Emi Fukui

Retinal thickness of myopic eyes determined by spectralis optical coherence tomography

Aims To determine the relationship between the macular thickness and volume determined by spectral domain optical coherence tomography (SD-OCT) and the refractive error (RE) and axial length (AL). Methods 48 eyes of 24 healthy Japanese subjects were examined. The REs (spherical equivalent) were measured with the Tonoref RKT-7000 autorefractometer (Nidek Inc, Aichi, Japan), and the ALs were determined by the IOL-Master (Carl Zeiss Meditec Inc, Dublin, California, USA). The thicknesses and volumes of the central, inner, and outer macular areas were measured by Spectralis SD-OCT (Heidelberg Engineering, Heidelberg, Germany). The correlations between the macular thickness and volume and the RE and AL were determined by linear regression analyses. Results The average central foveal thickness (within 1 mm) was 278.7±10.8 μm and the volume was 0.22±0.01 mm3. The foveal thickness was negatively correlated with the RE and positively correlated with the AL (p<0.01 for both). Similar correlations were also found for the volume of the central macular areas. Conclusions The significant correlation of the foveal thickness and the RE and AL in healthy eyes should be considered when these parameters are evaluated in eyes with retinal diseases.

Asymmetrical thickness of parafoveal retina around surgically closed macular hole

Since the initial report on the surgical closure of idiopathic macular holes (MHs),1 the surgical technique for closing an MH has been significantly modified. The peeling of the internal limiting membrane (ILM) was shown to improve the anatomical and functional success rate.2 3 In successfully closed MHs, the parafoveal temporal retina appeared to be thinner than the nasal parafoveal area in the optical coherence tomographic (OCT) images.4 We measured the retinal thickness by Spectralis HRA-OCT (Heidelberg Engineering GmbH, Heidelberg, Germany) before and after vitrectomy in eyes with an MH. Ten eyes of 10 patients with an idiopathic MH were studied. The patients underwent 23-gauge pars plana vitrectomy with phacoemulsification and placement of a posterior chamber intraocular lens. The ILM was stained in all of the eyes with approximately 0.5 ml of 0.25% indocyanine green (ICG) that was evenly injected intravitreally for 1 min then washed out. The ILM was peeled over 2 to 3 disc diameters around the MH, and then 20% sulphur …

Spectral domain optical coherence tomographic findings at convalescent stage of acute zonal occult outer retinopathy.

Purpose To describe the morphology of the retina at the convalescent stage of acute zonal occult outer retinopathy (AZOOR) from images obtained by spectral domain optical coherence tomography (SD-OCT). Methods The visual fields, electroretinograms (ERGs), and OCT images were reviewed in two women aged 24 and 33 years. The patients were followed for one and four years, respectively. Results In both cases, the anterior and posterior segments were almost normal, although both patients had a sudden unilateral vision decrease and photopsia. Goldmann perimetry revealed enlarged blind spots and scotomas. The ERGs were reduced in both cases. SD-OCT showed that the junction of the inner and outer segment, the IS/OS line, of the photoreceptors was irregular or lost in the affected retinas. The retina in these areas was thinner due to a decrease in the thickness of both the outer nuclear layer (ONL) and inner nuclear layer (INL) in Case 2. Conclusions The decrease in retinal thickness at the convalescent stage of AZOOR is most likely due to a shortening of not only the photoreceptors and ONL but also to a thinning of the INL in a severe case.

Retinal involvement in uveitis associated with Hodgkin disease.

