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Purpose Peripheral retinal leakage (PRL) of contrast medium from the ora serrata (i.e., the peripheral part of the retina) was recently reported in normal eyes using ultra-widefield fluorescein angiography. We occasionally see PRL of gadolinium-based contrast agents (GBCAs) in the vitreous from the temporal and inferior sides of the ora serrata on MR images of subjects without ophthalmic disease. In this study, we retrospectively evaluated these MR images to determine if PRL was associated with aging. We also evaluated whether the initial leakage appeared in the temporal and inferior sides, and whether there was uniform distribution within the vitreous after 24 hours. Methods In 127 subjects (9 volunteers, 85 patients with sudden deafness, and 33 patients with a suspicion of endolymphatic hydrops), pre- and post-contrast-enhanced heavily T2-weighted 3D-fluid attenuated inversion recovery (FLAIR) images were obtained. The presence or absence of PRL was subjectively evaluated. For patients with a suspicion of endolymphatic hydrops, 3D-real inversion recovery (IR) images were also obtained at pre-, 10 mins, 4 hours, and 24 hours after intravenous administration (IV) of GBCA. Four circular ROIs were placed in the vitreous humor and the signal intensity was measured. Results In the cases with PRL (n = 88) and without PRL (n = 47), the median age was 59 and 47 years, respectively (P = 0.001). At 4 hours after IV-GBCA, the mean signal increase in the inferior temporal ROI was greater than all the other ROIs. At 24 hours after IV-GBCA, no significant difference in signal intensity was observed for the four ROIs. Conclusion PRL of GBCA is age-dependent and occurs mainly from the inferior temporal side of the ora serrata. The contrast effect was uniformly distributed at 24 hours after IV-GBCA. Future observations in a variety of diseases will determine the clinical significance of these findings.

Purpose: To report a case of 16-month-old boy with a novel variant TSPAN12 gene-presenting as unilateral myopia, pediatric cataract, and heterochromia in a patient with familial exudative vitreoretinopathy. Observation: A 16-month-old otherwise healthy boy was referred to Boston Children’s Hospital for evaluation of strabismus. Ocular examination revealed intermittent esotropia, left hypotropia, and limited left eye elevation in both adduction and abduction. Full cycloplegic hyperopic correction of +3.50 diopters (D) over both eyes was given to the patient. Over several months, refraction of the right eye showed progressive myopia (−6.00 D) with new onset iris heterochromia. Fundus examination showed there was a large area of chorioretinal atrophy with abrupt ending of the blood vessels; anterior to the ora serrata there were diffuse vitreous bands and veils that reached the lens anteriorly in direct contact with the lenticular opacity. A novel heterozygous nonsense likely pathogenic variant was identified in the TSPAN12 gene (NM_012338.3) c.315T>A (p.Cys105Ter) confirming the diagnosis of FEVR. Conclusion and importance: Asymmetric FEVR rarely present with unilateral axial myopia however association with acquired heterochromia and cataract has never been reported. We report a case of FEVR caused by a novel TSPAN12 likely pathogenic nonsense variant presenting as unilateral progressive myopia, acquired heterochromia, and pediatric cataract.

To assess the histological correlate of neovascular or exudative myopic macular degeneration (nMMD) in highly myopic human eyes, we examined histomorphometrically histologic sections of enucleated eyes of Caucasian patients. The study included 284 eyes (age: 61.9 ± 13.7 years; range: 24–89 years; axial length: 25.5 ± 3.1 mm; range: 20–37 mm). An nMMD was detected in 5 eyes (axial length: 29.6 ± 2.6 mm; range: 26.0–31.0 mm). All these eyes showed within or close to the nMMD a macular Bruch’s membrane (BM) defect, fibrous tissue with erythrocyte-filled blood vessels, and proliferations of irregularly pigmented and irregularly piled-up retinal pigment epithelium (RPE) cells each of which was connected with a curled-up, PAS (Periodic-Acid-Shiff)-positive membrane. The nMMD lesions were covered by proliferated RPE cells. RPE cells were not detected within the retina. In binary regression analysis, a higher nMMD prevalence was associated with a higher prevalence of macular BM defects (odds ratio: > 1000; P P = 0.43) in that model. After adjustment for the presence of macular BM defects, the nMMD prevalence was not associated with BM thickness (measured at the posterior pole, equator-posterior pole midpoint, equator and shortly posterior to the ora serrata) (P = 0.10; P = 0.87; P = 0.40; and P = 0.36, respectively), RPE cell layer thickness (P = 0.83; P = 0.79; P = 0.31; P = 0.38, resp.), RPE cell density (P = 0.56; P = 0.91; P = 0.47; P = 0.87, resp.), choriocapillaris thickness (P = 0.47; P = 0.93; P = 0.41; P = 0.75, resp.), and choriocapillaris density (P = 0.99; P = 0.94; P = 0.17; P = 0.97, resp.). The results suggest that nMMD is characterized by a fibrous pseudo-metaplasia of the RPE and is strongly associated with macular BM defects, without other detected histomorphometric differences in thickness or density of the RPE, BM, and choriocapillaris.

