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Parameters of ocular fundus on spectral-domain optical coherence tomography for glaucoma diagnosis
摘要： In this review, we summarize the progression of several parameters assessed by spectral-domain optical coherence tomography (SD-OCT) in recent years for the detection of glaucoma. Monitoring the progression of defects in the retinal nerve fiber layer (RNFL) thickness is essential. Imaging and analysis of retinal ganglion cells (RGCs) and inner plexiform layer (IPL), respectively, have been of great importance. Optic nerve head (ONH) topography obtained from 3D SD-OCT images is another crucial step. Other important assessments involve locating the Bruch’s membrane opening (BMO), estimating the optic disc size and rim area, and measuring the lamina cribrosa displacement. Still other parameters found in the past three years for glaucoma diagnosis comprise central retinal artery resistive index, optic disc perfusion in optical coherence tomography angiography (OCTA) study, peripapillary choroidal thickness, and choroidal area in SD-OCT. Recently, several more ocular fundus parameters have been found, and compared with the earlier parameters to judge the accuracy of diagnosis. While a few of these parameters have been widely used in clinical practice, a fair number are still in the experimental stage.
关键词： optic nerve head,retinal nerve fiber layer,lamina cribrosa,optical coherence tomography,macular thickness,ganglion cells,glaucoma progression
更新于2025-09-09 09:28:46
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Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy
摘要： Purpose: To test the efficacy of the intravitreal dexamethasone (DEX) implant in patients with retinal vein occlusions (RVOs) who have failed multiple anti-vascular endothelial growth factor (anti-VEGF) treatments. Methods: A randomized exploratory study of ten patients with branch RVO or central RVO who received at least two previous anti-VEGF treatments and had persistent or unresponsive cystoid macular edema. Treatment with the DEX implant was either every 4 months or pro re nata (PRN) depending on their group assignment for 1 year. Multifocal electroretinography and microperimetry were the primary end points, with high-resolution optical coherence tomography and best-corrected visual acuity as the secondary end points. Results: All patients in both the every 4 month and PRN cohorts who completed the study received the three maximal injections of DEX; therefore, the data from both cohorts were combined and reported as a case series. On average, the multifocal electroretinography amplitude increased significantly from 5.11±0.66 to 24.19±5.30 nV/deg2 at 12 months (P,0.005), mean macular sensitivity increased from 7.67±2.10 to 8.01±1.98 dB at 4 months (P=0.32), best-corrected visual acuity increased significantly from 51.0±5.1 to 55.4±5.1 early treatment of diabetic retinopathy study letters at 2 months (P,0.05), and central retinal thickness decreased from 427.6±39.5 to 367.1±37.8 μm at 4 months (P,0.05). Intraocular pressure increased significantly in one patient, with that patient requiring an additional glaucoma medication for management. Additionally, cataract progression increased significantly (P,0.05) in this patient population and partially limited analysis of other end points. Conclusion: DEX should be considered as a treatment option in patients with RVOs who have failed anti-VEGF therapy, as the results of this study demonstrated an improvement in retinal morphology and macular function. Cataract progression did occur following multiple consecutive injections; however, steroid-induced glaucoma was not a limiting factor.
