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1.
Ophthalmology ; 125(2): 255-266, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28964581

RESUMO

PURPOSE: Swept-source (SS) OCT angiography (OCTA) was used to determine the prevalence, incidence, and natural history of subclinical macular neovascularization (MNV) in eyes with nonexudative age-related macular degeneration (AMD). DESIGN: Prospective, observational, consecutive case series. PARTICIPANTS: Patients with intermediate AMD (iAMD) or geographic atrophy (GA) secondary to nonexudative AMD in 1 eye and exudative AMD in the fellow eye. METHODS: All patients were imaged using both the 3×3 mm and 6×6 mm SS OCTA fields of view (PLEX Elite 9000; Carl Zeiss Meditec, Inc, Dublin, CA). The en face slab used to detect the MNV extended from the outer retina to the choriocapillaris, and projection artifacts were removed using a proprietary algorithm. MAIN OUTCOME MEASURES: Prevalence of subclinical MNV and time to exudation with Kaplan-Meier cumulative estimates of exudation at 1 year. RESULTS: From August 2014 through March 2017, 160 patients underwent SS OCTA (110 eyes with iAMD and 50 eyes with GA). Swept-source OCTA identified subclinical MNV at the time of first imaging in 23 of 160 eyes, for a prevalence of 14.4%. Six eyes demonstrated subclinical MNV during the follow-up. Of 134 eyes with follow-up visits, a total of 13 eyes demonstrated exudation, and of these 13 eyes, 10 eyes were found to have pre-existing subclinical MNV. By 12 months, the Kaplan-Meier cumulative incidence of exudation for all 134 eyes was 6.8%. For eyes with subclinical MNV at the time of first SS OCTA imaging, the incidence was 21.1%, and for eyes without subclinical MNV, the incidence was 3.6%. There was no difference in the cumulative incidence of exudation from pre-existing MNV in eyes with iAMD or GA (P = 0.847, log-rank test). After the detection of subclinical MNV, the risk of exudation was 15.2 times (95% confidence interval, 4.2-55.4) greater compared with eyes without subclinical MNV. CONCLUSIONS: By 12 months, the risk of exudation was greater for eyes with documented subclinical MNV compared with eyes without detectable MNV. For eyes with subclinical MNV, recommendations include more frequent follow-up and home monitoring. Intravitreal therapy is not recommended until prospective studies are performed.


Assuntos
Corioide/patologia , Neovascularização de Coroide/diagnóstico , Angiofluoresceinografia/métodos , Degeneração Macular/complicações , Tomografia de Coerência Óptica/métodos , Idoso , Idoso de 80 Anos ou mais , Corioide/irrigação sanguínea , Neovascularização de Coroide/etiologia , Feminino , Fundo de Olho , Humanos , Macula Lutea/patologia , Degeneração Macular/diagnóstico , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
2.
Biomed Microdevices ; 13(2): 267-77, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21161600

RESUMO

This paper reports a micromachined drug delivery device that is wirelessly operated using radiofrequency magnetic fields for implant applications. The controlled release from the drug reservoir of the device is achieved with the microvalves of poly(N-isopropylacrylamide) thermoresponsive hydrogel that are actuated with a wireless resonant heater, which is activated only when the field frequency is tuned to the resonant frequency of the heater circuit. The device is constructed by bonding a 1-mm-thick polyimide component with the reservoir cavity to the heater circuit that uses a planar coil with the size of 5-10 mm fabricated on polyimide film, making all the outer surfaces to be polyimide. The release holes created in a reservoir wall are opened/closed by the hydrogel microvalves that are formed inside the reservoir by in-situ photolithography that uses the reservoir wall as a photomask, providing the hydrogel structures self-aligned to the release holes. The wireless heaters exhibit fast and strong response to the field frequency, with a temperature increase of up to 20°C for the heater that has the 34-MHz resonant frequency, achieving 38-% shrinkage of swelled hydrogel when the heater is excited at its resonance. An active frequency range of ~2 MHz is observed for the hydrogel actuation. Detailed characteristics in the fabrication and actuation of the hydrogel microvalves as well as experimental demonstrations of frequency-controlled temporal release are reported.


