A virtual model of the retina based on histological data as a tool for evaluation of the visual fields

Background:To settle the fundamentals of a numerical procedure that relates retinal ganglion-cell density and threshold sensitivity in the visual field.The sensitivity of a generated retina and visual pathways to virtual stimuli are simulated,and the conditions required to reproduce glaucoma-type defects both in the optic-nerve head(ONH)and visual fields are explored.Methods:A definition of selected structural elements of the optic pathways is a requisite to a translation of clinical knowledge to computer programs for visual field exploration.The program is able to generate a database of normalized visual fields.The relationship between the number of extant receptive fields and threshold sensitivity is plotted for background sensitivity and corresponding automated perimetry.A solution in two planes to the 3D distribution of axons in the ONH is proposed.Visual fields with induced damage in the optic disc are comparable in pattern and quantity to glaucomatous records.Results:The two-level simulation of the ONH facilitates the analysis of optic-cup/retinal defects.We can generate the virtual optic pathways tailored to the age and morphology of the patient’s eye,and it is possible to reproduce glaucomatous damage by“reverse engineering”engineering.The virtual cortical model renders a quantitative relationship between visual defect and neural damage.Conclusions:A two-level computing of the retina/optic nerve facilitates the analysis of neuroretinal defects and can be incorporated to automatic perimeters to facilitate visual field analysis.

Predictive visual field outcomes after optic chiasm decompressive surgery by retinal vessels parameters using optical coherence tomography angiography

AIM:To evaluate the predictive value of superficial retinal capillary plexus(SRCP)and radial peripapillary capillary(RPC)for visual field recovery after optic cross decompression and compare them with peripapillary nerve fiber layer(pRNFL)and ganglion cell complex(GCC).METHODS:This prospective longitudinal observational study included patients with chiasmal compression due to sellar region mass scheduled for decompressive surgery.Generalized estimating equations were used to compare retinal vessel density and retinal layer thickness preand post-operatively and with healthy controls.Logistic regression models were used to assess the relationship between preoperative GCC,pRNFL,SRCP,and RPC parameters and visual field recovery after surgery.RESULTS:The study included 43 eyes of 24 patients and 48 eyes of 24 healthy controls.Preoperative RPC and SRCP vessel density and pRNFL and GCC thickness were lower than healthy controls and higher than postoperative values.The best predictive GCC and pRNFL models were based on the superior GCC[area under the curve(AUC)=0.866]and the tempo-inferior pRNFL(AUC=0.824),and the best predictive SRCP and RPC models were based on the nasal SRCP(AUC=0.718)and tempo-inferior RPC(AUC=0.825).There was no statistical difference in the predictive value of the superior GCC,tempo-inferior pRNFL,and tempo-inferior RPC(all P>0.05).CONCLUSION:Compression of the optic chiasm by tumors in the saddle area can reduce retinal thickness and blood perfusion.This reduction persists despite the recovery of the visual field after decompression surgery.GCC,pRNFL,and RPC can be used as sensitive predictors of visual field recovery after decompression surgery.

Values of macular ganglion cell-inner plexiform layer and 10-2 visual field measurements in detecting and evaluating glaucoma

