RESUMEN
PURPOSE: To distinguish functioning from failed filtration blebs (FBs) implementing a deep learning (DL) model on slit-lamp images. METHODS: Retrospective, cross-sectional, multicenter study for development and validation of an artificial intelligence classification algorithm. The dataset consisted of 119 post-trabeculectomy FB images of whom we were aware of the surgical outcome. The ground truth labels were annotated and images splitted into three outcome classes: complete (C) or qualified success (Q), and failure (F). Images were prepared implementing various data cleaning and data transformations techniques. A set of DL models were trained using different ResNet architectures as the backbone. Transfer and ensemble learning were then applied to obtain a final combined model. Accuracy, sensitivity, specificity, area under the ROC curve, and area under the precision-recall curve were calculated to evaluate the final model. Kappa coefficient and P value on the accuracy measure were used to prove the statistical significance level. RESULTS: The DL approach reached good results in unraveling FB functionality. Overall, the model accuracy reached a score of 74%, with a sensitivity of 74% and a specificity of 87%. The area under the ROC curve was 0.8, whereas the area under the precision-recall curve was 0.74. The P value was equal to 0.00307, and the Kappa coefficient was 0.58. CONCLUSIONS: All considered metrics supported that the final DL model was able to discriminate functioning from failed FBs, with good accuracy. This approach could support clinicians in the patients' management after glaucoma surgery in absence of adjunctive clinical data.
Asunto(s)
Aprendizaje Profundo , Glaucoma , Trabeculectomía , Humanos , Presión Intraocular , Estudios Retrospectivos , Inteligencia Artificial , Estudios Transversales , Trabeculectomía/métodos , Glaucoma/diagnóstico , Glaucoma/cirugíaRESUMEN
PURPOSE: The approach to managing patients with retinal vein occlusion (RVO) and cystoid macular edema (CME) with good initial visual acuity (VA) better than 6/12 has not been investigated. This study aimed to evaluate functional and anatomical outcomes of intravitreal treatment and observation in patients with CME due to RVO, who presented with good initial VA. Methods: Multicenter retrospective cohort study. Seventy-nine eyes of 79 patients with CME secondary to RVO and initial VA better than 6/12, either treated with anti-VEGF therapy or observed. Clinical parameters and OCT measures were recorded. Main Outcome Measure: Proportion of patients losing ≥1 line of VA at 12 months. Secondary outcomes: Visual and anatomical results at 12 and 24 months, and correlation between number of injections and VA outcomes. RESULTS: Fifty-three percent of patients maintained VA at month 12. VA of 6/6 - 6/7.5 was maintained in 59% and 57% at 12 and 24 months, respectively. At 24 months, the number of anti-VEGF injections was strongly correlated with VA among patients with BRVO and CRVO. CONCLUSION: This study marks the first exploration of patients with RVO and initial VA better than 6/12, indicating that most patients sustained good VA, and anti-VEGF treatment maintained and improved VA.
RESUMEN
BACKGROUND: To report a case of cataract surgery in unintentional Ozurdex (Allergan, Inc., Irvine, California, USA) injection into the lens. CASE PRESENTATION: A 82-years old man reporting decreased visual acuity in his right eye came to our Ophthalmology service. Due to the clinical history, and on the basis of ophthalmoscopic and imaging examinations diabetic macular edema was diagnosed. Thus, intravitreal dexamethasone implant was scheduled and therefore performed. The following day Ozurdex appeared to be located into the lens. After careful evaluation and strict follow up examinations, due to the risks associated with the presence of the implant into the lens, phacoemulsification with Ozurdex removal and intraocular lens (IOL) implantation was scheduled and performed. CONCLUSIONS: In this case report we reported the surgical management of accidental into-the lens dexamethasone implant carefully taking into account the dexamethasone pharmacokinetic.