Retinitis pigmentosa (RP) is the most common inherited retinal dystrophy with a prevalence of about 1 in 4000, affecting approximately 1.5 million people worldwide. Patients with RP experience progressive visual field loss as the retina degenerates, destroying light-sensitive photoreceptor cells (rods and cones), with rods affected earlier and more severely than cones. Spatio-temporal patterns of retinal degeneration in human RP have been well characterised; however, the mechanism(s) giving rise to these patterns have not been conclusively determined. One such mechanism, which has received a wealth of experimental support, is described by the trophic factor hypothesis. This hypothesis suggests that rods produce a trophic factor necessary for cone survival; the loss of rods depletes this factor, leading to cone degeneration. In this paper we formulate a partial differential equation mathematical model of RP in one spatial dimension, spanning the region between the retinal centre (fovea) and the retinal edge (ora serrata). Using this model we derive and solve an inverse problem, revealing for the first time experimentally testable conditions under which the trophic factor mechanism will qualitatively recapitulate the spatio-temporal patterns of retinal regeneration observed in human RP.

Introduction . Currently there are only fragmentary and inconsistent studies of the vitreoretinal interface and the internal limiting membrane (ILM). It the available literature we did not succeed in searching for the necessary data on the actual anatomy of the ILM in various areas of the retina. In order to clarify microanatomy of the vitreoretinal interactions we performed our own studies. Purpose. To clarify microanatomy of the ILM in its central and peripheral areas by means of the scanning electron microscopy (SEM) imaging. Material and methods . A study of peculiarities of the ILM area using cross-sections of the human eye from the extreme periphery of the retina close to ora serrata, and to the equatorial and macular areas by means of SEM imaging. Results . Results of our studies show that the ILM at the periphery of the retina is 4-5 pm thick, has a loosely organized fibrous structure, and has no distinct boundary with retina. Fibrils of the vitreous at the periphery of the retina braided into the retina in a parallel manner rather than perpendicularly. Approaching the center, the fibrous structures at the retinal surface become denser and thinner. Closer to the equator, there is formed the ILM structured as a membrane of 1 pm thickness. In the macular zone the ILM has the least thickness of 250 nm. In the macular zone the ILM is mono-structural without any signs of pores or similar formations. A kind of finding was a micro-anatomic pattern at the joint site between vitreous and retina at the far periphery where, there were no distinct boundary between the retina, ILM, and vitreous with boundary region formed by the layer of sparsely packed collagen fibrils. Refined data fairly prove ILM thinning on the way from periphery towards the center. Conclusions. Results of studies of ILM microanatomy fairly prove ILM thinning on the way from periphery towards the center. Contrary to the common belief it happened that vitreous fibrils at the periphery braid into the retina parallel to the latter rather than perpendicularly.

Purpose To identify the characteristics of peripheral retinal anomalies associated with persistent fetal vasculature (PFV) and evaluate the complications and outcomes. Methods Retrospective, noncomparative case series of patients with PFV who underwent surgery. Type of PFV, presence of peripheral retinal anomalies, extent of the retrolental membrane, complications, and functional and anatomical results were evaluated. Results Twenty-nine eyes of 28 patients were enrolled in the study: 14 eyes (48.3%) with anterior PFV, 10 eyes (34.5%) with posterior PFV, and 5 eyes (17.2%) with combined PFV. The retina was found to elongate anteriorly as finger-like projections beyond the ora serrata, incorporating into retrolental fibrovascular tissue in 81.8% of the anterior PFV cases. Cases with more extensive retrolental tissue had a higher risk of retinal complications (p = 0.009) and anterior segment complications (p = 0.026) than those with localized disease. Leaving the peripheral part of the fibrovascular tissue in place led to complications by later contraction. A total of 35.7% of the anterior PFV cases had 20/200 or better vision at the final follow-up versus 6.7% of the cases with posterior involvement. Retinal attachment was achieved in 12 eyes (80%) with posterior involvement. Four eyes (13.7%) resulted in total retinal detachment at final follow-up. Conclusions The high incidence of peripheral retinal anomalies that are found in anterior PFV patients and their relation to retinal complications warrant careful examination of the ora serrata-ciliary body area. Limbal approach may be preferred as a safer method in cases with an extensive fibrovascular membrane obscuring the view. Leaving the peripheral part of the fibrovascular tissue may result in severe postoperative complications, which should be avoided.

AIM: To describe the involution patterns of vessel growth of retina through fluorescein angiography (FA) of children, who had been under treatment up to 1y previously intravitreal ranibizumab (IVR) as monotherapy for retinopathy of prematurity (ROP). METHODS: This is a retrospective study. The medical information and FA of 17 children (34 eyes) whose area of avascular retina from the ora serrata was more than two disc diameters (DD) were analyzed. RESULTS: Among 34 eyes, all were the presence of finger-shaped vessels and arteriolar-venular shunts (100%, 34/34 eyes). Popcorn abnormalities were found in most of the eyes (94.1%, 32/34 eyes). Furthermore, in many cases (23.5%, 8/34 eyes), there were leakage persisting in the region of the junction between avascular and vascular retina. In contrast, just 2 eyes (5.9%) showed damage of retinal capillary bed and 3 eyes (8.8%) showed large area of retinal pigment epithelium (RPE) atrophy. CONCLUSION: Although IVR can be very effective in ROP, we should remain cautious as infants may remain avascular peripheral retinas and abnormal vessel. FA allows accurate visualization of vessel abnormalities in eyes with ROP, which will be helpful to affect assessment of disease activity and therapeutic effect.