AIM:To assess the performance of macular ganglion cell-inner plexiform layer thickness(mGCIPLT)and 10-2 visual field(VF)parameters in detecting early glaucoma and evaluating the severity of advanced glaucoma.METHODS:Totally 127 eyes from 89 participants(36 eyes of 19 healthy participants,45 eyes of 31 early glaucoma patients and 46 eyes of 39 advanced glaucoma patients)were included.The relationships between the optical coherence tomography(OCT)-derived parameters and VF sensitivity were determined.Patients with early glaucoma were divided into eyes with or without central 10°of the VF damages(CVFDs),and the diagnostic performances of OCT-derived parameters were assessed.RESULTS:In early glaucoma,the mGCIPLT was significantly correlated with 10-2 VF pattern standard deviation(PSD;with average mGCIPLT:β=-0.046,95%CI,-0.067 to-0.024,P<0.001).In advanced glaucoma,the mGCIPLT was related to the 24-2 VF mean deviation(MD;with average mGCIPLT:β=0.397,95%CI,0.199 to 0.595,P<0.001),10-2 VF MD(with average mGCIPLT:β=0.762,95%CI,0.485 to 1.038,P<0.001)and 24-2 VF PSD(with average mGCIPLT:β=0.244,95%CI,0.124 to 0.364,P<0.001).Except for the minimum and superotemporal mGCIPLT,the decrease of mGCIPLT in early glaucomatous eyes with CVFDs was more severe than that of early glaucomatous eyes without CVFDs.The area under the curve(AUC)of the average mGCIPLT(AUC=0.949,95%CI,0.868 to 0.982)was greater than that of the average circumpapillary retinal nerve fiber layer thickness(cpRNFLT;AUC=0.827,95%CI,0.674 to 0.918)and rim area(AUC=0.799,95%CI,0.610 to 0.907)in early glaucomatous eyes with CVFDs versus normal eyes.CONCLUSION:The 10-2 VF and mGCIPLT parameters are complementary to 24-2 VF,cpRNFLT and ONH parameters,especially in detecting early glaucoma with CVFDs and evaluating the severity of advanced glaucoma in group level.

Neuroimaging in atypical normal tension glaucoma:debating routine implementation in the absence of classic neurological findings

●AIM:To assess the necessity of neuroimaging in patients with neurological or atypical findings of normal tension glaucoma(NTG)who do not exhibit typical glaucoma manifestations.●METHODS:A retrospective analysis was conducted on 90 atypical NTG patients who underwent cranial magnetic resonance imaging(MRI)due to atypical symptoms.The demographic characteristics,clinical parameters,and radiological findings were recorded.●RESULTS:Among the patients,66.7%had abnormal radiology results,with the most common findings being gliosis(34.4%),sequelae of cerebrovascular events and vascular malformations(14.4%),and benign intracranial mass lesions(11%).Non-glaucomatous visual field defects were more frequently observed in patients with abnormal neuroimaging results.However,there were no significant differences in intraocular pressure,optic disc parameters,retinal nerve fiber layer thickness,and visual field indices between patients with normal and abnormal radiological results.The mean age of the patients was 58.74y.Interestingly,there was a significant age difference,with the abnormal radiology group having a higher median age(P=0.021).●CONCLUSION:The study highlights the importance of cranial imaging in older NTG patients to detect underlying pathologies and prevent misdiagnosis.It suggests that neuroimaging may be warranted in NTG patients with atypical visual field defects incompatible with glaucoma.However,routine neuroimaging in all NTG patients without classic neurological signs may not be necessary.

Reversibility of visual field defects through induction of brain plasticity: vision restoration, recovery and rehabilitation using alternating current stimulation

For decades visual field defects were considered irreversible because it was thought that in the visual system the regeneration potential of the neuronal tissues is low.Nevertheless,there is always some potential for partial recovery of the visual field defect that can be achieved through induction of neuroplasticity.Neuroplasticity refers to the ability of the brain to change its own functional architecture by modulating synaptic efficacy.It is maintained throughout life and just as neurological rehabilitation can improve motor coordination,visual field defects in glaucoma,diabetic retinopathy or optic neuropathy can be improved by inducing neuroplasticity.In ophthalmology many new treatment paradigms have been tested that can induce neuroplastic changes,including non-invasive alternating current stimulation.Treatment with alternating current stimulation(e.g.,30 minutes,daily for 10 days using transorbital electrodes and^10 Hz)activates the entire retina and parts of the brain.Electroencephalography and functional magnetic resonance imaging studies revealed local activation of the visual cortex,global reorganization of functional brain networks,and enhanced blood flow,which together activate neurons and their networks.The future of low vision is optimistic because vision loss is indeed,partially reversible.

