Lamellar macular hole surgery - current concepts, future prospects.

The aim of this literature review was to summarize novel optical coherence tomography (OCT) imaging biomarkers that have recently been described in the literature and are frequently encountered clinically. The literature was reviewed to identify novel OCT biomarkers reported to date. A descriptive summary of all terms and representative illustrations were provided to highlight the most relevant features. Thirty-seven OCT terminologies were identified. The vitreomacular interface disorder group included the four stages of epiretinal membrane, macular pseudohole, tractional lamellar hole (LH), degenerative LH, cotton ball sign, and foveal crack sign. The age-related macular degeneration group included outer retinal tubulation, multilayered pigment epithelial detachment, prechoroidal cleft, onion sign, double-layer sign, complete outer retinal atrophy, complete retinal pigment epithelium and outer retinal atrophy, and reticular pseudodrusen. The uveitic disorder group consisted of bacillary layer detachment, syphilis placoid, rain-cloud sign, and pitchfork sign. The disorders relating to the toxicity group included flying saucer sign and mitogen-activated protein kinase (MEK) inhibitor-associated retinopathy. The disorders associated with the systemic condition group included choroidal nodules and needle sign. The pachychoroid spectrum group included pachychoroid and brush border pattern. The vascular disorder group included pearl necklace sign, diffuse retinal thickening, disorganization of retinal inner layers, inner nuclear layer microcysts, hyperreflective retinal spots, paracentral acute middle maculopathy, and acute macular neuroretinopathy. The miscellaneous group included omega sign (ω), macular telangiectasia (type 2), and omega sign (Ω). Thirty-seven OCT terminologies were summarized, and detailed illustrations consolidating the features of each biomarker were included. A nuanced understanding of OCT biomarkers and their clinical significance is essential because of their predictive and prognostic value.

Different modes of full-thickness macular hole formation

Redefining Lamellar Holes and the Vitreomacular Interface: An Ultrahigh-Resolution Optical Coherence Tomography Study

The pathogenesis of macular pseudohole (MPH) is supposed to be different from that of macular lamellar hole (LMH). MPH is thought to be caused by centripetal contraction of previously present epiretinal membrane. LMH is considered to be an effect of abortive process of full-thickness macular hole formation, or a result of de-roofing of a foveal cyst in persistent cystoid macular oedema. In most cases of LMH, epiretinal membranes are present. The aim of this paper is to show that LMH and MPH may have a common origin and that LMH may evolve from MPH as an epiretinal membrane contracts. Observational two-case series of patients with MPH and epiretinal membrane. Spectral domain optical coherence tomography (SD-OCT) was performed during follow-up. In 6months of follow-up in case 1 and 2months in case 2, MPH progressed to non-full-thickness macular defect, fulfilling the criterion of LMH in SD-OCT. Non-vitreous interface traction was detected. SD-OCT proves that MPH may progress to LMH without any vitreous traction. Progressive contraction of epiretinal membranes may be a cause of both MPH and LMH, being an advanced stage of the same non-full-thickness macular disorder.

Purpose: The aim of our study is to investigate the effects of hyperbaric oxygen (HBO2) therapy on retinal layers in healthy eyes. Method: Thirty patients who were taken to outpatient HBO2 for any indication were included in the study. All patients underwent 10 sessions of HBO2; 20 healthy patients were taken as the control group. We used the spectral-domain optical coherence tomography (SD-OCT) to obtain automated measurements of thickness for each retinal layer – i.e., the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL) and retinal pigment epithelium (RPE) – and to conduct foveal (central 1 mm), inner-ring (parafoveal 1 to 3mm), and outer-ring (perifoveal 3 to 6mm) retinal layer measurements. Retinal OCT scans were performed before HBO2, after the first and 10th sessions. All retinal layer thicknesses were assessed with SD-OCT software system and compared between each visit. Retinal thicknesses were calculated in the central, inner ring and outer ring subfields (nine quadrants). Results: In SD-OCT measurements, there were no statistically significant difference before HBO2, after the first and 10th sessions in terms of foveal, inner-ring and outer-ring thickness of RNFL, GCL, IPL, INL, OPL, ONL and RPE. Conclusions: Our study demonstrated that there was no change in the thickness of the retinal layers after the first and 10th sessions in healthy eyes.

