Desprendimiento de la capa bacilar de la retina asociado a enfermedad inflamatoria ocular

El desprendimiento de la capa bacilar de la retina es la separación de los segmentos internos de los fotorreceptores del resto de la retina neurosensorial, o separación entre la zona miode y elipsoide de la retina, que en un hallazgo reciente se puede identificar mediante la tomografía de coherencia óptica de dominio espectral. El objetivo es actualizar los conocimientos sobre el desprendimiento de la capa bacilar de la retina y el uso de la tomografía de coherencia óptica de dominio espectral en las enfermedades oculares que están asociadas con este signo. Se consultaron las fuentes bibliográficas como Google académico, SciELO LAC, Medline y MEDICARIBE. Se limitaron los resultados al idioma español e inglés y a los últimos cinco años. Se recuperaron 54 documentos, de ellos 18 resultaron relevantes a esta investigación. Los autores más mencionados fueron Ramtohul, Metha y Cicinelli. Ellos trabajaron el signo clínico en cuestión y reportaron la experiencia en la atención a los pacientes aquejados con esta enfermedad ocular. El desprendimiento de la capa bacilar de la retina es un signo presente en varias enfermedades asociadas a inflamación del segmento posterior ocular. La tomografía de coherencia óptica de dominio espectral es una técnica efectiva para determinarlo, aunque estos planteamientos aún son escasos en la literatura, lo cual reafirma la importancia científica de continuar los estudios a partir de hipótesis iniciales desde el punto de vista histológico y tomográfico.

Retinal bacillary layer detachment is the separation of the inner segments of the photoreceptors from the rest of the neurosensory retina, or separation between the myode and ellipsoid zone of the retina, which in a recent finding can be identified by spectral-domain optical coherence tomography. The objective is to update the knowledge about the detachment of the bacillary layer of the retina and the use of spectral-domain optical coherence tomography in ocular diseases that are associated with this sign. Bibliographic sources such as academic Google, SciELO LAC, MEDLINE and MEDICARIBE were consulted. Fifty-four documents were retrieved, of which 18 were relevant to this research. The results were limited to the Spanish and English language and to the last five years. The most mentioned authors were Ramtohul, Metha and Cicinelli. They worked on the clinical sign in question and reported the experience in caring for patients afflicted with this ocular disease. Detachment of the bacillary layer of the retina is a sign present in several diseases associated with ocular posterior segment inflammation. Spectral-domain optical coherence tomography is an effective technique to determine it, although it is still scarce in the literature, which reaffirms the scientific validity of continuing studies from initial hypotheses from the histological and tomographic point of view.

Quantitative Measurements of Macular and Optic Nerve Head Blood Flow Parameters Following Cataract Surgery in Eye Department, Red Cross Tertiary General Hospital, Athens, Greece

Objective: To evaluate the effect of uncomplicated cataract surgery on macular and optic nerve head blood flow with Optical Coherence Tomography Angiography (OCT-A). Retinal vascular changes and macular vessel remodeling following cataract surgery is an area of interest, as the effect, cause and duration of such changes remain debatable.Setting: Eye Department, Red Cross Tertiary General Hospital, Athens, Greece.Methods: In this study, we recruited cataract surgery candidates who had regular post operative visits and underwent longitudinal OCT-A examinations before and after surgery.Results: Macular vessel density increased in the post operative visits both in the superficial (SCP) and deep capillary network (DCP) (P<0.001) and showed a persistent effect over 3 months follow-up. Macular thickness increased over the first postoperative month, but returned to preoperative values at 3 months. Foveal avascular zone (FAZ) measurements and vessel density at radial peripapillary capillaries (RPC) were unaffected.Conclusions: OCT-A enables a quantitative analysis of blood flow by regular patient monitoring. In this study, we found that after cataract surgery, macular blood flow increased significantly. The reason for this could be attributed to post operative inflammatory process or vascular remodeling due to change in retinal metabolic demands.

Comparison of spectral-domain optical coherence tomography parameters between the eyes of anisometropic amblyopia children and normal eyes / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the thickness of retina in macular area and retinal nerve fiber layer(RNFL)around optic disc between the eyes of monocular anisometropic amblyopia children and normal eyes.METHODS: A total of 62 children(124 eyes)with monocular anisometropic amblyopia who were treated in Chengdu Women's and Children's Central Hospital from January 2021 to October 2022 were selected as the experimental group, and 60 children(60 eyes; right eye)with normal vision who were treated in the same period were selected as the control group. Spectral-domain optical coherence tomography(SD-OCT)was used to detect the retinal thickness in macular region and the RNFL thickness around optic disc in the two groups, and comparative analysis was performed.RESULTS: The retinal thickness and perioptic RNFL thickness of amblyopic children in experimental group were thicker than those in control group, and most of them had significant differences(P&#x003C;0.05). The retinal thickness and perioptic RNFL thickness of contralateral non-amblyopic children in experimental group were thinner than those in control group, but there were no significant differences in most of them(P&#x003E;0.05).CONCLUSIONS: There are differences in the retinal thickness of the macula and perioptic RNFL in the amblyopic eye and the contralateral non-amblyopic eye of monocular anisometropic amblyopic children compared with normal eyes, and the contralateral non-amblyopic eye is not completely equal to the normal eye.