Asunto(s)
Dexametasona , Implantes de Medicamentos , Glucocorticoides , Humanos , Dexametasona/administración & dosificación , Masculino , Anciano de 80 o más Años , Glucocorticoides/administración & dosificación , Implantes de Medicamentos/efectos adversos , Cristalino/cirugía , Edema Macular/tratamiento farmacológico , Edema Macular/etiología , Edema Macular/diagnóstico , Facoemulsificación , Implantación de Lentes Intraoculares/efectos adversos , Agudeza Visual , Inyecciones IntravítreasRESUMEN
BACKGROUND: To report real-world outcomes of patients with primary Reghmatogenous Retinal Detachment (RRD) treated with Pneumatic Retinopexy (PnR) according to the indications of the Pneumatic Retinopexy versus Vitrectomy for management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) trial. METHODS: Multicenter, retrospective study. Patients treated with PnR for RRD between 2021 and 2023 and a follow-up of at least 6 months were included. Single-procedure anatomical success, final anatomical success, complications, causes of failures, best corrected visual acuity (BCVA) after surgery, and the vision-related quality of life using the 25-Item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) were reported. RESULTS: A total of 76 eyes of 76 patients were included. Mean age was 60 ± 8.1 years. Primary anatomic reattachment was achieved by 84.3% of patients and final anatomical reattachment after pars plana vitrectomy was obtained in 100% of patients. BCVA improved from 0.32 (20/40) to 0.04 (20/20) logMar (p < 0.001) at 6 months. The main cause of failure was related to the presence of additional (likely missed) retinal breaks (66.6% of cases). Also, primary PnR failure was more frequent in eyes of patients with older age, macular involvement, worse baseline BCVA, greater extent of the RRD, and increased duration from diagnosis to treatment. Overall, the mean NEI-VFQ 25 composite score was 93.9% ± 6.4 at 6 months. CONCLUSIONS: The criteria of the PIVOT trial can be applied to real-world scenarios in the decision-making process for the treatment of primary RRD, with excellent anatomical and functional outcomes.
Asunto(s)
Calidad de Vida , Desprendimiento de Retina , Agudeza Visual , Vitrectomía , Humanos , Desprendimiento de Retina/cirugía , Desprendimiento de Retina/fisiopatología , Persona de Mediana Edad , Femenino , Masculino , Agudeza Visual/fisiología , Estudios Retrospectivos , Anciano , Vitrectomía/métodos , Endotaponamiento/métodos , Estudios de Seguimiento , Resultado del Tratamiento , Fluorocarburos/administración & dosificaciónRESUMEN
INTRODUCTION: The purpose of this study was to investigate long-term outcomes of intravitreal injections (IVI) of antivascular endothelial growth factor (VEGF) in neovascular age-related macular degeneration (nAMD) with type 3 macular neovascularization (MNV). METHODS: This retrospective study included 19 eyes of 17 patients with nAMD and type 3 MNV treated with anti-VEGF IVI with a loading dose and a PRN regimen. Best corrected visual acuity (BCVA), central macular thickness (CMT), presence of macular intraretinal fluid (IRF) and subretinal fluid (SRF), flow area (FA), subfoveal choroidal thickness (CT), and macular atrophy (MA) were assessed at baseline (T0) and during follow-up (T1, post-loading phase; T2, 1 year; T3, 2 years; T4 >2 years). The correlations between MA at the last follow-up and standard deviation (SD) values of CMT and CT during follow-up were assessed. The influence of the number of injections on the change in MA over time was also analyzed. MA differences at T4 were assessed for pseudodrusen presence. RESULTS: BCVA improved significantly during follow-up (p = 0.013) particularly increasing from baseline to post-loading phase and then did not modify significantly thereafter. CMT significantly reduced from T0 to T1 and remained stable during follow-up (p = <0.001). MNV flow area showed a trend toward an increase in the post-loading phase that was not statistically significant (p = 0.082) and CT decreased significantly during follow-up (p < 0.001). MA changed significantly during follow-up (p < 0.001) with a significant increase from T0 to T3 and from T0 to T4 (p < 0.010). A Cochran-Armitage test for trend showed a significant reduction (p = 0.001) of macular IRF and SRF during follow-up. MA at T4 showed a significant positive correlation with SD (standard deviation) values of CMT (p = 0.040) and CT (p = 0.020). Indeed, the number of injections did not influence the change over time of MA (p = 0.709). MA at T4 was not statistically significantly different between patients with pseudodrusen at baseline (p = 0.497). CONCLUSIONS: Intravitreal anti-VEGF injections with PRN regimen in MNV type 3 showed functional and anatomical benefits. Variations of retinal thickness and choroidal thickness during treatment were related to MA modification over time.
