The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole.

Summary Optical coherence tomography (OCT) is a new method that could aid analysis of neurodegeneration in multiple sclerosis (MS) by capturing thinning of the retinal nerve fibre layer (RNFL). Meta-analyses of data for time domain OCT show RNFL thinning of 20·38 μm (95% CI 17·91–22·86, n=2063, p

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Optical coherence tomography in multiple sclerosis: a systematic review and meta-analysis

The onset of multiple sclerosis (MS) in childhood poses diagnostic and therapeutic challenges, particularly if the symptoms of the first demyelinating event resemble acute disseminated encephalomyelitis (ADEM). MRI is an invaluable diagnostic tool but it lacks the specificity to distinguish ADEM from the first attack of MS. Advanced MRI techniques might have the required specificity to reveal whether the loss of integrity in non-lesional tissue occurs as a fundamental feature of MS. Although the onset of MS in childhood typically predicts a favourable short-term prognosis, some children are severely disabled, either physically or cognitively, and more than 50% are predicted to enter the secondary-progressive phase of the disease by the age of 30 years. Immunomodulatory therapies for MS and their safe application in children can improve long-term prognosis. Genetic and environmental factors, such as viral infection, might be uniquely amenable to study in paediatric patients with MS. Understanding the immunological consequences of these putative exposures will shed light on the early pathological changes in MS.

https://www.thelancet.com/pdfs/journals/laneur/PIIS1474-4422(07)70242-9.pdf

Multiple sclerosis in children: clinical diagnosis, therapeutic strategies, and future directions

Objective
Cross-sectional studies of optical coherence tomography (OCT) show that retinal nerve fiber layer (RNFL) thickness is reduced in multiple sclerosis (MS) and correlates with visual function. We determined how longitudinal changes in RNFL thickness relate to visual loss. We also examined patterns of RNFL thinning over time in MS eyes with and without a prior history of acute optic neuritis (ON).

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Longitudinal study of vision and retinal nerve fiber layer thickness in multiple sclerosis.

Optical coherence tomography studies in multiple sclerosis have primarily focused on evaluation of the retinal nerve fibre layer. The aetiology of retinal changes in multiple sclerosis is thought to be secondary to optic nerve demyelination. The objective of this study was to use optical coherence tomography to determine if a subset of patients with multiple sclerosis exhibit primary retinal neuronopathy, in the absence of retrograde degeneration of the retinal nerve fibre layer and to ascertain if such patients may have any distinguishing clinical characteristics. We identified 50 patients with multiple sclerosis with predominantly macular thinning (normal retinal nerve fibre-layer thickness with average macular thickness < 5th percentile), a previously undescribed optical coherence tomography defined phenotype in multiple sclerosis, and compared them with 48 patients with multiple sclerosis with normal optical coherence tomography findings, 48 patients with multiple sclerosis with abnormal optical coherence tomography findings (typical for multiple sclerosis) and 86 healthy controls. Utilizing a novel retinal segmentation protocol, we found that those with predominant macular thinning had significant thinning of both the inner and outer nuclear layers, when compared with other patients with multiple sclerosis (P < 0.001 for both), with relative sparing of the ganglion cell layer. Inner and outer nuclear layer thicknesses in patients with non-macular thinning predominant multiple sclerosis were not different from healthy controls. Segmentation analyses thereby demonstrated extensive deeper disruption of retinal architecture in this subtype than may be expected due to retrograde degeneration from either typical clinical or sub-clinical optic neuropathy. Functional corroboration of retinal dysfunction was provided through multi-focal electroretinography in a subset of such patients. These findings support the possibility of primary retinal pathology in a subset of patients with multiple sclerosis. Multiple sclerosis-severity scores were also significantly increased in patients with the macular thinning predominant phenotype, compared with those without this phenotype (n = 96, P=0.006). We have identified a unique subset of patients with multiple sclerosis in whom there appears to be disproportionate thinning of the inner and outer nuclear layers, which may be occurring as a primary process independent of optic nerve pathology. In vivo analyses of retinal layers in multiple sclerosis have not been previously performed, and structural demonstration of pathology in the deeper retinal layers, such as the outer nuclear layer, has not been previously described in multiple sclerosis. Patients with inner and outer nuclear layer pathology have more rapid disability progression and thus retinal neuronal pathology may be a harbinger of a more aggressive form of multiple sclerosis.

/pdf/primary-retinal-pathology-in-multiple-sclerosis-as-detected-1dpvrcpjgt.pdf

Primary retinal pathology in multiple sclerosis as detected by optical coherence tomography

Background
Axonal distribution within the retinal nerve fiber layer (RNFL) measured by optical coherence tomography (OCT) correlates with axonal viability and integrity.

Optical coherence tomography in multiple sclerosis: thickness of the retinal nerve fiber layer as a potential measure of axonal loss and brain atrophy.

Purpose:The aim of this article was to estimate the natural course of vitreomacular traction (VMT) disorder using high-resolution spectral-domain optical coherence tomography.Methods:Nineteen eyes of 19 patients with idiopathic symptomatic VMT and who underwent spectral-domain optical coherence tomo

Long-term evaluation of vitreomacular traction disorder in spectral-domain optical coherence tomography.

Background
The aim of this study is to present functional and anatomical results of pars plana vitrectomy without gas tamponade in lamellar macular holes. Additionally, the study determines factors influencing final outcome.

Surgical treatment of lamellar macular holes

Background
The pathogenesis of macular pseudohole (MPH) is supposed to be different from that of macular lamellar hole (LMH). MPH is thought to be caused by centripetal contraction of previously present epiretinal membrane. LMH is considered to be an effect of abortive process of full-thickness macular hole formation, or a result of de-roofing of a foveal cyst in persistent cystoid macular oedema. In most cases of LMH, epiretinal membranes are present. The aim of this paper is to show that LMH and MPH may have a common origin and that LMH may evolve from MPH as an epiretinal membrane contracts.

Evolution from macular pseudohole to lamellar macular hole — spectral domain OCT study

The authors presented their experiences concerning the treatment of 26 eyes (in 25 patients) with retinal detachment complicated by PVR in which pars plana vitrectomy and silicone oil tamponade were applied. The patients have been previously operated with traditional methods however without success. Positive results, it is retinal attachment completely or in the superior and central part of the fundus with residual detachment inferiorly were achieved in 19 eyes (73%). An useful visual acuity (> 1/50) was achieved in 12 eyes and in 7 (27%) it was better than 5/50. Our results confirmed that this method (pars plana vitrectomy with silicone oil tamponade) is a method of choice in complicated retinal detachment, in which traditional methods failed.

Krzysztof Dziegielewski

Papers

Optical coherence tomography in multiple sclerosis: thickness of the retinal nerve fiber layer as a potential measure of axonal loss and brain atrophy.

Long-term evaluation of vitreomacular traction disorder in spectral-domain optical coherence tomography.

Surgical treatment of lamellar macular holes

Evolution from macular pseudohole to lamellar macular hole — spectral domain OCT study

Vitrectomy in treatment of retinal detachment with proliferative vitreoretinopathy