Evaluation of the predictive effect of parafoveal blood flow density of macula on the number of intravitreal Conbercept injections in patients with branch retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate blood flow density within 300μm(FD-300)around the foveal avascular zone(FAZ)in optical coherence tomography angiography(OCTA)of patients with macular edema(ME)complicated with non-ischemic branch retinal vein occlusion(BRVO), and to explore and evaluate the predictive effect of this parameter on the number of intraocular drug injections.METHODS: A retrospective case study. A total of 50 patients(50 eyes)who were diagnosed as non-ischemic BRVO combined with ME and received intravitreal conbercept(IVC)in the Affiliated Eye Hospital of Nanjing Medical University from January 2021 to March 2022 were selected, and they were treated with 3+PRN regimen. The 25 cases(25 eyes)treated with intraocular injection ≤5 times were classified as group B, and 25 cases(25 eyes)treated with intraocular injection &#x003E;5 times were classified as group C, and 25 fellow eyes were randomly selected as control group A. OCTA was used to scan the macular area in 3mm×3mm to collect images of retinal blood flow, the central macular thickness(CMT)and FD-300. The CMT, best-corrected visual acuity(BCVA), and FD-300 were compared between the two groups at baseline, 1, 3, 6 and 12mo after the third injection.RESULTS: The BCVA(LogMAR)of the affected eye in both groups B and C at 1, 3, 6 and 12mo after the third injection was significantly lower than baseline(all P&#x003C;0.05); the CMT and FD-300 were significantly lower than baseline(all P&#x003C;0.05). Pearson correlation analysis showed that the change of BCVA(LogMAR)was positively correlated with the baseline FD-300 and CMT(group B: r=0.77, 0.70, all P&#x003C;0.01; group C: r=0.89, 0.78, all P&#x003C;0.01). The number of intraocular injections was negatively correlated with the baseline FD-300(group B: r=-0.63, P&#x003C;0.01; group C: r=-0.71, P&#x003C;0.01). Logistic regression analysis showed that the FD-300 at baseline is a factor that affects the number of intraocular drug injection.CONCLUSION: IVC can effectively alleviate macular edema of the affected eye,improve visual acuity and reduce FD-300. The eyes with worse BCVA and lower FD-300 at baseline may require more injections of anti-VEGF. Observation of FD-300 with OCTA can better predict eventual vision recovery of non-ischemic BRVO with ME before treatment.

Evaluation of macular function changes in glaucoma using MAIA microperimetry / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the characteristics of microperimetry in patients with glaucoma, and investigate the correlation between microperimetry and best corrected visual acuity(BCVA), standard automatic perimetry and optical coherence tomography(OCT)index.METHODS: This case-control study included 45 patients(76 eyes)with glaucoma(glaucoma group), among which 15 patients(25 eyes)with primary open-angle glaucoma and 30 patients(51 eyes)with chronic angle-closure glaucoma, and 40 healthy individuals(76 eyes)were included in the control group. MAIA microperimetry, Humphrey perimetry, and BCVA tests were performed in all examined eyes. Correlation analysis was performed using the structural indices measured by OCT.RESULTS: The mean sensitivity(MS)in macular area measured by microperimetry and the ganglion cell complex(GCC)and retinal nerve fiber layer(RNFL)thickness measured by OCT were decreased in glaucoma patients when compared to the control group. Additionally, the mean defect(MD)measured by Humphrey perimetry(10-2 visual field test), focal loss volume(FLV), global loss volume(GLV)measured by OCT, and 63% bivariate contour ellipse area(BCEA )measured by MAIA microperimetry were higher than those of the control group. The MS was negatively correlated with MD, FLV, GLV and BCVA(LogMAR)in the glaucoma group(rs=-0.839, -0.665, -0.530, and -0.424, all P&#x003C;0.01). In contrast, MS was positively correlated with GCC and RNFL in the glaucoma group(rs=0.437, 0.500, all P&#x003C;0.01). MAIA microperimetry had a shorter detection time. Receiver operating characteristic(ROC)curve analysis showed that MAIA microperimetry had moderate accuracy for the diagnosis of glaucoma.CONCLUSIONS: MAIA microperimetry has high sensitivity and can detect retinal sensitivity reduction in areas of structural damage tested by OCT. The microperimetry values were correlated with BCVA, standard automatic perimetry parameters, and OCT parameters. MAIA microperimetry combined with OCT will increase the early diagnosis rate of glaucoma.