Asunto(s)
Inhibidores de la Angiogénesis , Angiografía con Fluoresceína , Inyecciones Intravítreas , Ranibizumab , Tomografía de Coherencia Óptica , Factor A de Crecimiento Endotelial Vascular , Agudeza Visual , Humanos , Estudios Retrospectivos , Masculino , Femenino , Inhibidores de la Angiogénesis/administración & dosificación , Anciano , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Tomografía de Coherencia Óptica/métodos , Estudios de Seguimiento , Anciano de 80 o más Años , Ranibizumab/administración & dosificación , Angiografía con Fluoresceína/métodos , Mácula Lútea/patología , Bevacizumab/administración & dosificación , Resultado del Tratamiento , Degeneración Macular Húmeda/tratamiento farmacológico , Degeneración Macular Húmeda/diagnóstico , Degeneración Macular Húmeda/fisiopatología , Fondo de Ojo , Factores de Tiempo , Persona de Mediana EdadRESUMEN
To analyze in vivo scleral changes induced by MicroPulse transscleral laser therapy (MP-TLT) in refractory glaucoma using anterior segment-optical coherence tomography (AS-OCT). Forty-two candidate patients for MP-TLT were consecutively enrolled and underwent AS-OCT at baseline and after six months. MP-TLT success was defined as an intraocular pressure (IOP) reduction by one-third. The main outcome measures were the mean superior (S-), inferior (I-), and total (T-) intra-scleral hypo-reflective space area (MISHA: mm2) and scleral reflectivity (S-SR, I-SR, T-SR; arbitrary scale) as in vivo biomarkers of uveoscleral aqueous humor (AH) outflow. The IOP was the secondary outcome. The relations between the baseline-to-six months differences (D) of DS-MISHA, DI-MISHA, and DT-MISHA and DS-SR, DI-SR, DT-SR, and DIOP, were investigated. At 6 months, the median IOP reduction was 21% in the failures and 38% in the successes. The baseline S-MISHA, I-MISHA, and T-MISHA did not differ between the groups, while S-SR and T-SR were higher in the successes (p < 0.05). At six months, successful and failed MP-TLTs showed a 50% increase in S-MISHA (p < 0.001; p = 0.037), whereas I-SR and T-SR reduced only in the successes (p = 0.002; p = 0.001). When comparing DS-MISHA, DI-MISHA, and DT-MISHA and DS-SR, DI-SR, and DT-SR, there were no significant differences between the groups. In the successful procedures, DIOP was positively correlated with DT-MISHA and DI-MISHA (ρ = 0.438 and ρ = 0.490; p < 0.05). MP-TLT produced potentially advantageous modifications of the sclera in refractory glaucoma. Given the partial correlation between these modifications and post-treatment IOP reduction, our study confirmed that the activation of the uveoscleral AH outflow route could significantly contribute to the IOP lowering after MP-TLT.
Asunto(s)
Humor Acuoso , Glaucoma , Presión Intraocular , Terapia por Láser , Esclerótica , Tomografía de Coherencia Óptica , Humanos , Tomografía de Coherencia Óptica/métodos , Esclerótica/cirugía , Esclerótica/diagnóstico por imagen , Masculino , Femenino , Glaucoma/cirugía , Glaucoma/diagnóstico por imagen , Persona de Mediana Edad , Terapia por Láser/métodos , Anciano , Humor Acuoso/metabolismo , Úvea/diagnóstico por imagen , Úvea/cirugía , Adulto , Resultado del TratamientoRESUMEN
INTRODUCTION: The aim of the study was to evaluate functional and anatomical changes in type 1 and type 2 naïve macular neovascularization (MNV) patients treated with brolucizumab injections up to 1 year of treatment (week 48). METHODS: Thirty-eight eyes of 38 patients with active MNV were enrolled at the Ophthalmology Clinic of the University "G. d'Annunzio," Chieti-Pescara, Italy. All patients were scheduled for brolucizumab intravitreal injections as per label, according to the standard HAWK and HARRIER trials guidelines. Enrolled patients underwent complete ophthalmic evaluation, including optical coherence tomography (OCT) and OCT angiography. All measurements were evaluated at baseline and then monthly up to week 48. The main outcome measures were changes in best-corrected visual acuity (BCVA); central macular thickness (CMT); subfoveal choroidal thickness (SCT); pigment epithelial detachment presence and maximum height (PEDMH); intraretinal fluid (IRF) presence, subfoveal subretinal fluid (SSRF) presence and maximum height, macular atrophy area, and neovascular membrane flow area in the slab extending from the outer retina to choriocapillaris (ORCC flow). RESULTS: CMT and BCVA significantly changed in both groups over time. ORCC flow and SCT significantly reduced in both groups over time. Atrophy areas increased from 0 to 0.17 mm2 and from 0 to 0.23 mm2 in type 1 MNV and type 2 MNV patients, respectively. PEDMH reduced in type 1 MNV from 138 µm at T0 to 96 µm at T5. Changes in fluids were noted, with SSRF thickness reduction and IRF changes in both groups. CONCLUSION: Our one-year results of treatment confirm brolucizumab to be efficient and safe in both type 1 and type 2 MNV patients, proposing novel OCT parameters as possible biomarkers of treatment.
