Search Results (100)

Recent evidence suggests that SARS-CoV-2 may induce subtle anatomical changes in the retina, detectable through advanced imaging techniques. This retrospective case–control study utilized optical coherence tomography (OCT) to assess medium-term retinal alterations in 55 healthcare workers, including 25 individuals with PCR-confirmed COVID-19 and 30 non-COVID-19 controls, all of whom had worked in COVID-19 clinical settings. Comprehensive ophthalmological examinations, including OCT imaging, were conducted six months after infection. The analysis considered demographic variables, comorbidities, COVID-19 severity, risk factors, and treatments received. Central macular thickness (CMT) was significantly increased in the post-COVID-19 group (p < 0.05), with a weak but statistically significant positive correlation between CMT and disease severity (r = 0.245, p < 0.05), suggesting potential post-inflammatory retinal responses. No significant differences were observed in retinal nerve fiber layer (RNFL) or ganglion cell complex (GCL + IPL) thickness. However, mild negative trends in inferior RNFL and average GCL+IPL thickness may indicate early neurodegenerative changes. Notably, patients with comorbidities exhibited a significant reduction in superior and inferior RNFL thickness, pointing to possible long-term neurovascular impairment. These findings underscore the value of OCT imaging in identifying subclinical retinal alterations following COVID-19 and highlight the need for continued surveillance in recovered patients, particularly those with pre-existing systemic conditions. Full article

Purpose: We sought to evaluate the long-term effects of oral citicoline; vitamins A, B, C, and E; and blackcurrant therapy in patients with primary open-angle glaucoma (POAG) using optical coherence tomography (OCT), OCT angiography (OCTA), and microperimetry parameters. Materials and Methods: Fifteen patients with POAG (the treated group) received one soluble liquid sachet of a complementary dietary supplement containing, in a fixed combination, citicoline; vitamins A, B, C, and E; and blackcurrant (Citizin^®, Bruschettini s.r.l., Genova, Italy) daily for 20 days a month for 1 year. Fifteen age-matched patients with POAG were given a placebo and served as a control group. The patients underwent best-corrected visual acuity (BCVA) analysis, Goldmann applanation tonometry, microperimetry examination, OCT, and OCTA at the beginning of the study and then 1, 6, and 12 months later. Results: A significant improvement in the overall retinal nerve fiber layer (RNFL) thickness values (compared with the control group) was recorded at the 6- (p < 0.009) and 12 (p < 0.001)-month follow-ups in the treated group. The ganglion cell complex (GCC) increased in thickness (compared with the control group) at the 12-month follow-up (p < 0.0001) in the treated group. The mean macular vessel density (MVD) and the mean peripapillary vessel density (PVD) in the treated group were significantly higher than those in the control group at the 12-month follow-up. Microperimetry examination, BCVA, and Goldmann applanation tonometry showed no statistically significant alterations. Conclusions: A fixed combination of citicoline; vitamins A, B, C, and E; and blackcurrant administered orally may have a positive impact on RNFL, GCC, MVD, and PVD in patients with POAG. Full article

Background/Objectives: Certain aspects of retinal thickness assessed by optical coherence tomography (OCT) in patients with Parkinson’s disease (PD) require additional clarification. It is supposed that attributing reduced retinal thickness in PD to dopaminergic loss may not be acceptable as it also happens in diseases where dopaminergic loss does not occur. The objective of our study is to compare the ganglion cell/inner plexiform layer (GCIPL), peripapillary retinal nerve fiber layer (pRNFL), and macular thickness of PD and dopa responsive dystonia (DRD) patients with healthy controls (HC), to investigate whether DRD patients, as a distinctive model of genetically induced dopamine deficiency, have reduced retinal thickness in comparison with PD, and to analyze correlation between retinal thickness and various PD clinical parameters. Methods: We analyzed 86 patients with PD, 10 patients with DRD, and 96 age- and sex-matched HC. Results: GCIPL, pRNFL, and central macula thickness (CMT) are statistically significantly thinner in PD patients compared to HC (p < 0.001, all). GCIPL and CMT are also statistically significantly thinner in DRD patients compared to HC (p = 0.012, p = 0.001, respectively). GCIPL thickness correlates positively with the daily dose of levodopa (r = 0.244, p < 0.01). The thickness of GCIPL and pRNFL correlate negatively with current age (r = −0.219; p < 0.01 and r = −0.358; p < 0.05, respectively). All retinal parameters are statistically significantly thinner in females than in males (p < 0.05). Conclusions: Patients with PD and DRD did not differ in GCIPL and pRNFL thickness when compared to one another. These results, supported by positive correlation of levodopa dose and GCIPL thickness in PD patients, emphasize the importance of dopamine in maintaining retinal thickness. Full article

