Danjie Li

Restored Photoreceptor Outer Segment Damage in Multiple Evanescent White Dot Syndrome

PURPOSE To report retinal tomography and function in the course of multiple evanescent white dot syndrome (MEWDS). DESIGN Prospective case series. PARTICIPANTS Seven patients with unilateral MEWDS. METHODS We performed optical coherence tomography (OCT), multifocal electroretinography (mfERG), full-field electroretinography (ffERG), fluorescein and indocyanine green angiography, and visual field examinations in 7 patients with active to resolved MEWDS. MAIN OUTCOME MEASURES OCT imaging of the posterior fundus with a 6 x 6-mm square, best-corrected visual acuity (BCVA), fundus characteristics, visual field measurements, mfERG, and ffERG responses. RESULTS All patients reported unilateral blurred vision and spotty visual field defects. The fundi had yellow or white dots of various sizes and extent in the affected eyes. The visual fields had enlarged blind spots in all affected eyes and scotomas in 3 of the 7 eyes. In 5 of the all fellow eyes, 4 fellow eyes had an enlarged blind spot, peripheral visual field defects, or both; 1 eye had only a peripheral field defect. OCT showed a disrupted or irregular photoreceptor inner/outer segment (IS/OS) junction line of varied extent in 7 affected eyes and 1 fellow eye. During 1.5 weeks to 6 months follow-up (mean, 3.4 months), the BCVA returned to 1.2 along with resolution of the white dots in all eyes. The IS/OS line was restored in 7 eyes, but 1 eye had focal disruption. The visual fields returned to normal in 5 affected eyes; however, an enlarged blind spot remained in 2 affected eyes and a peripheral defect remained in 2 fellow eyes. On ffERG and mfERG, the decreased responses recovered markedly in the 7 affected eyes. CONCLUSIONS The lesions responsible for MEWDS appear to disrupt the photoreceptor outer segments; morphologic and functional recovery can occur. Although the symptoms and fundus lesions were visible unilaterally, the photoreceptor dysfunction was bilateral in most cases.

Vitreous Changes in High Myopia Observed by Swept-Source Optical Coherence Tomography

PURPOSE To observe vitreous changes in high myopia using swept-source optical coherence tomography (SS-OCT). METHODS We performed slit-lamp biomicroscopy and SS-OCT in the highly myopic right eyes of 151 patients (mean age, 52.7 years; mean refraction, -11.4 diopters [D]) and the right eyes with no myopia of 363 healthy control volunteers (mean age, 52.8 years; mean refraction, -1.4 D). To estimate the sizes of the posterior precortical vitreous pockets (PPVPs), we measured the height between the fovea and the anterior border of the PPVPs. RESULTS Patients with partial posterior vitreous detachments (PVDs) around the macula and complete PVDs in high myopia were significantly (P < 0.0001) younger (47.1 ± 14.1 and 61.2 ± 12.0 years, respectively) than controls (59.0 ± 9.6 and 69.7 ± 6.6 years). The PPVPs with no PVDs were significantly (P < 0.001) higher in 32 eyes with high myopia (984 ± 292 μm) than 164 controls (553 ± 166 μm). After a complete PVD with a Weiss ring developed, the vitreous cortex was on the macula in 40.5% of the eyes with high myopia, which differed significantly (P < 0.0001) from the 8.7% of the controls. Myopic foveoschisis was present in 14 (9.3%) of 151 eyes. In eyes with foveoschisis, three (21.4%) eyes had partial PVDs and 11 (78.6%) eyes had complete PVDs; there was no residual cortex in 8 (72.7%) of 11 eyes with complete PVDs. CONCLUSIONS Highly myopic eyes may have larger PPVPs than normal eyes. Partial PVDs around the macula and complete PVDs occur at younger ages. The vitreous cortex more frequently remains on the macula after development of complete PVDs in highly myopic eyes.

Posterior Precortical Vitreous Pockets and Connecting Channels in Children on Swept-Source Optical Coherence Tomography