关键词： intravitreal dexamethasone implant,multifocal electroretinography,retinal vein occlusion,anti-VEGF,cataract progression
更新于2025-09-09 09:28:46
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High Symmetry of Visual Acuity and Visual Fields in <i>RPGR</i> -Linked Retinitis Pigmentosa
摘要： PURPOSE. Mutations in retinitis pigmentosa GTPase regulator (RPGR) cause 70% to 90% of X-linked retinitis pigmentosa (XLRP3) cases, making this gene a high-yield target for gene therapy. This study analyzed the utility of relevant clinical biomarkers to assess symmetry and rate of progression in XLRP3. METHODS. A retrospective, cross-sectional analysis of 50 XLRP3 patients extracted clinical data including visual acuity (VA), visual fields (I4e and III4e targets), foveal thickness, and ERG data points alongside molecular genetic data. Symmetry was assessed by using linear regression analysis. Kaplan-Meier survival curves (KMCs) and generalized linear mixed model calculations were used to describe disease progression. RESULTS. Ninety-six percent of patients exhibited a rod–cone phenotype, and 4% a cone–rod phenotype. Open reading frame 15 (ORF15) was confirmed as a mutational hotspot within RPGR harboring 73% of exonic mutations. Significant variability, but no clear genotype–phenotype relationship, could be shown between mutations located in exons 1–14 versus ORF15. All biomarkers suggested a high degree of symmetry between eyes but demonstrated different estimates of disease progression. VA and foveal thickness, followed by perimetry III4e, were the most useful endpoints to evaluate progression. KMC estimates predicted a loss of 6/6 vision at a mean of 34 years (62.9; 95% confidence interval). CONCLUSIONS. XLRP3 affects retinal structure and function symmetrically, supporting the use of the fellow eye as an internal control in interventional trials. VA and kinetic visual fields (III4e) seem promising functional outcome measures to assess disease progression. KMC analysis predicted the most severe decline in vision between the third and fourth decade of life.
关键词： gene therapy,retinitis pigmentosa GTPase regulator (RPGR),retinitis pigmentosa,disease progression
更新于2025-09-09 09:28:46
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Evaluation of a Region-of-Interest Approach for Detecting Progressive Glaucomatous Macular Damage on Optical Coherence Tomography
摘要： Purpose: To evaluate a manual region-of-interest (ROI) approach for detecting progressive macular ganglion cell complex (GCC) changes on optical coherence tomography (OCT) imaging. Methods: One hundred forty-six eyes with a clinical diagnosis of glaucoma or suspected glaucoma with macular OCT scans obtained at least 1 year apart were evaluated. Changes in the GCC thickness were identified using a manual ROI approach (ROIM), whereby region(s) of observed or suspected glaucomatous damage were manually identified when using key features from the macular OCT scan on the second visit. Progression was also evaluated using the global GCC thickness and an automatic ROI approach (ROIA), where contiguous region(s) that fell below the 1% lower normative limit and exceeded 288 lm2 in size were evaluated. Longitudinal signal-to-noise ratios (SNRs) were calculated for progressive changes detected by each of these methods using individualized estimates of test–retest variability and age-related changes, obtained from 303 glaucoma and 394 healthy eyes, respectively. Results: On average, the longitudinal SNR for the global thickness, ROIA and ROIM methods were (cid:2)0.90 y(cid:2)1, (cid:2)0.91 y(cid:2)1, and (cid:2)1.03 y(cid:2)1, respectively, and was significantly more negative for the ROIM compared with the global thickness (P ? 0.003) and ROIA methods (P ? 0.021). Conclusions: Progressive glaucomatous macular GCC changes were optimally detected with a manual ROI approach. Translational Relevance: These findings suggests that an approach based on a qualitative evaluation of OCT imaging information and consideration of known patterns of damage can improve the detection of progressive glaucomatous macular damage.
关键词： progression,optical coherence tomography,macula,glaucoma
更新于2025-09-04 15:30:14
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The Impact of Blue Light Cystoscopy with Hexaminolevulinate (HAL) on Progression of Bladder Cancer – A New Analysis
摘要： Background: The International Bladder Cancer Group (IBCG) recently proposed a new de?nition of disease progression in non-muscle invasive bladder cancer (NMIBC), including change in T-stage, change to T2 or higher or change from low to high grade. Objective: To establish whether blue light cystoscopy with hexaminolevulinate (HAL) impacts the rate of progression and time to progression using the revised de?nition. Methods: An earlier long-term follow-up of a controlled Phase III study reported outcomes following blue light cystoscopy with HAL (255 patients) or white light (WL) cystoscopy (261 patients) in NMIBC patients. The data was re-analysed according to the new de?nition. Results: In the original analysis, after 4.5 years (median), eight HAL and 16 WL patients were deemed to have progressed (transition from NMIBC to muscle invasive bladder cancer, (T2-4)). According to the new de?nition, additional patients in both groups were found to have progressed: 31 (12.2%) HAL vs 46 (17.6%) WL (p = 0.085) with four (1.6%) HAL and 11 (4.2%) WL patients progressing from Ta to CIS. Time to progression was longer in the HAL group (p = 0.05). Conclusions: Applying the new IBCG de?nition there was a trend towards a lower rate of progression in HAL patients, particularly in those progressing from Ta to CIS. Time to progression was signi?cantly prolonged. This suggests that patients should receive blue light cystoscopy with HAL rather than WL at resection. Adoption of the new de?nition could allow more patients at risk of progression to be treated appropriately earlier.
