Search Results (51)

Introduction: Recent technological progress in optical imaging—such as adaptive optics, interferometry and tomography—has greatly improved the resolution of retinal imaging. The ability to capture sequential images over time is particularly valuable for continuous monitoring and assessment of retinal diseases. Methods: This cross-sectional study involved patients with type 2 diabetes mellitus and age-matched controls from the Diabetes and Ophthalmology Department of the Emergency Military Clinical Hospital “Dr. Constantin Papilian” Cluj-Napoca between October 2023 and October 2024. These patients were assessed for inclusion and exclusion criteria and then categorized into two groups: the diabetes group and control group. Each participant underwent a comprehensive ophthalmological examination and retinal evaluation using SS-OCT (Spectralis Heidelberg Engineering, Heidelberg, Germany). The parameters measured included the superficial and deep foveal avascular zones (FAZ) in only one eye for each patient, selected based on image quality. Additionally, each patient underwent quantitative analysis of serum C-reactive protein (CRP) levels. Results: A total of 33 patients (33 eyes) featured, 13 men and 20 women. The DM group showed statistically significant higher results for CRP value compared to healthy subjects (p < 0.001). Also, both superficial and deep FAZ areas were statistically significantly higher for diabetes patients compared to the healthy controls (p < 0.05). The correlation analysis revealed that there was no significant correlation between CRP and either superficial FAZ (p = 0.809) or deep FAZ (p = 0.659). However, a significant positive moderate correlation was found between superficial FAZ and deep FAZ (r = 0.577, p = 0.015). Conclusions: Our findings showed a significantly enlarged FAZ in diabetic patients compared to healthy individuals, highlighting its potential as an early indicator of microvascular alterations in diabetes. While CRP levels were notably elevated in the diabetic group, no significant association was found between CRP and FAZ measurements, suggesting that FAZ changes may occur independently of systemic inflammatory status. Full article

Objective: To conduct a comparative analysis of layer-by-layer macular thickness, peripapillary retinal nerve fiber layer (pRNFL), and minimum rim width (MRW) between the eyes of patients with prostate cancer undergoing treatment with androgen receptor pathway inhibitors (ARPIs) and those of age- and sex-matched healthy controls, with the aim of assessing the potential effects of ARPIs on retinal structure. Methods: In this prospective cross-sectional study, 80 eyes of 80 patients with ARPI-treated metastatic prostate cancer and 80 eyes of 80 age-matched healthy controls were evaluated using Heidelberg Spectralis optical coherence tomography (OCT). Layer-by-layer macular thickness, pRNFL, and MRW were measured and compared between groups. Results: Thickness in most segments of retinal layers and pRNFL, as well as all MRW values, were significantly lower in the ARPI-treated group than in the controls (p < 0.05). No significant differences were observed between groups in terms of age, visual acuity, intraocular pressure, central corneal thickness, or lens status. Conclusions: This study is the first to evaluate layer-by-layer macular thickness in patients with metastatic prostate cancer treated with ARPIs, revealing significant thinning in nearly all macular layers, pRNFL, and MRW. These findings suggest that ARPI therapy may induce neurodegenerative changes in retinal and optic nerve structures. Therefore, further research is warranted to assess the ocular safety of these therapeutic agents. Full article

Objectives: The aim of this research was to evaluate the diagnostic performance of Spectralis optical coherence tomography (OCT) parameters for ocular hypertensive (OH) and glaucoma suspect (GS) eyes in an Asian population from Taiwan. Methods: This retrospective cross-sectional study included 258 OH (mean deviation [MD]: −1.10 ± 1.75 dB), 380 GS (MD: −1.24 ± 2.63 dB), and 742 normal (MD: −1.47 ± 3.29 dB) eyes. The diagnostic performance of Spectralis OCT parameters, including optic nerve head (ONH) and macular parameters, was compared among groups. The area under the receiver operating characteristic curve (AUC) of each parameter signified its power to differentiate between normal and OH or GS eyes. Results: In various scanning protocols, circumpapillary retinal nerve fiber layer (NFL)-temporal (AUC = 0.538), macular NFL-outer temporal (AUC = 0.611), and retinal average thickness (RAT)_1.8 (AUC = 0.578) were the best parameters in distinguishing OH eyes from normal eyes. Moreover, minimum rim width (MRW)-mean global (AUC = 0.737), macular NFL-outer temporal (AUC = 0.558), and RAT_2.8 (AUC = 0.543) were the best parameters in distinguishing GS eyes from normal eyes. After adjusting for age and refraction effects, we determined that the AUCs for OH and GS were 0.694 and 0.646, respectively. Conclusions: Our real-world data indicate that Spectralis OCT parameters show some potential for early glaucoma detection and monitoring, but their current diagnostic effectiveness remains limited. When managing OH eyes, caution is required in evaluating macular retinal NFL thickness in addition to the ONH. Bruch’s membrane opening–MRW is a potential objective indicator of ONH changes in GS eyes. Full article