Multimodal imaging features of dome-shaped macula with subretinal fluid in adolescents with high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the multimodal image features of dome-shaped macula(DSM)with subretinal fluid(SRF)in adolescents with high myopia, and investigate its typical features and identification methods.METHODS: This is a retrospective study. A total of 21 adolescent patients(39 eyes)who were diagnosed as DSM in high myopic eyes with SRF in the macula area in our hospital from January 2021 to May 2022 were selected. All patients underwent color fundus photography(CFP), fundus autofluorescence(FAF), spectral-domain optical coherence tomography(SD-OCT), optical coherence tomography angiography(OCTA)and electro oculography(EOG). Among them, 18 patients(36 eyes)underwent fundus fluorescein angiography(FFA), and they were followed-up for 12mo to record the change of the central macular thickness(CMT).RESULTS: Fundus examination showed tessellated retina in affected eyes, and the deposition of granular material could be seen in the fovea of the macular area. SD-OCT showed a dome-like bulge of the whole layer in the macular area, localized detachment of the subfoveal nerve epithelial layer, the medium and high reflection attachment on the inner surface of the outer membrane, and the heterogeneous reflection of the retinal pigment epithelium(RPE)layer. FAF showed a mild “bull's eye sign” change in the macular area. FFA showed granular transmitted fluorescence around the foveal avascular zone. En face of OCTA could see a clear boundary of the neuroepithelial detachment zone. When the tangential line corresponds to the ellipsoid zone-RPE layer, the granular high reflection in different sizes scattered in the neuroepithelial detachment zone could be seen, and no obvious choroidal neovascularization(CNV)was formed. During the follow-up of OCTA, SRF in the macular area can be spontaneously increased or absorbed irregularly. EOG indicates that the ratio of light peak to dark trough(LP/DT, i.e. Arden ratio)was normal, with an Arden ratio&#x0026;#x003E;1.55. CMT at 1, 3, 6, 12mo(247.10±13.03, 246.62±12.23, 248.05±14.00, 247.92±11.66 μm)during follow-up period were compared with baseline(246.95±11.46 μm), and the difference was not statistically significant(F=0.144, P=0.965).CONCLUSION: Multimodal imaging is helpful in the clinical diagnosis of DSM with SRF in the macula area in high myopic eyes of adolescents, and plays an important role in the differential diagnosis of the early stage of typical Best disease.

Changes of microvascular structure in the macular region of pediatric uveitis / 中华眼底病杂志

Objective:To observe and analyze the macular microvascular system changes in unilateral pediatric uveitis (PU) and healthy contralateral eyes.Methods:A cross-sectional case-control study. From January 2019 to July 2021, 21 eyes of 21 patients with PU diagnosed in one eye (PU group), 21 unaffected contralateral eyes (contralateral eye group), and 21 age-matched volunteers with 21 eyes (NC group) during the same period were examined in Peking Union Medical College Hospital. Optical coherence tomography angiography was used to scan the 6 mm × 6 mm fundus macular area in the three groups of selected eyes to measure the vessel density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of the retina, the area of the avascular zone (FAZ) in the fovea of the macula, the choroidal thickness under the fovea (SFCT), and the retinal thickness in the fovea of the macula (CRT). The device comes with a software choriocapillary flow measurement tool, which can obtain the macula's choriocapillary density (CCD) with the fovea as the center and the diameter of the annular area of 1.0 mm, 1.5 mm, and 3.0 mm, respectively. They were recorded as CCD-1.0, CCD-1.5, and CCD-3.0. The measurement data of multiple groups were compared by analysis of variance; if the variance of the three groups of data was not uniform, the Kruskal-Wallis test was used. Multiple linear regression analysis was used to evaluate the potentially related factors of CCD.Results:Compared with the contralateral eye group and the NC group, the vessel density of SCP ( H=-13.857,-25.500; P=0.043, P<0.001), DCP ( H=-15.333, -31.595; P=0.007, P<0.001) and CCD-1.0 ( H=-14.000,-16.214; P=0.040, 0.012) of the clinically quiescent PU group were significantly decreased. CRT and FAZ were not statistically different between PU and NC groups ( F=0.955; P=1.000, 0.661). Compared with the NC group, the mean vessel density of SCP and DCP in the contralateral eye group decreased, and the difference in DCP vessel density was statistically significant ( H=-16.262, P=0.004). There was no statistically significant difference between the CCD of two groups ( P=1.000). The SFCT of the PU group was significantly thicker than that of the NC group ( F=5.552, P=0.004), however, difference was not statistically significant from the fellow eye group ( F=5.552, P=0.270). The results of multiple linear regression analysis revealed that the CCD-1.0, CCD-1.5, and CCD-3.0 showed a linear correlation with the area of FAZ ( β=-0.494, -0.527, -0.566; P=0.015, 0.009, 0.010) and CRT ( β=-0.322, -0.466, -0.342; P=0.026, 0.002, 0.028). CCD-1.0 and CCD-1.5 showed a linear correlation with the vessel density of DCP ( β=0.277, 0.275; P=0.047, 0.045). Conclusion:Both retinal and choroidal microvasculature are abnormal in resting eyes with PU, and macular circulation disorders may be present in the unaffected fellow eye.

Effect of intravitreal anti-VEGF injection on choroidal thickness in patients with diabetic macula edema / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate for any detectable change in sub-foveal choroidal thickness following intravitreal injections of Ranibizumab or Aflibercept in patients with central involving diabetic macula edema(DME), evidenced by optical coherence tomography(OCT).<p>METHODS: Totally 17 patients with central involving DME who required and agreed to intravitreal anti-VEGF injection were invited to be the subject of this study. These injection-naive subjects were undergone three loading doses of monthly intravitreal anti-VEGF(Ranibizumab 0.5 mg/0.05 mL for 9 patients or Aflibercept 2 mg/0.05 mL for 8 patients)injection, and a clinic review appointment 1mo after the third injection. The changes of foveal choroidal thickness, visual acuity and central retinal thickness at 1mo were observed before and after treatment in 2 groups by enhanced depth image-optical coherence tomography(EDI-OCT). <p>RESULTS: We recorded a significant sub-foveal choroidal thinning and vision improvement after three loading doses of anti-VEGF(all <i>P</i><0.05). The thinning effect between Ranibizumab and Aflibercept group was insignificant(all <i>P</i>>0.05). There was no significant correlation between pre-treatment sub-foveal choroidal thickness and vision improvement(<i>r_s</i>=-0.269, <i>P</i>=0.296). There was also no significant correlation between choroidal thickness changes with vision improvement, central retinal thickness change and age of subjects(all <i>P</i> >0.05).<p>CONCLUSION: Intravitreal Ranibizumab and Aflibercept injections both leads to significant sub-foveal choroidal thinning in DME subjects. It was accompanied with significant vision improvement with no evidence of immediate detrimental effect of choroidal thinning. Future research with a longer study duration would help in establishing the duration and long term effect of choroidal thinning.