To assess structure and function across the transition zone (TZ) between relatively healthy and diseased retina in acute zonal occult outer retinopathy. Six patients (6 eyes; age 22-71 years) with acute zonal occult outer retinopathy were studied. Spectral-domain optical coherence tomography, fundus autofluorescence, near-infrared reflectance, color fundus photography, and fundus perimetry were performed and images were registered to each other. The retinal layers of the spectral-domain optical coherence tomography scans were segmented and the thicknesses of two outer retinal layers, that is, the total receptor and outer segment plus layers, and the retinal nerve fiber layer were measured. All eyes showed a TZ on multimodal imaging. On spectral-domain optical coherence tomography, the TZ was in the nasal retina at varying distances from the fovea. For all eyes, it was associated with loss of the ellipsoid zone band, significant thinning of the two outer retinal layers, and in three eyes with thickening of the retinal nerve fiber layer. On fundus autofluorescence, all eyes had a clearly demarcated peripapillary area of abnormal fundus autofluorescence delimited by a border of high autofluorescence; the latter was associated with loss of the ellipsoid zone band and with a change from relatively normal to markedly decreased or nonrecordable visual sensitivity on fundus perimetry. The results of multimodal imaging clarified the TZ in acute zonal occult outer retinopathy. The TZ was outlined by a distinct high autofluorescence border that correlated with loss of the ellipsoid zone band on spectral-domain optical coherence tomography. However, in fundus areas that seemed healthy on fundus autofluorescence, thinning of the outer retinal layers and thickening of the retinal nerve fiber layer were observed near the TZ. The TZ was also characterized by a decrease in visual sensitivity.

One patient with past ocular history of full thickness macular hole surgically closed in the right eye was followed with diagnostic of lamellar macular hole in the left eye since 2000. After uncomplicated cataract surgery in the left eye in March 2008, the lamellar hole spontaneously progressed to full thickness macular hole. The patient underwent pars plana vitrectomy, membrane peel and gas bubble injection, with successful closure of the macular hole and improvement in the visual acuity. Optical coherence tomography (OCT) scans through the macula were performed at the initial and follow-up visits. To the best of our knowledge, this is the first description of a long-standing stable lamellar macular hole progressing into a full thickness macular hole. The causative factors for this progression remain unclear.

The application of spectral domain optical coherence tomography as a surrogate for neurodegeneration in a range of neurological disorders demands better understanding of the physiological variation of retinal layer thicknesses, which may mask any value of this emerging outcome measure. A prospective study compared retinal layer thicknesses between control subjects (n = 15) and runners (n = 27) participating in a 10-km charity run. Three scans were performed using an eye-tracking function (EBF) and automated scan registration for optimal precision at (1) baseline, (2) directly after the run, and (3) following a rehydration period. Retinal layer segmentation was performed with suppression of axial retinal vessel signal artifacts. Following the run, there was an increase in the relative retinal nerve fibre layer (p = 0.018), the combined inner plexiform/ganglion cell layer (p = 0.038), and the outer nuclear layer (p = 0.018) in runners compared to controls. The initial increase of thickness in the outer nuclear layer of runners (p < 0.0001) was likely related to (noncompliant) rehydration during exercise. Following a period of rest and rehydration, the difference in thickness change for all retinal layers, except the retinal nerve fibre layer (RNFL) (p < 0.05), disappeared between the two groups. There is a quantifiable change in the axial thickness of retinal layersthat which can be explained by an increase in the cellular volume. This effect may potentially be caused by H2O volume shifts.

