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BACKGROUND: The unique neurovascular structure of the retina has provided an opportunity to observe brain pathology in many neurological disorders. However, such studies on neurodegeneration with brain iron accumulation (NBIA) disorders are lacking. OBJECTIVES: To investigate NBIA's neurological and ophthalmological manifestations. METHODS: This cross-sectional study was conducted on genetically confirmed NBIA patients and an age-gender-matched control group. The thickness of retinal layers, central choroidal thickness (CCT), and capillary plexus densities were measured by spectral domain-optical coherence tomography (SD-OCT) and OCT angiography, respectively. The patients also underwent funduscopy, electroretinography (ERG), visual evoked potential (VEP), and neurological examination (Pantothenate-Kinase Associated Neurodegeneration-Disease Rating Scale [PKAN-DRS]). The generalized estimating equation model was used to consider inter-eye correlations. RESULTS: Seventy-four patients' and 80 controls' eyes were analyzed. Patients had significantly decreased visual acuity, reduced inner or outer sectors of almost all evaluated layers, increased CCT, and decreased vessel densities, with abnormal VEP and ERG in 32.4% and 45.9%, respectively. There were correlations between visual acuity and temporal peripapillary nerve fiber layer (positive) and between PKAN-DRS score and disease duration (negative), and scotopic b-wave amplitudes (positive). When considering only the PKAN eyes, ONL was among the significantly decreased retinal layers, with no differences in retinal vessel densities. Evidence of pachychoroid was only seen in patients with Kufor Rakeb syndrome. CONCLUSION: Observing pathologic structural and functional neurovascular changes in NBIA patients may provide an opportunity to elucidate the underlying mechanisms and differential retinal biomarkers in NBIA subtypes in further investigations. © 2023 International Parkinson and Movement Disorder Society.
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Enfermedades Neurodegenerativas , Neurodegeneración Asociada a Pantotenato Quinasa , Humanos , Estudios Transversales , Potenciales Evocados Visuales , Retina/diagnóstico por imagen , Retina/patología , Encéfalo , Enfermedades Neurodegenerativas/patología , Tomografía de Coherencia Óptica , HierroRESUMEN
PURPOSE: To evaluate the optic nerve head microvasculature in eyes with acute and chronic optic neuropathies using swept-source optical coherence tomography angiography. METHODS: In this cross-sectional, observational study, optical coherence tomography angiography images were obtained from the optic nerve heads of 21 eyes of 12 patients with optic disk edema, pseudoedema and atrophy, and 12 eyes of 6 healthy subjects using a 1,050-nm optical coherence tomography angiography (Topcon DRI OCT; Triton). Peripapillary vasculature was assessed within five horizontal slabs consisting of the nerve fiber layer (NFL), ganglion cell layer, inner nuclear layer, choroidal layer, and full-thickness retinal layer. In addition, prelaminar and laminar slabs were evaluated. Vessel density was measured within a 3.4-mm diameter circle centered on the optic disk. RESULTS: The abnormalities of the peripapillary capillary network were most apparent in the NFL and total retinal slabs. In eyes with disk edema, an increase or decrease in the visibility of the peripapillary capillary network was observed. Eyes with optic atrophy had decreased visibility of peripapillary capillary network corresponding to the region or sector of NFL thinning. Prelaminar capillary network was dilated and tortuous in eyes with disk edema. The mean vessel density was statistically significantly lower and the mean NFL thickness was statistically significantly thinner in eyes with optic atrophy compared with normal eyes (both P < 0.001). Vessel density was significantly correlated with the peripapillary NFL thickness (P < 0.001). CONCLUSION: Optical coherence tomography angiography provides high-resolution, noninvasive visualization of the microvasculature of the optic nerve head and peripapillary region. Changes in the microvasculature in this region may prove useful in better characterization of optic neuropathies.