Assuntos
Hidrogéis/química , Bombas de Infusão Implantáveis , Microtecnologia/instrumentação , Ondas de Rádio , Tecnologia sem Fio/instrumentação , Resinas Acrílicas/química , Magnetismo , Temperatura
3.
Am J Ophthalmol ; 209: 18-26, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31562858

RESUMO

PURPOSE: Choriocapillaris (CC) imaging of normal eyes with swept-source optical coherence tomographic angiography (SS-OCTA) was performed, and the percentage of CC flow deficits (FD%) and the average area of CC flow deficits (FDa) were compared within the given macular regions. DESIGN: A prospective, cross-sectional study. METHODS: Subjects with normal eyes ranging in age from their 20s through their 80s were imaged with SS-OCTA (PLEX Elite 9000; Carl Zeiss Meditec, Dublin, California, USA) using both 3×3-mm and 6×6-mm macular scan patterns. The CC images were generated using a previously published and validated algorithm. In both 3×3-mm and 6×6-mm scans, the CC FD% and FDa were measured in circular regions centered on the fovea with diameters as 1 mm and 2.5 mm (C1 and C2.5). In 6×6-mm scans, the FD% and FDa were measured within an additional circular region with diameter as 5 mm (C5). The correlations between FD% and FDa from each region were analyzed with Pearson correlation coefficients. RESULTS: A total of 164 eyes were analyzed. There was excellent correlation between CC FDa and FD% measurements from each region. In the 3×3-mm scans, the correlations in the C1 and C2.5 regions were 0.83 and 0.90, respectively. In the 6×6-mm scans, the correlations in C1, C2.5, and C5 regions were 0.90, 0.89, and 0.89, respectively. CONCLUSIONS: When measuring CC FDs, we found excellent correlations between FDa and FD% in regions from 3×3-mm and 6×6-mm scans. Further studies are needed to determine if one parameter is more useful when studying diseased eyes.


Assuntos
Corioide/irrigação sanguínea , Artérias Ciliares/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo/fisiologia , Corioide/diagnóstico por imagem , Artérias Ciliares/diagnóstico por imagem , Estudos Transversais , Feminino , Angiofluoresceinografia/métodos , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia de Coerência Óptica/métodos , Adulto Jovem
5.
Ophthalmol Retina ; 3(2): 122-132, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31014759

RESUMO

PURPOSE: Different swept-source (SS) OCT scan patterns were used to image geographic atrophy (GA) to determine if they provided similar area and enlargement measurements in eyes with age-related macular degeneration (AMD). DESIGN: Prospective, observational case series. PARTICIPANTS: Patients with GA secondary to nonexudative AMD. METHODS: Patients were imaged using SS OCT (PLEX Elite 9000; Carl Zeiss Meditec, Dublin, CA), with follow-up imaging performed after 6 months and 1 year. Both the 6×6 mm and 12×12 mm scan patterns were obtained at each visit. Area measurements of GA were obtained from the en face images generated from a slab with boundaries extending 64 to 400 µm beneath Bruch's membrane. MAIN OUTCOME MEASURES: Comparison of area measurements and enlargement rates (ERs) measurements between the 6×6 mm and 12×12 mm scan patterns. RESULTS: Thirty-two eyes of 25 patients with GA secondary to nonexudative AMD were enrolled. The mean lesion area measurements at baseline were 3.81 mm2 for the 6×6 mm scan and 3.75 mm2 for the 12×12 mm scan. At baseline and over 1 year, the lesion area measurements between the 6×6 mm and the 12×12 mm scan patterns were comparable for all eyes (0.04 mm2; P < 0.001, analysis of variance). The annual ER measurements from the 6×6 mm and 12×12 mm scan patterns were similar (Pearson r = 0.99), with an average ER using the square root transformation strategy of 0.3 mm/year. CONCLUSIONS: Both the 6×6 mm and the 12×12 mm scan patterns resulted in similar area and ER measurements for GA when visualized using the en face images. With the 12×12 mm scan pattern, which represents a 40° field of view (FOV), the measurement of GA using OCT en face imaging is no longer limited by the 6×6 mm FOV. Since macular GA can extend beyond the 6×6 mm FOV, the 12×12 mm FOV can now image all macular GA. With a FOV now similar to autofluorescence and color fundus imaging, SS OCT imaging can be used as the sole imaging method for the detection, measurement, and ER assessment of all GA associated with AMD in clinical practice and in clinical trials.


