RESUMO
BACKGROUND: Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system with neuroaxonal damage. It is the principal driver of non-traumatic disability in young adults. Visual symptoms are common and optic neuritis (ON) may be the revealing feature in up to 30% of cases. Structural optical coherence tomography (OCT) represents a biomarker of central nervous system neurodegeneration in MS. OCT-angiography (OCT-A) is a noninvasive tool allowing the study of retinal vasculature and the detection of microvascular damage in neuro-retinal diseases. In this study, we aimed to assess structural and microvascular retinal changes in patients with MS with and without ON and to correlate the findings with visual function and MS disability. METHODS: We conducted a cross-sectional study including patients diagnosed with MS according to the 2017 McDonald criteria. All patients underwent complete neurological examination with evaluation of the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Severity Score (MSSS) and an ophthalmological examination including OCT and OCT-A. Patients were compared with age- and sex-matched healthy subjects. The primary endpoints were assessment of retinal nerve fiber layer (RNFL) thickness, ganglion cell layer (GCL+), and ganglion cell complex (GCL++) thicknesses on OCT. Vascular densities in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC) were assessed on OCT-A, as well as central avascular zone (CAZ) parameters, lacunarity and fractal dimension. RESULTS: A total of 160 MS eyes with and without a previous history of ON and 64 age- and gender-matched healthy eyes were analyzed. Among 160 eyes with MS, 69 had a history of ON. We observed a decrease in RNFL and GCL++ thickness in all 12 quadrants in MS patients when compared to healthy controls. Multivariate analysis by linear regression noted a significant correlation for temporal GCL++ and inferonasal RNFL thickness that were decreased in the MS group. A greater decrease in retinal layers thickness was identified in MS patients with a history of ON. On OCT-A, vascular density in (SCP) was significantly reduced in the MS group (P<0.002). A significant correlation between RNFL thickness and retinal vascular density was found but only in less than half of the hourly quadrants. A significant correlation was noted between visual acuity and CC density (P<0.0001). We also noted an inverse correlation between EDSS scores and CC density (P=0.02 and r=-0.275) and between MSSS and RNFL/GCL++ thicknesses. CONCLUSIONS: RNFL and GCL++ layers were thinner in MS patients with a history of ON and were reversely correlated with disease severity. Moreover, retinal vascular changes were observed in MS even in eyes without ON, and CC was reversely correlated with visual function and current disability. Thus, structural OCT coupled with OCT-A could represent a noninvasive and dynamic biomarker of MS severity and progression.
Assuntos
Esclerose Múltipla , Neurite Óptica , Retina , Vasos Retinianos , Tomografia de Coerência Óptica , Humanos , Tomografia de Coerência Óptica/métodos , Feminino , Masculino , Estudos Transversais , Adulto , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/complicações , Esclerose Múltipla/patologia , Retina/diagnóstico por imagem , Retina/patologia , Pessoa de Meia-Idade , Vasos Retinianos/diagnóstico por imagem , Vasos Retinianos/patologia , Neurite Óptica/diagnóstico por imagem , Neurite Óptica/etiologia , Neurite Óptica/diagnóstico , Neurite Óptica/patologia , Angiofluoresceinografia/métodos , Adulto Jovem , Acuidade VisualAssuntos
Doenças da Coroide , Granuloma , Sarcoidose , Humanos , Sarcoidose/diagnóstico , Sarcoidose/complicações , Sarcoidose/patologia , Granuloma/diagnóstico , Granuloma/patologia , Doenças da Coroide/diagnóstico , Doenças da Coroide/patologia , Doenças da Coroide/etiologia , Feminino , Masculino , Pessoa de Meia-IdadeRESUMO
Systemic Lupus Erythematosus (SLE) is a chronic auto-immune condition with systemic and ocular involvement. Ophthalmological findings are diverse and can involve all layers of the globe. Posterior segment manifestations can include lupus retinopathy, retinal vascular occlusions and lupus choroidopathy. We report here a rare case of central retinal artery occlusion (CRAO) associated with anterior ischemic optic neuropathy (AION) in a young female patient as presenting signs of SLE. In this case report, we highlight a very uncommon initial presentation of this severe systemic vasculitis. A multidisciplinary approach is required in order to prevent life-threatening vaso-occlusive complications.