SD-OCT assessment and visual field changes 1 year or more after a single episode of unilateral acute primary angle closure / Avaliação do SD-OCT e mudanças do campo visual 1 ano ou mais após episódio único de fechamento angular primário agudo unilateral

ABSTRACT Objective: To evaluate structural and visual field (VF) changes after ≥1 year of a single acute primary angle closure (APAC) attack using spectral-domain optical coherence tomography (SD-OCT) and standard automated perimetry (SAP). Methods: Patients with a single unilateral APAC crisis at least 1 year ago were included consecutively from 2013 to 2016. Contralateral eye was used as control. All patients underwent ophthalmic examination, RNFL imaging by SD-OCT, and SAP using Octopus 1-2-3. Results: 54 eyes (27 patients) were enrolled. Male-to-female ratio was 1:2. Mean time for the SD-OCT and SAP assessment after the crisis was 5.0±5.1 (1.0-23.5) years, and IOP was 52.5±9.8 mmHg. In APAC eyes, the thicknesses of all quadrants of peripapillary RNFL (36.3%; P<0.001) and some macular sections (from 2.1% to 4.7%; P<0.01) were reduced compared to contralateral eyes. Additionally, in APAC eyes, the mean defect on VF was negatively and statistically correlated with the reduction of all quadrants of peripapillary RNFL thickness. Conclusion: A single episode of APAC was associated with peripapillary RNFL and macular thickness and with VF defects after ≥1 year of the crisis in the affected eye. Statistically meaningful correlations were found between structural and functional damage.

RESUMO Objetivo: Avaliar alterações estruturais e do campo visual 1 ano ou mais após uma crise única de fechamento angular primário agudo utilizando tomografia de coerência óptica de domínio espectral e perimetria automatizada padronizada. Métodos: Pacientes que apresentaram crise unilateral única de fechamento angular primário agudo há pelo menos 1 ano foram consecutivamente incluídos entre 2013 e 2016. Os olhos contralaterais foram utilizados como controles. Todos os pacientes foram submetidos a exame oftalmológico, avaliação das camadas de fibras nervosas da retina utilizando tomografia de coerência óptica de domínio espectral e perimetria automatizada padronizada com o Octopus 1-2-3. Resultados: Foram incluídos 54 olhos (27 pacientes) com razão homem:mulher de 1:2. O tempo médio após a crise foi de 5,0±5,1 anos (1,0 a 23,5) e a pressão intraocular na crise foi 52,5±9,8mmHg. Nos olhos com fechamento angular primário agudo, todas as espessuras das camadas de fibras nervosas da retina peripapilares (36,3%; p<0,001) e de algumas seções maculares (de 2,1 a 4,7%; p<0,01) estavam reduzidas em comparação aos olhos contralaterais. Além do mais, nos olhos submetidos a fechamento angular primário agudo, o mean defect do campo visual foi estatisticamente e negativamente correlacionado com a redução da espessura de todos os quadrantes peripapilares da camada de fibras nervosas da retina. Conclusão: Um único episódio de fechamento angular primário agudo foi associado com redução na espessura da camada de fibras nervosas da retina peripapilar e da espessura macular e com defeitos de campo visual 1 ano ou mais após a crise no olho afetado. Correlações estatisticamente significativas foram identificadas entre danos estruturais e funcionais.

Descolamento seroso da retina neurossensorial associado à mácula dome-shaped: relato de dois casos / Serous detachment of the sensorineural retina associated with the dome-shaped macula: report of two cases

RESUMO A mácula dome-shaped consiste na elevação convexa da região macular, encontrada principalmente em pacientes com alta miopia. O significado clínico e a correlação com outras patologias oculares ainda são incertos. Este artigo tem como objetivo descrever dois casos de mácula dome-shaped com acúmulo de fluido sub-retiniano em olhos alto míopes. Trata-se de pacientes com baixa acuidade visual, fundus miopicos e nítida elevação em forma de cúpula na área macular vista na tomografia de coerência óptica. A mácula dome-shaped pode cursar com descolamento seroso da retina neurossensorial envolvendo a fóvea, levando à baixa acuidade visual. Sua patogênese ainda não é bem estabelecida. De acordo com a tomografia de coerência óptica, a mácula dome-shaped pode ser classificada em três tipos morfológicos, sendo, nesses dois casos, demonstrada a disposição oval horizontalizada. Interessante ressaltar que o diagnóstico de mácula dome-shaped deve ser considerado em pacientes alto míopes, especialmente quando há queixa de baixa acuidade visual, que pode estar relacionada à presença de fluido sub-retiniano. Como o exame clínico não permite o diagnóstico adequado da mácula em cúpula, a realização da tomografia de coerência óptica com cortes verticais e horizontais é fundamental na suspeita de mácula dome-shaped.