Assuntos
Técnicas de Diagnóstico Oftalmológico , Atrofia Geográfica/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Atrofia Geográfica/patologia , Humanos
6.
Int J Surg Case Rep ; 65: 189-192, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31726255

RESUMO

BACKGROUND: Paraesophageal hernia (PEH) is a rare form of hiatal hernia, which commonly occurs in elderly people. Although asymptomatic, it can be associated with severe life-threatening complications, such as gastric volvulus. Surgical treatment is reserved for symptomatic patients. Herein, we present two cases of complicated PEH that were treated with laparoscopic posterior cruroplasty and anterior gastropexy. CASE SUMMARY: An 88-year old woman presented with epigastric pain, hematemesis and food intolerance for the last two days. Physical exam revealed mild abdominal distention. Chest X-ray showed a left thoracic opacity, and barium swallow images showed a mixed type III PEH. Abdominal CT-scan images confirmed the diagnosis of incomplete gastric volvulus. The patient underwent a laparoscopic hernia reduction with sac excision, posterior cruroplasty and anterior gastropexy with continuous barbed suturing. The postoperative course was uneventful, and follow-up showed complete resolution of her symptoms. A 91-year old patient was admitted for dyspnea and fever, with vomiting and food intolerance for the last 7 days. Physical exam revealed absent sounds on both lungs. Chest X-ray showed a large left opacity. CT-scan images revealed a giant PEH with complete gastric volvulus. The patient underwent emergency laparoscopic hernia reduction and sac excision, with re-inforced posterior cruroplasty, and anterior gastropexy with continuous barbed suturing. There were no surgical complications, but the patient died on the 4th day postoperatively due to respiratory failure. CONCLUSION: Early laparoscopic posterior cruroplasty and anterior gastropexy is a safe and effective surgical alternative for elderly patients with comorbidities, presenting with symptomatic PEH.

7.
Ophthalmic Surg Lasers Imaging Retina ; 50(8): 474-484, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31415693

RESUMO

BACKGROUND AND OBJECTIVE: To demonstrate the utility of widefield swept-source optical coherence tomography angiography (SS-OCTA) for the diagnosis and management of proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: Consecutive patients with vision-threatening diabetic retinopathy were imaged with widefield SS-OCTA using the 12 mm × 12 mm scan pattern. RESULTS: Twenty-four eyes of 12 patients underwent SS-OCTA imaging. In all 24 eyes, the en face total retinal flow images detected areas of decreased retinal perfusion, and the en face vitreoretinal interface (VRI) slabs detected foci of retinal neovascularization (NV). NV was treated and followed using the VRI images. CONCLUSIONS: Widefield SS-OCTA is a useful, noninvasive technology for the detection and monitoring of NV in PDR. Features of interest, such as areas of decreased retinal perfusion, increased retinal thickness, and NV, can be identified from different en face slabs extracted from a single 12 mm × 12 mm scan. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:474-484.].