Factors influencing improvement of visual field after trans-sphenoidal resection of pituitary macroadenomas:a retrospective cohort study

AIM: To investigate the influencing factors of visual field improvement after trans-sphenoidal resection of pituitary macroadenomas. METHODS: This retrospective cohort study included 201 patients (366 eyes) with visual field defect induced by pituitary macroadenomas. All of them were treated with trans-sphenoidal surgery. Ophthalmologic evaluation, best -corrected visual acuity (BCVA), and visual field examination were performed before and 3mo after surgery. BCVA, visual field defect index mean deviation (MD), duration of symptoms, age, sex, and volume of tumors were compared. Expression of vascular endothelial growth factor (VEGF) and Ki-67 of tumor tissue were detected by immunohistochemical technique. RESULTS: The mean age of patients was 44.23 +/- 1.29y. Ninety -three patients were female and 108 were male. The mean tumor volume was 14.36 +/- 6.23 cm(3). The mean duration of preoperative symptoms was 11.50 +/- 0.88mo. Mean preoperative MD was -17.50 +/- 0.82 dB. Mean Preoperative visual acuity was 0.64 +/- 0.04. Postoperative visual field improved in 270 (73.77%) eyes, unchanged in 96 (26.23%) eyes. Multivariate logistic regression displayed that the factors independently influencing visual field improvement were young age (OR=1.71, 95%CI: 1.325-2.387, P=0.013), low preoperative MD absolute value (OR=1.277, 95%CI: 1.205-1.355, P<0.001), small volume of tumor (OR=1.458, 95%CI: 1.060-4.289, P<0.001), low expression of VEGF in tumor tissue (OR=1.554, 95%CI: 1.089-2.457, P=0.022), and low expression of Ki-67 in tumor tissue (OR=1.552, 95%CI: 1.161-2.847, P=0.026). CONCLUSION: After pituitary macroadenomas trans sphenoidal resection, the independent influencing factors of the visual fields recovery were low preoperative MD absolute value, young age, small volume of tumor, and expression levels of VEGF/Ki-67.

Correlation of pattern reversal visual evoked potential parameters with the pattern standard deviation in primary open angle glaucoma

AIM:To evaluate whether glaucomatous visual field defect particularly the pattern standard deviation(PSD)of Humphrey visual field could be associated with visual evoked potential(VEP)parameters of patients having primary open angle glaucoma(POAG).METHODS:Visual field by Humphrey perimetry and simultaneous recordings of pattern reversal visual evoked potential(PRVEP)were assessed in 100 patients with POAG.The stimulus configuration for VEP recordings consisted of the transient pattern reversal method in which a black and white checker board pattern was generated(full field)and displayed on VEP monitor(colour 14')by an electronic pattern regenerator inbuilt in an evoked potential recorder(RMS EMG EP MARK II).RESULTS:The results of our study indicate that there is a highly significant(P【0.001)negative correlation of P100 amplitude and a statistically significant(P【0.05)positive correlation of N70 latency,P100 latency and N155 latency with the PSD of Humphrey visual field in the subjects of POAG in various age groups as evaluated by Student’s t-test.CONCLUSION:Prolongation of VEP latencies were mirrored by a corresponding increase of PSD values.Conversely,as PSD increases the magnitude of VEP excursions were found to be diminished.

Visual field mean deviation and relevant factors in 928 Chinese retinitis pigmentosa patients

AIM: To investigate the associations between demographic and clinical factors with the rate of visual field mean derivation(MD) decline in retinitis pigmentosa(RP) patients.METHODS: Correlations of MDs with the visual acuity and retinal pigmentation were analyzed in 928 RP patients. MD decreasing rate in 10 y and potential influences of gender, age, family history and retinal pigmentation on the rate were explored in 201 RP patients. RESULTS: In the 928 patients, average MD and visual acuity were-14.44±8.61 dB and 0.79±0.35 respectively and when MD was lower than-9.18 dB the visual acuity would be below 1.0(20/20). The average MD medium between eyes with or without retinal pigmentation was-14.82 dB. In 123 non-pigmented eyes, the average MD were lower than the medium but in 153 pigmented eyes it was higher than that. In the 201 patients, the average decreasing value of MD in 10 years’ period was-8.01±3.66 dB and the value were correlated to retinal pigmentation but not to gender, age or RP family history. CONCLUSION: The rate of MD decline in RP eyes is significantly related to retinal pigmentation. Our study demonstrates the quantitative rate of MD decline in RP patients and the value of MD could well reflect the severity of RP.

