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Fulltext Evaluation of Macular and Retinal Nerve Fiber Layer Thickness in Children with Type 1 Diabetes Mellitus without Retinopathy

Mohd-Ilham I, Tai ELM, Suhaimi H, Shatriah I

Korean J Ophthalmol, 2021 08;35(4):287-294.
PMID: 34162187 DOI: 10.3341/kjo.2020.0106

PURPOSE: There are limited data from Asian countries regarding retinal thickness in children with type 1 diabetes mellitus (T1DM). This study aimed to compare the macular and retinal nerve fiber layer (RNFL) parameters between diabetic children without retinopathy and non-diabetic healthy children. We also evaluated the factors associated with RNFL thickness in children with T1DM.
METHODS: A comparative cross-sectional study was conducted among children with T1DM and healthy children aged 7 to 17 years old in Hospital Universiti Sains Malaysia from 2017 to 2019. Children with retinal disease or glaucoma were excluded. Macular and RNFL thicknesses were measured using spectral-domain optical coherence tomography. Demographic information, duration of diabetes, blood pressure, body mass index, visual acuity, and retinal examination findings were documented. Glycosylated hemoglobin levels, renal function, and blood lipid levels were also collected.
RESULTS: Forty-one children with T1DM and 80 age- and sex-matched children were enrolled. Both sexes were affected. Mean duration of diabetes mellitus was 3.66 years. The mean glycated hemoglobin levels in the T1DM group was 9.99%. The mean macular and RNFL thicknesses in children with T1DM were 277.56 (15.82) µm and 98.85 (12.05) µm, respectively. Children with T1DM had a significantly thinner average macula, superior outer macula, nasal outer macula, mean RNFL, and inferior RNFL thickness compared to controls (p < 0.05). There was a significant association between nephropathy and the mean RNFL thickness.
CONCLUSIONS: Children with T1DM had significantly decreased mean macular and RNFL thicknesses. Nephropathy is associated with an increased RNFL thickness.

Matched MeSH terms: Macula Lutea*
Fulltext The role of intravitreal anti-vascular endothelial growth factor injection in peripheral exudative hemorrhagic chorioretinopathy: A systematic review

Gowda A, Bahrami B, Jie WWJ, Casson R, Chan WO

Surv Ophthalmol, 2024;69(2):173-178.
PMID: 37806565 DOI: 10.1016/j.survophthal.2023.10.004

Anti-vascular endothelial growth factor (anti-VEGF) injections have revolutionized the field of ophthalmology, and their use in a variety of retinal diseases is growing. One target disease is peripheral exudative hemorrhagic chorioretinopathy, a disease that is uncommon and poorly understood. Despite this, there are numerous studies and case reports outlining the potential role of intravitreal injection of anti-VEGF medicines to treat it. As such, an evidence-based understanding of its risk-benefit profile is vital. We performed a comprehensive search in the PubMed, Google Scholar, and Cochrane databases for published studies and case reports relating to the use of anti-VEGF injections in peripheral exudative hemorrhagic chorioretinopathy. Anti-VEGF was first used in 2010 to aid in the management of peripheral exudative hemorrhagic chorioretinopathy. Since then, it has been increasingly used to manage this disease. Other potential management strategies, including laser photocoagulation, cryotherapy, photodynamic therapy, and vitrectomy are explored and compared with anti-VEGF where possible. Anti-VEGF appears to be an effective therapy in managing peripheral exudative hemorrhagic chorioretinopathy, especially when there is an exudative threat to the macula.

Matched MeSH terms: Macula Lutea*
Ocular hazards of playing badminton

Chandran S

Br J Ophthalmol, 1974 Aug;58(8):757-60.
PMID: 4433488
Matched MeSH terms: Macula Lutea/injuries
Fulltext Pattern-pulsed MfVEP waveform of age-related macular degeneration patients

Rosli, Y., Maddess, T.L., James, A.C., Goh, X.L.

