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Thomas Gast, Christopher Anderson Clark, Ting Luo, Stephen A Burns; Presumed cytoid bodies and retinal ganglion cell apoptosis imaged in vivo by AOSLO in cotton wool spots (CWS). Invest. Ophthalmol. Vis. Sci. 2017;58(8):1881.
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© ARVO (1962-2015); The Authors (2016-present)
To image by AOSLO and OCT the acute and chronic retinal changes associated with CWS
Subjects with HTN, DM and interferon related CWS were imaged with OCT and AOSLO including a patient imaged within 24 hours of occurrence who was also imaged 9 additional times over his 3 month clinical course. The acute and chronic changes of CWS on the individual retinal layers were quantified by OCT. Qualitative descriptions of the retinal changes seen by AOSLO and interpretation based on histology are made.
Prominent findings on AOSLO include the imaging of apparent cytoid bodies within CWS. The axons in continuity with the CWS on the disk or retrograde side showed multiple linearly arranged enlargements developing over several days which then fade. These may represent the accumulation of organelles in retrograde transport to the cell bodies of ganglion cells whose axons were involved in the CWS. The temporal, or anterograde side of the acute lesion, showed scattered bodies within the distribution of the axons transgressing the CWS. These developed over several days post the occurrence of the acute CWS and occurred at greater distances from the CWS over time. These were interpreted as likely representing ganglion cells in the process of apoptosis. These observed changes in the retrograde and anterograde axonal pathways fade with time.Acutely, on OCT, there is remarkable thickening of the nerve fiber layer displacing the inner retinal layers. This resolves over time but contra-intuitively results in a thickened ONL in the area of the prior CWS, a thickened more reflective local NFL in the area of the CWS - presumably from astrocytic scarring, and thinning of the NFL in the areas of axons which passed through the CWS.
AOSLO imaging of CWS shows apparent cytoid bodies and imaging over the full temporal course of an acute CWS showed many of the changes observed histologically including cytoid bodies, and retinal ganglion cells in the process of apoptosis as well as changes in the anterograde and retrograde axon fibers. OCT showed distinct changes in retinal layer thicknesses that can serve as long term markers of the CWS even after it is not clinically visible.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Axon bundle retrograde to cotton wool spot
Cytoid bodies in CWS
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