Purpose The purpose of this study was to determine if it is possible for the macula to remain attached if a bullous retinal detachment blocks the examiner's view to the macula. Methods A mathematical analysis compared the arc length of the attached retina versus the length of a detached retina necessary to obscure the macula (hang over the visual axis). The shape (oblate ellipsoid) and dimensions of the retina were based on a published study. The complete path of the hanging retina was calculated as a static catenary so as to depict the lowest possible position ("worst case scenario"). Results The measured and calculated angle between the fovea and ora serrata was 105 degrees. When considering a catenary shape of the hanging retina, the macula could, mathematically, still be attached despite the retina hanging down 1.03 mm below the visual axis for an emmetropic eye. The maximal distance calculated was 1.095 mm for a -12 diopter (D) myopic eye. Conclusions If the macular center cannot be viewed due to a bullous superior retinal detachment hanging into the examiner's view, it is unlikely but possible that the macula remains attached. If the view is obscured by at least 1 mm below the fovea, it is not mathematically possible for the fovea to be attached. Translational relevance The status of the macula being detached is subject to mathematical constraints, which, explored herein, offer a higher certainty of clinical decision making that could inform management for better clinical results.

Purpose To introduce a novel technique of encircling laser prophylaxis (ora secunda cerclage Stickler syndrome, OSC/SS) to prevent rhegmatogenous retinal detachment (RRD) in Stickler syndrome eyes. Patients and Methods After first eye RRD at age 50 and at age 18, respectively, a 53-year-old father and his 22-year-old son with type 2 SS (STL2) gave informed consent and underwent OSC/SS prophylaxis, performed in each fellow eye. A 26-year-old STL2 daughter then suffered first eye retinal detachment and similarly chose fellow eye OSC/SS prophylaxis. A second son, 28 years of age with STL2, chose OSC/SS prophylaxis in both eyes. Results The three OSC/SS treated fellow eyes have gone 12 years, 11 years, and 8 years without RRD. STL1 and less common STL2 eyes are known to have a similar rate of RRD, and 80% of STL1 fellow eyes develop RRD at a median of 4 years in the absence of prophylaxis. Moreover, five of six (83%) known STL2 family members suffered RRD, only the STL2 son with bilateral OSC/SS remaining bilaterally attached. All five OSC/SS treated eyes (average 8.7 years post-prophylaxis) retained preoperative visual acuity of 20/20 to 20/30, with an average, asymptomatic reduction of meridional field in each eye to 50 degrees. In contrast, in the three eyes having suffered RRD prior to presentation, visual acuity ranged from 20/125 to 8/200 and average meridional field was 29 degrees. Conclusion Encircling grid laser (OSC) modified in Stickler eyes to encompass the ora serrata and extend posteriorly to and between the vortex vein ampullae (OSC/SS) is a reasonable RRD prophylaxis option to offer STL1 and STL2 patients as an alternative to no treatment or less effective prophylaxis. Because of rarity and severity, the ultimate proof of safety and efficacy will likely come not from randomized trials, but from a non-randomized, prospective, cohort comparison study of such individual efforts., Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/AzHz4xYUV_w

The vitreous is a simple structure with only 1–2 questions in basic ophthalmology exams. The most important part to consider when studying the vitreous is its attachment to underlying structures and the spaces formed through these attachments. An example of questions in this regard is to ask about the site of strongest attachment, where the vitreous base, an attachment of vitreous to structures surrounding ora serrata, represents the strongest attachment.

AimsTo assess treatment outcomes after proton beam irradiation (PBI) without surgical localisation of uveal melanomas involving the iris, ciliary body and anterior choroid.MethodsRetrospective chart review of 125 patients evaluated at Massachusetts Eye and Ear and treated with PBI using a light field set-up without localisation surgery between November 1975 and April 2017. The tumours were characterised as follows: iris (n=18, 14.4%), ciliary body (n=12, 9.6%), iridociliary (n=58, 46.4%), ciliochoroidal (n=24, 19.2%) and iridociliochoroidal (n=13, 10.4%). The tumours were measured by transillumination and ultrasonography before treatment. Tumours with posterior margin located less than two disc diameters from the ora serrata were treated using the light field technique. Patient outcomes after PBI were evaluated.ResultsMost patients had good vision at the time of tumour diagnosis (69.6% had baseline visual acuity (VA) of ≥20/40). Median VA at last follow-up (median follow-up: 72.1 months) was 20/63. Recurrences occurred in 12 patients (9.6%) at a median time of 4.0 years post-treatment. Recurrences were treated by repeat PBI (n=5) or enucleation (n=7). Secondary enucleation was performed in 18 patients (14.4%), and 61.1% of these were due to complications. Neovascular glaucoma (NVG) developed in 21 patients (16.8%). Of seven patients who developed NVG after anti-vascular endothelial growth factor (anti-VEGF) therapies became available, five were treated with intravitreal Avastin injections (23.8% of patients with NVG). Of 69 patients diagnosed with cataract after treatment, 51 (73.9%) were characterised as radiation-related. Death from metastatic uveal melanoma occurred in 20.8% of the cohort, with a median follow-up of 10.1 years.ConclusionsPatients treated with PBI using a light field set-up technique experience good outcomes after irradiation. Eye preservation and retention of good VA are seen in the majority of cases, and tumour recurrence is low.

Purpose The appearance of the far peripheral retina in normal eyes was observed using an Optos ultra-wide field fluorescein angiography imaging system. Methods A cross-sectional study of ultra-wide field pseudocolor and angiography images obtained using the Optos 200Tx. Four different non-vascular and six vascular-associated fluorescence features in far peripheral retina were analyzed. Results A total of 166 eyes in 83 patients met the inclusion criteria. The mean patient age was 40.78 ± 10.94 years (range: 20–65 years) with a female-to-male ratio of 0.98. Slight cataract were present in 64 eyes (38.55%), low to moderate myopia in 50 eyes (30.12%), and unspecified visual disturbances in 52 eyes (31.33%). Far peripheral retinas were found to have mottled florescent band in 42.17% eyes, ground glass hyperfluorescence in 84.34% eyes, granular hyperfluorescence in 12.65% eyes, local mottled fluorescence in 10.84% eyes, vascular anastomosis with a peripheral avascular area in 36.23% eyes, invisible capillary details in 50.67% eyes, vessels passing through the ora serrata in 16.98% eyes, late-phase slight leakage in 32.53% eyes, angiectasis in 18.67% eyes, and microaneurysm in 34.94% eyes. Conclusion Ultra-wide field fluorescein angiography revealed various fluorescence features in the periphery of normal eyes, providing a basis for interpreting normal and pathological changes in peripheral retina and an important reference for clinical work.