Background/Objectives: Leber hereditary optic neuropathy (LHON) is often misdiagnosed in its early stages as idiopathic single isolated optic neuritis (SION) or multiple-sclerosis-associated optic neuritis (MS-ON) due to the young age of the patients, the subacute vision loss, and the central visual field defect. The aim of this retrospective study was to evaluate changes in the peripapillary RNFL and GCLT over time in patients with early LHON, MS-ON, and SION in order to differentiate Leber hereditary optic neuropathy (LHON) from optic neuritis (ON) in the early stages of the disease. Methods: Patients with LHON and ON (either idiopathic single isolated optic neuritis (SION) or ON as the first symptom of relapsing–remitting multiple sclerosis (MS-ON) were included. Optical coherence tomography (OCT) scans were reviewed. The inclusion criteria were at least one follow-up OCT examination and a definite diagnosis after examination. Changes in the peripapillary retinal nerve fibre layer (RNFL) and macular ganglion cell layer thickness (GCLT) in both groups were evaluated over time and compared with normative data. The analysis focused on the early phase (0–45 days) after symptom onset. Results: Nine LHON patients with early OCT scans and twenty patients with ON were included. Quantitative OCT analysis showed greater RNFL swelling in LHON compared to ON during the first 60 days after symptom onset. Between day 61 and day 120, subnormal RNFL values were observed in both groups compared to controls. Thereafter, the RNFL decreased continuously and severely in the LHON group. The RNFL of ON patients did not show a clear progression after day 120. The GCLT in five LHON eyes showed a strong and solid decrease from day 0 to day 45, which was stronger than the moderate atrophy measured in ON eyes. Continuous GCL atrophy was measured until day 121 in LHON, after which a floor effect was reached. The GCLT in the inner nasal and inner inferior sectors was significantly smaller in LHON compared to ON patients on days 0–45. Conclusions: Thinning of the GCLT occurs at an early stage in LHON patients. Thus, GCLT may become a diagnostic tool to differentiate LHON from ON in the early phase of disease. Full article

Background/Objectives: We sought to assess the relationship between contrast sensitivity (CS) and optical coherence tomography (OCT) findings, including ganglion cell–inner plexiform layer (GCIPL) thickness, in eyes with cystoid macular edema, secondary to branch retinal vein occlusion (BRVO-CME), treated with intravitreal ranibizumab (IVR). Methods: This prospective study included 44 patients with BRVO-CME who underwent treatment with IVR (three monthly injections and pro re nata) and were followed up for 12 months. We collected data on CS, best-corrected visual acuity (BCVA), and OCT findings (ellipsoid zone [EZ] and external limiting membrane status [ELM], central foveal thickness [CFT], and average GCIPL thickness) at the time of the final visit when macular edema was resolved. Multiple regression analysis was used to evaluate the relationship between visual functions and OCT findings, age, and lens status. Results: Multiple regression analysis revealed that lower GCIPL thickness was significantly associated with worse CS (β = 0.008; 95% CI, 0.002–0.014; p = 0.011), whereas this was not the case with BCVA. Lower CFT and mild cataracts were also associated with worse CS (CFT: β = 0.003; 95% CI, 0.001–0.004; p = 0.001; mild cataract: β = −0.182; 95% CI, −0.286–−0.078; p = 0.001) and worse BCVA (CFT: β = −0.002; 95% CI, −0.003–−0.001; p < 0.001; mild cataract: β = 0.079; 95% CI, 0.008–0.150; p = 0.029). Conclusions: GCIPL thickness may serve as a valuable biomarker for CS in eyes with BRVO-CME following IVR treatment. Full article