Asunto(s)
Neovascularización Retiniana , Degeneración Macular Húmeda , Humanos , Inhibidores de la Angiogénesis/uso terapéutico , Estudios de Seguimiento , Anticuerpos Monoclonales Humanizados , Tomografía de Coherencia Óptica/métodos , Atrofia/tratamiento farmacológico , Inyecciones Intravítreas , Degeneración Macular Húmeda/tratamiento farmacológico , Estudios RetrospectivosRESUMEN
INTRODUCTION: To evaluate changes of retinal capillary non-perfusion areas (RCNPA) and the retinal capillary vessel density (RCVD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) using widefield optical coherence tomography angiography (WFOCTA) in patients with diabetic retinopathy (DR) and diabetic macular edema (DME) treated with intravitreal ranibizumab injection (IRI). MATERIALS AND METHODS: 24 eyes of 24 patients with DR and DME candidates to a loading dose of IRI were enrolled. All patients underwent WFOCTA with the PLEX Elite 9000 device with 15 × 9 mm scans centered on the foveal center at baseline (T0) and 1 month after each intravitreal injection at 30 days (T1), 60 days (T2), and 90 days (T3). In all patients, the variation of RCNPA and the RCVD of the of the SCP and DCP were calculated using automatic software written in Matlab (MathWorks, Natick, MA). RESULTS: The SCP showed a significant longitudinal variation of RCNPA (p = 0.04). Post-hoc analysis revealed a statistically significant reduction of RCNPA at T1 (p = 0.04) and a not significant reduction at T2 (p=0.18) and T3 (p=0.96). The DCP showed longitudinal changes of the RCNPA that tended to statistical significance (p = 0.09). Post-hoc analysis revealed a trend towards a statistically significant reduction of RCNPA at T3 (p = 0.09) not statistically significant, at T1 (p=0.17) and T2 (p=0.75). The RCVD of SCP and DCP showed no significant changes in any of the time points. CONCLUSIONS: Widefield OCT angiography showed a decrease of RCNPA after IRI, probably related to the reperfusion of retinal capillaries.
RESUMEN
PURPOSE: to assess the anatomical and functional changes after brolucizumab intravitreal injection (BIVI) in macular neovascularization type 1 (MNV1). Setting/Venue: Ophthalmology Clinic, University "G. d'Annunzio" of Chieti-Pescara. METHODS: A total of 24 eyes of 24 patients suffering from naïve MNV1 candidates to BIVI as per label with q12/q8 dosing regimen after the loading dose were enrolled in this prospective study. Main outcome measures during a 16-weeks follow up period included changes of best corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal subretinal fluid thickness (SSRFT), subfoveal sub-RPE fluid thickness (SSRPEFT), subfoveal choroidal thickness (SFCT) and pigment epithelial detachment (PED) maximum height (PED-MH). In addition, percentages of eyes with intraretinal fluid, subretinal fluid and sub-RPE fluid at different time points and percentages of eyes candidates to a q8 or q 12 injection interval after disease activity assessment at week 16 were evaluated. RESULTS: BCVA improved significantly from baseline (T0) to week 12 (T3) (p=0.028). CMT showed a significant reduction from 456.0±123.0 µm at T0 to 265.0±85.0 µm at T3 (p<0.001). SSRFT and SSRPEFT reduced significantly as well (p<0.001 and p=0.049 respectively). PED-MH reduced significantly from 162.0±110.0 µm at T0 to 94.1±38.9 µm at T3 (p=0.020) and SFCT from 203.0±56.9 µm at T0 to 146.0±64.2 µm at T3 (p=0.006). IRF presence changed significantly from 41.7% of eyes at T0 to 20.8% at T3 (p=0.045). SSRF reduced significantly during follow up, being present in 62.5% of eyes at T0 and 4.2% of eyes at T3 (p<0.001). Subfoveal sub-RPE fluid decreased significantly during time being present in 20.8% of eyes at T0 and 0% at T3 (p=0.013). Most of the eyes (18 eyes, 75%) at week 16 after disease activity assessment were shifted in the q12 interval and only a minority of eyes shifted in a q8 interval (6 eyes, 25%). CC Flow and ORCC flow did not show significant differences during follow up. CONCLUSIONS: Brolucizumab is efficient in reducing all retinal fluids during the loading phase and shows reduction of macular thickness, choroidal thickness, and PED height. Most eyes at disease activity assessment (75%) fall into 12 week-interval and the minority (25%) into the 8 week-interval.
RESUMEN
AIM: To evaluate the impact of cataract surgery on cognitive function in very elderly patients (≥ 85 years). METHODS: A prospective, nonrandomized, comparative study of very elderly patients (≥ 85 years), and elderly patients (≥ 65 < 85 years) scheduled for first time cataract surgery. Cognitive function, quality of life (QoL), best corrected visual acuity (BCVA), endothelial cell count (ECC), and central corneal thickness (CCT) were assessed at 90 days before surgery (T0), at surgery (T1), and at 30 (T2) and 90 days (T3) after surgery. Macular thickness (MT) was evaluated at T2. Six-item cognitive impairment test (6CIT) was used to evaluate cognitive function while the Catquest-9SF test was used to assess QoL. The confusion assessment method (CAM) was used to evaluate the presence of delirium episodes at within 48 h from T1. RESULTS: A total of 78 patients (very elderly n = 24, elderly n = 54) were enrolled; average age 80.3 ± 6.2 years old. Significant improvements for cognitive function, BCVA, QoL (p < 0.01) during the observational period were observed among the cohort. A greater improvement in cognitive function was observed in the very elderly patients between T1 and T2 (p = 0.02), while there was no difference in BCVA and QoL between the groups. There were no significant differences in ECC and CCT changes between the groups. No delirium episodes or significant macular abnormalities were registered. CONCLUSIONS: Cataract surgery in very elderly patients seems to offer a greater improvement in cognitive function as compared to elderly patients, and it is associated with a significant improvement in QoL, without any incidence of postoperative delirium.