PURPOSE Axial myopia is characterized by a thinning of the choroid. We examined whether the myopic choroidal thinning also includes a thinning of the choriocapillaris. METHODS Using light microscopy, we measured thickness and density of the choriocapillaris at the posterior pole, posterior pole-equator midpoint (PPEMP), equator and close to the ora serrata on histological sections of 58 enucleated human globes (mean age: 62.4 ± 17.8 years; range: 24-88 years; mean axial length: 27.8 ± 4.0 mm; range: 22.0-37.0 mm). RESULTS Choriocapillaris thickness decreased (p

A 13‑year‑old child diagnosed with neurofibromatosis type 1 who on a routine control presented with rhegmatogenous retinal detachment associated to dialysis of the ora serrata in the left eye (OS). There were no clinical signs or history of contuse ocular trauma. Neurofibromatosis produces alterations in fibroblasts of the cortex of the vitreous base. This results in deficient production of the collagen fibers that anchor the vitreous base to the pars plana and the peripheral neurosensory retina. Thus, suboptimal function of the fibroblasts explains spontaneous avulsion of the vitreous base. Such avulsion in turn is related to dialysis of the ora serrata.

To develop a nomogram based on age and disease type for sclerotomy placement in pars plana vitrectomy for infants and children with congenital and acquired vitreoretinopathies.A retrospective, single-center, single-surgeon comparative case series.A total of 171 eyes of 93 patients ranging in age from a postmenstrual age (PMA) of 34 weeks to a chronological age of 23 years with congenital and acquired vitreoretinopathies.The corneal white-to-white diameter and the distance between the ora serrata and surgical limbus (ora-limbus distance) in the nasal, temporal, inferior, and superior quadrants were measured externally in vivo under general anesthesia prior to planned pars plana vitrectomy or laser procedure. The average ora-limbus distance of the quadrants was calculated for each eye (mean ora-limbus distance); and mean ora-limbus distance was evaluated as a function of age and compared among age-matched subjects from control and disease groups. Results were used to create a nomogram for safe sclerotomy placement based on age and disease type.The main outcome measure was distance (millimeters) from the ora serrata to the surgical limbus; a secondary measurement was corneal white-to-white distance (millimeters).Among all subjects, the ora-limbus distance was greatest in the superior quadrant, followed by the temporal, inferior, and nasal quadrants. A positive logarithmic relationship between ora-limbus distance and age was demonstrated in all groups. Whereas age-adjusted mean ora-limbus distances were similar among the familial exudative vitreoretinopathy and control groups, growth trends differed in patients with coloboma, persistent fetal vasculature, Stickler syndrome and/or myopia, and retinopathy of prematurity (ROP). In ROP, when subjects12 months of age were considered separately, a negative correlation was found between the ora-limbus distance and PMA, with infants of lesser gestational age exhibiting greater restriction in ora-limbus distance.Placement of sclerotomies for pars plana vitrectomy in children requires consideration of ocular development in congenital and acquired vitreoretinopathies; we present an age-based nomogram for sclerotomy placement in infants and children based on analyses of ora-limbus distance in several pediatric ocular conditions.

To assess the dimensions of Brucke’s muscle, as the longitudinal portion, and of Muller’s muscle and Iwanoff’s muscle combined as circular and radial/reticular portions of the ciliary muscle. The histomorphometric study included human globes that had been enucleated due to an ocular tumor or end-stage glaucoma. After immunohistochemical staining of the ciliary muscles, the histology slides were examined under a light microscope applying a digitized image analysis system. The study included 55 globes [axial length 25.6 ± 3.0 mm (range 21.0 mm–36.0 mm)] from 55 patients [mean age, 33.7 ± 18.3 years (range:1–66 years)]. Length of Brucke’s muscle (mean 3.40 ± 0.76 mm) increased with longer axial length (P

The purpose of this study is to compare the efficacy of intraoperative 360° and localized laser retinopexy in 23-gauge pars plana vitrectomy (PPV) for rhegmatogenous retinal detachments (RRD) with undetected retinal breaks intraoperatively. This is a retrospective, comparative, interventional study. Medical records of 48 consecutive eyes with RRD of intraoperative undetected retinal breaks were reviewed. Nineteen patients (group I) received 360° laser retinopexy in PPV, while the remaining 29 patients (group II) underwent localized laser retinopexy. In group I, a triple row of confluent medium-white laser burns were placed posterior to the ora serrata. Anatomical and visual outcomes of the two groups were compared. The mean follow-up period was 13.46 ± 3.02 months. No significant difference was identified in baseline characteristics. A single-operation reattachment rate of 89.47% was achieved in group I, which was significantly higher than that of group II (55.17%, p = 0.01), and this trend was not weakened after adjustment for the confounding factor (odds ratio 0.15, p = 0.03). Moreover, greater improvement of postoperative best-corrected visual acuity was observed in group I. Significant complications sufficient to require further operation included proliferative vitreoretinopathy in 2 (4.17%) eyes and epiretinal membrane in 4 (8.33%) eyes. Three hundred sixty-degree laser retinopexy was associated with better anatomic and visual outcomes in RRD patients with unseen breaks intraoperatively, when compared with localized laser retinopexy in PPV.