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Disco Óptico/irrigación sanguínea , Enfermedades del Nervio Óptico/diagnóstico por imagen , Enfermedad Aguda , Adolescente , Adulto , Anciano , Enfermedad Crónica , Angiografía por Tomografía Computarizada , Estudios Transversales , Femenino , Angiografía con Fluoresceína/métodos , Humanos , Masculino , Microvasos/diagnóstico por imagen , Persona de Mediana Edad , Imagen Multimodal/métodos , Atrofia Óptica/diagnóstico por imagen , Disco Óptico/diagnóstico por imagen , Papiledema/diagnóstico por imagen , Tomografía de Coherencia Óptica , Adulto JovenRESUMEN
PURPOSE: To correlate macular findings on spectral domain optical coherence tomography (SDOCT) and optical coherence tomography angiography (OCTA) with quantitative ischemic index calculations on ultra-wide-field fluorescein angiography (UWFFA) in patients with sickle cell retinopathy. METHODS: In this retrospective case series, SDOCT, OCTA, and UWFFA images of patients with sickle cell retinopathy were evaluated. Eyes were staged based on the Goldberg classification of proliferative sickle cell retinopathy. Focal areas of macular thinning were assessed on SDOCT, macular vessel density was derived from OCTA, and peripheral ischemic index was calculated from UWFFA. RESULTS: Eighteen eyes of 10 patients were included. Mean age was 36.8 ± 16.8 years, and 6 patients (11 eyes) were SS, 3 patients (5 eyes) were SC, and 1 patient (2 eyes) was Sß thalassemia in hemoglobin electrophoresis. Abnormal macular findings included inner retinal atrophy in 11 eyes (61%) on SDOCT, vascular remodeling and nonperfusion in the superficial and deep retinal capillary plexus in 12 eyes (67%) on OCTA, and macular microvascular abnormalities in 9 eyes (50%) on UWFFA. Sickle cell retinopathy Stage I was identified in 4 eyes (22.2%), Stage II in 8 eyes (44.4%), and Stage III in 6 eyes (33.3%). Mean ischemic index was 14.1 ± 9.1%. Ischemic index was significantly correlated with hemoglobinopathy subtype (23.7 ± 9.8%, 9.3 ± 5.4%, and 16.3 ± 3.2%, for SC, SS, and Sß thalassemia disease, respectively), stage of sickle cell retinopathy (22.5 ± 9.2%, 12.5 ± 4.9%, and 4.5 ± 0.73% for Stages III, II, and I, respectively), and presence of retinal thinning on SDOCT (17.4 ± 9.7% vs. 8.8 ± 5.1%, respectively). CONCLUSION: Multimodal imaging can provide a more complete description of the microvascular and structural alterations associated with sickle retinopathy. The correlation between the severity of peripheral nonperfusion and stage and subtype of retinopathy suggests that UWF imaging may be a useful tool in the evaluation of these patients.
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Anemia de Células Falciformes/diagnóstico por imagen , Enfermedades de la Retina/diagnóstico por imagen , Adolescente , Adulto , Anciano , Angiografía por Tomografía Computarizada/métodos , Femenino , Angiografía con Fluoresceína/métodos , Humanos , Masculino , Microvasos/diagnóstico por imagen , Persona de Mediana Edad , Imagen Multimodal/métodos , Estudios Retrospectivos , Adulto JovenRESUMEN
Purpose: To compare the outcomes of fluorescein angiography (FA)-guided and indocyanine green angiography (ICGA)-guided half-dose photodynamic therapy (PDT) in patients with chronic central serous chorioretinopathy (CSC). Methods: In this retrospective comparative study, medical records of eyes with chronic CSC who underwent half-dose PDT were reviewed. A retina specialist performed FA-guided half-dose PDT, and the other performed ICGA-guided treatment. The success of applying PDT in the resolution of subretinal fluid was compared between the FA- and ICGA-guided methods. Results: Eighty-two eyes of 73 patients (41 eyes in each group) received half-dose PDT. After half-dose PDT, a significant improvement in the best-corrected visual acuity (BCVA) was found at the time of the last follow-up in both groups (both P < 0.001), with no significant intergroup difference. Central subfield and subfoveal choroidal thicknesses decreased significantly in both groups at the last follow-up (all P < 0.05), with no significant differences between the groups. Subretinal fluid (SRF) resolved in all eyes, and no persistent SRF was detected during the follow-up period. Conclusion: FA-guided and ICG-guided half-dose PDT may have similar efficacy for the treatment of chronic CSC.