Comparison of corneal biomechanical properties in normal tension glaucoma patients with different visual field progression speed

AIM：To compare the corneal biomechanical properties difference by ocular response analyzer（ORA） in normal tension glaucoma（NTG） patients with different visual field（VF） progression speed. METHODS：NTG patients with well-controlled Goldmann applanation tonometer（GAT） who routinely consulted Kitasato University Hospital Glaucoma Department between January 2010 and February 2014 were enrolled.GAT and ORA parameters including corneal compensated intraocular pressure（lOPcc）,Goldmann estimated intraocular pressure（lOPg）,corneal hysteresis（CH）,corneal resistance factor（CRF） were recorded.VF was tested by Swedish interactive threshold algorithm（SITA）-standard 30-2 fields.All patients underwent VF measurement regularly and GAT did not exceed 15 mm Hg at any time during the 3y follow up.Patients were divided into four groups according to VF change over 3y,and ORA findings were compared between the upper 25th percentile group（slow progression group） and the lower 25th percentile group（rapid progression group）.RESULTS：Eighty-two eyes of 56 patients were studied.There were 21 eyes（21 patients） each in rapid and slow progression groups respectively.GAT,lOPcc,lOPg,CH,CRF were 12.1＋1.4 mm Hg,15.8±1.8 mm Hg,12.8±2.0 mm Hg,8.4±1.1 mm Hg,7.9±1.3 mm Hg respectively in rapid progression group and 11.5±1.3 mm Hg,13.5±2.1 mm Hg,11.2±1.6 mm Hg,9.3±1.1 mm Hg,8.2±0.9 mm Hg respectively in slow progression group（P=0.214,〈0.001,0.007,0.017,0.413,respectively）.In bivariate correlation analysis,lOPcc,lOPcc-GAT and CH were significant correlated with m△MD（r =-0.292,-0.312,0.228 respectively,P =0.008,0.004,0.039 respectively）.CONCLUSION：Relatively rapid VF progression occurred in NTG patients whose lOPcc are rather high,CH are rather low and the difference between lOPcc and GAT are relatively large.Higher lOPcc and lower CH are associated with VF progression in NTG patients.This study suggests that GAT measures might underestimate the IOP in such patients.

Bruch's membrane opening-minimum rim width and visual field loss in glaucoma:a broken stick analysis

AIM：To determine the Bruch＇s membrane opening-minimum rim width（BMO-MRW） tipping point where corresponding visual field（VF） damages become detectable.METHODS：A total of 85 normal subjects and 83 glaucoma patients（one eye per participant） were recruited for the study.All of the patients had VF examinations and spectral-domain optical coherence tomography to measure the BMO-MRW.Total deviation values for 52 VF points were allocated to the corresponding sector according to the Garway-Heath distribution map.To evaluate the relationship between VF loss and BMOMRW measurements,a ＂broken-stick＂ statistical model was used.The tipping point where the VF values started to sharply decrease as a function of BMO-MRW measurements was estimated and the slopes above and below this tipping point were compared.RESULTS：A 25.9% global BMO-MRW loss from normative value was required for the VF loss to be detectable.Sectorally,substantial BMO-MRW thinning in inferotemporal sector（33.1%） and relatively less BMO-MRW thinning in the superotemporal sector（8.9%） were necessary for the detection of the VF loss.Beyond the tipping point,the slopes were close to zero throughout all of the sectors and the VF loss was unrelated to the BMO-MRW loss.The VF loss was related to the BMO-MRW loss below the tipping point.The difference between the two slopes was statistically significant（P≤0.002）.CONCLUSION：Substantial BMO-MRW loss appears to be necessary for VF loss to be detectable in patients with open angle glaucoma with standard achromatic perimetry.