ASM Science Journal, 2009;3(1):31-37.
MyJurnal

Responses were recorded from normal healthy subjects and age-related macular degeneration (AMD) patients and evaluated, using a new variant of mfVEP. Subjects information was recorded using 64 EEG channels with a computer-based acquisition system. The stimulus layout was a 84 region corticallyscaled dartboard comprising 12 sectors and seven concentric rings subtending a diameter of 23º, presented dichoptically at 60 Hz. Data from the control and AMD patients were statistically compared when fitted concurrently into the multiple regression analysis. The Pattern-pulse mfVEP technique could distinguish between normal eyes and those with a definite diagnosis of dry and wet AMD when responses from the macula were considered.

Matched MeSH terms: Macula Lutea
Dengue maculopathy: a case report

Tan SY, Kumar G, Surrun SK, Ong YY

Travel Med Infect Dis, 2007 Jan;5(1):62-3.
PMID: 17161325

Dengue fever is endemic in many countries of South East Asia. In spite of the occasional epidemics, dengue maculopathy remains a rare entity.

Matched MeSH terms: Macula Lutea/pathology*; Macula Lutea/virology*
Unusual presentation of severe dengue: Dengue maculopathy

Chuah KH, Ng CW, Zabri K, Wong CL

Med J Malaysia, 2017 02;72(1):73-74.
PMID: 28255149 MyJurnal

Dengue infection is epidemic but ocular complications of dengue are less reported. We report a case of dengueinfected patient with disturbing ocular symptoms. He was admitted for severe dengue. Subsequently, he presented with symptoms of bilateral central scotoma with metamorphosia. Fundus examination revealed cotton wool spots and flame-shaped haemorrhages at the macula, with dull foveal light reflex. He was diagnosed with bilateral dengue maculopathy. The patient was managed conservatively with surveillance. One week later, his eye symptoms improved and were resolved six months later. Early recognition and close monitoring remains the key to successful management and interventions are rarely needed.

Matched MeSH terms: Macula Lutea
Fulltext Dengue related maculopathy and foveolitis

Juanarita J, Azmi MN, Azhany Y, Liza-Sharmini AT

Asian Pac J Trop Biomed, 2012 Sep;2(9):755-6.
PMID: 23570008 DOI: 10.1016/S2221-1691(12)60223-8

A 24 year-old Malay lady presented with high grade fever, myalgia, generalized rashes, severe headache and was positive for dengue serology test. Her lowest platelet count was 45 × 10(9) cells/L. She complained of sudden onset of painlessness, profound loss of vision bilaterally 7 days after the onset of fever. On examination, her right eye best corrected vision was 6/30 and left eye was 6/120. Her anterior segment examination was unremarkable. Funduscopy revealed there were multiple retinal haemorrhages found at posterior pole of both fundi and elevation at fovea area with subretinal fluid. Systemic examination revealed normal findings except for residual petechial rashes. She was managed conservatively. Her vision improved tremendously after 2 months. The retinal hemorrhages and foveal elevation showed sign of resolving. Ocular manifestations following dengue fever is rare. However, bilateral visual loss can occur if both fovea are involved.

Matched MeSH terms: Macula Lutea/pathology
Fulltext Intravitreal injection of recombinant tissue plasminogen activator and pneumatic displacement of submacular haemorrhage

Fadhilah M, Mimiwati Z, Fong KC

Med J Malaysia, 2010 Dec;65(4):271-2.
PMID: 21901943

We report a case of a patient with hypertension and ischaemic heart disease on anti-platelet treatment, who developed uniocular profound visual loss from a submacular haemorrhage secondary to valsalva retinopathy. He was treated with a combination of intravitreal recombinant tissue plasminogen activator (rtPA) and sulphur hexafluoride (SF6) gas followed by strict prone positioning. He demonstrated significant displacement of the haemorrhage and improvement of vision postoperatively.

Matched MeSH terms: Macula Lutea*
Fulltext Spontaneous resolution of vitreomacular traction syndrome in a patient with diabetes with associated thickened posterior hyaloid prior to elective parsplanar vitrectomy demonstrated on optical coherence tomography

Bastion ML

BMJ Case Rep, 2010;2010.
PMID: 22791576 DOI: 10.1136/bcr.03.2010.2867

To describe an unusual case of vitreomacular traction syndrome spontaneously resolving prior to elective pars planar vitrectomy demonstrated on optical coherence tomography.