ABSTRACT Dome-shaped macula consists of the convex elevation of the macular region, found mainly in patients with high myopia. The clinical significance and the correlation with other ocular pathologies are still uncertain. This article aims to describe two cases of dome-shaped macula with accumulation of subretinal fluid in high myopic eyes. Those are patients with low visual acuity, myopic fundus and a clear dome-shaped elevation in the macular area at optical coherence tomography. A dome-shaped macula can course with a serous detachment of the sensorineural retina involving the fovea, leading to low visual acuity. Such a pathogenesis is still not well studied. According to the optical coherence tomography, dome-shaped macula can be classified into three morphological types, those two cases being shown in a horizontal, oval arrangement. It is interesting to note that the diagnosis of dome-shaped macula should be considered in patients with high myopia, especially when there is a complaint of low visual acuity, which may be related to the presence of subretinal fluid in cases of dome-shaped macula. As the clinical examination does not allow an adequate diagnosis of the domed macula, the performance of the optical coherence tomography with vertical and horizontal cuts is fundamental in the suspicion of the dome-shaped macula.

Meta-analysis of macular microcirculation in patients with no diabetic retinopathy evaluated by OCTA / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: Meta-analysis was performed to systematically evaluate the macular vessel density(VD)and foveal avascular zone(FAZ)areas in patients with no diabetic retinopathy(NDR)by using optical coherence tomography angiography(OCTA). This study aimed to investigate the microcirculatory characteristics of the retina in the early stage of diabetes.METHODS: PubMed, Embase, Web of Science and Cochrane Library databases were searched for publications from 1 January, 2011 to 5 January, 2021 on OCTA analysis of VD in different regions of the macular area in diabetic patients with NDR. Compare the differences in the superficial parafoveal VD(spafVD), superficial perifoveal VD(spefVD), deep parafoveal VD(dpafVD), deep perifoveal vessel density(dpefVD), superficial FAZ area and best corrected visual acuity(BCVA)between NDR group and the normal control group(healthy population matched for the age at the same time and gender with patients in the NDR group).RESULTS: Thirteen publications with a total of 1 227 eyes(558 eyes in normal control group and 669 eyes in NDR group)were included in the study. Meta-analysis showed that compared with the control group, NDR group displayed a significant decrease in spafVD(MD=-1.90, 95%CI: -2.43--1.37, P&#x003C;0.00001), spefVD(MD=-1.29, 95%CI: -2.14--0.44, P=0.003), dpafVD(MD=-2.18, 95%CI: -2.69--1.67, P&#x003C;0.00001)and dpefVD(MD=-2.37, 95%CI: -3.27--1.46, P&#x003C;0.00001), with a more significant reduction in dpefVD, and superficial FAZ area(MD=0.04, 95%CI: 0.03-0.06, P&#x003C;0.00001)was increased. There was no difference in BCVA(MD=0.00, 95%CI: -0.01-0.02, P=0.44)between the two groups.CONCLUSION:Capillary injury in the deep perifoveal region of the macular area is the earliest manifestation of retinal microcirculation disturbance in diabetic patients, and is also a key indicator for clinical follow-up of diabetic retinopathy.

Microperimetry differences in macular sensitivity threshold between first and second tested eyes / Diferenças no limiar de sensibilidade macular na microperimetria entre o primeiro e o segundo olhos testados

ABSTRACT Purpose: To comparatively assess the macular sensitivity threshold of microperimetry and the fixation stability between the first (right) and second (left) tested eye of normal participants. Methods: Thirty healthy patients were randomly assigned to two groups. The participants underwent microperimetry in the fast mode and expert mode in groups I and II, respectively. Each participant underwent a single test and the right eye was tested first. Results: The mean macular sensitivity threshold (± standard deviation [SD]) was 24.5 ± 2.3 dB and 25.7 ± 1.1 dB in the first (right) and second (left) eyes of group I, respectively (p=0.0415) and 26.7 ± 4.5 dB and 27.3 ± 4.0 dB in the first (right) and second (left) eyes of group II, respectively (p=0.58). There was no statistically significant difference between eyes in either group (p=0.1512). Regarding fixation stability (evaluated in the microperimetry expert mode group), the mean ± SD percentage of fixation points within the 1-degree central macula (P1) was 87.9 ± 11.5% in the right eye and 93.8 ± 6.6% in the left eye. The paired t-test did not show a statistically significant difference between eyes (p=0.140). Mean ± SD P2 value was 95.5 ± 4.9% in the right eye and 98.5 ± 2.1% in the left eye. The analysis demonstrated an increase in the percentage of fixation points in the second tested eye compared with the first one (paired t-test= 2.364; p=0.034). There was a negative correlation between the macular sensitivity threshold of the right eye and the duration of the examination for both groups (microperimetry expert mode: r=-0.717; p=0.0026; microperimetry in the fast mode: r=-0.843; p<0.0001). Conclusion: Mean macular sensitivity threshold was higher in the second tested eye in the microperimetry in the fast mode group and was similar in both eyes in the expert mode. Our data suggest that comprehension of the examination by the individual may impact the results of the microperimetry test.(AU)