Background/Objectives: The aim of this study was to quantify the interscan variability of vascular perfusion in patients with diabetic retinopathy (DR) using sequential optical coherence tomography angiography (OCT-A) scans. Methods: Patients with low-grade DR (DRSS score 20) underwent five sequential OCT-A imaging sessions. Vessel perfusion density (VPD) values of the superficial capillary plexus (SCP), intermediate capillary plexus (ICP), deep capillary plexus (DCP), and choriocapillaris (CC) were computed using ImageJ Version 1.54 software via a binarization process. The binarized images were analyzed to compute VPD using vessel density plugins. Inter-session variability was assessed using the coefficient of variation (CV) and intraclass correlation coefficient (ICC). The results were compared with an age-matched group of healthy controls. Results: A total of 16 eyes from 16 patients with DR (6 females, 37.5%) and 16 eyes from healthy controls (6 females, 37.5%) were included. Mean VPD values for SCP, ICP, DCP, and CC in patients with DR were 23.64, 13.64, 15.31, and 36.57, respectively. Corresponding values for the healthy subjects were 37.65, 23.32, 22.05, and 49.00, respectively. No significant differences were found in VPD across consecutive scanning sessions (p > 0.05) in either group. However, significant differences in VPD were observed between patients who were healthy and patients with diabetes. Conclusions: Sequential OCT-A imaging demonstrated no significant inter-session variability in both healthy subjects and subjects with diabetes. The Spectralis OCT-A system showed high reliability for imaging both healthy and diseased conditions. Full article

Background/Objectives: In this study, we aim to evaluate in vivo confocal microscopy (IVCM) findings of corneal stromal dystrophies (CSDs) including granular, macular and lattice corneal dystrophy that can be used for differential diagnosis and monitoring recurrences after surgical interventions. Methods: Patients diagnosed with CSD who were followed-up in the cornea and ocular surface unit were included in this study. IVCM was performed using the Heidelberg Retina Tomograph 3, Rostock Cornea Module (Heidelberg Engineering, Germany) and anterior segment optical coherence tomography (AS-OCT) imaging was performed using the Spectralis OCT (Heidelberg Engineering, Germany). The morphological structure, size and location of deposits, epithelial involvement and presence of inflammatory and dentritic cells were compared among the three stromal dystrophies. Results: A total of 72 eyes from 36 participants were included in this study. Twelve patients (33.33%) had granular corneal dystrophy (GCD), ten (27.77%) had macular corneal dystrophy (MCD) and fourteen (38.88%) had lattice corneal dystrophy (LCD). In GCD, highly reflective deposits varying in size (20 µm–300 µm) were observed. In MCD, diffuse hyperreflective stroma with dark striae, dentritic cells around deposits and abnormal keratocytes were observed. In LCD, there were branching, lattice-like and granular deposits with epithelial cell disruption in some of the eyes. In MCD, the central corneal thickness was thinner (449.44 ± 65.45 µm) compared to GCD and LCD (565.16 ± 49.62 µm and 569.91 ± 39.32 µm p < 0.001). Recurrence was observed in five patients following penetrating keratoplasty. Conclusions: IVCM is a valuable tool for distinguishing CSD subtypes and monitoring recurrence following surgical interventions. Full article