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OBJECTIVE: To assess the noninferiority of biosimilar aflibercept (P041, CinnaGen) to the originator aflibercept (AFL, Regeneron) in terms of efficacy, safety, and immunogenicity. DESIGN: This was a phase Ш, 52-week, multicenter, randomized, double-masked, and active control trial involving eyes in a 1:1 ratio. SUBJECTS: Patients with active subfoveal choroidal neovascularization secondary to age-related macular degeneration randomized into the 2 groups of P041 and AFL. METHODS: Patients received an injection of aflibercept every 4 weeks for 3 doses, followed by administration every 8 weeks up to week 48. MAIN OUTCOME MEASURES: The primary outcome was the noninferiority analysis of eyes maintaining vision at week 52. Secondary outcomes included the changes in visual acuity and retinal thickness, safety evaluation, and immunogenicity during the study. RESULTS: In total, 168 eyes of 168 patients were included. At week 52, the proportion of patients maintaining vision was 94.44% in the P041 group compared with 94.52% in the AFL group. The 95% confidence interval (CI) for the difference of maintaining vision from baseline did not exceed the predefined noninferiority margin of 10% (difference, -0.0008; 95% CI, -0.074 to 0.074; P = 0.98). Secondary outcomes indicated similar results in both arms (all P > 0.05). Safety measured outcomes and immunogenicity were similar between the 2 study groups. CONCLUSIONS: Biosimilar aflibercept was noninferior to AFL in eyes with neovascular age-related macular degeneration. Other efficacy and safety findings also indicated the similarity of 2 products. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Inhibidores de la Angiogénesis , Biosimilares Farmacéuticos , Inyecciones Intravítreas , Receptores de Factores de Crecimiento Endotelial Vascular , Proteínas Recombinantes de Fusión , Agudeza Visual , Degeneración Macular Húmeda , Humanos , Receptores de Factores de Crecimiento Endotelial Vascular/administración & dosificación , Receptores de Factores de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Proteínas Recombinantes de Fusión/administración & dosificación , Proteínas Recombinantes de Fusión/efectos adversos , Masculino , Femenino , Método Doble Ciego , Anciano , Inhibidores de la Angiogénesis/administración & dosificación , Resultado del Tratamiento , Degeneración Macular Húmeda/tratamiento farmacológico , Degeneración Macular Húmeda/diagnóstico , Biosimilares Farmacéuticos/administración & dosificación , Biosimilares Farmacéuticos/efectos adversos , Biosimilares Farmacéuticos/uso terapéutico , Tomografía de Coherencia Óptica/métodos , Estudios de Seguimiento , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Relación Dosis-Respuesta a Droga , Anciano de 80 o más Años , Angiografía con Fluoresceína/métodosRESUMEN
This article aimed to review current literature on the safety and efficacy of stem cell therapy in Stargardt disease. A comprehensive literature search was performed, and two animal and eleven human clinical trials were retrieved. These studies utilized different kinds of stem cells, including human or mouse embryonic stem cells, mesenchymal stem cells, bone marrow mononuclear fraction, and autologous bone marrow-derived stem cells. In addition, different injection techniques including subretinal, intravitreal, and suprachoroidal space injections have been evaluated. Although stem cell therapy holds promise in improving visual function in patients with Stargardt disease, further investigation is needed to determine the long-term benefits, safety, and efficacy in determining the best delivery method and selecting the most appropriate stem cell type.
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PURPOSE: To assess the correlation of the worldwide prevalence of visual impairment and depressive disorders. METHODS: This is an ecologic study on Global Burden of Disease 2019 data. Global and national prevalence numbers and rates of vision impairment (VI) and depressive disorders were obtained from database. The human development index (HDI) and socio-demographic index (SDI) were derived from international open databases. Main outcome measures were the correlation of the VI and depressive disorders in total and different age, sex, and socioeconomic subgroups. RESULTS: In 2019, the worldwide prevalence of total VI and total depressive disorders were 9.6% (95% Uncertainty Interval (UI): 8.0-11.3) and 3.8% (95% UI: 3.4-4.2), respectively. The prevalence rates of total VI (r = 0.38, P < 0.001) as well as cataract (r = 0.43, P < 0.001), age-related macular degeneration (AMD) (r = 0.32, P < 0.001), refractive disorders (r = 0.19, P < 0.001) and near vision loss (r = 0.33, P < 0.001) correlated, positively, with dysthymia. In addition, the prevalence rates of glaucoma (r for total depressive disorders = 0.37, P < 0.001 and r for major depressive disorders (MDD) = 0.38, P < 0.001) and AMD (r for total depressive disorders = 0.37, P < 0.001 and r for MDD = 0.28, P < 0.001) had a positive correlation with MDD and total depressive disorders. The correlations remained significant in sociodemographic subgroups. CONCLUSION: There was a significant correlation between national prevalence rates of VI and ocular disabilities with depressive disorders, worldwide.
