OSLI Retina

September 2018

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656 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C L I N I C A L S C I E N C E ■ Spectral-Domain Optical Coherence Tomography Findings in Patients With Macropsia Sohee Jeon, MD; Byungju Jung, MD; Won Ki Lee, MD, PhD BACKGROUND AND OBJECTIVE: To evaluate the retinal morphologic characteristics of patients with macrop- sia caused by epiretinal membrane (ERM) based on spectral-domain optical coherence tomography (SD- OCT). PATIENTS AND METHODS: A cross-sectional, non- interventional study was performed to compare the characteristics of retinal structures in eyes with ERM according to the presence or absence of macropsia. Twenty-six patients with ERM and macropsia were defined as the macropsia group and 26 age-matched patients with ERM without macropsia were the con- trol group. All participants underwent a full ophthal- mologic examination and SD-OCT examination. Mac- ropsia was diagnosed and quantified using a double dot chart. The thickness of retinal layers, including the outer nuclear layer (ONL) and inner segment / outer segment / retinal pigment epithelium (IS/OS/ RPE) at the central fovea, were measured by electronic calipers of the SD-OCT system. The interocular ratio of each parameter was calculated for each patient and compared between the two groups. The integrity of the external limiting membrane (ELM), IS/OS junc- tion, and cone outer segment tips (COST) line were evaluated. RESULTS: The thickness of the IS/OS/RPE differed sig- nificantly between both eyes in the macropsia group (P < .001), whereas the control group was not signifi- cantly different (P = .161). The ONL in the diseased eye was significantly thicker in the macropsia group than in the control group (P = .020), whereas these two groups did not differ significantly in the thickness of ONL in the control eye (P = .860). More patients had a disrupted COST line in the macropsia group (P < .001 for macropsia group, P = .252 for control group). No eye showed disrupted ELM and IS/OS junction, regardless of the presence of macropsia. CONCLUSIONS: Eyes with macropsia showed thicker foveal ONL, IS/OS/RPE, and more frequently disrupt- ed COST lines. This may indicate that the contractile strength of ERM can lead to centralization of photore- ceptor cells. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:656-663.] INTRODUCTION Epiretinal membrane (ERM) is one of the most common retinal diseases in aged persons, 1 which results in blurred vision or metamorphopsia, such as macropsia and micropsia. Several theories that explain the mechanisms that cause metamorphop- sia due to ERM include macular distortion, vascular leakage, edema of the inner retina, and changes in the photoreceptors, 2-7 but little certain evidence sup- ports any of these mechanisms as a direct cause of metamorphopsia. Recently, Ooto et al. evaluated the cone density of patients with ERM and central serous chorioretinopathy (CSC) using adaptive optics scan- ning laser ophthalmoscopy. Interestingly, a 45% to 70% lower cone density was detected in eyes with resolved CSC compared with normal eyes, 8 but they found no difference in mean cone density between the eyes of patients with ERM and normal eyes. 9 However, disrupted regularity of cone-packing geom- etry was detected in eyes with ERM, suggesting disar- rangement of photoreceptor cells. We speculated that the pattern of the photorecep- tor disarrangement would determine the characteris- tics of metamorphopsia. Macropsia is a condition that affects human visual perception in which objects are perceived to be larger than they actually are. Theo- retically, macropsia can develop when the central cone cells are concentrically displaced from their original site. Such displacement could be detected by spectral-domain optical coherence tomography (SD- OCT), which has improved the speed and sensitivity of OCT, allowing scanning at a higher resolution. 10-14 Therefore, in the present study, using SD-OCT, we compared the characteristics of retinal structures in From Keye Eye Center, Seoul, Korea (SJ); and the Department of Oph- thalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (BJ, WKL). Originally submitted August 22, 2017. Revision received January 25, 2018. Accepted for publication January 30, 2018. This study was supported by NRF-2017R1C1B2011374. Dr. Lee has served on advisory boards for and received consultant fees from Novartis, Bayer, Allergan, Alcon, and Santen and has received pay- ments for lectures from Novartis, Bayer, Allergan, and Alcon. The remain- ing authors report no relevant financial disclosures. Address correspondence to Won Ki Lee, MD, PhD, Department of Oph- thalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #505 Banpo-Dong, Seocho-Gu, Seoul, 137-701, Korea; email: wklee@catholic.ac.kr. doi: 10.3928/23258160-20180831-02

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