Purpose To report a case of inadvertent subretinal cannulation of ab externo suture trabeculotomy surgery associated with serous macular detachment. Methods Retrospective case report. Ophthalmic examination and portable spectral domain optical coherence tomography (Envisu C2300; Bioptogen, Morrisville, NC) were performed under general anesthesia. Results A 5-year-old girl with uveitis secondary to oligoarticular juvenile idiopathic arthritis underwent trabeculotomy surgery of the left eye for steroid-induced glaucoma refractory to medical management. The surgery was complicated by inadvertent subretinal cannulation with the prolene suture. Multiple, arcuate, hypopigmented subretinal tracks, originating from the ora serrata, were observed. Spectral domain optical coherence tomography images through the macula revealed subretinal fluid overlying funduscopically visible tracks, defects in photoreceptor outer segments overlying the tracks, and normal choroidal anatomy. The serous macular detachment resolved spontaneously after 4 months and visual acuity returned to baseline 20/25 in the left eye, consistent with reversible localized damage to the outer retina and retinal pigment epithelium. Conclusion We report a case of inadvertent subretinal cannulation during suture trabeculotomy surgery that resulted in serous macular detachment which resolved spontaneously. The inadvertent complication demonstrated a pathway for administration of therapeutics to the subretinal space.

Purpose: To suggest a low cost, non-contact smartphone-based screening system in retinopathy of prematurity (ROP), and to illustrate its potential clinical application as a potential future tool for teleophthalmology. Methods: Neonatal intensive care unit (NICU)-based bedside ROP screening done between January 2018 and May 2018. Documentation of ROP was done by using a smartphone and +40D, +28D, or +20D indirect non-contact condensing lenses. By using the coaxial light source of the phone, this system works as an indirect ophthalmoscope that creates a digital image of the fundus. With smartphone-based camera we extracted high-quality still images extracted from the video clip. Results: Total of 228 eyes of 114 infants screened for ROP between January 2018 and May 2018. Incidence of total ROP was 23.68%, out of which incidence of type 1 ROP was 8.77%. After initial screening with indirect ophthalmoscope, we uesd smartphone imaging to document ROP in 28 eyes out of 55 eyes having ROP. Image quality was good in 89.28% eyes. Field of view vary from 46°, 53°, and 90° with +20D, +28D, and +40D indirect condensing lenses, respectively, which gives excellent images for bedside ROP documentation. Conclusion: The described technique of smartphone fundus photography is a light weight, cost-effective, user friendly, high-quality wide-field fundus photographs for bedside documentation of ROP in NICUs using readily available instruments that are handy and portable with simple power sources. Smartphones has the potential to be operated with only one hand. It can also be used as a future telescreening device.

To assess anatomical changes in eyes with progressive myopia, we morphometrically examined the eyes of guinea pigs with lens-induced axial elongation. Starting at an age of 3–4 weeks, guinea pigs in the experimental group (n = 20 animals) developed unilateral lens-induced axial elongation by wearing goggles for 5 weeks compared to a control group of 20 animals without intervention (axial length:8.91 ± 0.08 mm versus 8.74 ± 0.07 mm; P P = 0.41), equator (P = 0.41), midpoint between equator and posterior pole (MBEPP) (P = 0.13) or posterior pole (P = 0.89). Retinal pigment epithelium (RPE) cell density decreased with longer axial length at the MBEPP (P = 0.04; regression coefficient beta = −0.33) and posterior pole (P = 0.01; beta = −0.40). Additionally, the thickness of the retina and sclera decreased with longer axial length at the MBEPP (P = 0.01; beta = −0.42 and P P P P

Purpose To assess associations between axial length and density of retinal pigment epithelium (RPE) cells in various ocular regions. Methods The histomorphometric investigation included histological sections of enucleated eyes of Caucasian patients. Using a light microscope, we counted the number of RPE cells on Bruch′s membrane at the ora serrata, in the pre-equatorial region, the equatorial and retro-equatorial region, at the midpoint equator/posterior pole, and at the posterior pole. Results The study included 65 globes with a mean axial length 25.9 ± 3.5 mm (range: 21.0–34.0 mm). Retinal pigment epithelium (RPE) cell count in the equatorial to retro-equatorial region (p

Purpose To compare the clinical outcomes of intravitreal bevacizumab (IVB) injection, with different dosing (0.25 mg/0.01 ml versus 0.625 mg/0.025 ml) in each eye of the same patient with retinopathy of prematurity (ROP). Methods Intravitreal bevacizumab (IVB) was injected into eight patients with stage 3+ in zone I or posterior zone II ROP (16 eyes). Bevacizumab, with different dosing (0.25 mg/0.01 ml and 0.625 mg/0.025 ml), was injected into the vitreous cavity of each eye. Results Among the 16 eyes treated with IVB, six eyes had zone I ROP and 10 eyes had zone II ROP. The mean birthweight was 800 ± 139 g (range, 533–955 g), and the mean gestational age was 25.9 ± 1.2 gestational weeks (range, 24.4–28.7 weeks). The postmenstrual age at initial treatment was 37.2 gestational weeks (range, 33.7–41 weeks). The mean follow-up was 312 ± 50 days (median, 305 days; range, 238–376 days). All eyes showed regression of plus sign after IVB injection within 1 week and revascularization to the ora serrata at the time of final visit. There was no difference in the time of anatomical achievement between the eyes with different doses. None of the patients received any additional IVB injection or laser photocoagulation. After the regression of ROP, tractional retinal detachment and macular ectopia were not observed in any patients during follow-up. Conclusions There was no difference in the short-term clinical outcomes of stage 3+ ROP in zone I or II between the eyes with low dose and conventional dose of IVB.

