Circulating angiopoietic cells and diabetic retinopathy in type 2 diabetes mellitus, with or without macrovascular disease.

PURPOSE: To investigate different types of circulating angiopoietic cells, such as vasculogenic circulating progenitor cells (CPCs), endothelial progenitor cells (EPCs), and mature EPCs (matEPCs) in patients with type 2 diabetes mellitus (T2DM), with or without diabetic retinopathy (DR) and with or without macrovascular disease (MVD). METHODS: One hundred twenty-six patients with T2DM-66 with MVD and 60 without MVD-were enrolled in a case-control study. MVD comprised coronary heart disease, peripheral arterial disease, stroke, or various combinations of those conditions. By a modified Early Treatment of Diabetic Retinopathy Study (ETDRS) classification, 55 patients were classified without DR (CO), 19 with mild nonproliferative DR (mNPDR), 16 with moderate-severe NPDR (msNPDR), 19 with early proliferative diabetic retinopathy (ePDR), and 17 with high-risk PDR (hrPDR). CPCs (CD34/CD133), EPCs (CD34/CD133/CD30), and matEPCs (CD34/CD133/CD309/CD31) were enumerated by flow cytometry. RESULTS: Patients with MVD CPCs, EPCs, and matEPCs showed a significant, stepwise decline with advancing stages of retinopathy. In contrast, in the patients without MVD, EPCs and matEPCs reached up to 56% of CPCs and 37% of EPCs. On the other hand, the percentage of EPCs and matEPCs was reduced to 5% of CPCs and EPCs each in MVD patients. Thus, the percentage of EPCs and matEPCs in comparison with that of CPCs and EPCs represented an 11- and 7-fold difference. CONCLUSIONS: The circulating angiopoietic CPCs, EPCs, and matEPCs in T2DM patients with DR had a different regulations, with increasing relative differences occurring in proliferative DR, apparently depending on the macrovascular comorbidities. Patients with MVD showed a strong retinopathy-stage-dependent depletion of all angiopoietic cells.

Spectral domain optical coherence tomography for higher precision in the evaluation of vitreoretinal adhesions in exudative age-related macular degeneration.

AIM: The role of changes at the vitreoretinal interface and vitreomacular traction forces in pathogenesis, and the course of exudative age-related macular degeneration (AMD) need further exploration. This study examines the localisation of adhesion and the direction of traction lines in eyes with exudative AMD. METHODS: The cubes 512×128 of Cirrus optical coherence tomography (OCT) and volume scans of Spectralis OCT were reviewed in a consecutive series of patients presenting between December 2008 and March 2009 with vitreomacular adhesion in exudative AMD. RESULTS: 30 eyes of 25 patients with exudative AMD and vitreomacular adhesion were studied. 50% had type III lesions, 46.7% occult and 3.3% predominantly classic lesions. The localisation of the adhesion corresponded in 100% with the area of the neovascularisation (CNV), in 73.3% traction directed towards the CNV and in 83.3% towards the optic disc could be noted. Spectral domain OCT and 3D visualisation enabled clearer localisation of vitreomacular adhesion and definition of resulting traction lines. CONCLUSION: There is a high prevalence of type III lesions within eyes with vitreomacular adhesions, and complete correspondence between the location of the adhesion and the CNV. There is also a high incidence of vitreopapillary adhesion in these cases, suggesting a possible role in pathogenesis.

Comparison of visual performance with blue light-filtering and ultraviolet light-filtering intraocular lenses.