PURPOSE We observed the posterior vitreous in children using swept-source optical coherence tomography (SS-OCT). METHODS The normal right eyes of 73 children (ages, 3-11 years) were studied using SS-OCT with 12-mm horizontal and vertical scans in the posterior fundus. RESULTS Posterior precortical vitreous pockets (PPVPs), narrow liquefied spaces along the vitreoretinal interface in the macula (mean, 165.4 ± 35.2 μm [depth] × 3327 ± 615.7 μm [width]), were observed at age 3 in horizontal scans. The PPVPs enlarged to 382.9 ± 51.8 × 4486.5 ± 342.3 from ages 4 to 6 (P < 0.01) and 524.9 ± 60.3 × 5485.9 ± 307.5 after age 7 (P < 0.01). In all subjects, the depth and width were means of 426.4 ± 38.2 and 4834.4 ± 228.1 μm, respectively. There were significant correlations between the PPVP size and age (PPVP depth, r = 0.42, P < 0.001; PPVP width, r = 0.42, P < 0.001), but not refractive error. The PPVP posterior wall was not visible in all eyes. The PPVP and Cloquets canal appeared as separate spaces at ages 3 and 4 years. The connecting channel between the PPVPs and Cloquets developed in 7.7%, 11.1%, 12.5%, 27.3%, 40%, 37.5%, and 50% at ages 5, 6, 7, 8, 9, 10, and 11, respectively. CONCLUSIONS The PPVPs emerged in front of the macula as a solitary space in early childhood. They first were narrow liquefied spaces anterior to the macula at age 3 and evolved to small boat-shaped spaces that gradually enlarged with age. The channels connecting the PPVPs and Cloquets canal begin to form after age 5. Their presence suggests a physiologic role of the PPVPs.

Retinal Ganglion Cell Analysis in Leber's Hereditary Optic Neuropathy

1. World Health Organization. Progress report 2011: Global HIV/ AIDS responseepidemic update and health sector progress towards universal access. Geneva: 2011. 2. Dennehy PJ, Warman R, Flynn JT, et al. Ocular manifestations in paediatric patients with acquired immunodeficiency syndrome. Arch Ophthalmol 1989;107:978–82. 3. De Smet MD, Butler KM, Rubin BI, et al. The ocular complications of HIV in the pediatric population. In: Recent advances in Uveitis. Proceedings of the 3rd International Symposium on Uveitis. Amsterdam: Kugler; 1993:315–9. 4. Kestelyn P, Lepage P, Karita E, Perre PV. Ocular manifestations of infection with the human immunodeficiency virus in an African paediatric population. Ocul Immunol Inflamm 2000;8:263–73. 5. Livingston PG, Kerr NC, Sullivan JL. Ocular disease in children with vertically acquired human immunodeficiency virus infection. J AAPOS 1998;2:177–81. 6. Padhani DH, Manji KP, Mtanda AT. Ocular manifestations in children with HIV infection in Dar es Salaam, Tanzania. J Trop Pediatr 2000;46:145–8.

En Face Imaging of Posterior Precortical Vitreous Pockets Using Swept-Source Optical Coherence Tomography

PURPOSE To obtain sequential flat (en face) images of posterior precortical vitreous pockets (PPVPs) using swept-source optical coherence tomography (SS-OCT). METHODS We performed SS-OCT in the right eyes of 112 volunteers (mean age, 30.1 years; mean refraction, -2.5 diopters) while sitting using 12-mm horizontal, vertical scans of the 12- × 9-mm plane × 2.6-mm depth through the macula and optic disc. En face images of the posterior vitreous were obtained by En-View, a SS-OCT program. RESULTS Swept-source OCT visualized the PPVPs and Cloquets canals in all subjects; the PPVPs appeared as boat-shaped lacunae in the horizontal scan and extended superiorly as clefts in the vertical scan. En face imaging showed PPVPs and Cloquets canals as two oval lacunae near the vitreoretinal interface and a septum between the nasal border of the PPVPs and Cloquets canals. In all cases, the lacunas of the PPVPs were larger than those of Cloquets canals. In 99 (88.4%) of 112 eyes, the PPVPs and Cloquets canals were fused by connecting channels. The mean width of the connecting channels was 920.2 ± 37.4 μm, and the mean height was 288.6 ± 20.0 μm. On the anterior en face images, the PPVPs became crescent-shaped in all eyes. CONCLUSIONS Using SS-OCT, we obtained en face images of PPVPs and Cloquets canals in vivo. The en face images of the PPVPs near the retina showed oval shapes that changed to crescents, which corresponded to the superior edge of the PPVPs. The PPVPs were fused with Cloquets canal by a flat-shaped connecting channel.

Retinal ganglion cell analysis in multiple evanescent white dot syndrome

BackgroundMultiple evanescent white dot syndrome (MEWDS) is an acute and usually unilateral retinopathy that occurs predominantly in young adults. This report presents the outcomes of ganglion cell analysis (GCA) in MEWDS.Case presentationA 41-year-old woman was diagnosed as MEWDS in right eye. At her initial visit, the deviation map of the ganglion cell analysis showed there was a decrease of the ganglion cell layer (GCL) + inner plexiform layer (IPL) thickness in both eyes, even though her left eye was not affected. A 29-year-old woman was also diagnosed as MEWDS in right eye. Although the deviation map of ganglion cell analysis showed there was a decrease of the GCL + IPL thickness in both eyes at her initial visit, her right eye was not affected.ConclusionGCA indicated there was a decrease (<1% of the distribution of normals) of the ganglion cell layer + inner plexiform layer thickness in both the affected and fellow eyes in 7 of 9 patients diagnosed as MEWDS in our hospital. Although the lesions responsible for MEWDS are thought to disrupt the photoreceptor outer segments, we observed changes in the inner retina in both the affected and fellow eye of MEWDS patients.

