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Retinal Thickening and Photoreceptor Loss in HIV Eyes without Retinitis.

Arcinue CA, Bartsch DU, El-Emam SY, Ma F, Doede A, Sharpsten L, Gomez ML, Freeman WR - PLoS ONE (2015)

Bottom Line: In each of the regions of interest studied (nasal, temporal, superior, inferior), the HIV group had significantly less mean cone photoreceptor density compared with age-matched controls (difference range, 4,308-6,872 cones/mm2).We also noted that the inner retina (combined thickness from ILM through RNFL to GCL layer) was also significantly thickened in all the different locations scanned compared with HIV-negative controls.Our present study shows that the cone photoreceptor density is significantly reduced in HIV retinae compared with age-matched controls.

View Article: PubMed Central - PubMed

Affiliation: Jacobs Retina Center at the Shiley Eye Institute, University of California San Diego (UCSD), La Jolla, California, United States of America.

ABSTRACT

Purpose: To determine the presence of structural changes in HIV retinae (i.e., photoreceptor density and retinal thickness in the macula) compared with age-matched HIV-negative controls.

Methods: Cohort of patients with known HIV under CART (combination Antiretroviral Therapy) treatment were examined with a flood-illuminated retinal AO camera to assess the cone photoreceptor mosaic and spectral-domain optical coherence tomography (SD-OCT) to assess retinal layers and retinal thickness.

Results: Twenty-four eyes of 12 patients (n = 6 HIV-positive and 6 HIV-negative) were imaged with the adaptive optics camera. In each of the regions of interest studied (nasal, temporal, superior, inferior), the HIV group had significantly less mean cone photoreceptor density compared with age-matched controls (difference range, 4,308-6,872 cones/mm2). A different subset of forty eyes of 20 patients (n = 10 HIV-positive and 10 HIV-negative) was included in the retinal thickness measurements and retinal layer segmentation with the SD-OCT. We observed significant thickening in HIV positive eyes in the total retinal thickness at the foveal center, and in each of the three horizontal B-scans (through the macular center, superior, and inferior to the fovea). We also noted that the inner retina (combined thickness from ILM through RNFL to GCL layer) was also significantly thickened in all the different locations scanned compared with HIV-negative controls.

Conclusion: Our present study shows that the cone photoreceptor density is significantly reduced in HIV retinae compared with age-matched controls. HIV retinae also have increased macular retinal thickness that may be caused by inner retinal edema secondary to retinovascular disease in HIV. The interaction of photoreceptors with the aging RPE, as well as possible low-grade ocular inflammation causing diffuse inner retinal edema, may be the key to the progressive vision changes in HIV-positive patients without overt retinitis.

No MeSH data available.


Related in: MedlinePlus

SD-OCT scans of A. HIV-positive, and B. HIV-negative control, showing total retinal thickness measurements.Top red line corresponds to the internal limiting membrane (ILM) and bottom red line corresponds to the Bruch’s membrane (BM).
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pone.0132996.g004: SD-OCT scans of A. HIV-positive, and B. HIV-negative control, showing total retinal thickness measurements.Top red line corresponds to the internal limiting membrane (ILM) and bottom red line corresponds to the Bruch’s membrane (BM).

Mentions: For a separate subset of patients (n = 10 HIV+ and 10 HIV-), we acquired raster scan pattern high-resolution SD-OCT scans (30° horizontal x 15° vertical, 1,536 A-scans/B-scan, sampling interval 127 μm) using the Heidelberg Spectralis. The OCT images were reviewed using original software from Spectralis. We analyzed three B-scans within the raster scan set (Fig 3). The first was centered on the fovea, the second was 10 scans superior to the fovea (1,270 microns), and the third was 10 scans inferior to the fovea (1,270 microns). For each scan, we measured the thickness at the center of the scan and the average thickness over a length of 1,000 microns equally split over the center of the scan. We used prototype segmentation software to analyze the individual layers of the retina and manually corrected artifacts within the segmentation. In this study, we calculated several measurements based on the segmentation. The first measurement was total retinal thickness, defined as the distance between the internal limiting membrane (ILM) and the Bruch’s membrane (BM). We defined the inner retina as the distance between the internal limiting membrane and the posterior edge of the ganglion cell layer (GCL). The outer retina was defined as the distance between the external limiting membrane (ELM) and the Bruch’s membrane (BM), including the array of photoreceptor inner segments (ISOS) [34]. The different layer interfaces that were segmented by the software were in order from anterior to posterior: ILM, retinal nerve fiber layer (RNFL), GCL, inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), ISOS and BM (Fig 4). We calculated a total of 8 layer thicknesses and 3 combination layer thicknesses (total, outer, inner) and the mean retinal thickness along a 1,000-micron lateral distance for the superior and inferior scan line and for the foveal center at the scan centered on the fovea. Thus, for each of the three scan lines, we calculated 12 retinal thickness measurements.


