choroidal neovascularization vessel density was measured based on optical coherence tomography angiography.
RESULTS
The brightness of CNV region in nonexudative CNV was statistically significantly lower than in active CNV with both optical coherence tomography transillumination ( P = 0.004) and dark-field scanning laser ophthalmoscopy ( P = 0.0015). No difference in brightness of the CNV region between nonexudative and active CNV was found based on fundus autofluorescence ( P = 0.44). The vessel density of nonexudative CNV was statistically significantly higher than that of active CNV with a median value of 64.5% (95% confidential interval [CI] 53.4-79.0%) and 55.3% (95% CI 52.2-60.0%), respectively ( P = 0.05).
CONCLUSION
Multimodal imaging revealed substantial alteration of the retinal pigment epithelium in active CNV but not in nonexudative CNV which correlates with the higher vessel density of nonexudative CNV.
Topics: Male; Female; Humans; Middle Aged; Aged; Aged, 80 and over; Retinal Pigment Epithelium; Pilot Projects; Case-Control Studies; Fluorescein Angiography; Choroidal Neovascularization; Tomography, Optical Coherence; Macular Degeneration; Multimodal Imaging
PubMed: 37487237
DOI: 10.1097/IAE.0000000000003896 -
Translational Vision Science &... Nov 2023Adaptive optics scanning laser ophthalmoscopy (AOSLO) enables the visualization and measurement of the retinal microvasculature structure in humans. We investigated the...
PURPOSE
Adaptive optics scanning laser ophthalmoscopy (AOSLO) enables the visualization and measurement of the retinal microvasculature structure in humans. We investigated the hypothesis that diabetes mellitus (DM) induces remodeling to the wall structure in small retinal arterioles. These alterations may allow better understanding of vascular remodeling in DM.
METHODS
We imaged retinal arterioles in one eye of 48 participants (26 with DM and 22 healthy controls) with an AOSLO. Structural metrics of 274 arteriole segments (203 with DM and 71 healthy controls) ≤ 50 µm in outer diameter (OD) were quantified and we compared differences in wall thickness (WT), wall-to-lumen ratio (WLR), inner diameter (ID), OD, and arteriolar index ratio (AIR) between controls and participants with DM. We also compared the individual AIR (iAIR) in groups of individuals.
RESULTS
The WLR, WT, and AIRs were significantly different in the arteriole segments of DM participants (P < 0.001). The iAIR was significantly deviated in the DM group (P < 0.001) and further division of the participants with DM into groups revealed that there was an effect of the presence of diabetic retinopathy (DR) on the iAIR (P < 0.001).
CONCLUSIONS
DM induces remodeling of wall structure in small retinal arterioles and in groups of individuals. The use of AIR allows us to assess remodeling independently of vessel size in the retina and to compute an index for each individual subject.
TRANSLATIONAL RELEVANCE
High-resolution retinal imaging allows noninvasive assessment of small retinal vessel remodeling in DM that can improve our understanding of DM and DR in living humans.
Topics: Humans; Arterioles; Retina; Retinal Vessels; Diabetic Retinopathy; Ophthalmoscopy; Diabetes Mellitus
PubMed: 37962539
DOI: 10.1167/tvst.12.11.16 -
International Ophthalmology Oct 2023To demonstrate the methodology and efficacy of using scanning laser ophthalmoscopy (SLO) and dynamic optical coherence tomography (OCT) to identify and treat symptomatic...
PURPOSE
To demonstrate the methodology and efficacy of using scanning laser ophthalmoscopy (SLO) and dynamic optical coherence tomography (OCT) to identify and treat symptomatic vitreous floaters using yttrium-aluminum garnet laser vitreolysis (YLV).
METHODS
This is a case series highlighted from a cross sectional retrospective study conducted at the Vitreous Retina Macula Specialists of Toronto. Forty eyes from thirty-five patients were treated with YLV between November 2018 and December 2020 for symptomatic floaters and imaged with SLO and dynamic OCT. Patients were re-treated with YLV if they reported ongoing significant vision symptoms during follow-up which correlated to visible opacities on exam and or imaging. Three cases will be highlighted to present the practical applications of SLO and dynamic OCT imaging for YLV treatment.