关键词： NMIBC,blue light cystoscopy,Hexaminolevulinate,progression,bladder cancer
更新于2025-09-04 15:30:14
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Progression Rate From Intermediate to Advanced Age-Related Macular Degeneration Is Correlated With the Number of Risk Alleles at the <i>CFH</i> Locus
摘要： PURPOSE. Progression rate of age-related macular degeneration (AMD) varies substantially, yet its association with genetic variation has not been widely examined. METHODS. We tested whether progression rate from intermediate AMD to geographic atrophy (GA) or choroidal neovascularization (CNV) was correlated with genotype at seven single nucleotide polymorphisms (SNPs) in the four genes most strongly associated with risk of advanced AMD. Cox proportional hazards survival models examined the association between progression time and SNP genotype while adjusting for age and sex and accounting for variable follow-up time, right censored data, and repeated measures (left and right eyes). RESULTS. Progression rate varied with the number of risk alleles at the CFH:rs10737680 but not the CFH:rs1061170 (Y402H) SNP; individuals with two risk alleles progressed faster than those with one allele (hazard ratio [HR] ? 1.61, 95% con?dence interval [CI] ? 1.08–2.40, P < 0.02, n ? 547 eyes), although this was not signi?cant after Bonferroni correction. This signal was likely driven by an association at the correlated protective variant, CFH:rs6677604, which tags the CFHR1-3 deletion; individuals with at least one protective allele progressed more slowly. Considering GA and CNV separately showed that the effect of CFH:rs10737680 was stronger for progression to CNV. CONCLUSIONS. Results support previous ?ndings that AMD progression rate is in?uenced by CFH, and suggest that variants within CFH may have different effects on risk versus progression. However, since CFH:rs10737680 was not signi?cant after Bonferroni correction and explained only a relatively small portion of variation in progression rate beyond that explained by age, we suggest that additional factors contribute to progression.
关键词： progression,age-related macular degeneration (AMD),genetics
更新于2025-09-04 15:30:14
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A Comparison of Progressive Loss of the Ellipsoid Zone (EZ) Band in Autosomal Dominant and X-Linked Retinitis Pigmentosa
摘要： PURPOSE. In patients with retinitis pigmentosa (RP), the inner segment ellipsoid zone (EZ; also known as the inner segment/outer segment [IS/OS] border) is a marker of the usable visual ?eld at a given point in time and of the progression of the disease over time. Here we compare the change in the width per year of the EZ band in patients with autosomal dominant (ad) and x-linked (xl) RP. METHODS. Using optical coherence tomography (OCT), 9-mm horizontal and vertical line scans through the fovea were obtained for one eye of 26 xlRP patients and 33 adRP patients. Scans were repeated on average 2.0 years later (range, 0.6–4.8 years). Using a manual segmentation procedure, the EZ band was delineated and its horizontal width (HW) and vertical width (VW) were determined. RESULTS. The adRP and xlRP patients had similar initial EZ HW (xlRP: 11.8 6 5.48, adRP: 12.4 6 6.38, P ? 0.69) and VW (xlRP: 8.5 6 4.98, adRP: 11.4 6 7.18, P ? 0.09). However, between visits the absolute loss and percent loss of the EZ width per year was signi?cantly greater for xlRP than adRP for both HW (xlRP: 1.0 6 0.68/y, 9.6 6 5.6%/y; adRP: 0.4 6 0.58/y, 3.4 6 5.4%/y; P < 0.001) and VW (xlRP: 0.8 6 0.88/y, 9.2 6 8.9%/y; adRP: 0.3 6 0.58/y, 4.2 6 6.4%/y; P < 0.01). There was a weak correlation between the loss of EZ width per year and the initial width for xlRP (r2 ? 0.17, P ? 0.036), but no correlation for adRP (r2 ? 0.004, P ? 0.73). The test–retest difference of EZ HW was 0.2 6 0.58. CONCLUSIONS. The OCT data here support a faster rate of loss per year in the case of xlRP. (ClinicalTrials.gov number, NCT00100230.)