Objectives: This study aimed to assess the role of macular pigment optical density (MPOD) in patients with a full-thickness macular hole (FTMH) compared to healthy controls, evaluating postoperative changes in MPOD and exploring potential correlations with visual outcomes. Methods: This prospective, cross-sectional, comparative study included 16 eyes from FTMH patients who achieved anatomical hole closure following pars plana vitrectomy with the inverted ILM flap technique. Each eye underwent a comprehensive ophthalmologic examination, including BCVA and intraocular pressure measurements, anterior segment evaluation, fundus examination, and macular assessment with Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT, Spectralis, Heidelberg Engineering Inc., Heidelberg, Germany). Macular pigment optical density (MPOD) was measured using one-wavelength reflectometry (Visucam 200, Zeiss Meditec, Jena, Germany). These evaluations were conducted preoperatively and at 1, 3, and 6 months postoperatively to assess changes over time and correlate MPOD with visual outcomes. Results: Significant baseline differences were observed between FTMH patients and controls for BCVA, mean MPOD, maximum MPOD, and MPOD volume (p < 0.05). Postoperative BCVA improved significantly (p = 0.0011), with a notable increase in MPOD volume at 6 months (p = 0.01). A positive correlation was found between BCVA improvement and MPOD volume increase (r = 0.739; p = 0.002). Conclusions: In conclusion, MPOD measurement may serve as a valuable addition to the follow-up of FTMH surgery, providing insights into photoreceptor function and macular metabolic activity, potentially correlating with visual recovery. Further longitudinal studies are needed to clarify its relationship with clinical variables, such as metamorphopsia and OCT microstructural findings. Full article

Cobalt is a trace element, crucial for red blood cell formation and neurological function. Cobalt toxicity is often only diagnosed after severe manifestations, including visual impairment. We aimed to investigate whether optical coherence tomography (OCT) and magnetic resonance imaging (MRI) can effectively detect cobalt-induced ocular toxicity in a murine model. Five wild-type mice (WT, C57Bl6) received daily intraperitoneal cobalt chloride injections for 28 days with a dosage of 12.5 mg/kg. Another 5 WT mice served as controls. After 28 days, all mice underwent manganese contrast-enhanced MRI and OCT examinations. Macroscopic and histological analysis of the enucleated eyes were performed. MRI revealed an increased signal in the optic nerves of injected mice. Anterion OCT provided in vivo visualization of the entire eye, demonstrating incipient cataract formation in the cobalt-injected mice. Both Spectralis domain OCT and Anterion, followed by histological analyses, confirmed preserved retinal structure with decreased thickness in the cobalt-injected group, with only minor neuronal damage and cell loss. Optic nerve analysis demonstrated myelin loss and increased inflammation with high levels of reactive gliosis. This study demonstrates optic neuropathy induced by cobalt toxicity, as shown by increased optic nerve signal on MRI without significant retinopathy. Anterion OCT showed incipient cataracts in the anterior segment. Full article

Background and Objectives: The aim of the present study is to analyze choroidal and choriocapillaris structural and functional changes in eyes affected by Central serous chorioretinopathy after Photodynamic Therapy (PDT) and Subthreshold Micropulse laser (SML) treatment. Materials and Methods: Forty-two eyes of forty-two patients were analyzed in this observational study. Twenty-four patients underwent SML treatment, whereas eighteen patients were treated with PDT. Examinations were performed at baseline and after 3 months of treatment. Main outcome measures were: Best corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), pigment epithelial detachment (PED) presence and maximum height (PEDMH), and choroidal vascularity index (CVI) measured by means of Spectralis HRA + OCT (Heidelberg Engineering, Heidelberg, Germany) Optical coherence tomography (OCT) and choriocapillaris flow voids (CCFV) measured on Optical Coherence Tomography Angiography (OCT-A) platform PLEX Elite 9000 device (Carl Zeiss Meditec Inc., Dublin, CA, USA). Results: Changes in BCVA were registered in both groups over time (p < 0.001). Structural changes in terms of reduced CMT and PED presence were noted in the two groups at follow-up (p < 0.001 and p = 0.001, respectively). Structural and functional choroidal changes were found in the two groups with reduced CCT and CVI over time (p = 0.004 and p = 0.007, respectively), with significant differences between the two groups for CVI parameter (p = 0.001). CCFV increased over time in the PDT group and decreased in the SML group. Conclusions: PDT and SML are effective approaches in CSC eyes and are able to improve structural and functional parameters over time. Choroidal and choriocapillaris parameters are promising biomarkers able to monitor disease course, showing greater impact of PDT on choroid-choriocapillaris complex over time. Full article