Northern elephant seals are one of the deepest diving marine mammals. As northern elephant seals often reach the bathypelagic zone, it is usually assumed that their eyes possess evolutionary adaptations that provide better ability to see in dim or scotopic environments. The purpose of this study was to carefully describe anatomical and histological traits of the eye that may improve light sensitivity. Northern elephant seals have large, somewhat elliptical eyes, with equatorial and anteroposterior diameters of 5.03 and 4.4 cm, respectively. The cornea is large in diameter and the lens is completely spherical. The iris has pronounced constrictor and dilator muscles, whereas the ciliary muscle is notably less developed. The tapetum lucidum is more prominent than in other pinnipeds, making up about 63% of retinal thickness in the posterior aspect of the globe. Within the retina, the pigmented epithelium lacks pigment except for the region close to the ora serrata. Parts of the photoreceptor and outer nuclear layers are folded. Although the photoreceptor layer is composed predominantly of rods, cone photoreceptors were also observed. Cells within the retinal ganglion cell layer are arranged in a single level. Ganglion cells reach their maximum density (∼1,300 cells per mm(2) ) dorsal to the optic disc, whereas the periphery of the retina is sparsely populated (

The human visual field, on the temporal side, extends to at least 90° from the line of sight. Using a two-alternative forced-choice procedure in which observers are asked to report the direction of motion of a Gabor patch, and taking precautions to exclude unconscious eye movements in the direction of the stimulus, we show that the limiting eccentricity of image-forming vision can be established with precision. There are large, but reliable, individual differences in the limiting eccentricity. The limiting eccentricity exhibits a dependence on log contrast; but it is not reduced when the modulation visible to the rods is attenuated, a result compatible with the histological evidence that the outermost part of the retina exhibits a high density of cones. Our working hypothesis is that only one type of neural channel is present in the far periphery of the retina, a channel that responds to temporally modulated stimuli of low spatial frequency and that is directionally selective.

We report a case of retinochoroidal coloboma in a 32 year old Nigerian female who first presented to the eye outreach clinic with a history of poor vision in the left eye of two years duration. The best corrected visual acuity was 6/5 and light perception with accurate light projection in the right and left eyes respectively. She was subsequently referred to the retina clinic for Neodymium:yttrium- aluminium- garnet (Nd:YAG) laser capsulotomy on account of a left posterior capsular opacity after cataract surgery at the eye outreach clinic with a best corrected visual acuity of 6/5 and 6/36 respectively in the right and left eye. Dilated binocular indirect ophthalmoscopy of the left eye revealed a large, wedge-shaped, excavated retinochoroidal defect with hyperpigmented edges involving the nasal retina extending across approximately five clock hours from 7 to 10 o’clock. The apex of the coloboma was approximately three disc diameters away from the optic nerve head and extended peripherally up to the ora serrata. The right fundus was normal. Retinochoroidal colobomas may occur in the absence of the known blinding sequelae like retinal detachment, choroidal neovascular membrane amongst others. Our patient had a cataract in the same eye with the retinochoroidal coloboma with subsequent visual gain post-surgery and increasing myopia.

To evaluate vascularization end limit of the peripheral retina and describe vascular development patterns of patients at the late period with aggressive posterior retinopathy of prematurity (APROP) who were treated with a single intravitreal injection of bevacizumab. All patients were examined with RetCam III and fluorescein angiography (FA) within 90–100 gestational week. The vascularization end limit according to the zones and vascular structural abnormalities were noted. A total of 116 eyes of 58 patients were included. The mean gestational age and birth weight were 28.31 ± 2.5 (23–33) weeks and 1156.29 ± 386.38 (360–2300) g, respectively. The mean age at the time of FA was 95.09 ± 3.8 (90–100) weeks. According to the vascular termini, four eyes (3.4%) were in zone II posterior, 30 eyes (25.8%) were in zone II anterior, 22 eyes (18.9%) were in zone III with a distance of > 2 disc diameter (DD) from ora serrata, and 60 eyes (51.7%) were in zone III with a distance of

A 35-year-old man presented after a high-speed motor vehicle accident and the driver's side curtain air bag causing blunt force trauma rupturing his right globe. The tangential force of the air bag resulted in an unusual arcuate horseshoe-shaped rupture through the lateral rectus insertion, causing avulsion of the muscle and tearing the sclera, with the apices of the tear extending anteriorly towards the limbus. Repair of the globe rupture was undertaken, and secondary vitrectomy revealed that the scleral tear had not involved the retina abutting the ora serrata. Silicone oil tamponade was used to fill the globe and the postoperative best corrected vision was 6/9. This is the first reported case of a ruptured globe caused by a side curtain air bag, resulting in a uniquely shaped arcuate scleral wound combined with lateral rectus avulsion, not associated with rhegmatogenous retinal damage, and is the first air bag-related globe rupture with scleral involvement to report a final best-corrected visual acuity better than 6/60.

Background Congenital ocular melanocytosis has been shown to be extremely uncommon in studies of numerous infants and children with retinoblastoma and disorders such as retinopathy of prematurity. Case presentation A 33-month-old Caucasian boy presented with a solid white predominantly endophytic retinoblastoma filling most of the nasal aspect of the fundus and extensive vitreous seeding. Fundus exam of the contralateral eye showed a broad-based flat melanotic area of the choroid extending from the subfoveal region to the ora serrata temporally. The child was treated by enucleation of the retinoblastoma-containing eye (homozygous non-germline RB1 mutation) and is being monitored annually. The patient has been followed for 4 years. Conclusions This rare presentation of advanced unilateral retinoblastoma and contralateral isolated choroidal melanocytosis in a young child emphasizes the importance of detailed fundus mapping of the non-affected eye and has potential implications due to the increased incidence of uveal melanoma later in life.