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Catarata , Trastorno Depresivo Mayor , Degeneración Macular , Baja Visión , Ceguera , Catarata/epidemiología , Salud Global , Humanos , Prevalencia , Trastornos de la Visión/epidemiología , Baja Visión/epidemiologíaRESUMEN
Candida spp. is the most common cause of endogenous fungal endophthalmitis. The diagnosis of this rare disease is based on clinical findings supported by positive blood culture. Recently, it has been shown that optical coherence tomography (OCT) characteristic findings are beneficial in making a correct diagnosis of fungal infection in cases with endogenous endophthalmitis. The current photo-essay aims to highlight the role of OCT in diagnosis of Candida endogenous endophthalmitis where OCT imaging of one of the retinal lesions disclosed a pre-retinal hyper reflective lesion with overlying punctate vitreous opacities. We propose "inverted snowing-cloud" sign for this OCT pattern considering the resemblance of the vitreous opacities to snowflakes.
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Purpose: To assess the changes in optic nerve head and macular microvascular networks after acute intraocular pressure (IOP) rise in healthy eyes versus the eyes of diabetic patients. Methods: In this prospective, interventional, comparative study, 24 eyes of 24 adults including 12 eyes of healthy nondiabetic subjects and 12 eyes with mild or moderate non-proliferative diabetic retinopathy (NPDR) were enrolled. IOP elevation was induced by a suction cup attached to the conjunctiva. IOP and optical coherence tomography angiographic (OCTA) images of the optic disc and macula were obtained before and immediately after the IOP rise. Results: Baseline and post-suction IOPs were not significantly different between the two groups (all P > 0.05). The mean IOP elevation was 13.93 ± 3.41 mmHg among all eyes and was statistically significant as compared to the baseline in both groups (both P < 0.05). After IOP elevation, healthy eyes demonstrated a reduction in the vessel density in the whole image deep and superficial capillary plexuses and parafoveal deep capillary plexus (DCP) (all P < 0.05). In diabetic retinopathy, foveal vessel density at DCP decreased significantly following IOP rise (P = 0.003). In both groups, inside disc vessel density decreased significantly after IOP rise (both P < 0.05), however, no significant change was observed in peripapillary vessel density (both P > 0.05). Conclusion: Acute rise of IOP may induce different levels of microvascular changes in healthy and diabetic eyes. Optic disc microvasculature originating from the posterior ciliary artery may be more susceptible to IOP elevation than that of retinal microvasculature.
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PURPOSE: To evaluate the effect of intravitreal recombinant tissue plasminogen activator (tPA) on diabetic tractional fibrovascular membranes (FVM) using proposed optical coherence tomography (OCT) criteria. METHODS: This prospective, interventional case series enrolled eyes with tractional retinal detachment who were candidates for pars plana vitrectomy. OCT images were obtained to evaluate the border of the attached-detached retina and overlying FVP at baseline and 1 week post-intravitreal tPA injection using the follow-up scan acquisition protocol. Two independent graders assessed retinal detachment (RD) height, FVM height, and retinal thickness at the site of membrane attachment. RESULTS: Thirteen eyes from 13 individuals were included. Assessment of RD height, FVM height, and retinal thickness at membrane attachment point were feasible at both visits in 10/13 (77%), 10/13 (77%), and 8/13 (62%) of eyes, respectively. There was excellent agreement between the two graders for all measurements (all ICC > 0.94). Release of the retina-membrane attachment point was not observed in any eyes. No statistically significant change was found in any of the measured parameters. CONCLUSIONS: Excellent agreement was achieved between the graders for quantitative assessment of diabetic FVM using our proposed OCT criteria. We did not observe a significant change in the FVM measurements, 1-week after intravitreal tPA injection.