PURPOSE To describe a patient with Hodgkin disease with posterior uveitis who also had a thinning of the retina and an antiretinal autoantibody in his serum. METHODS Our patient was a 58-year-old man who had been diagnosed with Hodgkin disease. He had a complete ophthalmologic examination including fluorescein angiography, electroretinography, perimetry, and spectral-domain optical coherence tomography. A search for antiretinal antibodies in the serum was made by Western blot analysis, and the retinal sites reactive to the antibodies were determined by immunohistochemistry. RESULTS The ocular signs were mild cellular infiltration in the anterior chamber and vitreous, and small, round chorioretinal lesions in the peripheral retina. The electroretinograms were slightly reduced. Small ring-like scotomas were detected in the Goldmann visual fields. An antiretina-specific 116-kDa antibody was detected in the serum by Western blot analysis, and the antibody reacted with the ganglion cell and inner nuclear layers of mice retinas. Although the visual acuities were maintained for over eight years, the macular thickness measured in the spectral-domain optical coherence tomography images was reduced. CONCLUSION The presence of an antiretinal autoantibody, granulomatous uveitis, and retinal thinning in a patient with Hodgkin disease suggests that the patient had a granulomatous uveitis associated with Hodgkin disease or lymphoma-associated uveitis with retinal involvement.

Idiopathic Macular Hole Displaced Toward Optic Disc after Vitrectomy with Internal Limiting Membrane Peeling

Purpose: To compare the distance between the optic disc and the fovea (disc-to-fovea distance) before and after a successful closure of an idiopathic macular hole (MH) by pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling.Methods: This was a retrospective observational study of 37 eyes of 36 patients with a MH that had undergone PPV. The distance between the point of intersection of a blood vessel and the disc margin and the center of the opened or closed MH at 6 months after surgery was measured in the Spectralis HRA+OCT (Heidelberg Engineering, Germany) images.Results: The mean disc-to-fovea distance was significantly shorter postoperatively than preoperatively (3,783.7 ± 308.5 μm and 3,914.5 ± 320.4 μm, respectively; P<0.0001). The distance in eyes with Stage 3 and 4 MH (n=22) was significantly greater than that in eyes with Stage 2 MH (136.7 ± 134.9 μm vs. 107.8 ± 107.8 μm, respectively; P= 0.012; n= 15).Conclusions: The significantly shorter postoperative disc-to-fovea distance in eyes with a closed MH especially Stage 3 and 4 MHs suggests that the fovea moves nasally after PPV with ILM peeling.

Retinoschisis detected by spectral-domain optical coherence tomography in von hippel-lindau disease.

PURPOSE To report the presence of retinoschises in a case of von Hippel-Lindau disease detected by spectral-domain optical coherence tomography. METHODS Case report of a 23-year-old man with von Hippel-Lindau disease who was seen for a regular follow-up examination. RESULTS Ophthalmoscopy showed several retinal capillary hemangioblastomas in both eyes. Spectral-domain optical coherence tomography showed retinoschises around the retinal capillary hemangioblastoma and also around the feeder and draining vessels of the peripheral larger hemangioblastoma. The retinoschises were found under the internal limiting membrane and also in the inner and outer retinal layers. Intraretinal columns were observed in the retinoschises. CONCLUSION Our observations show that retinoschises can develop in eyes with von Hippel-Lindau disease. The extensiveness of the retinoschises suggests that the retina is fragile in von Hippel-Lindau disease.

Comparison of Parafoveal Retinal Thickness in Eyes with Idiopathic Macular Hole to that with Rhegmatogenous Retinal Detachment after Vitrectomy

Background:The foveal contour is asymmetrical in the horizontal optical coherence tomographic (OCT) images in idiopathic macula holes (IMHs) successfully closed by pars plana vitrectomy (PPV). The purpose of this study was to compare the parafoveal retinal contour after PPV followed by gas tamponade for IMHs to that after vitrectomy for rhegmatogenous retinal detachment (RRD). Design:Retrospective study. Participants:Eleven eyes of 11 IMH patients and 10 eyes of 10 RRD patients who underwent PPV. Methods: The internal limiting membrane (ILM) was stained with indocyanine green and peeled in the IMH group but not in the RRD group. The postoperative retinal thickness was measured by spectral-domain OCT. Main outcome measures:The parafoveal thicknesses of the operated eyes were compared to the corresponding areas of the fellow un-operated eyes. Results: In the IMH group, the average postoperative thickness of the temporal sector was 312.6 μm and that of the corresponding area of the fellow eyes was 330.2 μm (P <0.05). Similarly, the thickness of the nasal sector was 362.6 μm and that of the fellow eyes was 345.8 μm (P<0.05). These differences were not observed in the RRD group. Additional measurements showed that the inner retinal layer was thinner in the temporal retina and the outer retinal layer was thicker in the nasal retina in the IMH group. Conclusions:The postoperative asymmetrical foveal contour was observed in only the IMH group. We suggest that these alterations were caused by procedures, such as ILM peeling, rather than the gas tamponade.