Assuntos
Diabetes Mellitus , Retinopatia Diabética/diagnóstico , Técnicas de Diagnóstico Oftalmológico , Angiofluoresceinografia/métodos , Neovascularização Retiniana/diagnóstico , Tomografia de Coerência Óptica/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vasos Retinianos/fisiopatologia
8.
Ophthalmol Retina ; 3(3): 211-219, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31014697

RESUMO

PURPOSE: Structural OCT images from eyes with nonexudative age-related macular degeneration (AMD) were graded for the presence of a double-layer sign to determine if the double-layer sign predicted subclinical macular neovascularization (MNV). DESIGN: Prospective, observational study. PARTICIPANTS: Nonexudative AMD patients with and without subclinical MNV identified by swept-source (SS) OCT angiography (OCTA). METHODS: Participants were enrolled prospectively into an SS OCTA imaging study. A set of test scans with and without subclinical MNV was compiled to assess the ability of trained graders to identify nonexudative type 1 MNV. The graders evaluated only the structural OCT B-scans of those eyes. The presence of a double-layer sign was used as a predictive sign for subclinical type 1 MNV. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) from 2 separate gradings were calculated and compared. MAIN OUTCOME MEASURES: The association between the presence of a double-layer sign and subclinical type 1 MNV. RESULTS: One hundred eyes with nonexudative AMD from 94 patients were used for this study. The test set contained 64 eyes with intermediate AMD, which included 20 eyes with subclinical MNV, and 36 eyes with late AMD, which included 13 eyes with subclinical MNV. Two junior graders read the scans separately then reached a consensus grading. They detected a double-layer sign in 24 of 33 eyes with subclinical MNV and did not detect a double-layer sign in 56 of 67 eyes without MNV. Their sensitivity, specificity, PPV, and NPV were 73%, 84%, 69%, and 86%, respectively. The senior grader detected a double-layer sign in 29 of 33 eyes with subclinical MNV and did not detect a double-layer sign in 58 of 67 eyes without MNV, achieving a sensitivity, specificity, PPV, and NPV of 88%, 87%, 76%, and 94%, respectively. For all graders, there were statistically significant associations between type 1 MNV and presence of the double-layer sign (P < 0.001). CONCLUSIONS: Presence of the double-layer sign on structural OCT B-scans was associated with subclinical type 1 MNV and can be used to identify these lesions with good predictive values in eyes with nonexudative AMD.


Assuntos
Neovascularização de Coroide/diagnóstico por imagem , Técnicas de Diagnóstico Oftalmológico , Degeneração Macular/diagnóstico por imagem , Tomografia de Coerência Óptica , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade
9.
Am J Ophthalmol ; 208: 1-11, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31229464

RESUMO

PURPOSE: Swept source optical coherence tomography angiography (SS-OCTA) was used to study the prevalence, incidence, and natural history of subclinical macular neovascularization (MNV) in eyes with unilateral nonexudative age-related macular degeneration. DESIGN: Prospective cohort study. METHODS: Patients were imaged using 3- × 3-mm and 6- × 6-mm SS-OCTA scan patterns. MNV was detected using the outer retina to choriocapillaris en face slab. Prevalence and incidence of subclinical MNV, Kaplan-Meier cumulative estimates for the overall risk of exudation, and the association between neovascular lesion size and the risk of exudation were assessed through 2 years. RESULTS: From August 2014 through March 2018, 227 patients (154 intermediate and 73 late age-related macular degeneration eyes) underwent SS-OCTA imaging. Thirty eyes (13.2%) had subclinical MNV at first imaging and 12 eyes (8.9%) developed subclinical MNV during follow-up. Of the 191 eyes with >1 visit, 19 developed exudation. Fourteen of these eyes had pre-existing subclinical MNV. The incidence of exudation from the time of first detection of any subclinical MNV was 34.5%. The relative risk of exudation after detection of subclinical MNV was 13.6 times greater (95% confidence interval 4.9-37.7) than in the absence of subclinical MNV (P < .001). There was no significant risk of exudation based on lesion size alone (P = .91). CONCLUSIONS: By 24 months, the risk of exudation was 13.6 times greater for eyes with subclinical MNV detected by SS-OCTA compared with eyes without subclinical MNV. For eyes with subclinical MNV in the absence of symptomatic exudation, we recommend close follow-up without treatment.