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Diabetes Mellitus , Retinopatía Diabética , Desprendimiento de Retina , Retinopatía Diabética/tratamiento farmacológico , Retinopatía Diabética/cirugía , Humanos , Inyecciones Intravítreas , Estudios Prospectivos , Desprendimiento de Retina/tratamiento farmacológico , Desprendimiento de Retina/cirugía , Activador de Tejido Plasminógeno/uso terapéutico , Tomografía de Coherencia Óptica , VitrectomíaRESUMEN
PURPOSE: To compare the effect of topical dexamethasone vs ketorolac vs combined dexamethasone-ketorolac after phacoemulsification on choroidal thickness (CT). SETTING: Tertiary university-based hospital. DESIGN: Prospective nonrandomized comparative case series. METHODS: Ninety-two eyes of 92 patients were assigned to the 3 groups after uneventful phacoemulsification: Group 1, dexamethasone; Group 2, ketorolac; Group 3, combined dexamethasone-ketorolac applied topically. CT at subfoveal (SFCT), nasal, and temporal as primary and central retinal thickness (CRT) as secondary outcomes were measured preoperatively and at 1 month, 3 months, and 6 months postoperatively using enhanced depth-imaging optical coherence tomography. RESULTS: Preoperative CT was similar between the groups (all P > .05). The groups differed in pattern of changes in nasal and temporal CT (both P < .001) although their changes of CRT (P = .13) and SFCT (P = .55) over time were similar. The mean of SFCT at 1 month, 3 months, and 6 months was significantly higher than baseline in dexamethasone (P < .001 for all follow-ups) and combined (P < .001 for both 1 month and 3 months and P = .03 for 6 months) groups, whereas it was not statistically significant in the ketorolac group (P = .07). There was an increase in the nasal and temporal CT in 3 groups, persisted at 6 months in dexamethasone (both P < .001) and ketorolac (both P < .001) groups, whereas the change was not statistically significant at 6 months in the combined group. Choroidal thickness measurements were performed in 31 eyes of 31 patients in group 1, 29 eyes of 29 patients in group 2, and 32 eyes of 32 patients in group 3. CONCLUSIONS: Dexamethasone and combined groups had statistically significant changes of SFCT after phacoemulsification; however, the ketorolac group did not. The pattern of SFCT changes was similar between 3 groups.
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Ketorolaco , Facoemulsificación , Coroides , Dexametasona , Humanos , Soluciones Oftálmicas , Estudios Prospectivos , Tomografía de Coherencia ÓpticaRESUMEN
PURPOSE: To evaluate outcomes of intravitreal injection of bevacizumab for the treatment of severe retinopathy of prematurity (ROP) associated with vitreous or retinal hemorrhages (VH or RH). METHODS: This is a prospective interventional case-series. Fourteen eyes of eight premature infants with severe ROP associated with vitreous or retinal hemorrhage were consecutively included. In eight eyes, VH and/or RH precluding complete laser ablation developed at the time of laser treatment. In six eyes, VH developed early after laser ablation. All participants underwent intravitreal injection of 0.625 mg (0.025 ml) bevacizumab immediately after diagnosis of VH or RH. Follow-up examinations were performed at days 1, 3, 7, and 14, and 1, 2 and 3 months after injection. Main outcome measure was the absence of unfavorable structural outcomes. RESULTS: Mean gestational age was 27.6 weeks (range, 26-29 weeks) and mean birth weight was 1047 g (range, 780-1500 g). Mean gestational age at the time of injection was 35.4 weeks (range, 32-38 weeks). In all eyes, plus disease disappeared completely within 2 weeks and VH and/or RH was absorbed at last follow-up. None of the eyes developed unfavorable structural outcomes. No eyes needed additional injection or laser treatment. No major systemic or ocular complications were observed. CONCLUSION: In this small series of patients, intravitreal injection of bevacizumab was effective for treatment of severe retinopathy of prematurity associated with vitreous or retinal hemorrhage.