PURPOSE: To compare the contrast sensitivity, glare, color perception, and visual acuity at different light intensities with yellow-tinted and clear intraocular lenses (IOLs) by different manufacturers. SETTING: Ludwig Boltzmann Institute of Retinology and Biomicroscopic Laser-Surgery, Department of Ophthalmology, Rudolf Foundation Clinic, Vienna, Austria. DESIGN: Comparative case series. METHODS: Eyes were randomized to 1 of the following IOLs: AF-1 (UY) (yellow tinted), AcrySof SN60AT (yellow tinted), AF-1 (UV) (clear), or AcrySof SA60AT (clear). One week and 2 months postoperatively, monocular contrast sensitivity function and color discrimination were tested and the corrected distance and near visual acuities were evaluated. All tests were performed under different light intensities (10 to 1000 lux). RESULTS: Of the 80 patients enrolled, 76 completed the study; there were 37 eyes in the yellow-tinted IOL group and 39 in the clear IOL group. There were no significant differences between yellow-tinted IOLs and clear IOLs except in color vision under mesopic conditions (10 lux). Patients with a yellow-tinted IOL made significantly more mistakes in the blue-light spectrum than patients with clear IOLs (P = .00015). There was no significant difference under photopic conditions (1000 lux). CONCLUSIONS: The yellow-tinted IOLs were equivalent to the clear IOLs in postoperative contrast sensitivity, visual acuity, and color perception under photopic conditions. Patients with yellow-tinted IOLs made statistically significantly more mistakes in the blue range under dim light than patients with clear IOLs.

Advantages of using a ray-traced, three-dimensional rendering system for spectral domain Cirrus HD-OCT to visualize subtle structures of the vitreoretinal interface.

BACKGROUND AND OBJECTIVE: To create a ray-traced, three-dimensional display system for Cirrus high-definition optical coherence tomography (Carl Zeiss Meditec, Inc., Dublin, CA) that improves the visualization of subtle structures of the vitreoretinal interface. PATIENTS AND METHODS: High-definition optical coherence tomography (HD-OCT) data for epiretinal membranes (17 eyes), macular holes (11 eyes), and posterior vitreal detachments (17 eyes) were collected. A display system that visualizes the acquired data using ray-tracing algorithms was designed and compared with the Cirrus HD-OCT 2.0 advanced visualization software system. The area around the vitreoretinal interface was visualized using a 100-microm-thick internal limiting membrane (ILM) fitted slab as well as ILM and retinal pigment epithelium surface reconstructions. RESULTS: Subtle structures could be visualized more distinctly using the ray-traced, three-dimensional rendering software. CONCLUSION: A ray-traced visualization system improves the visualization of subtle structures in and around the vitreoretinal interface.

Efficacy of intravitreal bevacizumab (Avastin) therapy for early and advanced neovascular age-related macular degeneration.

PURPOSE: To evaluate the safety and efficacy of intravitreal bevacizumab therapy for early and advanced neovascular age-related macular degeneration (ARMD). METHODS: A consecutive series of eyes with neovascular ARMD treated with monthly intravitreal injections of bevacizumab (1.25 mg/0.05 ml) as long as there was evidence of activity on fluorescein angiography (FA) and optical coherence tomography (OCT) was included and observed for 6 months. For further analysis they were assigned to either an early (untreated/newly diagnosed) or an advanced (predominantly fibrotic/pre-treated) ARMD group. We examined distance visual acuity (VA) with Early Treatment Diabetic Retinopathy Study (ETDRS) charts and central retinal thickness with OCT, as well as lesion size and safety aspects. RESULTS: Forty-four patients (44 eyes) were enrolled (21 early lesions, 23 advanced lesions). Mean VA changed from 0.74 logMAR at baseline to 0.68 logMAR at month 6 (P = 0.01). Improvement in VA was statistically significant only in eyes with early lesions (n = 21) from month 1 (P = 0.015) up to month 6 (P = 0.03). The changes in central retinal thickness (CRT) (P < 0.001) and total lesion size (P < 0.001) were significant in both groups (early and advanced) at all time-points during follow-up. No significant ocular or systemic adverse effects were observed. CONCLUSION: Intravitreal bevacizumab was tolerated well by our patients and we did not identify any apparent short-term safety concerns. We observed stabilization in VA overall, with significant improvement in the early lesion group.

Correlation of different circulating endothelial progenitor cells to stages of diabetic retinopathy: first in vivo data.

