Tosho Rii

Correlation between Length of Foveal Cone Outer Segment Tips Line Defect and Visual Acuity after Macular Hole Closure

PURPOSE To determine whether the postoperative length of the photoreceptor cone outer segment tips (COST) line defect is significantly correlated with best-corrected visual acuity (BCVA) after macular hole closure. DESIGN Retrospective, consecutive, observational case series. PARTICIPANTS Fifty-one eyes of 51 patients with a surgically closed macular hole were studied. METHODS Spectral-domain optical coherence tomography (SD-OCT) was used to obtain images of the foveal area, and the lengths of the COST line defect were measured in the images obtained 1, 3, 6, 9, and 12 months after macular hole surgery. The correlation between the length of COST line defect and the BCVA was determined. MAIN OUTCOME MEASURES The lengths of the COST line defect, the inner segment/outer segment (IS/OS) junction defect, the external limiting membrane (ELM) line defect in the SD-OCT images, and the BCVA. RESULTS The COST line defect was gradually restored centripetally 1 to 12 months postoperatively. The length of the COST line defect was significantly correlated with the BCVA at 1, 3, 6, 9, and 12 months postoperatively (P < 0.001). Forward stepwise regression analyses showed that the postoperative BCVA was significantly correlated with the length of the COST line defect (P < 0.001) but not with that of the IS/OS junction and ELM line defects after 6 months. The preoperative length of the COST line defect was significantly correlated with postoperative BCVA at 12 months (P = 0.020), but the length of the IS/OS junction and ELM line defects was not. The preoperative length of the COST line defect was significantly longer than the fluid cuff diameter of the macular hole (P = 0.020), indicating that the influence of the elevated neurosensory retina at the fluid cuff on the SD-OCT signals of the COST line was probably minimal. The postoperative BCVA at 12 months can be calculated by the following regression equation: BCVA = 0.00020 × (length of preoperative COST line defect [μm]) - 0.23 (F value = 15.4; P < 0.001). CONCLUSIONS The recovery of the foveal COST line defect is related to visual recovery after macular hole closure. The length of the preoperative COST line defect may predict the BCVA after macular hole surgery.

Significant Correlation Between Visual Acuity and Recovery of Foveal Cone Microstructures After Macular Hole Surgery

PURPOSE To determine whether a recovery of the microstructures of the foveal photoreceptors after macular hole closure is correlated with best-corrected visual acuity (BCVA). DESIGN Retrospective, consecutive, observational case series. METHODS SETTING Single-center academic practice. STUDY POPULATION Forty-one eyes of 41 patients with surgically closed macular holes. OBSERVATIONAL PROCEDURES: The presence and intactness of the cone outer segment tips (COST) line were determined by spectral-domain optical coherence tomography and compared with the presence of the inner segment/outer segment (IS/OS) junction and the external limiting membrane (ELM) at 1, 3, 6, 9, and 12 months after the macular hole surgery. MAIN OUTCOME MEASURE The correlation between the integrity of the foveal photoreceptor microstructures and the BCVA. RESULTS A distinct COST line was first seen at 6 months after the surgery. A distinct or irregular COST line was observed only in eyes with an intact IS/OS junction and ELM. Eyes with a distinct or irregular COST line had significantly better BCVA than those with a disrupted COST line in eyes with an intact IS/OS junction and ELM at 12 months (P = .030). The BCVA was ≥20/25 at 12 months in 91% of the eyes with a distinct or irregular COST line but in only 44% of the eyes without a COST line (P = .015). CONCLUSIONS The significant correlation between the BCVA and a distinct or irregular COST line after successful macular hole surgery indicates that the recovery of foveal cone microstructure is associated with good postoperative BCVA.

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.).

Foveal cone outer segment tips line and disruption artifacts in spectral-domain optical coherence tomographic images of normal eyes.

PURPOSE To determine the incidence of a continuous cone outer segment tips (COST) line at the fovea in spectral-domain optical coherence tomographic (SD-OCT) images of normal eyes. DESIGN Prospective, interventional case series. METHODS Forty-six right eyes of 46 normal individuals with visual acuities (VA) ≥20/20 were studied. SD-OCT images were obtained with a Cirrus HD-OCT instrument with both the standard 5-line raster and the high-definition (HD) 5-line raster scan modes. Images with signal strengths weaker than 5 (on a scale from 0 to 10) were excluded. The appearances of the COST line, photoreceptor inner segment/outer segment (IS/OS) junction, and external limiting membrane (ELM) line were determined in a masked way. RESULTS The incidence of eyes with an intact foveal COST line was about 95%, and the incidence was not significantly associated with the age, sex, refractive error, signal strength, horizontal or vertical scans, and the use of either the standard or HD scans. Fragmented COST lines appeared to be attributable to blocking artifacts caused by a hyperreflectivity at the foveal surface because the COST fragmentation had corresponding fragmentation of the ELM and IS/OS junction lines. The correlation between a fragmented COST line and the hyperreflectivity on the retinal surface was significant for the vertical HD scans (P = .011) but not for the vertical standard, horizontal standard, or horizontal HD scans. CONCLUSIONS Commercial SD-OCT instruments can detect the COST line. Fragmentations of the COST lines in normal eyes are most likely artifacts caused by a parabolic reflection of a surface hyperreflectivity of the foveal pit.