Light miscroscopy of the retina in the Atlantic stingray, Dasyatis sabina, reveal two distinct photoreceptor types. Histological criteria establish the two cell types as morphological rods and cones. The retina was studied through a sequential series of vertical sections in a protocol designed to evaluate the entire retina. By performing differential counts in multiple regions and expressing cones as a percent of the total photoreceptors in a domain, it was possible to determine relative cone density and distribution. Cone distribution varies throughout the retina in two patterns. First, relative cone density gradually decreases peripherally. Second, a cone-rich band occurs along the horizontal axis of the eye, extending from ora serrata to ora serrata. This structure appears to be a visual streak. Both distribution patterns are statistically significant and are consistent among animals regardless of age. © 1994 Wiley-Liss, Inc.

Purpose To examine the ultrastructure of lipofuscin bodies and melanosomes in retinal epithelium of elderly rhesus monkeys and determines changes in their number and morphology as a function of retinal eccentricity. Methods Electron microscopy was used to describe and quantify two major organelles in elderly monkey retinal epithelium, lipofuscin bodies and melanosomes, at different retinal loci extending from the macula to the peri-macula, equator, periphery and ora serrata. Osmium tetroxide was used to distinguish lipofuscin bodies from melanosomes. Results Lipofuscin bodies and melanosomes diminished in number with advanced age but there was an inverse relationship between these two organelles. Lipofuscin bodies were more numerous in the macula and melanosomes more numerous in the peripheral retina. Three types of lipofuscin bodies were identified: 1) smaller and tending to locate in the middle third of the epithelial cell, 2) larger, less common, and located more basally, and 3) extremely rare, melano-lipofuscin, containing a melanosome. When osmicated, all lipofuscin bodies contained electron dense materials. When osmium tetroxide was not used for fixation, the first two types of lipofuscin bodies lost their electron densities while the third type retained its electron density due to the melanosome it contained. Conclusion As previously reported for human retina, lipofuscin is most abundant in the macular and peri-macular epithelium and least abundant in the periphery, whereas melanosomes show the opposite relationship. This distribution pattern could contribute to the macula's greater vulnerability to photo-toxicity. Three types of lipofuscin bodies are found in aging monkey retinal epithelium. All types contain electron dense material, but the most prominent two types lose their densities in the absence of osmium tetroxide during fixation. Most of the electron densities in lipofuscin bodies must contain a material that binds strongly to osmium tetroxide such as polyunsaturated fatty acids.

Spontaneous findings noted in the eyes of Mauritian cynomolgus monkeys are described and descriptions are supplemented with illustrations. Findings observed after extensive histopathologic examinations (20 to 44 sections per eye) from 20 control, 17 treatment-naive stock monkeys, and 2 findings noted in drug-treated monkeys that were considered to be spontaneous are included. Also included are findings from 361 control monkeys of routine toxicity studies performed at our laboratories, for most of which a standard histopathological examination of 1 section per eye was conducted. Common observations in monkeys examined extensively and in historical controls were limited to lymphocytic or mononuclear cell infiltrations of the uvea and/or conjunctiva/sclera and, less commonly observed, melanocytoma of the ciliary body or iris. Findings noted only in monkeys examined extensively consisted of inflammation of the conjunctiva, ora serrata cysts, glial nodules, focal degeneration of the retina, cystoid degeneration of the central retina, ballooning degeneration of the ciliary epithelium, cyst of the ciliary body, and decreased pigmentation of the retinal pigment epithelium. Changes recorded only in historical controls included retinal atrophy and nuclear displacement in the retina. Lesions are discussed and compared with pertinent literature.

A 62-year-old male underwent pars plana vitrectomy for diabetic tractional retinal detachment. Multiple pars plana cysts varying from 2 to 0.5 disc diameter size were noted intraoperatively. These images highlight the utility of intraoperative widefield systems in combination with scleral depression for visualization of periphery of retina. The images also illustrate the details of cysts clearly along with their anatomical relation with ora serrata. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e169–e170.]

This chapter introduces several special types of rhegmatogenous retinal detachment; namely, retinal detachments with dialyses of the ora serrata, retinal detachment with giant retinal tear, retinal detachments with severe proliferative vitreoretinopathy, retinal detachment with choroidal detachment, congenital coloboma of the choroid with retinal detachment, retinal detachment with Marfan syndrome, and retinal detachment after vitreoretinal surgery. Particulars of the etiology, differential diagnosis, and surgery of each type are outlined.

Traumatic retinal detachment is caused by blunt contusion, and most of them starts from ora serrata dialysis. Intraocular foreign body usually associates with open-globe injury, for eyes with intraocular foreign body, the nature of the foreign body determines the clinical behavior. Tractional retinal detachment caused by trauma is one of the main causes of blindness. Endophthalmitis is a rare but serious complication, but Retinal detachment associates with endophthalmitis is very common.

The persistence of fetal vasculature (PFV) is an abnormal resorption in hyaloid vascular system. We report the case of a 2-year old child with evolutionary posterior form of bilateral vasculature presenting with leukocoria in the right eye. Clinical examination showed bilateral leukocoria, exotropia in the right eye and an exotropia in the left eye. Fundus examination of the right eye showed fibrovascular retinal band stretched to the ora serrata associated with total retinal detachment and peripheral pigment changes. Fundus examination of the left eye showed fibrovascular retinal band stretched from the papilla to the ora serrata, associated with partial inferior, anterior temporal detachment and peripheral pigment changes.