Assuntos
Exsudatos e Transudatos , Atrofia Geográfica/complicações , Neovascularização Retiniana/epidemiologia , Degeneração Macular Exsudativa/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/epidemiologia , Feminino , Angiofluoresceinografia , Atrofia Geográfica/diagnóstico , Humanos , Incidência , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Neovascularização Retiniana/diagnóstico , Neovascularização Retiniana/tratamento farmacológico , Fatores de Risco , Fatores de Tempo , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Degeneração Macular Exsudativa/diagnóstico , Degeneração Macular Exsudativa/tratamento farmacológico
10.
Am J Ophthalmol ; 200: 110-122, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30639367

RESUMO

PURPOSE: Swept-source optical coherence tomography angiography (SS-OCTA) was used to measure the age-dependent changes in macular choriocapillaris (CC) flow deficits (FDs) in normal eyes. DESIGN: A prospective, cross-sectional study. METHODS: Subjects with normal eyes ranging in age from their 20s to their 80s were imaged using a 100-kHz SS-OCTA instrument (PLEX Elite 9000, Carl Zeiss Meditec, Dublin, California, USA). Both 3 × 3-mm and 6 × 6-mm scans were used to image the macular CC. Visualization of the CC and quantification of FDs were performed using a previously validated algorithm. The percentage of FDs (FD%) in the central 1-mm circle (C1), 1.5-mm rim (R1.5), and 2.5-mm circle (C2.5) from the 3 × 3-mm and 6 × 6-mm scans and FD% in the 2.5-mm rim (R2.5) and 5-mm circle (C5) from the 6 × 6-mm scans were measured and correlated with age and axial length. RESULTS: A total of 164 subjects were enrolled, with at least 10 subjects from each decade of life. No meaningful correlations were found between FD% and axial length (|r| < 0.30). FD% in all fields increased with increasing age (all r > 0.50; all P < .001); however, the greatest increases were found in the central macula C1 regions and the smallest increases in the peripheral macula R2.5 regions. CONCLUSIONS: In normal aging, the FD% increased with age across the central 5 mm of the macula, but the greatest increase was found in the central 1-mm region of the macula.


Assuntos
Envelhecimento/fisiologia , Corioide/irrigação sanguínea , Macula Lutea/irrigação sanguínea , Retina/fisiologia , Epitélio Pigmentado da Retina/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comprimento Axial do Olho/anatomia & histologia , Corioide/diagnóstico por imagem , Estudos Transversais , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Normal , Estudos Prospectivos , Fluxo Sanguíneo Regional/fisiologia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Adulto Jovem
11.
Ophthalmic Surg Lasers Imaging Retina ; 49(11): 878-886, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30457647

RESUMO

BACKGROUND AND OBJECTIVE: Swept-source optical coherence tomography angiography (SS-OCTA) and different boundary-specific segmentation strategies were used to distinguish type 1 macular neovascularization (MNV) from type 2 MNV in eyes with exudative age-related macular degeneration (AMD). PATIENTS AND METHODS: Eyes with exudative AMD were enrolled in a prospective study. Segmentation strategies included a slab from the outer retina (OR) to the choriocapillaris (CC) for the entire MNV, a slab from the retinal pigment epithelium (RPE) to the CC for the type 1 MNV, and a slab from the OR to the RPE for the type 2 MNV. RESULTS: In 13 eyes, SS-OCTA B-scans and en face images using different segmentation strategies were able to identify type 1 and type 2 components of the MNV. CONCLUSION: In eyes with exudative AMD, SS-OCTA imaging and commercially available boundary-specific segmentation strategies were used to distinguish between type 1 and type 2 MNV. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:878-886.].


Assuntos
Angiofluoresceinografia/métodos , Macula Lutea/patologia , Neovascularização Retiniana/diagnóstico , Tomografia de Coerência Óptica/métodos , Degeneração Macular Exsudativa/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Fundo de Olho , Humanos , Macula Lutea/irrigação sanguínea , Masculino , Estudos Prospectivos
12.
Ophthalmic Surg Lasers Imaging Retina ; 49(5): 303-312, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29772040