Matched MeSH terms: Macula Lutea/pathology*
Macula retinal vasculitis and choroiditis associated with granulomatosis with polyangiitis

Lim LT, Vasudevan V, Shelton J, Vitale AT, Moorthy R

Retin Cases Brief Rep, 2017 Spring;11(2):119-122.
PMID: 27305849 DOI: 10.1097/ICB.0000000000000307

PURPOSE: To report a case series of two cases of granulomatosis with polyangiitis, previously known as Wegener granulomatosis, which developed macular necrosis, not previously associated with granulomatosis with polyangiitis, healed with fibrosis, despite aggressive immune-modulating therapy and good control of systemic disease.

METHODS: Case series of two cases with observation of treatment progress.

RESULTS: The results reported the progress of response to treatment in the two cases, which resulted in the final outcome of fibrosis in the macula region, despite being on aggressive immune-modulating therapy and good systemic control.

CONCLUSION: Granulomatosis with polyangiitis can be associated with macular necrosis leading to fibrosis, unresponsive to immune-modulating therapy.

Matched MeSH terms: Macula Lutea/pathology
Aetiology of deafness in children from a school for the deaf in Malaysia

Elango S

Int J Pediatr Otorhinolaryngol, 1993 May;27(1):21-7.
PMID: 8314665

One hundred and sixty-five children from the school for the deaf were screened to find out the aetiology of deafness. The screening included routine ophthalmological examination. Aetiology was unknown in 33 children (20%). Prenatal infection was found to be the cause of deafness in 61 cases (36.96%). Rubella eye signs were found in 59 children (35.76%), whereas the history of rubella infection during the first trimester of pregnancy was found in only 33 of these cases (55.93%). Perinatal complications were seen in 20 children (12.12%). Twenty children (12.12%) had meningitis during their early childhood period. Routine ophthalmological examination helped us to pick up cases with rubella eye signs. Ophthalmological examination should be included as part of any study done to find out the cause of deafness.

Matched MeSH terms: Macula Lutea/abnormalities
Fulltext Optical coherence tomography angiography of the macula and optic nerve head: microvascular density and test-retest repeatability in normal subjects

Lim CW, Cheng J, Tay ELT, Teo HY, Wong EPY, Yong VKY, et al.

BMC Ophthalmol, 2018 Dec 10;18(1):315.
PMID: 30526537 DOI: 10.1186/s12886-018-0976-y

BACKGROUND: Despite the potential usefulness of optical coherence tomography angiography in retinal and optic disc conditions, the reliability of the imaging modality remains unclear. This study set out to measure the microvascular density of macula and optic disc by mean of optical coherence tomography angiography and report the repeatability of the vessel density measurements.
METHODS: Cross sectional observational cohort study. Subjects with normal eyes were recruited. Two sets of optical coherence tomography angiography images of macula and optic nerve head were acquired during one visit. Novel in-house developed software was used to count the pixels in each images and to compute the microvessel density of the macula and optic disc. Data were analysed to determine the measurement repeatability.
RESULTS: A total of 176 eyes from 88 consecutive normal subjects were recruited. For macular images, the mean vessel density at superficial retina, deep retina, outer retina and choriocapillaries segment was OD 0.113 and OS 0.111, OD 0.239 and OS 0.230, OD 0.179 and OS 0.164, OD 0.237 and OS 0.215 respectively. For optic disc images, mean vessel density at vitreoretinal interface, radial peripapillary capillary, superficial nerve head and disc segment at the level of choroid were OD 0.084 and OS 0.085, OD 0.140 and OS 0.138, OD 0.216 and OS 0.209, OD 0.227 and OS 0.236 respectively. The measurement repeatability tests showed that the coefficient of variation of macular scans, for right and left eyes, ranged from 6.4 to 31.1% and 5.3 to 59.4%. Likewise, the coefficient of variation of optic disc scans, for right and left eyes, ranged from 14.3 to 77.4% and 13.5 to 75.3%.
CONCLUSIONS: Optical coherence tomography angiography is a useful modality to visualise the microvasculature plexus of macula and optic nerve head. The vessel density measurement of macular scan by mean of optical coherence tomography angiography demonstrated good repeatability. The optic disc scan, on the other hand, showed a higher coefficient of variation indicating a lower measurement repeatability than macular scan. Interpretation of optical coherence tomography angiography should take into account test-retest repeatability of the imaging system.
TRIAL REGISTRATION: National Healthcare Group Domain Specific Review Board ( NHG DSRB ) Singapore. DSRB Reference: 2015/00301.