RESUMO Objetivo: Avaliar comparativamente o limiar de sensibilidade macular da microperimetria e a estabilidade de fixação entre o primeiro (direito) e o segundo (esquerdo) olhos testados de indivíduos normais. Métodos: Trinta pacientes saudáveis foram divididos aleatoriamente em 2 grupos. Os participantes foram submetidos à microperimetria no "fast mode" e no "expert mode" no grupo I e II, respectivamente. Cada participante foi submetido a um único teste e o olho direito foi testado primeiro. Resultados: No grupo I, o limiar médio de sensibilidade macular (± DP) foi de 24,5 ± 2,3 dB e 25,7 ± 1,1 dB nos olhos direito e esquerdo, respectivamente (p=0,0415). No grupo II foi de 26,7 ± 4,5 dB e 27,3 ± 4,0 dB nos olhos direito e esquerdo, respectivamente (p=0,58). Não houve diferença estatisticamente significativa entre os olhos dos dois grupos (p=0,1512). Em relação à estabilidade de fixação (avaliada no grupo microperimetria no "expert mode"), a média das porcentagens dos pontos de fixação dentro do 1 grau central da mácula (P1) ± DP foi de 87,9 ± 11,5% no olho direito e de 93,8 ± 6,6% no olho esquerdo. O teste t pareado não mostrou diferença estatística entre os olhos (p=0,140). O valor médio de P2 ± DP foi de 95,5 ± 4,9% no olho direito e 98,5 ± 2,1% no olho esquerdo. Foi demonstrado um aumento na porcentagem de pontos de fixação no segundo olho testado quando comparado ao primeiro (teste t pareado= 2,364; p=0,034). Houve correlação negativa entre o limiar de sensibilidade macular do olho direito e a duração do exame nos dois grupos (microperimetria no "expert mode": r=-0,717; p=0,0026; microperimetria no "fast mode": r=-0,843; p <0,0001). Conclusão: O limiar médio de sensibilidade macular foi maior no segundo olho testado no grupo microperimetria no "fast mode" e foi semelhante nos dois olhos no "expert mode". Nossos dados sugerem que a compreensão do exame pelo indivíduo pode impactar nos resultados da microperimetria.(AU)

Densidad vascular/de perfusión en dos protocolos de angiotomografía de coherencia óptica ¿Intercambiables? / Vessel/ perfusion density in two optical coherence tomography angiography protocols. Interchangeable?

Resumen Introducción: Distintos protocolos de angiotomografía de coherencia óptica evalúan la mácula. Objetivo: R2) entre las densidades vascular y de perfusión de dos protocolos de angiotomografía de coherencia óptica, para determinar si sus mediciones podían intercambiarse. Método: Estudio observacional, comparativo, prospectivo, transversal entre dos protocolos de angiotomografía de coherencia óptica (AngioPlex, Zeiss) en sujetos sanos. Se identificó la R2 entre las densidades vascular y de perfusión central, interna y completa (protocolo de 3 x 3 mm), y central, interna, externa y completa (protocolo de 6 x 6 mm). Resultados: 78 ojos, mediana de edad 23 años. Hubo R2 altas entre las densidades interna y completa del protocolo de 3 x 3 mm (0.96), externa y completa del de 6 x 6 mm (0.96), y centrales vasculares y de perfusión (≥ 0.96); la R2 entre las densidades centrales vascular y de perfusión de distintos protocolos fue ≤ 0.71. Conclusiones: Las densidades vasculares y de perfusión tienen R2 alta dentro de un protocolo, pero no entre protocolos, porque estos miden preferentemente zonas distintas, lo cual limita intercambiar mediciones.

Abstract Introduction: Different optical coherence tomography angiography (OCTA) scanning protocols evaluate the macula. Objective: To compare the determination coefficients (R2) between vessel and perfusion densities of two OCTA scanning protocols, to learn whether their metrics could be interchanged. Method: Non-experimental, comparative, prospective, observational, cross-sectional study, between two OCTA scanning protocols (Angioplex, Zeiss) in healthy subjects. We found the R2 between central, inner, and full densities (3 x 3 mm protocol), and between central, inner, outer and full densities (6 x 6 mm protocol), both for vessel and perfusion densities. Results: 78 eyes, median age 23 years. There were high R2 between inner and full densities in the 3 x 3 mm protocol (0.96), between outer and full densities in the 6 x 6 mm protocol (0.96) and between central vessel and perfusion densities (≥0.96); R2 between central vessel and perfusion densities of different protocols (≤0.71). Conclusions: Vessel and perfusion densities have high determination coefficients within a scanning protocol, but not between protocols, because each preferentially measures different macular areas. The metrics of different protocols should not be interchanged for follow-up.