RESUMO

BACKGROUND AND OBJECTIVE: To demonstrate the advantage of optical coherence tomography angiography (OCTA) for the diagnosis and management of proliferative macular telangiectasia type 2 (MacTel2) masquerading as neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS: This is an observational cases series. Three patients referred with the diagnosis of neovascular AMD were identified in this retrospective study. In addition to color fundus, fluorescein angiography, and spectral-domain OCT (SD-OCT) imaging, SD-OCTA (AngioPlex; Carl Zeiss Meditec, Dublin, CA) was performed. RESULTS: SD-OCTA revealed bilateral parafoveal retinal microvascular changes in three patients and unambiguously confirmed the diagnosis of MacTel2. CONCLUSION: OCTA is an important tool for the correct diagnosis of MacTel2 in older patients with the concomitant or masquerading diagnosis of AMD. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:303-312.].


Assuntos
Neovascularização de Coroide/diagnóstico , Angiografia por Tomografia Computadorizada , Técnicas de Diagnóstico Oftalmológico , Degeneração Macular/diagnóstico , Telangiectasia Retiniana/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
Ophthalmic Surg Lasers Imaging Retina ; 49(5): 360-363, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29772047

RESUMO

Swept-source optical coherence tomography angiography (SS-OCTA) was used to diagnose choroidal neovascularization (CNV) arising from a choroidal nevus. A 61-year-old woman initially presented with submacular hemorrhage. She was diagnosed with neovascular age-related macular degeneration (AMD) and received three injections of bevacizumab (Avastin; Genentech, South San Francisco, CA). At a follow-up visit, SS-OCTA showed that the CNV appeared to arise from an adjacent choroidal nevus. This is the first report of using SS-OCTA to diagnose CNV associated with a choroidal nevus masquerading as neovascular AMD. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:360-363.].


Assuntos
Neoplasias da Coroide/diagnóstico por imagem , Neovascularização de Coroide/diagnóstico por imagem , Nevo/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Angiografia/métodos , Diagnóstico Diferencial , Feminino , Humanos , Degeneração Macular/diagnóstico , Pessoa de Meia-Idade
14.
Quant Imaging Med Surg ; 8(7): 658-666, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30211033

RESUMO

BACKGROUND: To estimate choriocapillaris flow deficits beyond normal intercapillary distance with swept source optical coherence tomography angiography (SS-OCTA). METHODS: Subjects were enrolled and repeated SS-OCTA scans were performed using the 3 mm × 3 mm scan pattern. Blood flow was identified using the complex optical microangiography (OMAGc) algorithm. The choriocapillaris (CC) was defined as a 20 µm slab of the flow volume beneath the outer boundary of Bruch's membrane (BM) and was compensated with the corresponding structural image for flow deficits measurement. Flow deficits were segmented based on one mean standard deviation from a normal database. A histogram based thresholding method was developed to remove small flow deficits that were determined by examining intercapillary spacing within normal CC networks. A registration method based on affine and B-spline transformation was utilized for the CC angiogram averaging. Four repeated scans were averaged, and results were compared with and without removal of small flow deficits after averaging a different number of scans (N=1, group 1; N=2, group 2; N=3, group 3 and N=4, group 4). RESULTS: Seven normal subjects were enrolled. Intercapillary distance was found to be 24 µm for the CC networks under OCTA, which was used as the threshold to exclude small flow deficits for CC quantification. After averaging, significant reduction in background noise and improvement in continuity of blood vessel networks were observed both on retinal and choriocapillaris angiograms. Flow deficit percentages of the choriocapillaris were significantly reduced with averaging (group 1 vs. group 2: P<0.0001; group 2 vs. group 3: P<0.001; group 3 vs. group 4: P<0.001). The flow deficit percentages were also significantly reduced after removing the small flow deficits (≤24 µm in diameter) in all groups (P<0.01). A statistically significant difference was found after removing small flow deficits (≤24 µm in diameter) between group 1 and group 2 (P<0.001), between group 2 and group 3 (P<0.05), and between group 3 and group 4 (P<0.05). However, the significance was decreased compared to that without small flow deficits removal. CONCLUSIONS: A method was developed to improve the robust estimation of choriocapillaris flow deficits by removing the small flow deficits corresponding to normal intercapillary spacing. After the removal of small flow deficits, fewer repeats were required for image averaging to achieve comparable accuracy of flow deficit measurements with SS-OCTA.