Matched MeSH terms: Macula Lutea/blood supply*
Fulltext Macular thickness as determined by optical coherence tomography in relation to degree of myopia, axial length and vitreous chamber depth in Malay subjects

Othman SF, Sharanjeet-Kaur, Manan FA, Zulkarnain AI, Mohamad Z, Ariffin AE

Clin Exp Optom, 2012 Sep;95(5):484-91.
PMID: 22716100 DOI: 10.1111/j.1444-0938.2012.00752.x

PURPOSE:This study aimed to determine the relationship between macular thickness and spherical equivalent refraction (SER), axial length (AL) and vitreous chamber depth (VCD) in Malay subjects.
METHODS: Sixty-three subjects (aged 19-24 years) with a mean SER of -1.79 ± 2.24 D, mean axial length of 24.26 ± 1.35 mm and mean vitreous chamber depth of 17.02 ± 1.33 mm were included in this clinical cross-sectional study. Stratus optical coherence tomography (Time Domain optical coherence tomography) was used to determine the thickness of the outer macular (perifovea) and inner macular (parafovea) at four different locations, that is, temporal, superior, nasal and inferior quadrants and also the fovea itself.
RESULTS: Positive correlations were found between the outer macular (perifovea) thickness and SER at the temporal (R = 0.47, p < 0.05), superior (R = 0.36, p < 0.05) and inferior (R = 0.31, p < 0.05) quadrants. Foveal thickness was also positively correlated with AL (R = 0.34, p < 0.05) and VCD (R = 0.32, p < 0.05). Negative correlations were found between outer macular thickness and axial length at the temporal (R = -0.46, p < 0.05), superior (R = -0.27, p < 0.05), nasal (R = -0.25, p < 0.05) and inferior (R = -0.36, p < 0.05) quadrants. Negative correlations were also found between outer macular thickness and VCD at the temporal (R = -0.51, p < 0.05), superior (R = -0.32, p < 0.05), nasal (R = -0.31, p < 0.05) and inferior (R = -0.40, p < 0.05) quadrants.
CONCLUSIONS: This study shows that the degree of myopia and elongation of the globe are associated with thinning of most areas of the perifovea. A trend for foveal thickening in the high myopia group is also inferred, although this does not apply to the low and moderate myopia groups.
Study site: Optometry and ophthalmology clinics, National Institute of Ophthalmic Sciences, Tun Hussein Onn National Eye Hospital (THONEH), Petaling Jaya

Matched MeSH terms: Macula Lutea/pathology*
Treatment of macular hole retinal detachment

Lai YK

Br J Ophthalmol, 1990 Apr;74(4):201-2.
PMID: 2337542

Seven patients with macular hole retinal detachment were treated by intravitreal gas injection with or without release of subretinal fluid. Macular buckling, diathermy, cryopexy, or vitrectomy were not used. The patients were placed prone for eight hours a day until the gas had absorbed. In five of the seven patients the retina became reattached within three days and remained reattached with follow-up periods of three to 22 months (average nine months). It is believed that such detachments are due to vitreoretinal traction and the intravitreal gas bubble relieves this traction. This technique is simple, safe, and does not require costly or sophisticated instruments. It has an added advantage in preserving macular function.

Matched MeSH terms: Macula Lutea/pathology*
Dosage-dependent reduction of macular pigment optical density in female breast cancer patients receiving tamoxifen adjuvant therapy

Lim IL, Loo AVP, Subrayan V, Khang TF, See MH, Alip A, et al.