Relationship between macular microstructure and visual acuity after scleral buckling for macular-off primary rhegmatogenous retinal detachment by 3D-OCT / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the correlation between macular mierostructure changes and visual outcomes after scleral buckling for macular-off primary rhegmatogenous retinal detachment(RRD)by three-dimensional optical coherence tomography(3D-OCT).<p>METHODS: Retrospective case review, the clinical data of scleral buckling in 30 eyes of 30 cases of RRD involving macular area were analyzed retrospectively. The changes of ellipsoid zone(EZ), external 1imiting membrane(ELM), subretinal fluid(SRF)and central retinal thickness(CRT)were observed and the relationship between them and best corrected visual acuity(BCVA)was analyzed by 3D-OCT at 2d, 2wk, 1, 3 and 6mo after operation.<p>RESULTS: Postoperative SRFH and CRT showed a descended trend. Postoperative BCVA showed an ascendant trend. Multiple comparisons: there were significant difference in each groups except SRFH(2wk <i>vs</i> 1mo, <i>P</i>>0.05), CRT(2d <i>vs</i> 2wk, <i>P</i>>0.05), BCVA(2d <i>vs</i> preoperation, 2wk <i>vs</i> preoperation, <i>P</i>>0.05). There are four forms of EZ and ELM::9 eyes, intact ELM and EZ(EZ+ELM+); B: 7 eyes, intact ELM with disrupted EZ:(EZ-ELM+); AC: 6 eyes, intact EZ with disrupted ELM:(EZ+ELM-); D: 8 eyes, disrupted ELM and EZ:(EZ-ELM-), the BCVA of the above four types are 0.15±0.04, 0.50±0.06, 0.54±0.05 and 0.59±0.09, there were significant difference in each groups except(C <i>vs</i> B, <i>P></i>0.05)and(C <i>vs</i> D, <i>P</i>>0.05). The incidence of SRF was 87% 2d after operation, 46.6% patients had persistent SRF at 6mo after operation. Postoperative CRT was positively correlated with postoperative SRFH.<p>CONCLUSION: After scleral buckling, the macular microstructure showed dynamic changes. The effect of SRF may be manifested as BCVA delayed recovery. With the slow absorption of SRF, CRT decreased and BCVA increased. The intact ELM or EZ shows better vision, but the disrupted ELM means worse vision.

The study of the risk factors and pathogenesis of idiopathic epimacular membrane / 中华眼底病杂志

Idiopathic macular membrane (iERM) is a fibrocellular membrane that forms on the inner surface of the retina. In its early stages, symptoms of iERM are usually not apparent. However, advanced iERM can cause different degrees of visual impairment and effect the quality of life of patients. Current studies suggest that iERM may be associated with posterior vitreous detachment (PVD), age, sex, race and/or ethnicity, poor lifestyle, refractive error, diabetes, hypercholesterolemia, and cardiovascular disease. The most well-established risk factors for iERM are age and PVD. The pathogenesis of iERM is extremely complex. Various cell types, such as Müller cells, Hyalocytes and myofibroblasts, nerve growth factor, interleukin-6, transforming growth factor β, vascular endothelial growth factor and other cytokines and growth factors, as well as a variety of genes and proteins are directly or indirectly involved in the formation of iERM, however, their exact role remains a mystery. In the future, further studies at the molecular level and gene level are needed to provide greater help for the clinical diagnosis and treatment of iERM.

Analysis of influencing factors on the prognosis of visual function in rhegmatogenous retinal detachment / 国际眼科杂志(Guoji Yanke Zazhi)

@#Rhegmatogenous retinal detachment(RRD)is the separation of the retinal nerve sensory layer and the pigment epithelium layer caused by retinal tears. It is a kind of ophthalmic emergency. If it is not treated in time, the blinding rate is close to 100%. Surgery is an important way to treat RRD. With the deepening of disease awareness and the improvement of retinal reattachment techniques, RRD reattachment has achieved a higher anatomical success rate, but in clinical, the postoperative visual experience of patients is still not ideal. This article mainly summarizes the influencing factors of RRD visual function prognosis and provides guidance for clinical treatment.

Effect of femtosecond laser-assisted cataract surgery on macular morphology / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the effect of femtosecond laser-assisted cataract surgery on macula morphology.<p>METHODS: Retrospective study. From June 2019 to May 2020, 79 eyes of 79 cataract patients were performed cataract surgery in both groups: femtosecond laser-assisted(study group: 38 cases)and conventional phacoemulsification(control group: 41 cases). Fovea and parafoveal macular thickness of cataract patients were measured by Heidelberg OCT preoperatively and 1wk, 1mo postoperatively, and then the difference of measurement results were analyzed.<p>RESULTS: The retinal thickness of the fovea, the fovea area and the outer retinal ring did not show significant difference in the both groups preoperatively and postoperatively(<i>P</i>>0.05). Retinal thickness in the inner ring in the both groups increased significantly postoperatively, which was statistically significant(<i>P</i><0.001). In the study group, the macular thickness in the inner ring increased slightly 1wk postoperatively, which was no statistical difference(<i>P</i>=0.057). The inner ring thickness at 1mo increased significantly compared with preoperatively and 1wk postoperatively, and the differences were statistically significant(<i>P</i><0.001); In the control group, the inner macular ring was significantly thicker at 1wk and 1mo(<i>P</i><0.001), and the thickness at 1mo was higher than 1wk, which was statistical difference(<i>P</i>=0.017). Comparison between the two groups: the thickness of macular in the inner ring in the control group was significantly higher than the study group 1wk and 1mo postoperatively, which was statistically significant(<i>t</i>=6.233; <i>t</i>=7.055, all <i>P</i><0.05).<p>CONCLUSION: Femtosecond laser does not increase the risk of macular damage during operation. Femtosecond laser-assisted cataract surgery is less inflammation and lower macular edema in early, which is a safe surgical option.

