Foveal cone count reduction in resolved endophthalmitis: an adaptive optics scanning laser ophthalmoscopy (AO-SLO)-based prospective pilot study

Aim To report the foveal cone count in eyes with resolved endophthalmitis vis-a-vis normal fellow eyes using an indigenous adaptive optics scanning laser ophthalmoscopy (AO-SLO). Methods In a prospective cross-sectional comparative pilot study, we recruited patients with resolved endophthalmitis in one eye (study eye) and a normal fellow eye (control eye). Collected data included measurement of the best-corrected visual acuity (BCVA), spectral-domain optical coherence tomography (OCT) imaging and AO-SLO imaging and cone counting at the fovea in both eyes. Results The study included 12 eyes of 6 patients. The mean age was 51.66 +/- 11.97 years (median 56 years). BCVA in all control eyes was 20/20 (logarithm of the minimum angle of resolution (LogMAR) 0), and in the study, eyes was 0.21 +/- 0.13 (median 0.19, Snellen 20/30; p=0.001; 95% CI -0.39 to -0.09). The follow-up was 18.66 +/- 12.32 (median 20 months). The cone count at the fovea in the control eye was 4356.33 +/- 1993.93 (median 4498), and in the study eye, it was 2357.16 +/- 1541.17 (median 2187.5; p=0.03; 95% CI -3556 to -1082). Conclusions Eyes with resolved endophthalmitis with near-normal vision have reduced number of foveal cones even in absence of OCT-detected gross structural changes. Translational Relevance The current work describes the application of cellular-level imaging technique called adaptive optics scanning laser ophthalmoscopy (AO-SLO) to the clinical condition of resolved endophthalmitis. The study of retinal cell biology at the cellular level is possible using the emerging technology of AO-SLO. This new investigative modality that has the potential to image the retina at the cellular level until the photoreceptors is more likely to unravel the pathophysiology of a variety of retinal diseases.

Automated summary

This study utilized adaptive optics scanning laser ophthalmoscopy to reveal a reduced number of foveal cones in eyes with resolved endophthalmitis, even in the absence of detectable gross structural changes. The emerging technology of AO-SLO allows for retinal cell biology study at the cellular level, providing insights into the pathophysiology of various retinal diseases.