Aim: The aim of this paper is to assess the changes in optical coherence tomography angiography (OCTA) parameters among normal individuals and for type 2 diabetes mellitus (DM) patients, with and without retinopathy, in the adult Saudi population. Methods: This was a prospective cross-sectional study; subjects were divided into four groups. Group 1, the control group, consisted of 40 eyes from normal healthy individuals, while the other three groups included subjects diagnosed with type 2 DM at various stages of retinopathy. All subjects’ OCT and OCTA images were acquired using a swept-source OCT (DRI Triton, Topcon, Inc., Tokyo, Japan). Parameters collected included superficial capillary plexus (SCP) vessel density (VD), foveal avascular zone (FAZ), macular thickness (MT), ganglion cell layer (GCL) thickness, and retinal nerve fiber layer (RNFL) thickness at central and perifoveal locations. OCTA acquisition included a 4.5 × 4.5 mm scan to measure FAZ and SCP VD, with the FAZ manually mapped onto OCTA images at the SCP. Results: There was a significant decrease in SCP VD (p < 0.05) in all quadrants except the central as the severity of diabetes increased. SCP VD was considerably lower in DM patients without retinopathy compared to controls. Additionally, the FAZ area exhibited a significant increasing trend as the severity of diabetic retinopathy (DR) increased. Regression analysis showed a significant decrease in RNFL thickness (p < 0.01) and GCL thickness (p < 0.01) in the nasal quadrant as DR severity increased, even after adjusting for age, gender, and mean arterial pressure. Furthermore, SCP VD showed a significant negative correlation with both the duration of DM and contrast sensitivity. Conclusions: OCT and OCTA parameters were significantly different between the control and diabetic patients with and without DR. The observed microvascular and contrast sensitivity alterations may precede detectable DR damage or changes in visual acuity. Full article

Background/Objectives: This study aimed to evaluate the association between the thickness of the macular ganglion cell-inner plexiform layer (GC-IPL), a marker of retinal neurodegeneration, and diabetic retinopathy (DR), a microvasculopathy, in type 2 diabetic patients (T2DM), and to determine the related risk factors. Methods: This cross-sectional study included 50 eyes of 25 T2DM with a median age of 64 and a median diabetes duration of 13 years. Complete diabetological, nephrological, and ophthalmological examination was performed, including color fundus photography according to the EURODIAB methodology and optical coherence tomography (OCT) of the macula. Patients with proliferative DR and diabetic macular edema were not included in the study. Data were analyzed using the software package Statistica™ 14.0.1.25 (TIBCO Inc., USA). Results: Fifty eyes were divided into two groups: no DR (n = 34) and non-proliferative DR (NPDR) (n = 16). The NPDR group had longer diabetes duration (p = 0.042), higher HbA₁c (p = 0.002), lower HDL cholesterol (p = 0.036), and also lower macular GC-IPL thickness (p = 0.027) than those without DR. The correlation between DR and GC-IPL was significantly negative (R = −0.319, p = 0.024). DR was positively related to diabetes duration (p = 0.047) and HbA₁c (p = 0.003), while the relation between GC-IPL and diabetes duration (p = 0.042) and HbA₁c (p = 0.043) was negative. Binary logistic regression analysis showed that HbA₁c (OR = 2.77, p = 0.007) and HDL cholesterol (OR = 0.08, p = 0.031) were the main predictors for DR, whereas the best model for predicting the GC-IPL thickness (R² = 0.223) obtained from stepwise regression analysis included HDL cholesterol, triglycerides, estimated glomerular filtration rate, and albumin/creatinine ratio. Conclusions: The negative correlation between macular GC-IPL and DR in T2DM indicates the coexistence of two parts, neurodegenerative and microvascular, in one diabetic eye complication, linked by the same well-known risk factors: diabetes duration and HbA₁c. Full article