Comparison of macular vascular density and retinal thickness in children with different degrees of myopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe and compare the changes of macular vascular density and retinal thickness in children and adolescents with different degrees using optical coherence tomography angiography(OCTA), then analyze their correlation.<p>METHODS: Our prospective cross-sectional study included 230 eyes of 115 children and adolescents aged 6-18a. According to spherical equivalent power(SE), they were divided into four groups: emmetropia group(32 eyes of 16 cases), mild myopia group(94 eyes of 47 cases), moderate myopia group(68 eyes of 34 cases), and high myopia group(36 eyes of 18 cases). Using RTVue XR scans of the 6mm×6mm region of the macula, the system automatically divided it into three rings: 1mm(fovea)ring, 1mm-3mm(parafovea)ring, and 3mm-6mm(perifovea)ring. And each ring was further divided into four quadrants: temporal(T), superior(S), nasal(N), and inferior(I). Quantitatively analysis was performed for the superficial and deep capillary densities and retinal thickness of each sector.<p>RESULTS: The superficial capillary density in the macula was in turn significantly decreased as in emmetropia(44.4±3.5)%, mild myopia(44.8±3.8)%, moderate myopia(44.3±3.8)%, and high myopia(42.6±4.5)% groups(<i>F</i>=2.963,<i>P</i>=0.033). The superficial capillary density of parafovea's temporal side were(46.1±3.5)%,(46.8±5.1)%,(46.2±4.3)%, and(43.8±5.5)% in the four groups, respectively(<i>F</i>=3.436, <i>P</i>=0.018). Similarly, the deep capillary density of the four groups was(49.9±4.1)%,(48.4±4.7)%,(47.9±5.5)%, and(45.3±4.7)%, respectively(<i>F</i>=4.806, <i>P</i>=0.003). The deep capillary density of the perifovea was(49±4.4)%,(47.2±5.2)%,(46.6±6)%, and(43.6±5.1)% in the 4 groups, respectively(<i>F</i>=5.495, <i>P</i>=0.001). The retinal thickness of the four groups was 293.9±12.9, 295.5±13.0, 290.9±12.0, and 284.5±10.7 μm(<i>F</i>=6.606, <i>P</i><0.001). The superficial capillary densities of parafoveal's temporal and nasal sides were positively correlated with SE(<i>r</i>=0.221, 0.219, <i>P</i>=0.001, 0.001). The deep capillary density of perifovea's temporal, superior, nasal and inferior side were positively correlated with SE(<i>r</i>=0.172, 0.200, 0.250, 0.296, <i>P</i>=0.011, 0.003, <0.001, <0.001). The central retinal thickness except the fovea were positively correlated with SE(<i>P</i><0.05).<p>CONCLUSION: With the increase of myopia degree of children and adolescents, the superficial capillaries density in the macula decreases, especially in the parafovea's temporal side; as well as the deep capillaries density, especially decreases in the perifovea. The central retinal thickness decreases in both parafovea and perifovea. With the myopia degree of children and adolescents increases, the structure and capillary circulation of the macula will be influenced, especially in the high myopia group.

Comparison of early stage SD-OCT findings in patients with primer open angle glaucoma and Parkinson's disease / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To provide an insight to the common pathophysiology of both most frequent and neurodegenerative diseases by comparing thickness parameters of macula and retinal nerve fiber layer(RNFL)by using spectral domain optical coherence tomography(SD-OCT)in patients with early stage of Parkinson's disease(PD), and early stage of primary open angle glaucoma(POAG). <p>METHODS A retrospective review was conducted of 48 patients with an early stage of POAG, 34 patients with an early stage of PD and 37 age- and gender-matched healthy eyes as a control group. The RNFL and macular thicknesses in the nine macular quadrants according to the ETDRS were measured with an SD-OCT and mean deviation(MD)values by a visual field analyzer. POAG patients were selected only MD smaller than -6 dB. Patients with MD values below -6 dB were considered as early stage glaucoma. PD severity was assessed using Hoehn and Yahr(H & Y)and Unified Parkinson's Disease Rating Scale(UPDRS). The PD group selected only H & Y Stage I-III patients. <p>RESULTS:Statistically significant difference was determined between all groups RNFL measurements except temporal RNFL(<i>P</i><0.05). Statistically significant difference was determined between all groups including fovea, mean macula thickness and macula outer quadrant thickness evaluations(<i>P</i><0.05). There was not any significant difference between thickness evaluation of macula inner quadrant for POAG and PD groups(<i>P</i>>0.05). A weak negative correlation was determined between duration of disease and UPDRS score together with macula and RNFL thickness parameters in PD group.<p>CONCLUSION:Similar thinning was detected by using SD-OCT for thickness parameters of macula and RNFL in early stage of POAG and early stage of PD group. However this thinning was more significant in early stage of POAG group. It can be declared that neurodegeneration on the macula which is caused by glaucoma is more destructive than PD. Thinning on foveal region is remarkable for PD patients.

Paracentral acute middle maculopathy in patient with atherosclerosis and angioplasty with stents in the coronary artery / Maculopatia média aguda paracentral em paciente com arterioesclerose e angioplastia com stent na artéria coronária

ABSTRACT Sophisticated imaging systems have helped to redefine the clinical presentation of acute macular neuroretinopathy and have markedly enhanced diagnostic sensitivity. The proposed mechanism of paracentral acute middle maculopathy is related to ischemia at the level of the superficial and deep retinal capillary plexi. This is a case report of a patient who developed an acute macular neuroretinopathy after an uneventful angioplasty with stents in the coronary artery.

RESUMO Sistemas de imagem sofisticados ajudaram a redefinir a apresentação clínica da neurorretinopatia macular aguda e têm sensibilidade diagnóstica marcadamente aumentada. A maculopatia média aguda paracentral tem sido relacionada à isquemia ao nível dos plexos capilares superficial e profundo da retina. Este é um relato de caso de paciente que desenvolveu uma neurorretinopatia macular aguda após uma cirurgia de angioplastia com stents da artéria coronária sem complicações.