RESULTS
Forty treated eyes were enrolled in this study, with twenty-six eyes (65%) requiring at least one repeat YLV treatment following the first treatment due to ongoing symptomatic floaters. Following the first YLV, there was a significant improvement in overall mean best corrected visual acuity compared to before treatment (0.11 ± 0.20 LogMAR units vs. 0.14 ± 0.20 LogMAR units, p = 0.02 (paired t test)). Case 1 demonstrates a dense, solitary vitreous opacity that has been localized with dynamic OCT imaging to track its movements and retinal shadowing with the patient's eye movements. Case 2 shows the utility of adjusting the fixation target to monitor the movement of vitreous opacities in real-time. Case 3 exhibits an association between decreased symptom burden and vitreous opacity density after YLV.
CONCLUSION
Image-guided YLV facilitates the localization and confirmation of vitreous opacities. SLO and dynamic OCT of the vitreous can provide a real-time evaluation of floater size, movement, and morphology, to help clinicians target treatment and monitoring of symptomatic floaters.
Topics: Humans; Retrospective Studies; Cross-Sectional Studies; Vitrectomy; Eye Diseases; Vitreous Body; Vision Disorders; Tomography, Optical Coherence
PubMed: 37402010
DOI: 10.1007/s10792-023-02765-4 -
Translational Vision Science &... Jun 2024To assess longitudinal reproducibility of metrics of foveal density (peak cone density [PCD], cone density centroid [CDC], and 80th percentile centroid area) in...
PURPOSE
To assess longitudinal reproducibility of metrics of foveal density (peak cone density [PCD], cone density centroid [CDC], and 80th percentile centroid area) in participants with normal vision.
METHODS
Participants (n = 19; five male and 14 female) were imaged at two time points (average interval of 3.2 years) using an adaptive optics scanning light ophthalmoscope (AOSLO). Foveally centered regions of interest (ROIs) were extracted from AOSLO montages. Cone coordinate matrices were semiautomatically derived for each ROI, and cone mosaic metrics were calculated.
RESULTS
On average, there were no significant changes in cone mosaic metrics between visits. The average ± SD PCD was 187,000 ± 20,000 cones/mm2 and 189,000 ± 21,700 cones/mm2 for visits 1 and 2, respectively (P = 0.52). The average ± SD density at the CDC was 183,000 ± 19,000 cones/mm2 and 184,000 ± 20,800 cones/mm2 for visits 1 and 2, respectively (P = 0.78). The average ± SD 80th percentile isodensity contour area was 15,400 ± 1800 µm2 and 15,600 ± 1910 µm2 for visits 1 and 2, respectively (P = 0.57).
CONCLUSIONS
Foveal cone mosaic density metrics were highly reproducible in the cohort examined here, although further study is required in more diverse populations.
TRANSLATIONAL RELEVANCE
Determination of the normative longitudinal changes in foveal cone topography is key for evaluating longitudinal measures of foveal cone topography in patients with progressive retinal dystrophies.
Topics: Humans; Retinal Cone Photoreceptor Cells; Male; Fovea Centralis; Female; Adult; Reproducibility of Results; Middle Aged; Cell Count; Young Adult; Ophthalmoscopy; Tomography, Optical Coherence; Visual Acuity
PubMed: 38913007
DOI: 10.1167/tvst.13.6.18 -
Ophthalmology. Retina Jan 2024Classify the appearance and quantify the growth rate of chorioretinal atrophy in patients who received voretigene neparvovec-rzyl (VN) for RPE65-mediated retinal...
PURPOSE
Classify the appearance and quantify the growth rate of chorioretinal atrophy in patients who received voretigene neparvovec-rzyl (VN) for RPE65-mediated retinal degeneration.
DESIGN
Multicenter retrospective analysis.
SUBJECTS
Patients who underwent subretinal VN injection at 5 institutions and demonstrated posterior-pole chorioretinal atrophy.