Asunto(s)
Catarata , Calidad de Vida , Anciano , Anciano de 80 o más Años , Catarata/epidemiología , Cognición , Humanos , Estudios Prospectivos , Agudeza VisualRESUMEN
The present study investigated the corneal sub-basal nerve plexus (SNP) modifications in glaucoma. Ninety-five glaucomatous patients were enrolled and divided into Group 1 and 2, preserved and preservative-free mono-therapy (30 and 28 patients), and Group 3, multi-therapy (37). Thirty patients with dry eye disease (DED) and 32 healthy subjects (HC) served as controls. In vivo confocal microscopy evaluated the nerve fibers density (CNFD), length (CNFL), thickness (CNFT), branching density (CNBD), and dendritic cell density (DCD). CNFD, CNFL, and CNBD were reduced in Group 3 and DED compared to HC (p < 0.05). CNFL was reduced in Group 3 compared to Group 2 (p < 0.05), and in Group 1 compared to HC (p < 0.001). CNFD, CNBD, and CNFT did not differ between glaucomatous groups. DCD was higher in Group 3 and DED compared to HC and Group 2 (p < 0.01). Group 3 showed worse ocular surface disease index (OSDI) scores compared to Group 1, 2, and HC (p < 0.05). CNFL and DCD correlated with OSDI score in Group 3 (r = −0.658, p < 0.001; r = 0.699, p = 0.002). Medical therapy for glaucoma harms the corneal nerves, especially in multi-therapy regimens. Given the relations with the OSDI score, SNP changes seem features of glaucoma therapy-related OSD and negatively affects the patient's quality of life.
RESUMEN
Background and Objectives: The aim of this study was to investigate the impact of oral administration of the combination of astaxanthin (AXT), lutein, folic acid, vitamin D3, and bromelain with antioxidants on choroidal blood flow in patients with age-related intermediate macular degeneration (AMD). Materials and Methods: Patients affected by intermediate AMD and treated with daily oral nutritional supplement with AXT, bromelain, vitamin D3, folic acid, lutein, and antioxidants for a period of at least 6 months were included in this retrospective study. A control group homogenous for age and sex was also included in the analysis. All participants underwent a complete ophthalmologic examination, spectral domain optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCTA) evaluation. Outcome measures were choroidal thickness (CHT) and choriocapillary vessel density (CCVD) after six months of AXT assumption. Results: CCVD values showed statistically significant difference between cases and controls at baseline (p < 0.001) and in the cases during follow-up (p < 0.001). The CHT measurements showed statistically significant difference between cases and controls (p = 0.002) and in the cases during follow-up (p < 0.001). Conclusions: The combined use of structural OCT and OCTA allows for a detailed analysis in vivo of perfusion parameters of the choriocapillaris and choroid and evaluation of changes of choroidal blood flow after oral nutritional supplements that affect blood flow velocity.
Asunto(s)
Luteína , Degeneración Macular , Antioxidantes/farmacología , Antioxidantes/uso terapéutico , Bromelaínas , Colecalciferol , Coroides , Suplementos Dietéticos , Ácido Fólico/farmacología , Ácido Fólico/uso terapéutico , Humanos , Luteína/farmacología , Luteína/uso terapéutico , Estudios Retrospectivos , Tomografía de Coherencia Óptica/métodos , XantófilasRESUMEN
Purpose: To describe clinical and genetic features in a series of Italian patients with sector retinitis pigmentosa (sector RP). Methods: Fifteen patients with sector RP were selected from the database of Hereditary Retinal Degenerations Referring Center of Careggi Hospital (Florence, Italy). Eleven patients from five independent pedigrees underwent genetic analysis with next-generation sequencing (NGS) confirmed with Sanger sequencing. The diagnosis of sector RP was based on the detection of topographically limited retinal abnormalities consistent with corresponding sectorial visual field defects. Best-corrected visual acuity (BCVA), fundus color pictures as well as fundus autofluorescence (FAF), spectral domain-optical coherence tomography (SD-OCT), full-field electroretinography (ERG), and 30-2 Humphrey visual field (VF) data were retrospectively collected and analyzed. Results: For the 30 eyes, the mean BCVA was 0.05 ± 0.13 logMAR, and the mean refractive error was -0.52 ± 1.89 D. The inferior retina was the most affected sector (86.7%), and the VF defect corresponded to the affected sector. FAF showed a demarcation line of increased autofluorescence between the healthy and affected retina, corresponding on SD-OCT to an interruption of the ellipsoid zone (EZ) band in the diseased retina. Dark-adapted ERG amplitudes were decreased in comparison to normative values. In five unrelated families, the sector RP phenotype was associated with sequence variants in the RHO gene. The same mutation c.568G>A p.(Asp190Asn) was found in nine patients of four families. Conclusions: Typical sector RP is a mild form of RP characterized by preserved visual acuity with limited retinal involvement and, generally, a more favorable prognosis than other forms of RP.