Impact of binocular visual field loss on driving performance in glaucoma patients

AIM:To evaluate the driving performance in young and middle-aged Chinese glaucoma patients with mild to severe visual field loss compared to those without glaucoma by using a driving simulation test.METHODS:Twenty-nine participants were included in this study:nine patients with glaucoma but pass the binocular Esterman visual field test,ten patients with glaucoma and fail the binocular Esterman visual field test,and ten age-matched healthy controls.A driving simulation test was designed as a frequency-based analysis of a lanekeeping task.The total performance error,the controlresponse amplitude and delay were calculated.RESULTS:Esterman visual field test fail group showed the longest delay of control-response among three groups(P=0.02).And the delay in lane-keeping task was significantly associated with inferior field of better-eye(r=0.51,P=0.004)and integrated visual field(r=0.55,P=0.002).CONCLUSION:Young and middle-aged glaucoma patients with binocular visual field loss suffered from a longer delay of response in driving simulation test,while inferior visual field having more impact than superior visual field.

Comparison of the SITA Faster–a new visual field strategy with SITA Fast strategy

AIM:To compare visual field defects using the Swedish Interactive Thresholding Algorithm(SITA)Fast strategy with SITA Faster strategy,a newly developed time-saving threshold visual field strategy.METHODS:Ninety-three participants(60 glaucoma patients and 33 normal controls)were enrolled.One eye from each participant was selected randomly for the study.SITA Fast and SITA Faster were performed using the 24-2 default mode for each test.The differences of visual field defects between the two strategies were compared using the test duration,false-positive response errors,mean deviation(MD),visual field index(VFI)and the numbers of depressed test points at the significant levels of P<5%,<2%,<1%,and<0.5%in probability plots.The correlation between strategies was analyzed.The agreement between strategies was acquired by Bland-Altman analysis.RESULTS:Mean test durations were 246.0±60.9 s for SITA Fast,and 156.3±46.3 s for SITA Faster(P<0.001).The test duration of SITA Faster was 36.5%shorter than SITA Fast.The MD,VFI and numbers of depressed points at P<5%,<2%,<1%,and<0.5%in probability plots showed no statistically significant difference between two strategies(P>0.05).Correlation analysis showed a high correlation for MD(r=0.986,P<0.001)and VFI(r=0.986,P<0.001)between the two strategies.Bland-Altman analysis showed great agreement between the two strategies.CONCLUSION:SITA Faster,which saves considerable test time,has a great test quality comparing to SITA Fast,but may be not directly interchangeable.

Visual field defects and retinal nerve fiber layer damage in buried optic disc drusen: a new insight

AIM: To assess the association between buried optic disc drusen(BODD) location using spectral-domain optical coherence tomography(SD-OCT) and the location of associated visual field defects(VFD) using the Garway-Heath mapping.METHODS: This monocentric retrospective crosssectional study was led at the authors’ institution. Adult patients diagnosed with BODD who had complete records with a reliable Humphrey? 24-2 visual field, macular, and papillary OCT were enrolled. Fisher’s exact test was used to measure the association between BODD location and VFD distribution according to Garway-Heath’s mapping.RESULTS: Totally 20 eyes of 15 patients were included(60% females). The median age(interquartile range) was 63(43)y and the median best corrected visual acuity(BCVA) was-0.08(0.08) log MAR. BODD were mostly located in zones A, E, and F. The minimal rim width(MRW) was globally preserved. The retinal nerve fiber layer(RNFL) was predominantly altered in zones D, E, and F. There was a significant correlation between BODD location and that of RNFL alterations in zones D(P=0.03) and E(P=0.025);Moreover, the presence of BODD in the E zone was significantly related to damaged RNFL in the neighbouring sectors D and F(P=0.012;P=0.02 respectively). Sixty-three percent(12/19) of visual fields were abnormal and there was a significant match(Phi=0.7, P=0.009) between drusen location and VFD only in zone D.CONCLUSION: BODD do not only affect young patients and can be more harmful than usually expected, as we found VFD in 63% of cases. There is a correspondence between BODD location, RNFL damage, and VFD distributions. The presence of BODD induces the overestimation of MRW,thereby disrupting its sensitivity as an early indicator of ganglion fibers damage.