Comparisons of foveal thickness and slope after macular hole surgery with and without internal limiting membrane peeling

Background We have shown that the foveal contour was asymmetrical after idiopathic macular hole (MH) closure by pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling. The purpose of this study was to determine whether these morphological changes differ in eyes after PPV without ILM peeling. Methods Ten eyes of 10 patients that underwent PPV without ILM peeling and 12 eyes of 11 patients with ILM peeling were studied. The MH in all eyes was <400 µm in diameter. Six months after the PPV, the macular thickness and foveal slope around the closed MH were determined by spectral-domain optical coherence tomography. The thickness of the ganglion cell complex was measured by another spectral-domain optical coherence tomography instrument >6 months after the surgery. Results The mean parafoveal retinal thickness in the non-peeled group was 367.1 µm in the nasal (N), 353.0 µm in the temporal (T), 366.9 µm in the superior (S), and 357.3 µm in the inferior (I) sectors. The T, S, and I sectors were significantly thicker than the corresponding sectors in the ILM peeled group (p=0.0008, 0.003, and 0.03, respectively). The mean ganglion cell complex was thicker not only in the N sector but also in the T sector in the non-peeled group. The mean retinal slopes in the non-peeled group (N, 40.2°; T, 37.6°; S, 41.2°; I, 39.5°) were flatter than those in the peeled group (N, 52.3°; T, 43.6°; S, 50.8°; I, 51.9°; p=0.009, 0.09, 0.008, and 0.017, respectively). Conclusion The symmetrical fovea after MH surgery in the non-ILM peeled eyes indicates that the asymmetrical fovea after ILM peeling was probably due to the ILM peeling.

Displacement of fovea toward optic disk after macular hole surgery with internal limiting membrane peeling

Purpose The purpose of this study was to demonstrate a displacement of the foveal depression toward the optic disk after idiopathic macular hole (MH) surgery with internal limiting membrane (ILM) peeling. Methods Two patients with a unilateral MH developed an MH in the fellow eyes. Vitrectomy with ILM peeling was performed on the fellow eye to close the MH. Images of spectral-domain optical coherence tomography (SD-OCT) were used to measure the disk-to-fovea distances pre MH formation, after MH formation, and 6 months after the closure of the MH. Results The disk-to-fovea distance was shorter at 6 months than after the development of the MH (4,109 µm and 4,174 µm in Case 1 and 4,001 µm and 4,051 µm in Case 2). Conclusion These results indicate that the fovea moves nasally after the MH surgery with ILM peeling.

Transient Increase of Retinal Nerve Fiber Layer Thickness after Vitrectomy with ILM Peeling for Idiopathic Macular Hole

Purpose. The purpose of this study was to determine the long-term changes in the circumpapillary retinal nerve fiber layer (RNFL) thickness following macular hole surgery with internal limiting membrane (ILM) peeling combined with phacoemulsification. Methods. Thirty-eight eyes of 37 patients who had pars plana vitrectomy (n = 36) between 2010 and 2014 were studied. The average thicknesses of the global and the six sectors of the RNFL were determined before and at 1, 3, 6, 12, and 24 (n = 22) months (M) after the surgery by spectral-domain optical coherent tomography. The postoperative mean RNFL thickness at each time was compared to that before the surgery by paired t-tests. Results. The RNFL of the operated eyes was significantly thicker at 1 month (1 M) and 3 M in all but the inferior-nasal sectors. The significant increase remained until 12 M in the superior-temporal and superior-nasal sectors. In addition, the RNFL was also significantly thicker in the temporal-inferior sector at 12 M based on the findings in 38 eyes. Conclusions. The postoperative RNFL was thicker in all but the nasal-inferior sector for at least 12 M after surgery. This prolonged increase of the RNFL thickness may indicate damage and mild edema of the RNFL.