Evaluation of Fundus Blood Flow in Normal Individuals and Patients with Internal Carotid Artery Obstruction Using Laser Speckle Flowgraphy

Purpose We investigated whether laser speckle flowgraphy (LSFG) results are comparable in both eyes and whether it is useful in the diagnosis of disparity in ocular ischemic syndrome (OIS) patients. Methods We compared the mean blur rate (MBR) value for various fundus regions in both eyes of 41 healthy subjects and 15 internal carotid artery occlusion (ICAO) cases. We calculated the standard value of the Laterality Index (LI), which was the MBR comparison of both eyes in each of the regions, in the control subjects. We then investigated the correlation between both eyes for the LIs in the entire fundus, the degree of ICAO and visual function. Results The disparity of the LIs in both eyes was least in the entire area of the fundus in control subjects and there was a significant correlation between both eyes of the 41 healthy individuals (P = 0.019). Significant correlations were found for the LI, visual acuity and degree of ICAO. The specificity and sensitivity of LI in the entire area was 93.8% and 100%, respectively. Conclusions LSFG revealed normal individuals have symmetrical fundus blood flow. LSFG could detect OIS and might be a useful tool for detecting disparities in fundus blood flow.

Observation of neovascularization of the disc associated with proliferative diabetic retinopathy using OCT angiography

PurposeTo describe the relationship between the vitreous and the neovascularization of the disc (NVD) using swept source optical coherence tomography (SS-OCT) and OCT angiography (OCTA).Study designRetrospective.MethodsWe examined 17 eyes of 11 consecutive patients diagnosed as NVD associated with proliferative diabetic retinopathy (PDR). The location of the NVD feeder or collector vessels were examined by using RTVue XR Avanti. To determine the condition of the posterior vitreous detachment (PVD) and the proliferative tissue of the NVD, we performed 12 mm horizontal and vertical scans through the disc using SS-OCT.ResultsOCT images of all 17 cases indicated there was no PVD on the optic disc. OCTA showed that the locations of the newly formed vessels from the optic disc were overwhelmingly outside the physiological cupping (95%). No cases exhibited formation of neovascularization inside the physiological cupping. OCT images revealed all 17 eyes had proliferative tissues located under the posterior wall of the vitreous, with 12 out of 17 eyes exhibiting additional invasion of the proliferative tissue into the vitreous through the posterior wall. Epiretinal membrane or a thickened posterior wall of the vitreous was present in 10 out of the 17 eyes.ConclusionsNVD associated with PDR arises from outside the physiological cupping and grows along the posterior wall of the vitreous. The absence of PVD on the optic disc is essential to the growth of NVD.

Optical coherence tomography patterns and outcomes of contusion maculopathy caused by impact of sporting equipment

BackgroundTo describe the patterns and outcomes of contusion maculopathy after ocular contusions resulting from accidental impact with sporting equipment.MethodsWe conducted a retrospective study of interventional case series. Patient Population: Twenty-one eyes of 21 patients who sustained blunt ocular trauma while playing a sport. Intervention/Observation Procedure(s): Surgery or observation by optical coherence tomography (OCT). Main Outcome Measure(s): The morphologic changes within the macula in the early stages after injury and changes in visual function in the early and recovery stages after injury.ResultsIn the early stage, OCT visualized four injury patterns: type Ι, commotio retinae (14.3%, 3 eyes) with increased reflectivity of the ellipsoid zone and retinal pigment epithelium; type II, incomplete macular hole(38.1%, 8 eyes) with three structural changes, i.e., a partial V-shaped macular hole, a jar-shaped macular hole with retinal tissue at the bottom, and a connective bridge attached to retinal tissues; type III, full-thickness macular hole (33.3%, 7 eyes); and type IV, foveal hemorrhage (14.3%, 3 eyes). During recovery, OCT images of types Ι and II showed almost normal macular morphology with better visual acuity (mean ± SD,0.02 ± 0.1 and 0.14 ± 0.21logMAR.). In types III and IV, the visual prognosis was poor (0.52 ± 0.34 and 0.22 ± 0.16), OCT images showed retinal atrophy at the fovea despite vitrectomy and sulfur hexafluoride (SF6) gas tamponade.ConclusionEarly OCT images identified four patterns of contusion maculopathy with different treatment outcomes. In types Ι and II, the visual function and retinal morphology remained intact. With types III and IV, respectively, the treatments of vitrectomy and SF6 gas tamponade for patients were effective.