Asunto(s)
Retinitis Pigmentosa/diagnóstico , Retinitis Pigmentosa/genética , Rodopsina/genética , Adulto , Anciano , Adaptación a la Oscuridad/fisiología , Electrorretinografía , Femenino , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Linaje , Fenotipo , Refracción Ocular/fisiología , Retina/fisiopatología , Retinitis Pigmentosa/fisiopatología , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Agudeza Visual/fisiología , Pruebas del Campo Visual , Campos Visuales/fisiología , Adulto JovenRESUMEN
PURPOSE: To investigate the relationship between choriocapillaris (CC) hypoperfusion and photoreceptor alterations in eyes with nonproliferative diabetic retinopathy (NPDR). METHODS: In this prospective, observational, case-control study, 30 eyes (30 patients) with NPDR and 30 healthy eyes from 30 controls were enrolled at the University G. d'Annunzio, Chieti-Pescara, Italy. This study cohort underwent an ophthalmologic examination, including optical coherence tomography and optical coherence tomography angiography. The main outcome measures were as follows: 1) "normalized" reflectivity of en face image segmented at the ellipsoid zone level, which was calculated to quantify the photoreceptor damage, and 2) CC perfusion density. Secondary outcome measures were as follows: 1) superficial retinal capillary plexus (SCP), intermediate retinal capillary plexus (ICP), and deep retinal capillary plexus (DCP) perfusion density (based on the area of vessels); 2) SCP, ICP, and DCP vessel length density (based on a map with vessels of 1-pixel width); and 3) SCP, ICP, and DCP vessel diameter. RESULTS: Mean ± SD age was 58.9 ± 11.1 years (range 38-79 years) in the NPDR group and 61.7 ± 11.3 years (range 39-87 years) in the control group (P > 0.05 for all the comparisons). Compared with controls, NPDR eyes displayed a lower "normalized" reflectivity (0.96 ± 0.25 in controls and 0.73 ± 0.19 in the NPDR group, P < 0.0001). Moreover, the NPDR group was characterized by an impaired perfusion in both the retinal and choroidal vasculature. In multiple regression analysis, ellipsoid zone "normalized" reflectivity displayed a significant direct association with CC perfusion density in patients with NPDR (P = 0.025 and P = 0.476, in NPDR and controls, respectively). CONCLUSION: Eyes with NPDR are affected by macular hypoperfusion and photoreceptor damage, the latter investigated as ellipsoid zone "normalized" reflectivity. The diabetic choroidopathy seems to be strongly associated with photoreceptor damage.
Asunto(s)
Angiografía con Fluoresceína/métodos , Células Fotorreceptoras de Vertebrados/patología , Vasos Retinianos/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Retinopatía Diabética , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
IMPORTANCE: To analyse the preoperative conjunctival thickness in glaucomatous patients undergoing filtration surgery (FS), using optical coherence tomography (OCT). BACKGROUND: The conjunctival status represents one of the most critical determinants of the FS outcome. DESIGN: Retrospective study. PARTICIPANTS: Sixty-seven patients candidate to FS for uncontrolled glaucoma were enrolled. METHODS: OCT was performed at the superior bulbar conjunctiva before FS, and at bleb site at the last follow-up (LF-up) after surgery. MAIN OUTCOME MEASURES: Preoperative full, epithelial, and stromal conjunctival thickness (FCT, CET, CST) and reflectivity (CR), and LF-up bleb-wall thickness (BT), reflectivity (BR) and intraocular pressure (IOP), were the major outcomes. The relations between preoperative parameters and LF-up-IOP, BT and BR were calculated. RESULTS: FS was completely successful in 23 patients (group 1), successful with medications in 22 (group 2), and failed in 22 (group 3). FCT, CET and CST were lower, whereas CR higher, in group 3 compared to groups 1 and 2 (P < .05); BT was lower (P < .001), whereas BR higher (P < .05) in group 3 compared to group 1. FCT and CST were predictors of FS outcome with lower thickness associated with increased odds of failure (odds ratio 0.922, P = .08; 0.941, P = .025). LF-up-IOP inversely correlated with FCT and CST (r = -0.447, P = .003; r = -0.408, P = .007), whereas positively correlated with CR (r = 0.789, P < .001). CONCLUSIONS AND RELEVANCE: Preoperative conjunctival thickness and reflectivity show significant correlations with the FS outcome, both in terms of IOP and bleb-wall features. Therefore, they may be proposed as predictive imaging biomarkers to estimate the risk of filtration failure.