Background/Objectives: Posterior staphyloma (PS) is a hallmark of pathological myopia, corresponding to a circumscribed outpouching of the eyeball with choroidal thinning and inward scleral deformation at its edges. Its pathogenesis is still unclear, thus constituting a research priority as the prevalence of myopia is increasing worldwide. Recently, it has been suggested that the optic nerve sheaths or oblique muscles are potential promoters of PS through the traction or compression effect that they apply to the eye wall. The inferior oblique muscle (IOM) inserts 1–2 mm from the macula. The projection of its insertion is accessible using Optical Coherence Tomography (OCT). Before launching prospective studies, we sought to detect any choroidal thinning (ChT) in the temporal vicinity of the macula and to measure the distance between it and the fovea (FT-distance). Methods: This retrospective cross-sectional pilot study included 120 eyes. Using Spectralis^®-OCT, the area centered by the Bruch’s membrane opening–fovea axis was analyzed for ChT and FT-distance. Results: Of the 112 defined eyes, 70% (78 eyes) had ChT. Pachymetry was significantly thinner (p = 0.018) in eyes with than without ChT. The mean FT-distance was 3601.9 ± 93.6 µm. Conclusions: The location of ChT coincided with the insertion distance of the IOM, suggesting a link between them. The association between the presence of ChT and a thinner pachymetry suggests a reduced scleral resistance, as a thinner pachymetry is related to a thinner sclera. Our results suggest a link between ocular deformation and the IOM, which may be relevant for the pathogenesis of PS, warranting further investigation. Full article

Objectives: The aim of this study is to describe and validate an optical-coherence-tomography (OCT)-based method to easily calculate specific volumes, addressing the limitations of current OCT software in automating volumetric analysis for specific entities in retinal pathologies. Methods: After manually drawing the specific entity on linear OCT scans using the calliper function and automated measurement of its area, the following formula was used for volumetric calculation: Volume [mm³] = ∑area [mm²] × OCT-scan distance [mm]. Retinal volume (RV) was measured by two independent observers in eyes with a normal foveal profile (NFP) and was compared with the automated measurements performed by the OCT software (Engineering GmbH, Heidelberg, Germany); the same process was repeated for the volume of the foveal cavity (FC) or foveoschisis (FS) in eyes with lamellar macular holes (LMHs). Power calculations were conducted to ensure adequate sample size. The measurements were re-acquired after six weeks. Intra- and inter-observer variability as well as comparison to automated RV calculations were analysed. Results: This study included a total of 62 eyes divided into two groups: the NFP (30 eyes) and LMH (32 eyes) groups. The Bland–Altman plots showed a high degree of agreement in both groups for inter-observer and intra-observer agreement. In addition, in the NFP group, a high degree of agreement was demonstrated between human observers and the OCT software (Spectralis). Conclusions: An easy, reliable, and widely applicable method to calculate volumes is described and validated in this paper, showing excellent inter- and intra-observer agreement, which can be applied to any entity requiring a specific study in the context of retinal pathologies. Full article

Artificial intelligence (AI) models have received considerable attention in recent years for their ability to identify optical coherence tomography (OCT) biomarkers with clinical diagnostic potential and predict disease progression. This study aims to externally validate a deep learning (DL) algorithm by comparing its segmentation of retinal layers and fluid with a gold-standard method for manually adjusting the automatic segmentation of the Heidelberg Spectralis HRA + OCT software Version 6.16.8.0. A total of sixty OCT images of healthy subjects and patients with intermediate and exudative age-related macular degeneration (AMD) were included. A quantitative analysis of the retinal thickness and fluid area was performed, and the discrepancy between these methods was investigated. The results showed a moderate-to-strong correlation between the metrics extracted by both software types, in all the groups, and an overall near-perfect area overlap was observed, except for in the inner segment ellipsoid (ISE) layer. The DL system detected a significant difference in the outer retinal thickness across disease stages and accurately identified fluid in exudative cases. In more diseased eyes, there was significantly more disagreement between these methods. This DL system appears to be a reliable method for accessing important OCT biomarkers in AMD. However, further accuracy testing should be conducted to confirm its validity in real-world settings to ultimately aid ophthalmologists in OCT imaging management and guide timely treatment approaches. Full article

Background: Thickening of the inner nuclear layer (INL) or microcystic macular changes has been reported to be implicated in glaucoma patients, but their potential impact on disease progression remains unclear. We investigated the relationship between baseline microcystic macular edema in the INL or INL thickness and subsequent visual field (VF) progression in glaucoma patients. Methods: This retrospective observational study included primary open-angle glaucoma with follow-up exceeding 3 years. We identified macular cystic changes through Spectralis optical coherence tomography and measured the INL thickness using automated segmentation. Glaucoma progression was determined using the Guided Progression Analysis program of the Humphrey filed analyzer, calculating the mean deviation (MD) changes (dB/year). Results: Microcystic macular changes were observed in 12 (7.5%) of 162 patients. Patients with microcystic macular change had thicker INL thickness than those without it (p = 0.010). Progressors had a higher probability of having microcystic macular changes and a thicker average INL thickness than nonprogressors (p = 0.003, p = 0.019). Thicker INL thickness was associated with faster VF progression based on MD slope (dB/year) in the multivariate regression analysis (p = 0.045). Additionally, greater intraocular pressure (IOP) fluctuation was found to be associated with both a thicker INL and the presence of microcystic changes in the multivariate regression analysis (p = 0.003, 0.028). Conclusions: Increased macular INL thickness indicative of INL changes was linked to subsequent VF progression in glaucoma patients. These findings suggest that retinal inner nuclear change could serve as an indicator of progressive glaucoma. Full article