Background/Objectives: Spontaneous macular hole closure is a rare phenomenon, with lamellar hole epiretinal proliferation (LHEP) frequently implicated as a potential mechanism. This study aims to analyze the presence of LHEP in patients with full-thickness macular holes (FTMHs) or lamellar macular holes (LMHs) that closed spontaneously without intervention. Methods: A retrospective longitudinal analysis of optical coherence tomography (OCT) scans was conducted for 73 patients diagnosed with FTMH or LMH in a single institution. Patients with documented spontaneous hole closure were further analyzed for the presence of LHEP, other OCT findings, and clinical characteristics. Results: Of the 73 patients, eight (11%) exhibited spontaneous closure of their macular holes. LHEP was identified in all cases, regardless of hole type (FTMH or LMH). Associated OCT features on diagnosis included VMT in one eye (13%), partial or complete posterior vitreous detachment in seven eyes (88%) and epiretinal membrane in eight eyes (100%). During hole closure, an outer nuclear layer bridge was noted in six eyes (75%). Various extents of outer retinal recovery were noted following closure. After closure, five holes (63%) remained closed without further intervention, while three (38%) reopened and required surgical intervention. Conclusions: Spontaneous macular hole closure is strongly associated with the presence of LHEP, highlighting its potential role in retinal repair mechanisms. While in most patients the spontaneous closure is permanent, surgical intervention may be necessary in cases of hole recurrence.

PurposeBecause air pollution has been linked to glaucoma and AMD, we characterized the relationship between pollution and retinal structure.MethodsWe examined data from 51,710 UK Biobank participants aged 40 to 69 years old. Ambient air pollution measures included particulates and nitrogen oxides. SD-OCT imaging measured seven retinal layers: retinal nerve fiber layer, ganglion cell–inner plexiform layer, inner nuclear layer, outer plexiform layer + outer nuclear layer, photoreceptor inner segments, photoreceptor outer segments, and RPE. Multivariable regression was used to evaluate associations between pollutants (per interquartile range increase) and retinal thickness, adjusting for age, sex, race, Townsend deprivation index, body mass index, smoking status, and refractive error.ResultsParticipants exposed to greater particulate matter with an aerodynamic diameter of <2.5 µm (PM2.5) and higher nitrogen oxides were more likely to have thicker retinal nerve fiber layer (β = 0.28 µm; 95% CI, 0.22–0.34; P = 3.3 × 10−20 and β = 0.09 µm; 95% CI, 0.04–0.14; P = 2.4 × 10−4, respectively), and thinner ganglion cell–inner plexiform layer, inner nuclear layer, and outer plexiform layer + outer nuclear layer thicknesses (P < 0.001). Participants resident in areas of higher levels of PM2.5 absorbance were more likely to have thinner retinal nerve fiber layer, inner nuclear layer, and outer plexiform layer + outer nuclear layers (β = –0.16 [95% CI, –0.22 to –0.10; P = 5.7 × 10−8]; β = –0.09 [95% CI, –0.12 to –0.06; P = 2.2 × 10−12]; and β = –0.12 [95% CI, –0.19 to –0.05; P = 8.3 × 10−4], respectively).ConclusionsGreater exposure to PM2.5, PM2.5 absorbance, and nitrogen oxides were all associated with apparently adverse retinal structural features.

BackgroundEpiretinal proliferation (ERP) is an extension of preretinal tissue, creating a thin, semi-translucent layer of fibrous tissue on the retina. ERP has been recently associated with degenerative lamellar macular holes (DLMH) and full-thickness macular holes (FTMH). The proposed surgery for patients has been vitrectomy and ERM peeling, but there is no consensus on whether DLMH is a stable condition or should be resolved with surgical treatment. The purpose was to investigate optical coherence tomography (OCT) changes and visual outcomes of degenerative LMH and FTMH secondary to ERP after pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling.MethodsThis retrospective case series evaluated 14 eyes with DLMH and eight eyes with FTMH. All 22 eyes were associated with ERP and treated with PPV with ILM peeling. Best-corrected visual acuity (BCVA, in logMAR), OCT findings, including presence of foveal bump and ellipsoid zone integrity, were documented. Wilcoxon signed-rank tests were used for numerical data. Statistical significance was based on a value of p < 0.05.ResultsAmong the 14 DLMH cases, the mean Snellen equivalent VA was 20/75 at baseline; 20/59 at the 4–12-month postoperative period; and 20/56 at the final follow-up visit. For the eight FTMH cases, the mean Snellen equivalent VA was 20/94 at baseline; 20/45 at the 4–12-month postoperative period; and 20/38 at the final follow-up visit. Compared to baseline VA, FTMH cases demonstrated a statistically significant improvement in the 4–12-month postoperative VA (p < 0.05) and in the final postoperative VA (p < 0.05). Among all cases, a strong correlation was observed between baseline logMAR and change in logMAR from baseline to final follow-up (R2 = 0.671).ConclusionThis study demonstrated that surgical intervention led to improved visual and anatomic outcomes in patients with DLMH and FTMH, with a correlation between baseline VA and postoperative visual outcomes. The results suggest that patients with worse preoperative VA experienced the greatest benefit in visual outcome from PPV and ILM peeling. Future studies would look at the timing of when to ideally intervene to improve anatomic and visual outcomes.