Retinal Thickening and Photoreceptor Loss in HIV Eyes without Retinitis.

Arcinue CA, Bartsch DU, El-Emam SY, Ma F, Doede A, Sharpsten L, Gomez ML, Freeman WR - PLoS ONE (2015)

SD-OCT scans of A. HIV-positive, and B. HIV-negative control, showing total retinal thickness measurements.Top red line corresponds to the internal limiting membrane (ILM) and bottom red line corresponds to the Bruch’s membrane (BM).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4526563&req=5

pone.0132996.g004: SD-OCT scans of A. HIV-positive, and B. HIV-negative control, showing total retinal thickness measurements.Top red line corresponds to the internal limiting membrane (ILM) and bottom red line corresponds to the Bruch’s membrane (BM).
Mentions: For a separate subset of patients (n = 10 HIV+ and 10 HIV-), we acquired raster scan pattern high-resolution SD-OCT scans (30° horizontal x 15° vertical, 1,536 A-scans/B-scan, sampling interval 127 μm) using the Heidelberg Spectralis. The OCT images were reviewed using original software from Spectralis. We analyzed three B-scans within the raster scan set (Fig 3). The first was centered on the fovea, the second was 10 scans superior to the fovea (1,270 microns), and the third was 10 scans inferior to the fovea (1,270 microns). For each scan, we measured the thickness at the center of the scan and the average thickness over a length of 1,000 microns equally split over the center of the scan. We used prototype segmentation software to analyze the individual layers of the retina and manually corrected artifacts within the segmentation. In this study, we calculated several measurements based on the segmentation. The first measurement was total retinal thickness, defined as the distance between the internal limiting membrane (ILM) and the Bruch’s membrane (BM). We defined the inner retina as the distance between the internal limiting membrane and the posterior edge of the ganglion cell layer (GCL). The outer retina was defined as the distance between the external limiting membrane (ELM) and the Bruch’s membrane (BM), including the array of photoreceptor inner segments (ISOS) [34]. The different layer interfaces that were segmented by the software were in order from anterior to posterior: ILM, retinal nerve fiber layer (RNFL), GCL, inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), ISOS and BM (Fig 4). We calculated a total of 8 layer thicknesses and 3 combination layer thicknesses (total, outer, inner) and the mean retinal thickness along a 1,000-micron lateral distance for the superior and inferior scan line and for the foveal center at the scan centered on the fovea. Thus, for each of the three scan lines, we calculated 12 retinal thickness measurements.

Bottom Line: In each of the regions of interest studied (nasal, temporal, superior, inferior), the HIV group had significantly less mean cone photoreceptor density compared with age-matched controls (difference range, 4,308-6,872 cones/mm2).We also noted that the inner retina (combined thickness from ILM through RNFL to GCL layer) was also significantly thickened in all the different locations scanned compared with HIV-negative controls.Our present study shows that the cone photoreceptor density is significantly reduced in HIV retinae compared with age-matched controls.

View Article: PubMed Central - PubMed

Affiliation: Jacobs Retina Center at the Shiley Eye Institute, University of California San Diego (UCSD), La Jolla, California, United States of America.

ABSTRACT

Purpose: To determine the presence of structural changes in HIV retinae (i.e., photoreceptor density and retinal thickness in the macula) compared with age-matched HIV-negative controls.

Methods: Cohort of patients with known HIV under CART (combination Antiretroviral Therapy) treatment were examined with a flood-illuminated retinal AO camera to assess the cone photoreceptor mosaic and spectral-domain optical coherence tomography (SD-OCT) to assess retinal layers and retinal thickness.

Results: Twenty-four eyes of 12 patients (n = 6 HIV-positive and 6 HIV-negative) were imaged with the adaptive optics camera. In each of the regions of interest studied (nasal, temporal, superior, inferior), the HIV group had significantly less mean cone photoreceptor density compared with age-matched controls (difference range, 4,308-6,872 cones/mm2). A different subset of forty eyes of 20 patients (n = 10 HIV-positive and 10 HIV-negative) was included in the retinal thickness measurements and retinal layer segmentation with the SD-OCT. We observed significant thickening in HIV positive eyes in the total retinal thickness at the foveal center, and in each of the three horizontal B-scans (through the macular center, superior, and inferior to the fovea). We also noted that the inner retina (combined thickness from ILM through RNFL to GCL layer) was also significantly thickened in all the different locations scanned compared with HIV-negative controls.

Conclusion: Our present study shows that the cone photoreceptor density is significantly reduced in HIV retinae compared with age-matched controls. HIV retinae also have increased macular retinal thickness that may be caused by inner retinal edema secondary to retinovascular disease in HIV. The interaction of photoreceptors with the aging RPE, as well as possible low-grade ocular inflammation causing diffuse inner retinal edema, may be the key to the progressive vision changes in HIV-positive patients without overt retinitis.

No MeSH data available.


Related in: MedlinePlus