Assuntos
Disco Óptico , Tomografia de Coerência Óptica , Humanos , Angiografia , AngiofluoresceinografiaRESUMO
PURPOSE: To study the appearance of angioid streaks (AS) in swept source optical coherence tomography angiography. METHODS: Retrospective observational study of 16 patients (31 eyes) with various stages of AS. All included patients underwent complete ophthalmologic examinations including best-corrected visual acuity (BCVA), slit-lamp examination, indirect ophthalmoscopy and fundus photography. Swept source optical coherence tomography (SS-OCT), OCT angiography (OCT-A) and fluorescein angiography were also performed. RESULTS: En face OCT detected hyper-reflective points in 65% of cases, with a choriocapillaris (CC) shadow on the corresponding OCT-A. Diffuse CC rarefaction was detected in 94%. In eyes without neovascular complications, streaks were visible as a hyposignal in the outer retina. An irregular vascular network (IVN) was detected in 80% of eyes. It filled the spaces between the AS and corresponded to flat elevation of the retinal pigmentary epithelium. Twenty-four eyes had choroidal neovascularization (CNV). CNV was type 1 in 8%, type 2 in 43%, mixed in 20% and unclassified in 29% because of a large scar. We found multiple sites of CNV in 8% of cases. CNV shape was tangled in 66% and in 2 eyes with newly diagnosed CNV. OCT-A showed a perilesional halo around new CNV. The morphology and configuration of neovascular network follow the IVN and the path of the AS and arises in proximity to sites of BM disruption. CONCLUSION: OCT-A allows early detection and monitoring of AS and their neovascular complications. It shows CC rarefaction, IVN and a predominantly tangled shape of CNV. However, there are some limitations associated with difficulty in characterizing signs of CNV activity.
Assuntos
Estrias Angioides , Neovascularização de Coroide , Estrias Angioides/complicações , Estrias Angioides/diagnóstico , Corioide , Neovascularização de Coroide/diagnóstico por imagem , Angiofluoresceinografia , Humanos , Tomografia de Coerência ÓpticaAssuntos
Doença da Arranhadura de Gato , Oclusão da Artéria Retiniana , Animais , Doença da Arranhadura de Gato/diagnóstico , Doença da Arranhadura de Gato/diagnóstico por imagem , Gatos , Humanos , Imagem Multimodal , Retina/diagnóstico por imagem , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/etiologiaAssuntos
Neoplasias da Túnica Conjuntiva/diagnóstico , Dirofilariose/diagnóstico , Infecções Oculares Parasitárias/diagnóstico , Corticosteroides/uso terapêutico , Animais , Antibacterianos/uso terapêutico , Neoplasias da Túnica Conjuntiva/tratamento farmacológico , Diagnóstico Diferencial , Dirofilaria repens/fisiologia , Dirofilariose/tratamento farmacológico , Dirofilariose/parasitologia , Cães , Infecções Oculares Parasitárias/tratamento farmacológico , Infecções Oculares Parasitárias/parasitologia , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , TunísiaAssuntos
Fóvea Central/diagnóstico por imagem , Imagem Óptica , Doenças Retinianas/diagnóstico , Tomografia de Coerência Óptica , Transtornos da Visão/diagnóstico , Criança , Cor , Consanguinidade , Fóvea Central/metabolismo , Fóvea Central/patologia , Humanos , Masculino , Transtornos da Pigmentação/diagnóstico , Transtornos da Pigmentação/metabolismo , Transtornos da Pigmentação/patologia , Doenças Retinianas/metabolismo , Doenças Retinianas/patologia , Tunísia , Transtornos da Visão/metabolismo , Transtornos da Visão/patologiaAssuntos