Background/aimsTomographic analysis of macular and peripapillary retinal nerve fibers layer (RNFL) thickness in patients with history of congenital (CC) and developmental cataract (DC).MethodsAnalysis of macular and RNFL thickness using a spectral-domain optical coherence tomography was performed. Retinal layers thickness was measured using the internal segmentation software. Measurements of affected (unilateral and bilateral), contralateral eyes and control eyes were compared.ResultsPatients with history of CC or DC (n = 13 and 11 respectively) and 35 healthy control subjects were enrolled. Thicker inner and outer nuclear layers (INL, ONL) and thicker ONL were found when CC and DC group when compared to controls respectively. Bilateral CC showed the most relevant differences. Slight thickening of CC inner retinal layers were found when compared to DC. Increased superonasal RNFL thickness was found in CC group when compared to DC and controls. Thickening of RNFL of contralateral unaffected eyes of unilateral CC were found when compared to controls.ConclusionSignificant macular and RNFL thickness changes between CC, DC patients and controls that partially involve also contralateral unaffected eyes of unilateral congenital cataract were found. CC and DC groups show significant differences only in inner retinal layers thickness. Our data suggest that early visual deprivation may influence retinal arrangements occurring during development involving predominantly the outer nuclear layer and para/perifoveal inner retinal layers, and confirm that early treatment of CC allow to achieve better long-term visual outcome. Moreover functional and structural data support the hypothesis that unilateral amblyopia is not exclusively an unilateral issue.

Objective To investigate the value of tumor hemodynamics and morphological features from conventional dynamic contrast-enhanced MRI (DCE-MRI) scan before surgery in predicting postoperative recurrence time in breast cancer patients. Methods A retrospective analysis of 58 patients with breast cancer who had recurred after operation from November 2012 to December 2014 in Liaoning Cancer Hospital was performed. According to the recurrence time, the patients were divided into early recurrence group (≤2 years after surgery, 33 cases) and late recurrence group (>2 years after surgery, 25 cases). All patients underwent routine DCE-MRI scans before surgery, and hemodynamic features of the three-dimensional volume of the tumor and the morphological and textural features of the tumor in each phase were extracted by computer. The counts and measurement data of patients in early recurrence group and late recurrence group were compared by Fisher′s exact probability method and Mann-Whitney U test, and receiver operating characteristic (ROC) curves were drawn. The multivariate logistic regression was used to calculate the combined efficacy in predicting early recurrence and late recurrence. Kaplan-Meier method was used to analyze the survival prognosis, and Log-Rank test was used to compare the differences in survival curves between groups. Results There was no significant difference in background parenchymal enhancement, lesion margin, lesion internal enhancement characteristics, lesion morphology, time-signal intensity curve type and the degree of whole-breast vascularity increase between early recurrence and late recurrence groups (P>0.05).There were significant differences in the maximum concentration of contrast (Max Conc), the area under the time signal curve (AUC) and the maximum slope value of the time signal curve (Max Slope) (P<0.05). Comparative analysis of the radiomics parameters of 8 phases DCE-MRI found that the sphericity of morphological characteristic parameters in the phase 3 was statistically different between the early recurrence and late recurrence groups (P=0.03). Area under the ROC curve of AUC, Max Conc, Max Slope and parameter sphericity of phase 3 morphological characteristics for predicting early and late recurrence were 0.664, 0.659, 0.684 and 0.670, respectively. The area under the ROC combined with the above four parameters for prediction was 0.765, with a specificity of 63.6% and a sensitivity of 84.0%; the predictive efficacy was higher than that of univariate. Fifty-eight patients were followed up for 17 to 64 months with a median follow-up of 47 months. The disease-free survival and overall survival in the early recurrence group were significantly lower than those in the late recurrence group, and the difference was statistically significant (P<0.05). Conclusion It is of certain value to predict the postoperative recurrence time of breast cancer based on the tumor hemodynamic characteristics combined with morphological characteristics from preoperative non-invasive conventional DCE-MRI. Key words: Breast neoplasms; Magnetic resonance imaging; Texture analysis; Recurrence