METHODS
Ultrawidefield scanning laser ophthalmoscopy or color fundus photos were assessed before and after subretinal VN. Atrophy was defined as regions with ≥ 2 of the following: (1) partial or complete retinal pigment epithelial depigmentation; (2) round shape; (3) sharp margins; and (4) increased visibility of choroidal vessels. Atrophy was qualitatively classified into different subtypes. All atrophy was manually segmented. Linear mixed-effects models with random slopes and intercepts were fit using atrophy area and square root of atrophy area.
MAIN OUTCOME MEASURES
Number of eyes with each atrophy pattern, and slopes of linear mixed-effects models.
RESULTS
Twenty-seven eyes from 14 patients across 5 centers developed chorioretinal atrophy after subretinal VN. A mean of 5.8 ± 2.7 images per eye obtained over 2.2 ± 0.8 years were reviewed, and atrophy was categorized into touchdown (14 eyes), nummular (15 eyes), and perifoveal (12 eyes) subtypes. Fifteen eyes demonstrated > 1 type of atrophy. Thirteen of 14 patients demonstrated bilateral atrophy. The slopes of the mixed-effects models of atrophy area and square root of atrophy area (estimate ± standard error) were 1.7 ± 1.3 mm/year and 0.6 ± 0.2 mm/year for touchdown atrophy, 5.5 ± 1.3 mm/year and 1.2 ± 0.2 mm/year for nummular atrophy, and 16.7 ± 1.8 mm/year and 2.3 ± 0.2 mm/year for perifoveal atrophy. The slopes for each type of atrophy were significantly different in the square root of atrophy model, which best fit the data (P < 0.05).
CONCLUSIONS
Chorioretinal atrophy after subretinal VN for RPE65-mediated retinal degeneration developed according to a touchdown, nummular, and/or perifoveal pattern. Perifoveal atrophy grew the most rapidly, while touchdown atrophy grew the least rapidly. Understanding the causes of these findings, which are present in a minority of patients, merits further investigation.
FINANCIAL DISCLOSURE(S)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Topics: Humans; Retinal Degeneration; Retrospective Studies; Choroid Diseases; Atrophy
PubMed: 37660736
DOI: 10.1016/j.oret.2023.08.017 -
Diagnostics (Basel, Switzerland) Nov 2023To describe longitudinal changes in patients with non-paraneoplastic autoimmune retinopathy (npAIR) by utilizing different diagnostic modalities/tests.
BACKGROUND
To describe longitudinal changes in patients with non-paraneoplastic autoimmune retinopathy (npAIR) by utilizing different diagnostic modalities/tests.
METHODS
The index study is a retrospective longitudinal review of sixteen eyes of eight patients from a tertiary care eye hospital diagnosed with npAIR. Multiple diagnostic modalities such as wide-angle fundus photography (WAFP), WA fundus autofluorescence (WAFAF), spectral-domain optical coherence tomography (SD-OCT), Goldmann visual field (GVF) perimetry, microperimetry (MP), electrophysiologic testing, and adaptive optics scanning laser ophthalmoscopy (AOSLO) were reviewed and analyzed.
RESULTS
At the baseline visits, anomalies were detected by multimodal diagnostic tests on all patients. Subjects were followed up for a median duration of 11.5 [3.0-18.7] months. Structural changes at the baseline were detected in 14 of 16 (87.5%) eyes on WAFP and WAFAF and 13 of 16 (81.2%) eyes on SD-OCT. Eight of the ten (80%) eyes that underwent AOSLO imaging depicted structural changes. Functional changes were detected in 14 of 16 (87.5%) eyes on GVF, 15 of 16 (93.7%) eyes on MP, and 11 of 16 (68.7%) eyes on full-field electroretinogram (ff-ERG). Multifocal electroretinogram (mf-ERG) and visual evoked potential (VEP) tests were performed in 14 eyes, of which 12 (85.7%) and 14 (100%) of the eyes demonstrated functional abnormalities, respectively, at baseline. Compared to all the other structural diagnostic tools, AOSLO had a better ability to demonstrate deterioration in retinal microstructures occurring at follow-ups. Functional deterioration at follow-up was detected on GVF in 8 of 10 (80%) eyes, mf-ERG in 4 of 8 (50%) eyes, and MP in 7 of 16 (43.7%) eyes. The ff-ERG and VEP were stable in the majority of cases at follow-up.