15.
Ophthalmic Surg Lasers Imaging Retina ; 49(10): e157-e160, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30395679

RESUMO

A 73-year-old woman with 2 weeks of progressive painless vision loss was found to have bilateral corneal edema, jaw claudication, and temporal headache. Multimodal imaging revealed an Amalric choroidal infarct in the left eye visualized by widefield indocyanine green angiography and swept-source optical coherence tomography angiography (SS-OCTA). Prompt intravenous corticosteroid treatment resulted in 20/20 vision, and giant cell arteritis (GCA) was confirmed by a temporal artery biopsy. The case underscores the use of widefield SS-OCTA as a non-invasive test to aid in the diagnosis of GCA, as well as bilateral cornea edema as a rare presentation of GCA. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e157-e160.].


Assuntos
Doenças da Coroide/etiologia , Corioide/irrigação sanguínea , Edema da Córnea/etiologia , Angiofluoresceinografia/métodos , Arterite de Células Gigantes/complicações , Infarto/etiologia , Tomografia de Coerência Óptica/métodos , Idoso , Biópsia , Doenças da Coroide/diagnóstico , Edema da Córnea/diagnóstico , Feminino , Fundo de Olho , Arterite de Células Gigantes/diagnóstico , Humanos , Infarto/diagnóstico , Doenças Raras , Artérias Temporais/patologia
16.
Invest Ophthalmol Vis Sci ; 59(1): 203-211, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29340648

RESUMO

Purpose: To achieve reproducible imaging of the choriocapillaris and associated flow voids using swept-source OCT angiography (SS-OCTA). Methods: Subjects were enrolled and SS-OCTA was performed using the 3 × 3 mm scan pattern. Blood flow was identified using the complex optical microangiography (OMAG) algorithm. The choriocapillaris was defined as a slab from the outer boundary of Bruch's membrane (BM) to approximately 20 µm below BM. Compensation for the shadowing effect caused by the RPE and BM complex on the choriocapillaris angiogram was achieved by using the structural information from the same slab. A thresholding method to calculate the percentage of flow voids from a region was developed based on a normal database. Results: Twenty normal subjects and 12 subjects with drusen were enrolled. SS-OCTA identified the choriocapillaris in normal subjects as a lobular plexus of capillaries in the central macula and the lobular arrangement became more evident toward the periphery. In all eyes, signal compensation resulted in fewer choriocapillaris flow voids with improved repeatability of measurements. The best repeatability for the measurement was achieved by using 1 standard deviation (SD) for the thresholding strategy. Conclusions: SS-OCTA can image the choriocapillaris in vivo, and the repeatability of flow void measurements is high in the presence of drusen. The ability to image the choriocapillaris and associated flow voids should prove useful in understanding disease onset, progression, and response to therapies.


Assuntos
Corioide/irrigação sanguínea , Fluxo Sanguíneo Regional/fisiologia , Drusas Retinianas/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Capilares/diagnóstico por imagem , Capilares/fisiologia , Corioide/diagnóstico por imagem , Feminino , Angiofluoresceinografia , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Drusas Retinianas/diagnóstico por imagem , Tomografia de Coerência Óptica , Adulto Jovem
17.
Invest Ophthalmol Vis Sci ; 58(12): 5098-5104, 2017 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-28986595