关键词： optical coherence tomography,retinitis pigmentosa,progression
更新于2025-09-04 15:30:14
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Progression of retinitis pigmentosa on multimodal imaging: the PREP‐1 study
摘要： Importance: It is important to establish reliable outcome measures to detect progression in retinitis pigmentosa (RP). Background: To evaluate progression of RP using multimodal imaging, including spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence (FAF) and microperimetry (MP). Design: Retrospective longitudinal study at a tertiary teaching hospital. Participants: 205 eyes of 106 patients with RP with 1-5 years of follow-up. Methods: Demographics and visual acuity (VA) were recorded, and each modality was graded at baseline and every annual follow-up. SD-OCT was graded for the width of ellipsoid zone (EZ), FAF was graded for the diameter and area of the hyperautofluorescent ring (if present), and MP was graded for mean, central and paracentral sensitivity. Spearman’s correlation was used to measure correlations at baseline. Mixed effects models were used to estimate the annual change of each parameter, adjusted for disease duration. Main outcome measures: Rate of progression. Results: The median VA at baseline was 75 letters and was positively correlated with mean and central sensitivity (r: 0.372 and 0.394; p=0.01 for both). All parameters (except paracentral sensitivity) were strongly correlated with each other (r: 0.673-0.991; p<0.001 for all). The annual rates of change for each parameter were as follows: VA, -2.3 letters (p<0.001); EZ, -151um (p<0.001); ring diameter, -132um (p<0.001); ring area, -0.4mm2 (p<0.001); mean sensitivity, -0.3 dB (p<0.001); central sensitivity, -0.7 dB (p<0.001); paracentral sensitivity, -0.4 dB (p<0.001). Conclusion and relevance: Structural and functional measures are well correlated in RP and can reliable measure disease progression within the course of a year.
关键词： Optical Coherence Tomography,Multimodal Imaging,Microperimetry,Fundus Autofluorescence,Disease Progression
更新于2025-09-04 15:30:14
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Detecting an Event of Progression Using Glaucoma Probability Score and the Stereometric Parameters of Heidelberg Retina Tomograph 3
摘要： Purpose: To evaluate the correlation of the change in glaucoma probability score (GPS) and the stereometric optic nerve head (ONH) parameters of the Heidelberg Retina Tomograph (HRT)3 to an event of glaucomatous progression observed with stereoscopic ONH photography. Methods: The subjects for this retrospective follow-up study were monitored with the HRT and stereoscopic ONH photographs. Stable, high-quality imaging and at least 18 months of follow-up was required. The topography examinations were acquired using HRT II and calculated with HRT3 software. The event of progression was determined by masked evaluation of stereoscopic ONH photographs. Results: A total of 476 eyes of 342 subjects met the inclusion criteria. All the examinations with HRT II were backwards compatible with either the GPS or the stereometric parameters of HRT3. The highest statistical significance for the correlation with progression was observed in the change in cup volume and cup:disc area ratio (p<0.0005). The vertical cup:disc ratio was the parameter with the largest area under the receiver operating characteristics curve (AUC = 0.696). The AUC calculated for the change in GPS was 0.541. The GPS showed no statistically significant correlation with progression (p = 0.213). Conclusions: Detecting an event of glaucomatous progression should not be based solely on the change in GPS or the stereometric parameters of the HRT. The good backwards compatibility between HRT II and HRT3 should allow the detection of a trend of glaucomatous progression even when changing from HRT II to HRT3 during the follow-up of glaucoma.
关键词： Heidelberg Retina Tomograph,Backwards compatibility,Glaucoma,Progression
更新于2025-09-04 15:30:14