Asunto(s)
Cirugía Filtrante , Glaucoma , Trabeculectomía , Segmento Anterior del Ojo/diagnóstico por imagen , Biomarcadores , Conjuntiva/diagnóstico por imagen , Glaucoma/diagnóstico , Glaucoma/cirugía , Humanos , Estudios Retrospectivos , Tomografía de Coherencia ÓpticaRESUMEN
Background and Objectives: the aim of the study was to evaluate the repeatability and reproducibility of optical microangiography (OMAG)-based optical coherence tomography angiography (OCTA) in the optic nerve head (ONH) and radial peripapillary capillary (RPC) perfusion assessment of healthy eyes. Materials and Methods: in this observational study, a total of 40 healthy subjects underwent ONH evaluation, using an OMAG-based OCTA system at baseline (T0), after 30 min (T1), and after 7 days (T2). The main outcome measures were the vessel density (VD) and flux index (FI) of the RPCs, as well as peri-papillary retinal nerve fibre layer (pRNFL) thickness. The analysis was performed by two observers independently. The coefficient of repeatability (CR), within the subject coefficient of variation (CVw) and intrasession correlation coefficient (ICC), to evaluate intrasession repeatability of measurements was calculated for each observer. Results: the high intrasession and intersession repeatability and reproducibility were assessed in the two observers for all three outcome measures. Of note, the CRs for the first and the second observer were 0.011 (95% confidence interval (CI) 0.009-0.014) and 0.016 (95% CI 0.013-0.020) for FI, 0.016 (95% CI 0.013-0.021) and 0.017 (95% CI 0.014-0.021) for VD, and 2.400 (95% CI 1.948-3.092) and 3.732 (95% CI 3.064-4.775) for pRNFL thickness, respectively. The agreement between them was excellent for pRNFL assessment and very good for FI and VD. Conclusion: OCTA has a great potential in the accurate assessment of ONH and peri-papillary microcirculation. It allows for repeated and reproducible measurements without multiple scans-related bias, thus guaranteeing an independent operator analysis with good reproducibility and repeatability.
Asunto(s)
Angiografía por Tomografía Computarizada/métodos , Disco Óptico/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Adulto , Capilares/anatomía & histología , Capilares/diagnóstico por imagen , Femenino , Humanos , Masculino , Disco Óptico/anatomía & histología , Disco Óptico/irrigación sanguínea , Reproducibilidad de los Resultados , Neuronas Retinianas/ultraestructuraRESUMEN
PURPOSE: To describe the occurrence of epiretinal membrane (ERM) in eyes with vitreomacular traction and to correlate the presence of ERM with retinal structural alterations detected using spectral domain optical coherence tomography. METHODS: In this retrospective observational cross-sectional study, we collected data from 502 eyes (307 patients) with diagnosis of vitreomacular traction. The presence of ERM and retinal lesions (cystoid cavities, neuroepithelial detachment, external limiting membrane, and ellipsoid zone discontinuity) was determined by standardized grading of macular spectral domain optical coherence tomography scans. RESULTS: The occurrence of ERM in eyes with vitreomacular traction was 37.5%. The mean ± SD central foveal thickness was 411 ± 60 µm in eyes with ERM and 380 ± 148 µm in eyes without ERM (P < 0.05). The occurrence of cystoid cavities (38.3% vs. 23.2%, P < 0.05), neuroepithelial detachment (24.5% vs. 9.9%, P < 0.0001), external limiting membrane discontinuity (16.5% vs. 5.1%, P < 0.0001), and ellipsoid zone discontinuity (13.3% vs. 6.7%, P < 0.05) was higher in eyes with ERM. The mean ± SD best-corrected visual acuity was 0.45 ± 0.16 logarithm of the minimum angle of resolution (Snellen equivalent of approximately 20/50) in eyes with ERM and 0.37 ± 0.09 in eyes without ERM (Snellen equivalent of approximately 20/40, P < 0.0001). Symptoms of metamorphopsia were present in 55 of 188 eyes with ERM (29.3%) and 40 of 314 eyes without ERM (12.7%, P < 0.0001). CONCLUSION: This study reported the occurrence of ERM in eyes with vitreomacular traction and demonstrated that ERM is significantly associated with an increased occurrence of other structural changes of the neuroretina and a negative effect on quantity and quality of vision.