PurposeTo assess layer‐ and location‐specific retinal thickness deficits in autosomal dominant optic atrophy (ADOA) on Spectralis SD‐OCT.MethodsThis cross‐sectional study included 41 ADOA patients with OPA1 exon 28 (2826delT) mutation (age, 8.6‐83.5 years; best‐corrected visual acuity (BCVA), 8‐89 ETDRS letters) and 55 mutation‐free first‐degree healthy control relatives (age, 8.9‐68.7 years; BCVA, 80‐99 ETRDS letters). Participants underwent routine examination and OCT with thickness analysis of the total retina, inner retinal layers and outer retinal layers. Individual segmentation was performed of the perifoveal retinal nervefiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer, outer plexiform layer, outer nuclear layer and peripapillary RNFL. Segmentation lines were moved manually to fit optimally with the borders between the layers. Combinations of layers and sectors were tested for their diagnostic significance. Statistical analysis was corrected for age, gender, spherical equivalent, axial length and family clustering in a mixed model analysis.ResultsThe perifoveal RNFL, GCL, IPL and the peripapillary RNFL were all significantly thinner in ADOA patients than in healthy controls (p &lt; 0.0001). No statistical difference was found for other layers. The largest deficit was found in the GCL (‐49.9%), and it reached its maximum in the “nasal inner macula” sector with a thickness deficit of ‐63%. Attenuation of the peripapillary RNFL was most prominent temporally to the optic disc (‐58.4%).ConclusionsIn ADOA, retinal ganglion cells are most prominently missing in the nasal perifoveal area of the GCL, which together with the temporal peripapillary RNFL area serves as the strongest diagnostic OCT marker of ADOA.

To evaluate changes in the segmented retinal layers of pituitary adenoma (PA) patients and to identify the relationship between these changes and visual function. A total of 47 (PA patients) and 22 (healthy subjects) eyes were reviewed from the medical records. The PA patients performed a visual field (VF) test before surgery and 1month after surgery. By optical coherence tomography scanning, eight retinal layers were measured: retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer, outer nuclear layer, retinal pigment epithelium, and photoreceptor layer. The PA group showed reduced RNFL, GCL, and IPL thicknesses (p = 0.004,< 0.001,< 0.001) and thicker INL thickness (p = 0.012) than did the controls. The mean deviation of preoperative VF in the PA group was positively correlated with RNFL, GCL, and IPL thicknesses (R = 0.664, 0.720, 0.664; p < 0.001,< 0.001,< 0.001) and negatively correlated with the INL thickness (R = -0.400; p = 0.010). Among the 47 eyes, 32 eyes (68%) were included for subgroup analysis. Preoperative RNFL, GCL, and IPL thicknesses were thicker in the postoperatively improved VF group (p = 0.019, 0.009, 0.005). The preoperative cutoff values for visual recovery were 23.6μm for RNFL thickness, 30.6μm for GCL thickness, and 28.9μm for IPL thickness. During chiasmal compression, the thickening of the INL has presented in addition to thinning of the inner retinal layers. Also, changes in retinal anatomical structures are related to the extent of VF defect and can be used as a predictor of postoperative visual recovery.