Anormalidades do Olho/diagnóstico , Anormalidades do Olho/genética , Doenças Genéticas Ligadas ao Cromossomo X/diagnóstico , Retina/anormalidades , Síndrome de Aicardi/diagnóstico , Síndrome de Aicardi/genética , Criança , Aberrações Cromossômicas , Transtornos Cromossômicos/diagnóstico , Transtornos Cromossômicos/genética , Cromossomos Humanos Par 8/genética , Cromossomos Humanos X/genética , Feminino , Doenças Genéticas Ligadas ao Cromossomo X/genética , Humanos , Lactente , Recém-Nascido , Masculino , Retina/diagnóstico por imagem , Retina/patologia , Trissomia/diagnóstico , Trissomia/genética , Síndrome de Turner/diagnóstico , Síndrome de Turner/genéticaAssuntos
Oftalmopatias Hereditárias/complicações , Oftalmopatias Hereditárias/diagnóstico por imagem , Edema Macular/diagnóstico por imagem , Edema Macular/etiologia , Degeneração Retiniana/complicações , Degeneração Retiniana/diagnóstico por imagem , Cistos/diagnóstico , Cistos/diagnóstico por imagem , Cistos/etiologia , Oftalmopatias Hereditárias/diagnóstico , Fundo de Olho , Humanos , Edema Macular/diagnóstico , Masculino , Pessoa de Meia-Idade , Imagem Óptica , Degeneração Retiniana/diagnóstico , Tomografia de Coerência ÓpticaRESUMO
PURPOSE: to report a case of a woman who had a severe cranial trauma complicated by two ophalmologic potentially cecitating complications: right carotido-cavernous fistula and left traumatic optic neuropathy. OBSERVATION: A 56 years-old woman, without any medical history, referred, one month after fall from a height of 3 meters, for right exophthalmos. Ophthalmic examination of the right eye completed by retinal angiography suspected carotid-cavernous fistula which was confirmed by angio-MRI. In the left eye, the visual acuity was decreased to no light perception and fundus examination showed optic nerve head palor secondary to traumatic optic neuropathy. Arterial embolization was performed and allowed closing of the fistula. CONCLUSION: Optic neuropathy and carotido-cavernous fistula are two severe complications that can occur simultaneously in the same patient. The prognosis of the optic neuropathy may be compromised, and the treatment of carotido-cavernous fistula benefited from progress in interventional neuro-radiology.
Assuntos
Fístula Carótido-Cavernosa/etiologia , Traumatismos Craniocerebrais/complicações , Doenças do Nervo Óptico/etiologia , Fístula Carótido-Cavernosa/diagnóstico , Fístula Carótido-Cavernosa/terapia , Seio Cavernoso/patologia , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/terapia , Embolização Terapêutica , Exoftalmia/diagnóstico , Exoftalmia/etiologia , Exoftalmia/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/terapia , Resultado do TratamentoAssuntos
Coristoma/diagnóstico , Neoplasias da Coroide/diagnóstico , Neovascularização de Coroide/diagnóstico , Osteoma/diagnóstico , Tomografia de Coerência Óptica , Bevacizumab/administração & dosagem , Coristoma/complicações , Coristoma/tratamento farmacológico , Neoplasias da Coroide/complicações , Neoplasias da Coroide/tratamento farmacológico , Neovascularização de Coroide/complicações , Neovascularização de Coroide/tratamento farmacológico , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Pessoa de Meia-Idade , Osteoma/complicações , Osteoma/tratamento farmacológico , Fatores de Tempo , Tomografia de Coerência Óptica/métodosRESUMO
PURPOSE: To describe the contribution of multimodal imaging in the various stages of Stargardt disease (STGD). PATIENTS AND METHODS: We retrospectively reviewed 46 eyes of 23 STGD patients with identified ABCA4 mutations. All patients underwent a complete ophthalmic examination, spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence (FAF), fluorescein angiography (FA) and Indocyanine green angiography (ICGA). RESULTS: The mean age of patients was 25.5 years (range 8-56). Fundus examination was normal in 2 patients (subclinical stage), where SD-OCT showed localized retrofoveolar retinal pigment epithelium (RPE) thickening. FAF was normal in 1 eye and showed mild heterogeneous hyper-FAF in 3 eyes. Twelve eyes had mild salt and pepper changes in the macula (early stage) with diffuse retinal atrophy on SD-OCT and mixed hyper and hypoautofluorescence on FAF. Nine patients showed central atrophy with white-yellow flecks distributed in the posterior pole and mid-periphery. This phenotype showed total foveal atrophy on SD-OCT and normal peripapillary area on FAF. Twelve eyes had a large demarcated area of RPE atrophy, pigment clumping and migration extending to the peripheral retina associated with peripapillary atrophy. These eyes showed diffuse retinochoroidal atrophy on OCT with diffuse alterations reaching the peripapillary area on FAF. On FA, it was difficult to analyze the choroidal silence sign in patients with advanced stages of the disease. A hyperfluorescent window defect pattern was also found in patients with white-yellow flecks and did not correspond exactly to them, or to the areas of peripheral autofluorescent lesions. ICGA showed hypocyanescent areas seen at intermediate and late phases with multiple cyanescent points adjacent to them. On ICGA, hypocyanescent areas were more extensive than lesions observed on FAF. CONCLUSIONS: Multimodal imaging is helpful for the diagnosis of early stages of STGD disease and to better understand its pathophysiology. FAF and mostly SD-OCT have supplanted FA in the early, especially subclinical, stages. Over all, ICGA shows more extensive damage, making this tool useful for better understanding STGD and suggesting possible direct damage to the choriocapillaris associated with RPE lesions. In advanced stages, only DNA testing can confirm the diagnosis of STGD.
Assuntos
Técnicas de Diagnóstico Oftalmológico , Degeneração Macular/congênito , Imagem Multimodal/métodos , Adolescente , Adulto , Criança , Progressão da Doença , Família , Feminino , Genes Recessivos , Humanos , Degeneração Macular/diagnóstico , Degeneração Macular/genética , Degeneração Macular/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Doença de Stargardt , Adulto JovemAssuntos
Contusões/complicações , Traumatismos Oculares/complicações , Oclusão da Artéria Retiniana/etiologia , Oclusão da Veia Retiniana/etiologia , Adulto , Contusões/patologia , Traumatismos Oculares/patologia , Feminino , Humanos , Oclusão da Artéria Retiniana/patologia , Oclusão da Veia Retiniana/patologia , Transtornos da Visão/etiologia , Transtornos da Visão/patologiaAssuntos
Traumatismos Oculares/diagnóstico , Neoplasias Oculares/diagnóstico , Subluxação do Cristalino/diagnóstico , Limbo da Córnea/patologia , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Traumatismos Oculares/complicações , Traumatismos Oculares/patologia , Neoplasias Oculares/patologia , Feminino , Humanos , Subluxação do Cristalino/etiologia , Subluxação do Cristalino/patologiaRESUMO
Best vitelliform macular dystrophy is the second most frequent hereditary maculopathy, with bilateral involvement and juvenile onset. It is clinically characterized by bilateral deposits of lipofuscin-like autofluorescent material in the subretinal space, with a typical phenotypic manifestation taking the form of a vitelliform macular lesion evolving gradually into more advanced stages. The purpose of our study was to describe fundus autofluorescence patterns and OCT findings in three patients (6 eyes) with several stages of Best vitelliform macular dystrophy. Optical coherence tomography (OCT) has become the first imaging technique to order when confronted with a hereditary maculopathy suggesting Best disease. Fundus autofluorescence combined with OCT allow for better diagnosis and management, which are necessary for any genetic analysis.