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Inhibidores de la Angiogénesis/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Coagulación con Láser , Hemorragia Retiniana/terapia , Retinopatía de la Prematuridad/terapia , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Hemorragia Vítrea/terapia , Anticuerpos Monoclonales Humanizados , Bevacizumab , Terapia Combinada , Femenino , Edad Gestacional , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Inyecciones Intravítreas , Masculino , Estudios Prospectivos , Hemorragia Retiniana/tratamiento farmacológico , Hemorragia Retiniana/cirugía , Retinopatía de la Prematuridad/tratamiento farmacológico , Retinopatía de la Prematuridad/cirugía , Resultado del Tratamiento , Hemorragia Vítrea/tratamiento farmacológico , Hemorragia Vítrea/cirugíaRESUMEN
Optical coherence tomography angiography (OCTA) is a revolutionary method in the visualization of the vascular system in different retinal and choroidal layers. During the last 4 years since the commercial availability of different OCTA devices, attempts have been made to utilize this technology in various aspects of ocular oncology from the differentiation of benign and malignant lesions to assisting in evaluation of post-treatment complications, such as radiation retinopathy. However, current OCTA technology is restricted by various artefacts and inherent limitations, some of which are more pronounced in the presence of elevated tumoural lesions. Imminent advancements in OCTA systems and image acquisition processes promise a great potential for application of OCTA in ocular oncology.
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Enfermedades de la Retina , Tomografía de Coherencia Óptica , Coroides , Angiografía con Fluoresceína , Humanos , Retina , Enfermedades de la Retina/diagnóstico por imagen , Vasos Retinianos/diagnóstico por imagenRESUMEN
AIM: To determine the minimum number of optical coherence tomography B-scan corrections required to provide acceptable vessel density measurements on optical coherence tomography angiography images in eyes with diabetic macular edema. METHODS: In this prospective, noninterventional case series, the optical coherence tomography angiography images of eyes with center-involving diabetic macular edema were assessed. Optical coherence tomography angiography imaging was performed using RTVue Avanti spectral-domain optical coherence tomography system with the AngioVue software (V.2017.1.0.151; Optovue, Fremont, CA, USA). Segmentation error was recorded and manually corrected in the inner retinal layers in the central foveal, 100th and 200th optical coherence tomography B-scans. The segmentation error correction was then continued until all optical coherence tomography B-scans in whole en face image were corrected. At each step, the manual correction of each optical coherence tomography B-scan was propagated to whole image. The vessel density and retinal thickness were recorded at baseline and after each optical coherence tomography B-scan correction. RESULTS: A total of 36 eyes of 26 patients were included. To achieve full segmentation error correction in whole en face image, an average of 1.72 ± 1.81 and 5.57 ± 3.87 B-scans was corrected in inner plexiform layer and outer plexiform layer, respectively. The change in the vessel density measurements after complete segmentation error correction was statistically significant after inner plexiform layer correction. However, no statistically significant change in vessel density was found after manual correction of the outer plexiform layer. The vessel density measurements were statistically significantly different after single central foveal B-scan correction of inner plexiform layer compared with the baseline measurements (p = 0.03); however, it remained unchanged after further segmentation corrections of inner plexiform layer. CONCLUSION: Multiple optical coherence tomography B-scans should be manually corrected to address segmentation error in whole images of en face optical coherence tomography angiography in eyes with diabetic macular edema. Correction of central foveal B-scan provides the most significant change in vessel density measurements in eyes with diabetic macular edema.