Retinal detachment with a break at the pars plicata associated with congenital malformation of lens–zonule–ciliary body complex is rare; most reports are of young Japanese male patients with atopic dermatitis. The present case report is the first to describe the condition in a Chinese patient with no atopic dermatitis or trauma history. A 22-year-old male presented with blurred vision in the left eye for 4 months. Fundus examination revealed shallow lower temporal retinal detachment. Further examination with scleral indentation under maximal pupil dilatation identified a break at the far periphery beyond the ora serrata and pars plana. Gonioscopy revealed a pars plicata break at the nonpigmented ciliary epithelium associated with congenital ciliary process hypoplasia and subtle lens defect at the same meridian. The retina was successfully reattached after segmental scleral buckling, cryopexy, and laser photocoagulation.

Purpose To report wide-field fluorescein angiography findings in the peripheral retina of eyes with childhood glaucoma. Methods Fluorescein angiograms were examined retrospectively in 12 patients with childhood glaucoma who underwent wide-field fluorescein angiography after surgical or medical treatment of glaucoma. This series included 12 eyes of 6 patients with primary congenital glaucoma, 5 eyes of 3 patients with glaucoma associated with congenital cataract surgery, 4 eyes of 2 patients with glaucoma associated with a systemic condition, and 1 eye of 1 patient with phakomatosis pigmentovascularis Type II. RetCam fundus photography images and digital fluorescein angiography were performed under general anesthesia. Results The most common finding observed in our series was peripheral retinal nonperfusion, which affected 20 eyes (91%). Other notable features seen were circumferential branching of the retinal vessels parallel to the ora serrata (77%), venous shunts (50%), and abnormal capillary branching patterns, including capillary dilatation (41%) and tortuous capillary tangles (18%). Leakage at the junction of vascular and avascular retina was not commonly seen (13.6%). None of the eyes had evidence of retinal neovascularization or fibrovascular proliferation. Conclusion Retinal vascular abnormalities and peripheral nonperfusion are novel findings in childhood glaucoma. Further studies are needed to understand the significance and possible long-term consequences of these findings.

BACKGROUND AND OBJECTIVE: Localization of retinal breaks in rhegmatogenous retinal detachment (RRD) after pneumatic retinopexy (PR) can be challenging once the retina is reattached. Laser can be applied to the pigmented and always-attached ora serrata in the meridian of the retinal breaks prior to pneumatic retinopexy, resulting in subsequent rapid localization of the breaks even in the presence of a gas bubble or media opacity. PATIENTS AND METHODS: Ten cases of indirect laser photocoagulation marking at the ora prior to intraocular gas injection in PR for RRD. Subsequent laser retinopexy was completed 48 hours after utilizing the landmarks at the ora to localize the reattached retinal breaks. RESULTS: In all 10 cases, laser photocoagulation marking was easily applied to the ora in the meridian of the retinal breaks prior to gas injection with no complications. The retinal breaks were subsequently identified 48 hours after gas injection. CONCLUSION: Laser marking of the ora prior to pneumatic retinopexy is a rapid and effective way to localize the re-attached retina breaks. [ Ophthalmic Surg Lasers Imaging Retina . 2016;47:570–572.]

Purpose To assess a potential role of Bruch´s membrane (BM) in the biomechanics of the eye, we measured its thickness and the density of retinal pigment epithelium (RPE) cells in various ocular regions in eyes of varying axial length. Methods Human globes, enucleated because of an ocular tumor or end-stage glaucoma were prepared for histological examination. Using light microscopy, the histological slides were histomorphometrically examined applying a digitized image analysis system. Results The study included 104 eyes with a mean axial length of 27.9±3.2 mm (range:22.6mm-36.5mm). In eyes without congenital glaucoma, BM was significantly thickest (P

To measure the thickness of Bruch's membrane (BM) and assess its associations with axial length.Using a light microscope, we measured the thickness of Bruch's membrane, choroid and sclera on horizontal anterior-posterior histological sections of enucleated human globes.The study included 54 eyes (42 with glaucomatous optic nerve damage; 23 globes with axial length ≥26.5 mm) with a mean axial length of 26.6 ± 3.3 mm (range: 21.0-34.0 mm). In the non-highly myopic eyes, BM was significantly thicker at the pars plana region (6.6 ± 1.1 μm) than at the equator (4.1 ± 1.5 μm; p 0.001), the midpoint between equator and posterior pole (4.1 ± 1.5 μm; p 0.001), the parapapillary region (4.5 ± 1.0 μm; p = 0.006) or the posterior pole (4.4 ± 1.7 μm; p = 0.001). At any measurement location at or behind the ora serrata, BM thickness did not differ significantly (all p ≥ 0.40) between the non-glaucomatous non-highly myopic group and the glaucomatous non-highly myopic group, or between the non-highly myopic group and the highly myopic group. BM thickness at any location was not significantly (all p 0.45) related to axial length. The ratio of scleral thickness to BM thickness and the ratio of choroidal thickness to BM thickness significantly decreased with longer axial length for measurements taken behind the equator.BM is physiologically thickest in the pars plana, with no major thickness differences between locations at or behind the ora serrata. In contrast to choroidal and scleral thickness, BM thickness is not significantly related to axial length. Axially elongated eyes have a normal BM thickness, despite a thinned choroid and sclera.