Background/Objectives: The automated analyses of optical coherence tomography (OCT) scans of the retina occasionally suggest the presence of tissue deficits when no visual field defects can be detected. This study was made to find the sources of such alerts. Methods: Data from a population-based cohort of 360 participants aged 30–80 years was analysed for the anatomical sources of alerts after the extensive exclusion of participants where any suspicion of abnormality could be raised. An analysis was made of 12 × 9 mm volume scans centred between the disc and the fovea. The exclusions comprised 107 eyes with definite or borderline abnormal visual fields or other potentially confounding characteristics. A statistical analysis of the thickness patterns was made using the manufacturer’s proprietary algorithm. The analysis comprised alerts corresponding to local layer thickness values in the lower 5th percentile of an independent reference population. Results: Of the 613 eligible healthy eyes, thickness deficit alerts were seen in 391. They were related to the angle between the temporal nerve fibre ridges being wider, narrower, or rotated compared to the reference template in 174 eyes and to the variations in the size of the macula in 207 eyes. The source was unidentifiable in 28 eyes. The common sources were a thin papillomacular nerve fibre layer accompanied by arcuate nerve fibre ridges spaced far apart and a thinly, but wider than the normal macular ganglion cell layer. Conclusions: Anatomical variation in the retinal nerve fibre and ganglion cell layers was the source of more than 90% of the thickness deficit alerts in the eyes with normal visual fields. Full article

Objectives: This study aimed to study the inner retina functional and morphological impairment of retinal ganglion cells (RGCs) from specific macular rings and sectors to identify whether selective macular regions were more vulnerable than others within the 20 central degrees in patients with open-angle glaucoma (OAG). Methods: In total, 21 OAG patients [mean age 50.19 ± 7.86 years, Humphrey Field Analyzer (HFA) 24-2 mean deviation (MD) between −5.02 and −22.38 dB, HFA 10-2 MD between −3.07 and −17.38 dB], providing 21 eyes, were enrolled in this retrospective case–control study. And 20 age-similar healthy subjects, providing 20 eyes, served as controls. The multifocal photopic negative response (mfPhNR) response amplitude density (RAD) from concentric rings and macular sectors and ganglion cell layer thickness (GCL-T) assessed by Spectral Domain–Optical Coherence Tomography (SD-OCT) was measured. Mean RAD and GCL-T values were compared between OAG and control ones by ANOVA. In OAG eyes, the relationship between mfPhNR and SD-OCT data was examined by linear regression analysis, and Pearson’s correlation coefficients were computed. Results: In considering all rings and sectors, compared to the controls, the OAG group showed a significant (p < 0.01) reduction in mean mfPhNR RAD and in GCL-T values with the greatest reduction in the central area. In OAG eyes, a significant (p < 0.01) correlation between all mfPhNR RAD and GCL-T values, with significant (p < 0.01) correlation coefficients, were found. Conclusions: In OAG eyes, RGC dysfunction was detectable by abnormal mfPhNR responses in localized macular areas, mainly in the central one. Localized macular RGC dysfunction was linearly correlated with the GCL morphological changes. Full article

Background/Objectives: This study aims to develop and validate a Glaucoma Health Score (GHS) that incorporates multiple individual glaucoma risk factors to enhance glaucoma detection in screening environments. Methods: The GHS was developed using a retrospective dataset from two clinical sites, including both eyes of glaucoma patients and controls. The model incorporated age, central corneal thickness, intraocular pressure, pattern standard deviation from a visual field threshold 24-2 test, and two parameters from an optical coherence tomography (OCT) test: the average circumpapillary retinal nerve fiber layer thickness and the minimum thickness of the six sectors of the macular ganglion cell plus the inner plexiform layer. The GHS was then validated in two independent datasets: one from primary care sites using Maestro OCT data (test dataset 1) and another from an academic center using DRI OCT Triton (test dataset 2). Results: Both eyes of 51 glaucoma patients and 67 controls were included in the development dataset. Setting the GHS cutoff at 75 points out of 100, test dataset 1, which comprised 41 subjects with glaucoma and 41 healthy controls, achieved an area under the receiver operating characteristic curve (AUROC) of 0.98, with a sensitivity of 71% and specificity of 98%; test dataset 2, which included 53 patients with glaucoma and 53 healthy controls, resulted in an AUROC of 0.95, with a sensitivity of 75% and specificity of 96%. A decision curve analysis across all datasets demonstrated a higher net benefit for the GHS model compared to individual OCT parameters. Conclusions: The GHS offers a feasible, standardized approach for early detection of glaucoma, providing strong specificity and acceptable sensitivity, with clear decision-making benefits in screening settings. Full article