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PURPOSE: To evaluate the impact of segmentation error on vessel density measurements in healthy eyes and eyes with diabetic macular oedema (DMO). METHODS: In this prospective, comparative, non-interventional study, enface optical coherence tomography angiography (OCTA) images of the macula from healthy eyes and eyes with DMO were acquired. Two expert graders assessed and corrected the segmentation error. The rate of segmentation error and the changes in vessel density and inner retinal thickness after correction of the segmentation error were recorded and compared between the two groups. RESULTS: 20 eyes with DMO and 24 healthy eyes were evaluated. Intergrader agreement was excellent (intraclass correlation coefficient ≥0.9) for all parameters in both groups. The rate of segmentation error was 33% and 100% in healthy and diabetic eyes, respectively (p<0.001). Nine healthy eyes (37.5%) and all eyes with DMO (100%) were noted to exhibit a change in at least one of the foveal or parafoveal vessel density measurements. The rate of any change in foveal and parafoveal vessel densities in both the superficial and deep capillary plexus was statistically significantly higher in the diabetic group (all p<0.001). No statistically significant change was observed in mean vessel density (superficial and deep capillary plexuses) after correction of the segmentation error in healthy and DMO eyes (All p>0.05). However, the mean absolute change in the vessel density measurements was statistically significantly higher in the diabetic group (all p<0.05). The mean absolute change in superficial and deep inner retinal thickness was statistically significantly higher in DMO (p=0.02 and p=0.002, respectively). CONCLUSIONS: In this study, misidentification of retinal layers and consequent vessel density measurement error occurred in all eyes with DMO and in one-third of healthy eyes. The segmentation error should be checked and manually corrected in the OCTA vessel density measurements, especially in the presence of macular oedema.
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Retinopatía Diabética/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/normas , Edema Macular/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tomografía de Coherencia Óptica/normasRESUMEN
PURPOSE: To evaluate the correlation of the visual acuity and diabetic retinopathy stage using optical coherence tomography and optical coherence tomography angiography metrics. METHODS: In this prospective study, optical coherence tomography and optical coherence tomography angiography images of patients with different stages of diabetic retinopathy were obtained. In optical coherence tomography angiography images, the size of foveal avascular zone, central macular thickness, and vessel density at superficial and deep capillary layers of the macula were measured. In optical coherence tomography images, the presence of intraretinal cyst, disorganization of retinal inner layer, and ellipsoid zone and external limiting membrane disruption were evaluated. The associations between the variables with visual acuity and diabetic retinopathy stage were analyzed. RESULTS: In total, 68 eyes of 38 patients with a mean age of 58.96 ± 10.59 years were included. In total, 34 eyes were categorized as non-proliferative diabetic retinopathy, 14 as active, and 20 as regressed proliferative diabetic retinopathy. Univariate analysis showed deep parafoveal vessel density, central macular thickness, ellipsoid zone disruption, disorganization of retinal inner layer, and external limiting membrane disruption had a significant relationship with visual acuity. However, in multivariate analysis, only central macular thickness and ellipsoid zone disruption had significant association with visual acuity (p = 0.02 and p = 0.01, respectively). There was a significant difference in deep parafoveal vessel density (p = 0.04), but not in foveal avascular zone area, between different stages of diabetic retinopathy. CONCLUSION: In this study, the foveal avascular zone area did not correlate with visual acuity and different stages of diabetic retinopathy. Structural abnormalities on optical coherence tomography images with especial focus on outer retinal disruption provided more reliable predictors for visual acuity outcomes in patients with diabetic retinopathy.
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Submacular perfluorocarbon liquid (PFCL) retention is a well-known complication of vitreoretinal surgeries; however, the optimal surgical technique for the removal of subfoveal PFCL is yet to be determined. We describe a novel surgical technique for the removal of retained submacular PFCL by performing a retinotomy adjacent to the inferotemporal arcade using a 41-gauge extendible subretinal injection needle and inducing a therapeutic retinal detachment. Through the same retinotomy, the bent 41-gauge needle was advanced into the subretinal space to reach the PFCL bubble. Subsequently, active aspiration of PFCL was performed. The surgical procedure was successfully performed in two patients. This technique appears to be an effective surgical approach for removing retained submacular PFCL bubble.
