BMC Eye Associates

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Peripapillary schisis* Peripapillary schisis is separation of the retinal layers in the peripapillary area. * The condi...
20/05/2025

Peripapillary schisis
* Peripapillary schisis is separation of the retinal layers in the peripapillary area.
* The condition can be found in high myopia, vitreopapillary traction, optic disc pit, optic disc coloboma and glaucoma.
* Peripapillary schisis believed to be secondary to vitreopapillary traction. The posterior hyaloid membrane has detached from the macula but still firmly attached to the optic nerve.
* The condition should not be confused with subretinal fluid seen in peripapillary choroidal neovascular membranes.

RNFL Deviation Map:* This represents a statistical plot derived from the RNFL Thickness Map and compares the patient’s R...
19/05/2025

RNFL Deviation Map:
* This represents a statistical plot derived from the RNFL Thickness Map and compares the patient’s RNFL to a group of age-matched controls.
* Areas that are statistically within normal limits (and/or are thicker than normal) are not marked on the map.
* Areas that are thinner than normal are marked with a yellow or red color to denote the extent of the statistical anomaly.

RNFL Graph: Advanced* This represents a graphical plot of the RNFL for each point measured along the RNFL Circular Tomog...
19/05/2025

RNFL Graph: Advanced
* This represents a graphical plot of the RNFL for each point measured along the RNFL Circular Tomogram.
* Underlying the plot are colorimetric curves that can be used to determine the statistical significance of each point.
* Commonly used descriptions of this graph include:
- Blunted Peaks
- Shifted Peaks
* Blunted Peaks:
This term is used to denote a graphical curve that has a thin segment. It is not so much a marker of statistical significance but rather serves a quick concept to understand how the patient’s RNFL compares to an age-matched control.
* Shifted Peaks:
This is a graphical curve that appears to be normal in height and shape, but is not aligned with a typical display. This can be due to a tilted optic nerve or altered anatomy that would not be considered glaucomatous in nature. The corollary of this finding is that any statistically anomalous areas (i.e. those indicated with the background colour yellow, red or white) would not be considered abnormal if the curve were simply moved, or shifted, into a more normal position. In this case, all of the curve would fall within the green (normal) spectrum.

Manual segmentation of enhanced images shows healthy patients, those with papilloedema and those with optic disc drusen....
18/05/2025

Manual segmentation of enhanced images shows healthy patients, those with papilloedema and those with optic disc drusen.
* Key: GCL, ganglion cell layer; IPL, inner plexiform layer; LC, lamina cribrosa; ODD, optic disc drusen; ONH, optic nerve head; RNFL, retinal nerve fibre layer; RPE, retinal pigment epithelium.

Myopic Foveoschisis:* Also referred to as Myopic Traction Maculopathy (MTM) or Myopic Macular Schisis, is a rare conditi...
18/05/2025

Myopic Foveoschisis:
* Also referred to as Myopic Traction Maculopathy (MTM) or Myopic Macular Schisis, is a rare condition occurring in patients with pathological myopia.
* This condition results from an increase in the size of the eyeball, leading to stretching and separation of the retinal and choroidal layers.
* Apart from posterior staphyloma and elongation of the eyeball, other factors contributing to etiology may be traction exerted by premacular cortical vitreous, stiff retinal vasculature, or internal limiting membrane rigidity.
* Multiple consequences of high myopia, such as lacquer cracks produced by breaks in the choroid due to ectasia, choroidal atrophy, and choroidal neovascularization, can coexist in eyes with myopic foveoschisis.
* Patients usually present with a gradual, often progressive, painless diminution of vision in either or both eyes, which may be affected simultaneously or sequentially.
* Based on OCT, 4 retinal "types" of MTM are recognized:
- Inner schisis or inner-outer schisis
- Outer schisis
- Schisis detachment
- Detachment
* OCT also delineates features of the fovea, and 3 foveal patterns are recognized:
- Intact fovea
- Inner lamellar macular hole
- Full-thickness macular hole
* There may be present associated epiretinal anomalies or outer lamellar macular holes.
* MTM can only be managed surgically. Pars plana vitrectomy and ILM peeling have shown promising results in eyes with MTM.
* Photos:
1) Myopic macular schisis involving the outer plexiform layer (Henle’s fibre layer) showing a thick inner layer and thin outer layer.
2) Compound myopic macular schisis involving inner retinal schisis (arrow) and outer retinal schisis (asterisk).
3) Full-thickness myopic macular hole with overlying operculum (arrow) in an eye with myopic macular schisis.