Background: The goal was to evaluate the diagnostic capability of different parameters obtained with the posterior pole (PP) software in Spectralis SD-OCT with the 8 × 8 grid tilted at 7° and horizontalized in glaucomatous eyes. Methods: A total of 299 eyes were included, comprising 136 healthy eyes and 163 with primary open-angle glaucoma (POAG). The following segmentations were evaluated: complete retina, retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), GCL and inner plexiform layer (GCLIPL), ganglion cell complex (GCC), outer plexiform layer and outer nuclear layer (OPLONL), inner retinal layer (IRL), and outer retinal layer (ORL). Different patterns of macular damage were represented using heatmaps for each studied layer, where the areas under the curve (AUROC) values and a retinal thickness cutoff point were defined to discriminate POAG patients. Results: There was not any difference in the diagnostic capability for detecting glaucoma between the grid tilted at 7° and horizontalized. The macular segmentations that offer the highest diagnostic ability in glaucoma discrimination were, in the following order, RNFL (AUROC = 0.796), GCC (AUROC = 0.785), GCL (AUROC = 0.784), GCLIPL (AUROC = 0.770), IRL (AUROC = 0.755), and the complete retina (AUROC = 0.752). In contrast, ORL and OPLONL do not appear to be helpful for discriminating POAG. Conclusions: Some results of PP software may be useful for discriminating POAG. Full article

Background: This study aims to establish a reference for the superior–inferior hemisphere asymmetry in thickness values for all macular layers for the posterior pole algorithm (PPA) available for the Spectralis SD-OCT device. Methods: We examined 300 eyes of 300 healthy Caucasian volunteers aged 18–84 years using the PPA, composed of a grid of 64 (8 × 8) cells, to analyze the thickness asymmetries of the following automatically segmented macular layers: retinal nerve fiber layer (RNFL); ganglion cell layer (GCL); inner plexiform layer (IPL); inner nuclear layer (INL); outer plexiform layer (OPL); outer nuclear layer (ONL); retinal pigment epithelium (RPE); inner retina; outer retina; complete retina. Mean ± standard deviation and the 2.5th and 97.5th percentiles of the thickness asymmetry values were obtained for all the corresponding cells. Results: All the macular layers had significant superior–inferior thickness asymmetries. GCL, IPL, INL, ONL and RPE showed significantly greater thicknesses in the superior than the inferior hemisphere, whereas RNFL and OPL were thicker in the inferior hemisphere. The largest differences between hemispheres were for RNFL and ONL. Conclusions: This is the first normative database of macular thickness asymmetries for the PPA and should be considered to distinguish normal from pathological values when interpreting superior–inferior macular asymmetries. Full article

The purpose of this study is to evaluate choroidal thickness (ChT) at the subfoveal and peripheral level after the instillation of 0.5% tropicamide + 10% phenylephrine 9 hydrochloride eye drops by using OCT scans in enhanced depth image (EDI) mode. In total, 53 patients (30 males and 23 females) were involved, and the mean age was 25.62 ± 2.41 (age range: 23–36). The dominant eye was treated with tropicamide + phenylephrine (Visumidriatic Fenil 100 mg/mL + 5 mg/mL, Visufarma) while the nondominant eye was used as the control. An OCT analysis was performed on both eyes before and 30 min after the instillation of a drop of mydriatic in the dominant eye. The ChT was measured by using the OCT software measurement tool (Spectralis; Heidelberg Engineering; Heidelberg, Germany, version 6.0). The results showed a statistically significant ChT decrease (p = 0.009) in the temporal sector after the treatment with tropicamide + phenylephrine. In the subfoveal and nasal sectors, no statistically significant ChT changes were detected (p = 0.94; p = 0.85) following the administration of the mydriatic eye drops. The ChT thinning in the temporal sector following the instillation of the tropicamide + phenylephrine eye drops suggests that in the case of ChT studies, mydriatic administration should be avoided. Full article