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OBJECTIVE: To evaluate the optic disc microvasculature in optic nerve head drusen (ONHD) vasculature in comparison to acute nonarteritic anterior ischemic optic neuropathy (NAION) and normal eyes using optical coherence tomography angiography (OCT-A). METHODS: Ten eyes with ONHD, 10 eyes with acute NAION, and 10 healthy eyes were included in this prospective, comparative, observational case series. OCT-A imaging was performed on the optic discs. Qualitative grading was performed for dilation and tortuosity of the peripapillary vessels by 3 graders. Quantitative comparison was performed for peripapillary and inside disc vessel densities in nerve head (NH) and retinal peripapillary capillary (RPC) slabs. RESULTS: The intergrader agreement for dilation and tortuosity of the peripapillary vessels was poor (0.313 and 0.182 for vascular dilation in nerve head and radial peripapillary capillary enface images, respectively, and 0.478 and 0.490 for vascular tortuosity in nerve head and radial peripapillary capillary enface images, respectively). In NH en face images, the vessel density measurements were statistically significantly different between the 3 groups (all p < 0.05). In RPC en face images, the vessel density measurements were statistically significantly different between the 3 groups (all p < 0.05) except for nasal peripapillary sector (0.08). CONCLUSION: Despite poor intergrader agreement in qualitative analysis, quantitative OCT-A evaluation may differentiate optic disc edema due to NAION from pseudodisc edema due to ONHD.
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Angiografía con Fluoresceína/métodos , Drusas del Disco Óptico/diagnóstico , Disco Óptico/patología , Neuropatía Óptica Isquémica/diagnóstico , Células Ganglionares de la Retina/patología , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Adulto , Femenino , Estudios de Seguimiento , Fondo de Ojo , Humanos , Masculino , Microvasos/patología , Fibras Nerviosas/patología , Estudios Prospectivos , Campos VisualesRESUMEN
Purpose: The purpose of this study was to compare the use of central and montaged ultra-wide-field fluorescein angiography (UWFFA) images for calculating the area of nonperfusion (NP) and ischemic index (ISI) in patients with retinal vein occlusion (RVO) and macular edema (ME) and to correlate these measurements with best-corrected visual acuity (BCVA) and central macular thickness (CMT). Methods: Thirty eyes of 30 RVO patients with recurrent ME were enrolled. Baseline UWFA images were sent to the Doheny Image Reading Center for quantitative analysis by certified graders. The association between ISI from the various zones and BCVA and CMT was examined by Spearman rank correlation and compared. Generalized linear models (GLMs) were used to analyze associations between BCVA and disease status. Results: The NP area and ISI for central and montaged images were not significantly different for any retinal zone. A modest but statistically significant negative linear correlation was observed between BCVA and ISI, ranging from r = -0.3825 in the perimacular area (PMA) to r = -0.584 in the far peripheral area (FPA). On GLM analysis, both PMA (ß = -1.059; 95% confidence interval: -1.74 to -0.378) and FPA (ß = -0.505; 95% confidence interval: -0.988 to -0.021) were significant independent predictors of BCVA. We found no correlation between ISI from the various zones and CMT in this cohort. Conclusions: Montaging of UWFFA images may not be required to adequately quantify and represent areas of NP in eyes with RVO. NP in both the PMA and peripheral retina appear relevant to visual function, highlighting the importance of evaluating the retinal periphery in these individuals.
Asunto(s)
Angiografía con Fluoresceína/métodos , Isquemia/fisiopatología , Edema Macular/fisiopatología , Oclusión de la Vena Retiniana/fisiopatología , Vena Retiniana/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Inhibidores de la Angiogénesis/uso terapéutico , Terapia Combinada , Femenino , Humanos , Inyecciones Intravítreas , Isquemia/diagnóstico por imagen , Isquemia/terapia , Coagulación con Láser , Edema Macular/diagnóstico por imagen , Edema Macular/terapia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Ranibizumab/uso terapéutico , Retina/patología , Oclusión de la Vena Retiniana/diagnóstico por imagen , Oclusión de la Vena Retiniana/terapia , Tomografía de Coherencia Óptica , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To report a patient with double pseudohypopyon from emulsification of heavy silicone oil. METHODS: A 65-year-old woman with rhegmatogenous retinal detachment and a large inferior break underwent pars plana vitrectomy and heavy silicone oil (Oxane HD; Bausch and Lomb, Toulouse, France) tamponade. Eighteen months later, she returned for follow-up examination. RESULTS: Slit-lamp examination revealed accumulation of emulsified silicone oil in both the inferior and superior portions of the anterior chamber leading to a "double pseudohypopyon" appearance. CONCLUSION: This case highlights the possibility of decomposition of the Oxane HD silicone oil with time creating an inverted pseudohypopyon from emulsification of light silicone oil in addition to a pseudohypopyon from heavy oil emulsification.