(1) With persistent symptoms emerging as a possible global consequence of COVID-19, the need to understand, diagnose, and treat them is paramount. This systematic review aims to explore the potential of optical coherence tomography (OCT) and/or optical coherence tomography angiography (OCTA) in effectively diagnosing long COVID. (2) The database PubMed and, to reduce selection bias, the AI research assistant Elicit, were used to find relevant publications in the period between February 2021 and March 2024. Included publications on OCT and OCTA analysis of participants with acute COVID symptoms, those after recovery, and participants with long COVID symptoms were organized in a table. Studies with participants under the age of 18, case reports, and unrelated studies, such as pure slit-lamp examinations and subgroup analyses were excluded. (3) A total of 25 studies involving 1243 participants and 960 controls were reviewed, revealing several changes in the posterior eye. Long COVID participants displayed significant thinning in retinal layers in the OCT, including the macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL). Divergent findings in recovered cohorts featured mRNFL reduction, GCL increase and decrease, and GCL-IPL decrease. Long COVID OCTA results revealed reduced vessel density (VD) in the superficial capillary plexus (SCP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP). In recovered patients, SCP consistently showed a reduction, and DCP exhibited a decrease in five out of six publications. The foveal avascular zone (FAZ) was enlarged in five out of nine publications in recovered participants. (4) During various stages of COVID-19, retinal changes were observed, but a comparison between long COVID and recovered cohorts was aggravated by diverse inclusion and exclusion criteria as well as small sample sizes. Changes in long COVID were seen in most OCT examinations as thinning or partial thinning of certain retinal layers, while in OCTA a consistently reduced vessel density was revealed. The results suggest retinal alterations after COVID that are variable in OCT and more reliably visible in OCTA. Further research with larger samples is important for advancing long COVID diagnosis and management. Full article

Purpose: To investigate the influence of intraretinal fluid (IRF) on change in retinal nerve fiber layer (RNFL) and retinal ganglion cell layer (RGCL) and thickness in patients with naive neovascular AMD under anti-VEGF treatment. Design: post hoc analysis. Methods: 97 eyes of 83 patients on continuous therapy with intravitreal anti-vascular endothelial growth factors (anti-VEGF) and a follow-up of 24 months were included. RGCL and RNFL thickness in the perifoveal (-O), parafoveal (PF), and nasal areas and number of injections (IVI) were recorded before the first IVI as well as 1 and 2 years after initiating treatment and compared longitudinally and between groups with and without IRF. Results: The group with IRF at baseline had a higher RNFL thickness at baseline and showed a significant reduction in RNFL-PF between baseline and first and second follow-ups (p < 0.001) but not between first and second follow-ups. The group without IRF showed no significant reduction in RNFL over time. The presence of IRF was not associated with a reduction in RNFL-O or RNFL-nasal. RGCL thickness decreased significantly in both groups with and without IRF after 2 years. Number of IVIs showed no significant correlation to RNFL or RGCL after stratification for the presence of IRF. Conclusions: The presence of IRF has a significant influence on RNFL thickness at baseline as well as on its changes over time during anti-VEGF therapy. The preoperative presence of IRF should be considered when comparing changes in RNFL thickness after IVI. Full article