Multimodal Imaging of Idiopathic Fovea Plana:- A 12-year-old full-term girl sought treatment after absent foveal reflexe...
17/05/2025

Multimodal Imaging of Idiopathic Fovea Plana:
- A 12-year-old full-term girl sought treatment after absent foveal reflexes were discovered on routine examination.
- She demonstrated normal pigmentation, intermittent exotropia, and mild hypermetropia in both eyes.
- Her best-corrected visual acuity was 20/25 in the right eye and 20/30 in the left eye.
- Anterior segment examination showed normal results in both eyes.
- OCT images (A, D) showed symmetrically absent foveal depressions.
- OCT angiography of the superficial capillary plexus (B, E) and deep capillary plexus (C, F) showed absent foveal avascular zones (FAZs).
- Idiopathic fovea plana is characterized by developmental absence of the FAZ in the superficial and deep capillary plexi, as demonstrated by OCT angiography.

Epiretinal Membrane with Pseudohole Appearance.
17/05/2025

Epiretinal Membrane with Pseudohole Appearance.

Disorganization of the retinal inner layers (DRIL):* The retina is a highly organized structure that is composed of dist...
16/05/2025

Disorganization of the retinal inner layers (DRIL):
* The retina is a highly organized structure that is composed of distinct layers; moreover, any structural perturbations to the organization of inner retinal layers can result in numerous functional problems.
* DRIL is characterized by the inability to clearly distinguish the layers of the inner retina. In particular, the boundaries of the INL, OPL, and ganglion cell–inner plexiform layer complex cannot be clearly identified in the foveal region in OCT.
* The extent of disorganization of retinal inner layers is a useful prognostic factor in a number of retinal conditions, including DME, central retinal vein occlusion, and ERM.
* In ERM, greater disorganization of retinal inner layers extent is associated with poorer visual outcomes after PPV, and this should be considered when discussing visual prognosis in patients who are candidates for surgery.
* Photo:Disorganization of the retinal inner layers. OCT images showing combinations of presence or absence of DRIL and DME. The central 1-mm area is enclosed in the box. Upper images show segmentation of inner retinal layers, with the white lines demarcating the boundaries between IPL-INL and the INL-OPL.

Diabetic macular edema(DME):* Chronic hyperglycemia-related accumulation of advanced glycated end products disrupts the ...
16/05/2025

Diabetic macular edema(DME):
* Chronic hyperglycemia-related accumulation of advanced glycated end products disrupts the blood–retina barrier (BRB), leading to endothelial cell junction breakdown and pericyte loss.
* The inner BRB is composed of endothelial cells in the retinal capillaries, while the outer BRB is composed of retinal pigment epithelium cells.
* When the BRB is altered, interstitial fluid is accumulated within and underneath the retina through leakage of molecules dependent on intact cell-to-cell junctions.
* Risk Factors:
- Risk factors for DME and DR are similar.
- These include a longer DM duration, poor control of DM with elevated glycolated hemoglobin A1c (HbA1c) levels, hypertension, and hyperlipidemia.
- Other secondary risk factors include impaired renal function and the use of thiazolidinediones.
- Photo: A: Schematic diagram of DME.
- Microaneurysms, or damaged capillaries, resulting from the breakdown of the BRB leak fluid to the extracellular space, resulting in a swollen retina.
- Resorption of DME is dependent on the adjacent capillaries and RPE.
- Resorption of fluid may leave behind lipoprotein residues, seen here as exudates.
* B: OCT image of DME.

OCT in Diabetic Macular Edema(DME):* Three basic structural changes can be seen on OCT: retinal swelling, cystoid macula...
16/05/2025

OCT in Diabetic Macular Edema(DME):
* Three basic structural changes can be seen on OCT: retinal swelling, cystoid macular edema, and subretinal fluid.
* The clinical entities of center-involved DME (CI-DME) and non-center–involved DME (non-CI DME) were adopted for the evaluation of macular fluid as follows:
- Center-involved DME: Retinal thickening in the macula that involves the central subfield zone (1 mm in diameter)
* Non-center–involved DME: Retinal thickening in the macula that does not involve the central subfield zone (1 mm in diameter).
* OCT is a more sensitive method for objective evaluation of vitreomacular interface abnormalities (VMIA), which include vitreomacular adhesion (VMA), vitreomacular traction (VMT), and epiretinal membrane (ERM).
* Identifying VMIA is crucial when diagnosing the etiology of macular edema, whether primarily from DME, from secondary causes of VMIA, or combined mechanism macular edema.
- Photos:
1) Basic structural changes in DME seen on OCT.:
- Yellow bracket– Generalized retinal swelling.
* Blue arrow– Cystoid macular edema.
* Red arrow– Subretinal fluid.
2) Montage of center-involved vs non-center–involved DME:
* Top Row A: Non-center–involved DME. Retinal thickening does not involve the central 1-mm subfield zone (innermost circle) per the en-face OCT heatmap, as seen on b-scan.
* Bottom Row B: Center-involved DME. Retinal thickening involves the central 1-mm subfield zone (innermost circle) per the en-face OCT heatmap and b-scan.

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