Streamline pair selection for comparative flow field visualization

Fluid dynamics simulation is often repeated under varying conditions.This leads to a generation of large amounts of results,which are difficult to compare.To compare results under different conditions,it is effective to overlap the streamlines generated from each condition in a single three-dimensional space.Streamline is a curved line,which represents a wind flow.This paper presents a technique to automatically select and visualize important streamlines that are suitable for the comparison of the simulation results.Additionally,we present an implementation to observe the flow fields in virtual reality spaces.

Visual Functions and TraceElement Metabolism in Tobacco-toxic Optic Neuropathy

Visual functions and nutrition metabolic characteristics werestudied in 8 subjects(16 eyes)with tobacco-toxic optic neuropathy(TTON).Their visual functions tested by psychophysical and electrophysiologicmethods showed that:1.central vision diminished in 16 eyes,2.dyschromatopsias were found in 14 tested eyes,3.bilateral symmetricalcentral or cecocentral scotomas were the visual field characteristics in allcases,4.PVEP were severe abnormal in 3 spatial frequencies in all cases and56.3% of 15' checkboard ...

VISUALIZATION OF THREE-DIMENSIONAL DATA FIELD AND ITS APPLICATION IN MACHINE TESTING

In order to realize visualization of three-dimensional data field （TDDF） in instrument, two methods of visualization of TDDF and the usual manner of quick graphic and image processing are analyzed. And how to use OpenGL technique and the characteristic of analyzed data to construct a TDDF, the ways of reality processing and interactive processing are described. Then the medium geometric element and a related realistic model are constructed by means of the first algorithm. Models obtained for attaching the third dimension in three-dimensional data field are presented. An example for TDDF realization of machine measuring is provided. The analysis of resultant graphic indicates that the three-dimensional graphics built by the method developed is featured by good reality, fast processing and strong interaction

Anti-inflammatory effect of miR-125a-5p on experimental optic neuritis by promoting the differentiation of Treg cells

Methylprednisolone pulse treatment is currently used fo r optic neuritis.It can speed visual recovery,but does not improve the ultimate visual outcomes.Recent studies have repo rted that miR-125 a-5 p has immunomodulatory effects on autoimmune diseases.However,it remains unclear whether miR-125 a-5 p has effects on optic neuritis.In this study,we used adeno-associated virus to overexpress or silence miR-125 a-5 p in mice.We found that silencing miR-125 a-5 p increased the latency of visual evoked potential and aggravated inflammation of the optic nerve.Ove rexpression of miR-125 a-5 p suppressed inflammation of the optic nerve,protected retinal ganglion cells,and increased the percentage of Treg cells.Our findings show that miR-125 a-5 p exhibits anti-inflammatory effects through promoting the diffe rentiation of Treg cells.

A New Classification for Retinitis Pigmentosa Including Multifocal Electroretinography to Evaluate the Disease Severity

Aim: To establish a useful and objective classification for retinitis pigmentosa (RP) to evaluate the disease severity. Methods: This is a retrospective cross-sectional study. Visual acuity (VA), visual field (VF) width, ellipsoid zone width on optic cohorence tomography (OCT) and multifocal electroretinography (mf ERG) values were obtained from medical records of patients with RP. A scoring criterion was developed wherein each variable was assigned a score from 0 to 5 depending on its distribution. The cumulative score (from 0 to 20) was used to classify disease severity from grade 0 to 5. The scores were correlated with each other and the final grade. Results: Data of 152 eyes of 92 patients who had the results of all tests were reviewed. The mean age was 41.2 years. The mean VA of the patients was 0.13 ± 0.16 Snellen lines. The majority of patients had a VA less than 20/40 (88.6%), a visual field smaller than 20˚ (78%), and an ellipsoid zone width smaller than 7˚ (84.4%). The majority of the patients (85.4%) were in advanced stage of the disease (Grade 4 and 5). Conclusions: We present a simple, objective and easy to use disease severity classification for RP which can be used to categorize patients and to evaluate and compare treatment results.