Optic Atrophy (OA) can be associated with the development of microcystic macular edema (MME) in the perifoveal retinal inner nuclear layer (INL). We aimed here to retrospectively determine the prevalence of MME in patients with non-glaucomatous OA in our tertiary ophthalmology department between 2015 and 2020. We then examined how MME affected the thicknesses of the different retinal layers and the differences in demographic and clinical characteristics between those patients who developed MME and those who did not. A total of 643 eyes (429 patients) were included (mean age 45.9 ± 17.8 years, 52% female). MME developed in 95 (15%) eyes and across all etiologies of OA except for toxic/nutritional causes, but the prevalence of MME varied between the different etiologies. The development of MME was associated with thinning of the ganglion cell layer (11.0 vs. 9.6 μm; p = 0.001) and the retinal nerve fiber layer (10.1 vs. 9.15 μm; p = 0.024), with INL thickening in the 3- and 6-mm diameter areas of the central fovea. Patients developing MME had significantly worse distance best-corrected visual acuity than those not developing MME (0.62 vs. 0.38 logMAR; p = 0.002). Overall, the presence of MME in OA cannot be used to guide the diagnostic work-up of OA. Full article

Background: Although visual field (VF) defects are common in compressive pituitary adenoma (CPA), their pathophysiology has not been fully elucidated. The mechanical theory (i.e., direct compression of the optic chiasm by the CPA) and the vascular theory (i.e., compression of the vessels supplying the visual path by the CPA) or their association could explain the visual impairment. The aim of this study was to determine whether the vascular density (VD) improved after surgical decompression of the optic chiasm in CPA patients and whether OCT-A could help to identify predictive factors for postoperative visual recovery. Methods: A prospective controlled study was conducted in patients who underwent transsphenoidal pituitary adenoma surgery. Patients were divided into two groups: with CPA and without CPA (NCPA). All patients underwent a neuro-ophthalmological examination, VF testing, macular and optic disc structural OCT [retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thicknesses] and OCT-A before and then 1 and 6 months after surgery. Results: Twenty-four eyes and fourteen eyes were included, respectively, in the CPA and NCPA groups. None of the VD parameters assessed by OCT-A were significantly improved after surgery in the CPA group. In the CPA group, the mean macular superficial VD was significantly decreased at 6 months. The multivariate analysis failed to identify any preoperative parameters predictive of postoperative VF improvement. Conclusions: Our preliminary findings suggest that the visual impairment observed in CPA patients could not be explained by the vascular theory. None of the preoperative OCT-A parameters allowed a postoperative VF recovery assessment. Trial registration number NCT04074642, ID-RCB 2019-A01186-51 date of registration 30 July 2019. Full article

Background/Objectives: To investigate macular vascular biomarkers for the detection of primary open-angle glaucoma (POAG). Methods: A total of 56 POAG patients and 94 non-glaucomatous controls underwent optical coherence tomography angiography (OCTA) assessment of macular vessel density (VD) in the superficial (SCP), and deep (DCP) capillary plexus, foveal avascular zone (FAZ) area, perimeter, VD, choriocapillaris and outer retina flow area. POAG patients were classified for severity based on the Glaucoma Staging System 2 of Brusini. ANCOVA comparisons adjusted for age, sex, race, hypertension, diabetes, and areas under the receiver operating characteristic curves (AUCs) for POAG/control differentiation were compared using the DeLong method. Results: Global, hemispheric, and quadrant SCP VD was significantly lower in POAG patients in the whole image, parafovea, and perifovea (p < 0.001). No significant differences were found between POAG and controls for DCP VD, FAZ parameters, and the retinal and choriocapillaris flow area (p > 0.05). SCP VD in the whole image and perifovea were significantly lower in POAG patients in stage 2 than stage 0 (p < 0.001). The AUCs of SCP VD in the whole image (0.86) and perifovea (0.84) were significantly higher than the AUCs of all DCP VD (p < 0.05), FAZ parameters (p < 0.001), and retinal (p < 0.001) and choriocapillaris flow areas (p < 0.05). Whole image SCP VD was similar to the AUC of the global retinal nerve fiber layer (RNFL) (AUC = 0.89, p = 0.53) and ganglion cell complex (GCC) thickness (AUC = 0.83, p = 0.42). Conclusions: SCP VD is lower with increasing functional damage in POAG patients. The AUC for SCP VD was similar to RNFL and GCC using clinical diagnosis as the reference standard. Full article