Optical coherence tomography (OCT) studies of acquired occipital lobe lesions in humans have demonstrated corresponding inner retinal thinning with the use of time-domain OCT (TD-OCT) (Jindahra et al. 2009), and later, with the use of spectral domain OCT (SD-OCT) (Yamashita et al. 2012). In the present study, we analysed the whole macular area in eyes with homonymous hemianopia by high-penetration swept-source OCT (SS-OCT; DRI OCT-1 Atlantis, Topcon, Tokyo, Japan) and produced maps of the three macular inner retinal layer thicknesses (μm): (i) the macular retinal nerve fibre layer (mRNFL), (ii) the ganglion cell layer and inner plexiform layer (GCL + IPL) and (iii) the ganglion cell complex (GCC; mRNFL + GCL + IPL) thicknesses. The software program calculates the average retinal thickness of the mRNFL, GCL + IPL, GCC and the total for each 2 × 1.5 mm grid square of the 12 × 9 mm scan area. The macular retinal thickness parameters (centred on the macula) were divided vertically into the hemianopic and unaffected sides, and the averaged data between the two eyes were used for further quantitative analyses. We examined 19 patients [male, n = 9; female, n = 10; age, 38–78 years (mean 60.5 years)] with unilateral retrogeniculate lesions and 56 age-matched normal control subjects [male, n = 30; female, n = 26; age, 20–82 years (mean, 56.2 years)]. The time between the SS-OCT measurement and the onset of brain lesions ranged from 1 month to 8.0 years (mean, 3.2 years). The age, sex and refraction values of the patients and the normal control subjects did not differ to a statistically significant extent (p = 0.3834, 0.7913 and 0.8657, respectively; age and refraction: unpaired Mann–Whitney U-test; sex: chi-squared test). In the eyes with homonymous hemianopia, each of these thicknesses of the hemianopic side was significantly thinner in comparison to normal eyes (Table 1). The macular inner retinal thicknesses on the hemianopic side of the central 2 × 3 mm area were significantly thinner than those in the unaffected sides (Table 1). A regression analysis revealed a negative linear relationship (linear regression, R2 = 0.605, p = 0.001) between the time after stroke and the GCL + IPL thickness on the hemianopic side of the central 2 × 3 mm area. The GCL + IPL and GCC thicknesses of the wide angle 6 × 9 mm area on the hemianopic side of the patients with stroke were significantly thinner than those in normal subjects and those on the unaffected side (Table 1). The area under the receiver operating characteristic curve (AUC) values of the central 2 × 3 mm area GCL + IPL and the GCC thickness for discriminating between the brain lesion group and the normal control group were significantly greater than those in the wide angle 6 × 9 mm area (Table 2). Our results using SS-OCT confirmed the observations of the previous studies using TD-OCT and SD-OCT, in that the inner retina showed statistically significant thinning corresponding to the affected visual hemifields in patients with acquired retrogeniculate damage. In addition, an area analysis revealed that the thinning predominantly occurred in the most central retina, close to the fovea. The latter finding is consistent with the results of experimental studies in primates, in which the selective loss of small ganglion cells projecting to the parvocellular layers of the lateral geniculate nucleus was observed after occipital lobe ablation (Weller et al. 1979; Cowey et al. 1989; Weller & Kaas 1989; Johnson & Cowey 2000). The similarity between animal experiments and human studies suggests that the retinal thinning of the OCT is—at least in part—due to trans-synaptic retrograde degeneration.
To evaluate the effects of intravitreal bevacizumab (IVB) injections early in the course of branch retinal vein occlusion (BRVO).We conducted a retrospective review of 30 patients (30 eyes) with macular edema (ME) secondary to BRVO. The mean duration from the onset to the first IVB injection was 5 weeks. The mean observation period was 30 months. All patients were followed monthly, with administration of additional IVB injections if there was persistent or recurrent ME within 6 months after the first injection. The main outcome parameter was best-corrected visual acuity (BCVA) at 12 and 24 months. Rescue therapy including laser photocoagulation was done as needed.Mean BCVA improved significantly from logMAR 0.59 ± 0.24 at baseline to 0.04 ± 0.15 (p < 0.001)at 12 month, 0.06 ± 0.19(p < 0.001)at 24 month.IVB injections given shortly after onset of branch retinal vein occlusion may result in a significant increase in vision in some patients.
The dose-response relationship between botulinum toxin and the alteration of ocular alignment of 15 esotropia cases (ET) and 15 exotropia cases (XT) was evaluated. We began with a dose of 0.25 units (U) per injection and stepped it up to 2.5 U per injection in ET and to 10 U per injection in XT. The average number of injections was 3.6 and 5.2, respectively. The maximum effect on ocular alignment developed 7 to 14 days after injection, and following recurrences ceased within 2 to 6 months, indicating a lasting effect. The maximum effect of each injection was within the limits of 10 to 30 prism diopters (delta). The maximum effect per unit dose of the small dose injection was greater than that of the large dose injection. In each dose, a greater effect was observed in the ET than in the XT, Recurrence was within the limits of 8 to 21 delta with both small dose injection and large dose injection. The recurrence amount per unit dose was greater with small dose injection than with large dose injection. The larger the dose injected, the more lasting was the effect obtained. This tendency was more prominent in ET than in XT. A roughly linear relationship between the dose and the ocular alignment was obtained on logarithmic graph paper, and the recurrence was reduced when the dose was increased. These findings suggest that repetitive injection effectively accumulates, resulting in a lasting effect.
The present study was performed to evaluate the ganglion cell complex (GCC) thickness as well as the significance map and analyse the time course of the change in GCC thickness in patients with homonymous hemianopia due to posterior cerebral artery (PCA) territory stroke using spectral-domain optical coherence tomography. This study included 40 control subjects and 11 patients with unilateral PCA territory stroke. The GCC parameters were quantified using a custom-built software programme. The GCC data, centred on the macula, was divided vertically into hemianopic and unaffected sides. GCC parameters were calculated using an average of those from both eyes. The relationship between the GCC parameters and the time after stroke was determined by regression analyses. The GCC parameters in the hemi-retinae corresponding to the affected hemifields significantly differed between the hemianopes and the control group. The area under the receiver operating characteristics curve of the GCC significance map areas was significantly high. A regression analysis revealed a significant relationship between the time after stroke and both the GCC significance map areas (r = 0.791, p = .004) and GCC thickness (r = −0.736, p = .010) on the hemianopic side. The GCC parameters on the hemianopic side were reduced in patients with acquired occipital homonymous hemianopia, and the reduction was slowly progressive probably due to transsynaptic retrograde degeneration of the retinal ganglion cells. A significance map analysis provides additional OCT parameters that could be used to investigate the effect of retrogeniculate lesions on the inner retina of patients.
We propose an algorithm of multiple comparisons with a control for a psychophysical test. Our algorithm is based on the step-down procedure and is applicable to the bootstrap test in logistic regression. We use logistic regression combined with guessing rate and log-likelihood ratio test statistics of multiple samples in order to test hypotheses by using non-parametric bootstrap resampling. We apply our algorithm to visual acuity measurement, and show that bootstrap resampling can be used to resolve problems with multiple comparisons especially when the numbers of observations among samples are not identical.