Macular integrity assessment to determine the association between macular microstructure and functional parameters in diabetic macular edema

AIM： To respectively evaluate macular morphological features and functional parameters by using spectraldomain optical coherence tomography（SD-OCT） and macular integrity assessment（MAIA） in patients with diabetic macular edema（DME）. METHODS： This prospective, non-controlled, open study included 61 eyes of 38 consecutive patients with DME. All patients underwent best-corrected visual acuity（BCVA） measurement, MAIA microperimetry, and SDOCT. DME morphology, including central retinal thickness（CRT） and central retinal volume（CRV）; integrity of the external limiting membrane（ELM） and photoreceptor inner segment/outer segment（IS/OS） junction; and the deposition of hard macular exudates were assessed within a 1000-μm central subfield area. MAIA microperimetry parameters evaluated were average threshold（AT）-retinal sensitivity, macular integrity index（MI）, fixation points within a circle of radius 1°（P1） and 2°（P2）, and bivariate contour ellipse area considering 63% and 95% of the fixation points（A63 and A95, respectively）. RESULTS： MI was significantly higher in eyes with disrupted ELM or IS/OS, compared with eyes with intact ELM and IS/OS. Values of BCVA（log MAR）, total AT, AT within 1000-μm diameter, P2, A63, A95, and CRT were significantly worse in eyes with disrupted IS/OS, compared with eyes with intact IS/OS. The values of BCVA（log MAR）, AT within 1000-μm diameter, and CRT were significantly worse in eyes with disrupted ELM, compared with eyes with intact ELM. These parameters were not significantly different between eyes with or without hard macular exudate deposition. CRV was not significantly different in the presence or absence of the integrity of ELM, IS/OS, or deposition of hard macular exudates. At the center, nasal and temporal sectors of the fovea, significant negative correlations were observed between retinal thickness and AT of the corresponding area. At the inferior and superior sectors of the fovea, no correlations were observed between retinal thickness and AT of the corresponding area. In the intact IS/OS group, significant negative correlations were observed between CRT and central AT. There was no correlation between retinal sensitivity and thickness when the IS/OS layer was disrupted. Multiple linear regression analyses revealed that IS/OS integrity was an independent factor affecting MI. CONCLUSION： Functional（BCVA and visual field） and morphological parameters（retinal thickness） were significantly associated with an intact IS/OS. Local photoreceptor integrity was a strong predictor of local visual function throughout the retina. MI revealed the functional status in DME, reflecting the IS/OS juction status in the macula.

Resection of bilateral occipital lobe lesions during a single operation as a treatment for bilateral occipital lobe epilepsy

BACKGROUND Neurosurgical treatment of severe bilateral occipital lobe epilepsy usually involves two operations several mos apart.AIM To evaluate surgical resection of bilateral occipital lobe lesions during a single operation as a treatment for bilateral occipital lobe epilepsy.METHODS This retrospective case series included patients with drug-refractory bilateral occipital lobe epilepsy treated surgically between March 2006 and November 2015.RESULTS Preoperative evaluation included scalp video-electroencephalography(EEG),magnetic resonance imaging,and PET-CT.During surgery(bilateral occipital craniotomy),epileptic foci and important functional areas were identified by EEG(intracranial cortical electrodes)and cortical functional mapping,respectively.Patients were followed up for at least 5 years to evaluate treatment outcome(Engel grade)and visual function.The 20 patients(12 males)were aged 4-30 years(median age,12 years).Time since onset was 3-20 years(median,8 years),and episode frequency was 4-270/mo(median,15/mo).Common manifestations were elementary visual hallucinations(65.0%),flashing lights(30.0%),blurred vision(20.0%)and visual field defects(20.0%).Most patients were free of disabling seizures(Engel grade I)postoperatively(18/20,90.0%)and at 1 year(18/20,90.0%),3 years(17/20,85.0%)and≥5 years(17/20,85.0%).No patients were classified Engel grade IV(no worthwhile improvement).After surgery,there was no change in visual function in 13/20(65.0%),development of a new visual field defect in 3/20(15.0%),and worsening of a preexisting defect in 4/20(20.0%).CONCLUSION Resection of bilateral occipital lobe lesions during a single operation may be applicable in bilateral occipital lobe epilepsy.