Breast, 2018 Jun;39:117-122.
PMID: 29660599 DOI: 10.1016/j.breast.2018.04.003

It is now increasingly common for breast cancer patients to receive adjuvant tamoxifen therapy for a period of up to 10 years. As survival rate increases, managing tamoxifen ocular toxicities is important for patients' quality of life. Macular pigments in photoreceptor cells protect against free radical damage, which can cause macular degeneration. By reducing macular pigment concentration, tamoxifen may increase the risk of macular degeneration. Here, we compared macular pigment optical density (MPOD) and central macular thickness between breast cancer patients on tamoxifen adjuvant therapy (n = 70), and a control group (n = 72). Multiple regression analysis indicated that MPOD decreases with increasing tamoxifen dosage, up to a threshold of about 20 g, after which MPOD plateaus out. Mean MPOD in the treatment group (mean = 0.40) was significantly lower (p-value = 0.02) compared to the control group (mean = 0.47) for the left eye, and for the right eye (treatment mean = 0.39; control mean = 0.48; p-value = 0.009). No significant difference in mean central macular thickness was found between the treatment and the control group (p-values > 0.4). In the control group, MPOD and central macular thickness showed significant correlation (r∼0.30; p-values 

Matched MeSH terms: Macula Lutea/drug effects*; Macula Lutea/pathology
Application of different imaging modalities for diagnosis of Diabetic Macular Edema: A review

Mookiah MR, Acharya UR, Fujita H, Tan JH, Chua CK, Bhandary SV, et al.

Comput Biol Med, 2015 Nov 1;66:295-315.
PMID: 26453760 DOI: 10.1016/j.compbiomed.2015.09.012

Diabetic Macular Edema (DME) is caused by accumulation of extracellular fluid from hyperpermeable capillaries within the macula. DME is one of the leading causes of blindness among Diabetes Mellitus (DM) patients. Early detection followed by laser photocoagulation can save the visual loss. This review discusses various imaging modalities viz. biomicroscopy, Fluorescein Angiography (FA), Optical Coherence Tomography (OCT) and colour fundus photographs used for diagnosis of DME. Various automated DME grading systems using retinal fundus images, associated retinal image processing techniques for fovea, exudate detection and segmentation are presented. We have also compared various imaging modalities and automated screening methods used for DME grading. The reviewed literature indicates that FA and OCT identify DME related changes accurately. FA is an invasive method, which uses fluorescein dye, and OCT is an expensive imaging method compared to fundus photographs. Moreover, using fundus images DME can be identified and automated. DME grading algorithms can be implemented for telescreening. Hence, fundus imaging based DME grading is more suitable and affordable method compared to biomicroscopy, FA, and OCT modalities.

Matched MeSH terms: Macula Lutea
Fulltext Single intravitreal ranibizumab for myopic choroidal neovascularization

Nor-Masniwati S, Shatriah I, Zunaina E

Clin Ophthalmol, 2011;5:1079-82.
PMID: 21847340 DOI: 10.2147/OPTH.S21057

We report a case of myopic choroidal neovascularization that showed improvement after a single injection of ranibizumab. A 45-year-old Chinese man with high myopia presented with sudden onset painless central scotoma of his right eye of 2 weeks' duration. There was no history of trauma. His right eye vision on presentation was 6/30 which showed no improvement with pinhole. The right fundus showed myopic maculopathy at the posterior pole with subretinal hemorrhage at the inferotemporal fovea. The optic disc was tilted with inferotemporal peripapillary atrophy. There was a myopic maculopathy appearance in the macula of the left eye. Fundus fluorescein angiography revealed choroidal neovascularization at the fovea of the right eye. A diagnosis of right eye choroidal neovascularization secondary to myopic maculopathy was made. A single intravitreal injection of ranibizumab 0.05 mL was given. Ten weeks following intravitreal injection, vision had improved to 6/7.5, and repeated fundus fluorescein angiography showed absence of choroidal neovascularization. Follow-up at 6 months showed visual acuity had normalized to 6/6 with glasses, which was maintained up to 12 months following treatment. The right fundus showed no further subretinal hemorrhage with no new lesions.

Matched MeSH terms: Macula Lutea
Emerging innovations in nano-enabled therapy against age-related macular degeneration: A paradigm shift

Kumar Dubey S, Pradhan R, Hejmady S, Singhvi G, Choudhury H, Gorain B, et al.