PURPOSE: To investigate vasculogenic circulating progenitor cells (CPCs), endothelial progenitor cells (EPCs), and mature EPCs in patients with type 1 diabetes mellitus (T1DM) with or without diabetic retinopathy (DR). METHODS: A case-control study comparing 90 patients with T1DM with and without DR was performed. Patients were studied and staged for retinopathy according to the Early Treatment of Diabetic Retinopathy Study (ETDRS) classification. Ninety patients were included: 30 without DR (control [CO]), 30 with mild nonproliferative DR (mNPDR), 10 with moderate-severe NPDR (msNPDR), 10 with mild-moderate proliferative diabetic retinopathy (mmPDR), and 10 with high-risk PDR (hrPDR). CPCs (CD34/CD133), EPCs (CD34/CD133/CD309), and mature EPCs (CD34/CD133/CD309/CD31) were enumerated by flow cytometry. RESULTS: EPCs were reduced in mNPDR (114 +/- 66; P < 0.001) and msNPDR (77 +/- 40; P = 0.042) compared with CO (244 +/- 115). In contrast, EPCs were unchanged in mmPDR (248 +/- 155) compared with CO. Strikingly, EPCs were augmented in hrPDR (389 +/- 124) compared with all other stages. Numbers of undifferentiated progenitor cells (CPCs) did not differ among CO, mmPDR, and hrPDR. Augmentation (3x) of mature EPCs in hrPDR (325 +/- 118; P < 0.001) compared with CO (100 +/- 49) but against all other stages of DR was observed. The percentage of mature EPCs/EPCs was augmented in an ETDRS classification-dependent manner. CONCLUSIONS: In patients with T1DM with DR, EPCs undergo stage-related regulation. In nonproliferative retinopathy, a reduction of EPCs was observed, and in proliferative retinopathy, a dramatic increase of mature EPCs was observed.

Posterior vitreomacular adhesion: a potential risk factor for exudative age-related macular degeneration?

PURPOSE: To compare the state of the posterior vitreous in exudative age-related macular degeneration (AMD) with eyes with nonexudative AMD and controls. DESIGN: Prospective, observational case series. METHODS: B-scan ultrasonography and optical coherence tomography (OCT) were performed in 163 eyes from 82 subjects older than 55 years, 50 eyes with exudative AMD, 57 with nonexudative AMD, and 56 control eyes. Main outcome measures were the number of eyes with complete posterior vitreous detachment (PVD) by ultrasound and the number of eyes with central vitreomacular adhesion by OCT. RESULTS: By ultrasonography, 17 (34.0%) of 50 eyes with exudative AMD had PVD as compared with 41 (71.9%) of 57 eyes with nonexudative AMD (P = .00002) and 34 (60.7%) of 56 controls (P = .017). OCT detected persistent central vitreoretinal adhesion surrounded by a detached posterior vitreous cortex in 18 (36%) of 50 eyes with exudative AMD, significantly higher than in nonexudative AMD (4/57 [7%]; P < .0001) and in controls (6/56 [10%]; P = .002). CONCLUSIONS: Persistent attachment of the posterior vitreous cortex to the macula may be another risk factor for the development of exudative AMD via vitreoretinal traction inducing chronic low-grade inflammation, by maintaining macular exposure to cytokines or free radicals in the vitreous gel, or by interfering in transvitreous oxygenation and nutrition of the macula. Inducing PVD may provide prophylactic benefit against exudative AMD.

Three-dimensional optical coherence tomography at 1050 nm versus 800 nm in retinal pathologies: enhanced performance and choroidal penetration in cataract patients.

Frequency domain optical coherence tomography (FD-OCT), based on an all-reflective high-speed InGaAs spectrometer, operating in the 1050 nm wavelength region for retinal diagnostics, enables high-speed, volumetric imaging of retinal pathologies with greater penetration into choroidal tissue is compared to conventional 800 nm three-dimensional (3-D) ophthalmic FD-OCT systems. Furthermore, the lower scattering at this wavelength significantly improves imaging performance in cataract patients, thereby widening the clinical applicability of ophthalmic OCT. The clinical performance of two spectrometer-based ophthalmic 3-D OCT systems compared in respect to their clinical performance, one operating at 800 nm with 150 nm bandwidth (approximately 3 microm effective axial resolution) and the other at 1050 nm with 70 nm bandwidth (approximately 7 microm effective axial resolution). Results achieved with 3-D OCT at 1050 nm reveal, for the first time, decisive improvements in image quality for patients with retinal pathologies and clinically significant cataract.