Reduction of foveal bulges and other anatomical changes in fellow eyes of patients with unilateral idiopathic macular hole without vitreomacular pathologic changes.

PURPOSE: To compare the foveal characteristics in fellow eyes (FE) of patients with unilateral idiopathic macular hole without vitreomacular pathologic changes with eyes of healthy controls. METHODS: Forty-seven FE and 52 eyes of 52 age- and sex-matched healthy controls were studied. Quantitative assessment of the dome-shaped appearance of the hyperreflective lines that represent external limiting membrane (ELM_bulge) and inner outer segment junctions (IS/OS_bulge) were made by optical coherence tomography (OCT) images. Inner retinal complex thickness (IRCT) was quantitatively assessed at 1000 and 2000 µm of the foveal center in nasal and temporal quadrants. Presence of alterations in the inner retinal outer layers and central foveal thickness (CFT) were also analyzed. RESULTS: Significantly lower ELM_bulge (p < 0.0001; Mann-Whitney test) and IS/OS_bulge (p < 0.001; student t test) and higher cases with COST alterations, expressed as a diffuse line (p < 0.006; Chi2 test) were found in FE than control eyes. IRCT were significantly reduced in FE at all the studied locations when comparing to control eyes (p < 0.05; student t test), maintaining anatomical proportionality among locations. CONCLUSION: FE without pathologic vitreomacular interactions seems to present some central cone alterations that may be related to other causes than vitreomacular traction.

Change of Outer Retinal Thickness in Fellow Eyes of Patients with Unilateral Age-related Macular Degeneration

PURPOSE: To compare the outer retinal thickness in normal fellow eyes of patients with unilateral age-related macular degeneration (AMD) and normal control eyes. METHODS: We retrospectively reviewed the medical records of 60 patients with unilateral exudative AMD including polypoidal choroidal vasculopathy and 60 normal controls. Spectralis optical coherence tomography was performed in the normal fellow eyes of patients with unilateral AMD and in the normal group. The thicknesses between the retinal pigment epithelium (RPE) line and the cone outer segment tips (COST) line, between the COST line and the photoreceptor inner segment/outer segment (IS/OS) line, and between the IS/OS line and the external limiting membrane (ELM) line were measured at the fovea in both groups. RESULTS: The thickness between the RPE and COST lines was 32.4 ± 3.0 µm in normal fellow eyes of patients with unilateral AMD and 35.3 ± 3.5 µm in the normal group (p < 0.001). Total retinal thickness, thicknesses between the COST and the IS/OS lines and the IS/OS and the ELM lines in fellow eyes were not significantly different from those of normal eyes (p = 0.126, 0.615, 0.874). There was no significant difference in total retinal thickness or each outer retinal thickness measured in normal fellow eyes between patients with neovascular AMD and polypoidal choroidal vasculopathy. CONCLUSIONS: The thickness between the RPE and the COST lines was thinner in the fellow eyes of patients with unilateral AMD than in the normal eyes. We suggest that less thickness between the RPE and COST lines might indicate a greater risk of AMD.

Asymmetrical recovery of cone outer segment tips line and foveal displacement after successful macular hole surgery.

PURPOSE: To determine whether the photoreceptor outer segments recover symmetrically after successful macular hole surgery, and whether the recovery is correlated with the degree of foveal displacement. METHODS: This was a retrospective, interventional case series. The medical records of 35 patients (n = 35 eyes) with a surgically closed macular hole were reviewed. Spectral-domain optical coherence tomography (SD-OCT) was used to obtain cross-sectional images across the fovea horizontally and vertically. The lengths of cone outer segment tips (COST) line defect in the temporal, nasal, superior, and inferior sectors of the fovea, the best-corrected visual acuity (BCVA), and the papillofoveal distance were measured before and at 6 and 12 months after the surgery. RESULTS: The temporal COST line defect was significantly longer than the nasal length defect preoperatively (P = 0.031), at 6 months (P < 0.001), and at 12 months (P = 0.038) postoperatively. The length of the temporal COST line defect was significantly correlated with the BCVA preoperatively (P = 0.014) and at 6 months postoperatively (P = 0.001). The papillofoveal distance was significantly shorter at 6 months (P = 0.029) and 12 months (P = 0.043) postoperatively than at the baseline. The center of the COST line defect was located further temporally from the fovea postoperatively, and the distance was shorter than the nasal foveal displacement at 6 months (158.8 ± 167.0 µm, P = 0.13) and 12 months (244.8 ± 172.7 µm, P = 0.008). CONCLUSIONS: The restoration of the temporal COST line was delayed after successful macular hole surgery. In addition, the fovea was displaced more nasally than the center of the COST line defect which recovered centripetally. (ClinicalTrials.gov number, NCT01959776.).