Int J Pharm, 2021 May 01;600:120499.
PMID: 33753164 DOI: 10.1016/j.ijpharm.2021.120499

Age-related macular degeneration (AMD), a degenerative eye disease, is the major cause of irreversible loss of vision among individuals aged 50 and older. Both genetic and environmental factors are responsible for the progressive damage to central vision. It is a multifactorial retinal disease with features such as drusen, hypopigmentation and/or hyperpigmentation of the retinal pigment epithelium, and even choroidal neovascularization in certain patients. AMD is of two major forms: exudative (wet) and atrophic (dry) with changes affecting the macula leading to impaired vision. Although the retina remains an accessible portion for delivering drugs, there are no current options to cure or treat AMD. The existing expensive therapeutics are unable to treat the underlying pathology but display several side effects. However, recent innovations in nanotherapeutics provide an optimal alternative of drug delivery to treat the neovascular condition. These new-age technologies in the nanometer scale would enhance bioactivity and improve the bioavailability of drugs at the site of action to treat AMD. The nanomedicine also provides sustained release of the drug with prolonged retention after penetrating across the ocular tissues. In this review, the insights into the cellular and molecular mechanisms associated with the pathophysiology of AMD are provided. It also serves to review the current progress in nanoparticle-based drug delivery systems that offer feasible treatments in AMD.

Matched MeSH terms: Macula Lutea
Fulltext Bilateral profound visual loss as a consequence of leukaemia – a case report

Raajini, Devi K., Safinaz, M.K., Hazlita, M.I.

Journal of Surgical Academia, 2015;5(1):61-63.
MyJurnal

An 18-year-old Malay gentleman was noted to have profound bilateral blurred vision for one month duration, associated with loss of weight, appetite, low grade fever and abdominal distension. Visual acuity on presentation was 6/60 on the right, counting finger on the left with no afferent pupillary defect. Anterior segments were unremarkable. Vitreous cells were occasional bilaterally. Fundus revealed multiple choroidal and sub-retinal Roth spots with areas of pre-retinal and intra-retinal haemorrhages, involving the macula in the left eye. Vessels were dilated and tortuous in all quadrants of the right eye. Many areas of capillary fall out at peripheral retina were demonstrated in fundus fluorescein angiogram. Further systemic and laboratory review confirmed the diagnosis of CML and chemotherapy was initiated. Both eye ischaemic retinopathy secondary to CML was confirmed and scatter pan retinal photocoagulation was performed bilaterally. Good improvement in vision noted during subsequent follow up to 6/24 on the right, 6/60 on the left. High levels of suspicion and accurate early recognition of fundus changes are vital in these types of cases to ensure the institution of prompt treatment.

Matched MeSH terms: Macula Lutea
Macular haemorrhage in adult acute leukaemia patients at presentation and the risk of subsequent intracranial haemorrhage

Jackson N, Reddy SC, Harun MH, Quah SH, Low HC

Br J Haematol, 1997 Jul;98(1):204-9.
PMID: 9233585

Retinal changes are common in adult acute leukaemia patients at presentation, but whether they correlate with the risk of subsequent intracranial haemorrhage is unknown. A 4-year study has been carried out in 82 newly-diagnosed acute leukaemia patients, aged 12-77 years, who were studied prospectively for the presence of intra-retinal haemorrhages (IRH), white-centred haemorrhages (WCH), cotton-wool spots (CWS) and macular haemorrhages (MH). Groups with and without these features were compared for their risk of intra-cranial haemorrhage (ICH) within the first 30 d following diagnosis. There was no association between the incidence of ICH and the presence of IRH, WCH or CWS. However, 6/13 of those with MH developed ICH, compared to 6/69 of those without MH (relative risk 5.0, CI 95% [2.03-12.33], P=0.003). The only other identifiable risk factor for ICH was the M3 subtype of AML, but if the four cases of M3-AML were discounted from analysis, MH remained a highly significant risk factor for ICH. Patients with MH should be monitored intensively for the development of ICH, and receive priority in the allocation of platelets where these are in short supply.

Matched MeSH terms: Macula Lutea*

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