CONCLUSIONS
The utilization of multimodal imaging/tests in the diagnosing and monitoring of npAIR patients can aid in identifying anomalous changes over time. Analysis of both the anatomical and functional aspects by these devices can be supportive of detecting the changes early in such patients. AOSLO shows promise as it enables the capture of high-resolution images demonstrating quantifiable changes to retinal microstructure.
PubMed: 37958272
DOI: 10.3390/diagnostics13213376 -
Scientific Reports Jul 2023Cigarette smoking is known to adversely affect cellular metabolism and is a risk factor for various retinal diseases. Fluorescence lifetime imaging ophthalmoscopy (FLIO)...
Cigarette smoking is known to adversely affect cellular metabolism and is a risk factor for various retinal diseases. Fluorescence lifetime imaging ophthalmoscopy (FLIO) has the potential to detect metabolic changes in the ocular fundus. Aim of this study was to analyze the influence of cigarette smoking on fluorescence lifetime (FLT) of healthy eyes using FLIO. Twenty-six non-smokers and 28 smokers aged between 20 and 37 years without systemic and ocular diseases were investigated by FLIO (excitation: 473 nm, emission: short spectral channel (SSC) 498-560 nm, long spectral channel (LSC) 560-720 nm). The FLT at the ETDRS grid regions were analyzed and compared. In SSC, the mean FLT (τ) of smokers was significantly longer in the ETDRS inner ring region, whereas the τ in LSC was significantly shorter in the outer ring. For the long component (τ), smokers with pack year < 7.11 showed significantly shorter τ in SSC than non-smokers and the smokers with pack year ≥ 7.11. There were no significant differences in retinal thickness. The lack of obvious structural differences implies that the observed FLT changes are likely related to smoking-induced metabolic changes. These results suggest that FLIO may be useful in assessing retinal conditions related to lifestyle and systemic metabolic status.
Topics: Humans; Young Adult; Adult; Fundus Oculi; Cigarette Smoking; Reproducibility of Results; Retina; Ophthalmoscopy; Retinal Diseases; Nicotiana; Tomography, Optical Coherence
PubMed: 37460627
DOI: 10.1038/s41598-023-37484-4 -
Journal of Clinical Medicine Jul 2023This study seeks to evaluate the results of nailfold videocapillaroscopies (NVCs) among patients with central serous chorioretinopathy (CSC) and their correlation with...
AIM
This study seeks to evaluate the results of nailfold videocapillaroscopies (NVCs) among patients with central serous chorioretinopathy (CSC) and their correlation with the choroid and retinal parameters.
MATERIAL AND METHODS
The examined group included 152 patients with acute, recurrent, chronic and neovascular CSC (34 F, 118 M, mean age 45.9 ± 8.9) and 41 healthy controls (12 F, 29 M, mean age 47 ± 11.5). The NVC examination, ophthalmoscopy, angio-OCT and OCT were performed. In addition, the medical history regarding chronic general disorders and known risk factors were recorded.
RESULTS
Abnormal NVC patterns and the dilated apical part of capillaries were found only in CSC patients ( = 0.000). Neoangiogenesis was observed in 25 acute (58.14%), 22 recurrent (42.31%), 16 chronic (36.36%) and 5 neovascular patients (45.45%) and 2 control subjects (4.88%) ( = 0.000). Glomerular capillaries were found in 8 acute (18.6%), 17 recurrent (31.48%), 25 chronic (56.82%) and 8 neovascular patients (72.73%) ( = 0.000). Meandering capillaries were more common in acute and recurrent CSC and glomerular capillaries were more common in chronic and aneurysmal dilations in neovascular CSC.
CONCLUSIONS
The observed digital microcirculation abnormalities in patients with CSC, such as dilation, meandering, tortuosity and glomerular, may confirm systemic micro-vasculopathy. The potential role of the NVC examination in assessing the CSC prognosis requires further evaluation.
PubMed: 37510932
DOI: 10.3390/jcm12144817