Asunto(s)
Membrana Epirretinal/diagnóstico , Edema Macular/complicaciones , Retina/patología , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Cuerpo Vítreo/patología , Desprendimiento del Vítreo/complicaciones , Anciano , Estudios Transversales , Membrana Epirretinal/etiología , Femenino , Humanos , Edema Macular/diagnóstico , Masculino , Estudios Retrospectivos , Desprendimiento del Vítreo/diagnósticoRESUMEN
PURPOSE: Choroideremia is a rare degenerative retinal disease that causes incurable blindness. It occurs as a result of the deficiency of the X-linked CHM gene, which encodes the Rab escort protein 1 (REP1). Gene therapy has been developed to treat CHM using adeno-associated viral vectors and is currently undergoing clinical trials. Expression of the CHM gene is ubiquitous throughout the retina, and it is therefore important to identify which retinal layers are affected in the disease process. The purpose of this study was to assess in particular the choriocapillaris using optical coherence tomography angiography because this layer is difficult to see with conventional imaging techniques. METHODS: Six men with choroideremia were identified and underwent standardized optical coherence tomography angiography as part of an ethics-approved clinical study and were compared with age-matched control subjects. RESULTS: The choriocapillaris appeared normal in regions where the retinal pigment epithelium remained intact, but it was deficient elsewhere. The outer retinal vasculature showed significant changes peripherally but also some changes centrally. The inner retinal vasculature appeared unaffected by the disease process. CONCLUSION: Choroideremia is a disease in which the choriocapillaris maintains a normal structure until the loss of the overlying retinal pigment epithelium. The inner retina also appears not to be affected at the vascular level. Although this study is limited by the small number of patients eligible for inclusion in the study, the observations support the concept of targeting gene therapy to the retinal pigment epithelium and outer retina because there is no evidence of independent degeneration of the choriocapillaris.
Asunto(s)
Coroides/patología , Coroideremia/diagnóstico , Angiografía con Fluoresceína/métodos , Vasos Retinianos/patología , Tomografía de Coherencia Óptica/métodos , Adulto , Coroideremia/terapia , Femenino , Estudios de Seguimiento , Fondo de Ojo , Terapia Genética/métodos , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
PURPOSE: To describe the helpfulness of using intraoperative optical coherence tomography (OCT) during surgery for full-thickness macular hole (FTMH). OBSERVATIONS: This observational case series identifies three patients with FTMH who were treated with vitrectomy, internal limiting membrane (ILM) peel with inverted ILM flap, which was tucked into the MH, and air with 18% Sulfur Hexafluoride (SF6) gas tamponade. Intraoperative OCT was used to confirm positioning of the ILM flap, even after complete air-fluid exchange. The patients were followed for three months after surgery and all reached a good morphological and functional outcome. CONCLUSIONS: If confirmed by a prospective longitudinal study, the intraoperative OCT might become an important tool in assisting FTMH surgery.
Asunto(s)
Técnicas de Diagnóstico Oftalmológico , Membrana Epirretinal/cirugía , Monitoreo Intraoperatorio/instrumentación , Perforaciones de la Retina/cirugía , Tomografía de Coherencia Óptica/métodos , Vitrectomía/métodos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Colgajos QuirúrgicosRESUMEN
PURPOSE: To assess the effect of topical antibiotic prophylaxis on postoperative endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents. METHODS: A systematic literature search was performed from inception to March 2016 using PubMed, Medline, Web of Science, Embase, and the Cochrane Library, to identify articles that reported cases of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents. We used a pooled analysis to estimate the incidence of cases of endophthalmitis who developed after injections performed with and without topical antibiotic prophylaxis. We used regression analysis to explore the effects of study characteristics on heterogeneity. RESULTS: From our search of electronic databases, we identified and screened 4,561 unique records. We judged 60 articles to have reported findings for cohorts of patients who met our inclusion criteria, (12 arms of randomized clinical trials, 11 prospective cohort studies, and 37 retrospective cohort studies), which included 244 cases of endophthalmitis and 639,391 intravitreal injections of anti-vascular endothelial growth factor agents. The final pooled estimate endophthalmitis proportions were 9/10,000 (95% confidence interval, 7/10,000-12/10,000) in the antibiotic-treated group and 3/10,000 (95% confidence interval, 2/10,000-5/10,000) in the untreated group. The estimated incidence of endophthalmitis with topical antibiotic prophylaxis was approximated three times the incidence without prophylaxis. Random effects regression showed that none of the study characteristics significantly affected the effect size in either group. CONCLUSION: Topical antibiotic after intravitreal injection of anti-vascular endothelial growth factor agents is associated with a higher risk of endophthalmitis.