RESUMO

Purpose: We compared area measurements for the same neovascular lesions imaged using swept source optical coherence tomography angiography (SS-OCTA) and enlarging scan patterns. Methods: Patients with neovascular age-related macular degeneration were imaged using a 100-kHz SS-OCTA instrument (PLEX Elite 9000). The scanning protocols included the 3 × 3, 6 × 6, 9 × 9, and 12 × 12 mm fields of view. Two groups were studied. Group 1 included small lesions contained within the 3 \( \times \) 3 mm scan, and Group 2 included larger lesions that were fully contained within the 6 \( \times \) 6 mm scan. Results: A total of 30 eyes of 26 patients were enrolled in Group 1 and 30 eyes of 25 patients were enrolled in Group 2. In Group 1, the automated mean lesion area measurements were 1.11 (SD = 0.78), 1.14 (SD = 0.80), and 1.27 (SD = 0.82) mm2 for the 3 \( \times \) 3, 6 \( \times \) 6, and 12 \( \times \) 12 mm scans, respectively (ANOVA P < 0.001; post hoc comparisons, P = 0.184, 3 \( \times \) 3 vs. 6 \( \times \) 6 mm; P < 0.001 for the other two pairs). In Group 2, the automated mean lesion area measurements were 5.43 (SD = 2.56), 5.53 (SD = 2.48), and 5.49 (SD = 2.65) mm2 for the 6 \( \times \) 6, 9 \( \times \) 9, and 12 \( \times \) 12 mm scans, respectively (ANOVA P = 0.435; post-hoc comparisons, P = 0.062, 6 \( \times \) 6 vs. 9 \( \times \) 9 mm; P = 0.553, 6 \( \times \) 6 vs. 12 \( \times \) 12 mm; P = 0.654, 9 \( \times \) 9 vs. 12 \( \times \) 12 mm). Conclusions: The similarity in lesion area measurements across different scan patterns suggests that SS-OCTA imaging can be used to follow quantitatively the enlargement of choroidal neovascularization as the disease progresses.


Assuntos
Corioide/irrigação sanguínea , Neovascularização de Coroide/diagnóstico , Artérias Ciliares/patologia , Angiografia por Tomografia Computadorizada , Vasos Retinianos/patologia , Tomografia de Coerência Óptica/métodos , Degeneração Macular Exsudativa/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
18.
Bull Cancer ; 71(5): 419-24, 1984.
Artigo em Francês | MEDLINE | ID: mdl-6525467

RESUMO

OEsophageal papillomas and carcinomas have been induced in Wistar rats using Ethyl-N-Butyl-Nitrosamine. None of those lesions were observed in a previous experiment on the same rats strains, with ethanol and apple brandy. Experimentally induced tumours in the rat are different from oesophageal cancers and associated mucous lesions in man. Both upper digestive mucosae are only similar in regards to their response to carcinogens.


Assuntos
Carcinoma/induzido quimicamente , Dietilnitrosamina , Neoplasias Esofágicas/induzido quimicamente , Nitrosaminas , Papiloma/induzido quimicamente , Animais , Carcinoma/patologia , Bochecha , Dietilnitrosamina/análogos & derivados , Neoplasias Esofágicas/patologia , Feminino , Neoplasias Hepáticas/induzido quimicamente , Masculino , Neoplasias Bucais/induzido quimicamente , Papiloma/patologia , Neoplasias Faríngeas/induzido quimicamente , Ratos
19.
Ann Pathol ; 6(3): 233-7, 1986.
Artigo em Francês | MEDLINE | ID: mdl-2430589

RESUMO

The introduction of a specific glycoprotein dye in the standard coloration permits the revelation of the epithelial acid mucins. A series of experiments permitted us to retain the Astra Blue and to define its conditions of usage. This simple technic has been routinely used for the last three years in our laboratory. It was particularly useful in the diagnosis of intestinal metaplasia and adenocarcinoma.


Assuntos
Indóis , Patologia/métodos , Histocitoquímica , Humanos , Coloração e Rotulagem/métodos
20.
Ann Pathol ; 10(5-6): 358-9, 1990.
Artigo em Francês | MEDLINE | ID: mdl-2085362

RESUMO

The disposable simple cell Cytocell 2 for Cytospin 2 Shandon cytocentrifuge offers the theoretical possibility of making two areas cell deposit on one microscope slide. Unfortunately, this is not realizable because the clip only presses the inferior part of the Cytocell 2. The authors propose a simple mean to resolve this problem.


Assuntos
Centrifugação/instrumentação , Técnicas Citológicas/instrumentação , Centrifugação/métodos
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