Correlation between foveal cone outer segment tips line and visual recovery after epiretinal membrane surgery.

PURPOSE: To determine whether there is a significant correlation between the integrity of the foveal microstructures and the best-corrected visual acuity (BCVA) after pars plana vitrectomy for epiretinal membrane (ERM) removal. METHODS: This was a retrospective, interventional case series. Forty-six eyes of 45 patients with an ERM underwent vitrectomy. The foveal area was examined by spectral-domain-optical coherence tomography (SD-OCT) preoperatively and postoperatively. The correlation between the length of the photoreceptor cone outer segment tips (COST) line defect, the inner segment/outer segment junction (IS/OS) line defect, the external limiting membrane (ELM) line defect, and the BCVA was determined. RESULTS: The length of the COST line defect was significantly correlated with the BCVA at postoperative 1, 3, 6, 9, and 12 months (P < 0.001 for all). Forward stepwise regression analyses showed that the postoperative BCVA was significantly correlated with the length of COST line defect (P < 0.001) but not with the IS/OS line and ELM line defects for up to 6 months. The preoperative length of the COST line defect was significantly correlated with the postoperative BCVA at 12 months (P = 0.005), but the lengths of the IS/OS line defect and ELM line defect were not. The factor that best predicted the postoperative BCVA was the length of the preoperative COST line defect (P = 0.04) but not the preoperative BCVA (P = 0.69). CONCLUSIONS: The recovery of the foveal COST line defect is correlated with the BCVA after ERM surgery. The length of the preoperative COST line defect can predict the potential foveal function. (ClinicalTrials.gov number, NCT01549249.).

Focal functional and microstructural changes of photoreceptors in eyes with acute zonal occult outer retinopathy.

PURPOSE: Acute zonal occult outer retinopathy (AZOOR) is characterized by an acute zonal loss of outer retinal function with minimal ophthalmoscopic changes in one or both eyes. We present a patient with AZOOR whose ultrastructural and functional findings were followed for 8 months. CASE: A 22-year-old woman developed an acute central scotoma in her right eye. Her best-corrected visual acuity (BCVA) was 0.5 OD and 1.2 OS. The ophthalmoscopic examinations, fluorescein angiography, and full-field electroretinograms (ERGs) were normal in both eyes. The amplitudes of the multifocal ERGs (mfERGs) were attenuated in the area corresponding to the scotoma. Spectral domain optical coherence tomography showed an absence of both the inner and outer segment (IS/OS) line of the photoreceptors and the cone outer segment tip (COST) line between the IS/OS line and the retinal pigment epithelium. These changes were seen in the area corresponding to the scotoma. One month later, the scotoma disappeared and the BCVA improved to 1.2 OD. The mfERGs increased to almost the same amplitude as the fellow eye. The IS/OS line became discernible but the COST line was still absent. The ophthalmological findings of the right macula remained normal during the 11-month follow-up period. CONCLUSIONS: Our findings indicate that the selective loss of the IS/OS and the COST lines is probably the morphological alterations corresponding with the reduced BCVA and the mfERGs in the areas of the visual field defects in the acute phase of AZOOR. But in the recovery phase, only the abnormality of the COST line is a subclinical sign for the disease. These findings should be important in understanding and evaluating the pathological mechanism in other outer retinal diseases.

Outer retinal microstructure in a case of acute idiopathic blind spot enlargement syndrome.

PURPOSE: To present a patient with acute idiopathic blind spot enlargement syndrome who had abnormal changes in the outer retinal microstructure limited to areas with reduced responses on multifocal electroretinograms as well as to the area involving a scotoma. METHODS AND RESULTS: We report the case of a 44-year-old man who developed an arcuate scotoma which was associated with a physiological blind spot in the left eye. The ophthalmoscopic, fluorescein angiographic, and full-field electroretinogram findings were normal. The amplitudes of the multifocal electroretinograms were reduced in the area of the scotoma. Optical coherence tomography showed that both the external limiting membrane and the inner and outer segment (IS/OS) line were intact, but that the middle cone outer segment tip line between the IS/OS line and the retinal pigment epithelium was absent in the nasal macular area of the left eye. CONCLUSIONS: These findings indicate that the integrity of not only the external limiting membrane and IS/OS line but also the cone outer segment tip line is important for the function of the retina.