Correlation between foveal interdigitation zone band defect and visual acuity after surgery for macular pseudohole.

Purpose: To determine the correlation between the integrity of the foveal microstructures and the best-corrected visual acuity (BCVA) after pars plana vitrectomy for a macular pseudohole. Methods: Thirty-one eyes of 31 patients with a macular pseudohole underwent vitrectomy with internal limiting membrane removal. The foveal area was examined by spectral domain optical coherence tomography preoperatively and postoperatively. The correlations between the BCVA and the lengths of the photoreceptor interdigitation zone (IZ), the ellipsoid zone, and the external limiting membrane band defects, and central foveal thickness were determined. Results: The BCVA improved significantly and the length of the IZ band defect decreased significantly after the surgery. Simple linear regression analyses showed that the BCVA was significantly correlated with the length of the IZ band defect preoperatively and also at 1 to 12 months postoperatively (P < 0.001 for all). The BCVA was not significantly correlated with the length of the ellipsoid zone, external limiting membrane band defect, and the central foveal thickness. Conclusion: The significant correlation between the length of the foveal IZ band defect and the BCVA preoperatively and postoperatively indicates that the foveal IZ band is related to the visual recovery in patients with macular pseudohole.

Two-year outcomes of pro re nata ranibizumab monotherapy for exudative age-related macular degeneration in Japanese patients

Purpose To describe outcomes of intravitreal ranibizumab using a pro re nata regimen for treatment-naive exudative age-related macular degeneration (AMD), in Japanese patients over the first 2 years. Methods Clinical records were retrospectively reviewed of 48 eyes of 48 patients with treatment-naive exudative AMD who underwent intravitreal ranibizumab therapy. After three monthly injections (induction), patients were examined monthly, and subsequent injections were performed as needed (pro re nata) for any residual activity, by fundus biomicroscopy and imaging studies, regardless of severity. Results Twenty-nine (60%) of the patients were men, and 19 (40%) were women; the mean age was 76.1 years. Of the 48 eyes evaluated, 17 (35%) had findings consistent with polypoidal choroidal vasculopathy, and five (10%) with retinal angiomatous proliferation. A mean of 6.0 ranibizumab injections were given in the first year, 3.5 in the second year, and 9.5 over the 2-year period. The best-corrected visual acuity (logarithm of minimum angle of resolution) improved significantly, from 0.35 at baseline to 0.21 at 12 months (P < 0.01), and remained stable at 0.21 at 24 months (P < 0.01). The mean central macular thickness decreased significantly, from 355.4 μm at baseline to 237.9 μm at 12 months (P < 0.01) and 247.7 μm at 24 months (P < 0.01). Conclusion Improved visual acuity and decreased central macular thickness were observed and maintained over a 2-year period, in a Japanese population receiving 3 monthly induction injections followed by a pro re nata regimen of ranibizumab for exudative AMD.

Comparative findings in childhood‐onset versus adult‐onset optic disc pit maculopathy

Purpose:  To compare the clinical characteristics of eyes with childhood‐onset to those with adult‐onset optic disc pit maculopathy.

Ultrastructural analyses of internal limiting membrane excised from highly myopic eyes with myopic traction maculopathy

PurposeTo evaluate the ultrastructure of the internal limiting membranes (ILMs) excised during vitrectomy from highly myopic eyes with myopic traction maculopathy (MTM). The clinical findings before and after the vitrectomy were compared.MethodsSeven eyes of 7 patients with macular retinoschisis were studied. Four of these eyes also had a foveal detachment but without a retinal break. All the eyes underwent vitrectomy with the creation of a posterior vitreous detachment and ILM peeling. The excised ILMs were examined by transmission electron microscopy (TEM).ResultsThe retinas were reattached in all eyes after the vitrectomy. No retinal breaks including macular holes were identified intraoperatively. Transmission electron microscopy showed glial cells in 4 eyes, retinal pigment epithelium-like cells in 4 eyes, and myofibroblast-like cells in 4 eyes on the excised ILMs. A newly produced basement membrane appeared to merge with the ILM in 5 eyes. Thick collagen was seen in 2 eyes, and fibrous long-spacing collagen in the newly synthesized collagen fibers was seen in 3 eyes. The cellular components of the glial cells appeared to have migrated through the thinner parts of the retina or through a defect of the ILM in 2 eyes.ConclusionsCells that migrate onto the surface of the ILM synthesize new collagen, which can create tangential traction. This may explain the success of vitrectomy with ILM peeling in treating MTM in highly myopic eyes.