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BACKGROUND/AIM: The aim of this paper is to compare retinal nerve fiber layer thickness (RNFL) and Bruch's membrane opening-based minimum rim width (BMO-MRW) in terms of their performance in detecting early and moderate/advanced glaucoma using receiver operating characteristics (ROC) analysis and the classification using the 5th percentile as a cut-off. METHODS: One hundred eyes from 100 patients with early glaucoma (mean deviation (MD): < -5.0 dB) and 100 eyes from 100 patients with moderate/advanced glaucoma (MD: > -5.0 dB) were carefully matched to healthy controls based on optic disc size. Then, the dataset was divided, based on the 50th percentile of the measured Bruch's membrane opening area (BMO-A), into small (BMO-A < 1.95 mm2) and large optic discs (BMO-A > 1.95 mm2). Finally, the discriminative performance of BMO-MRW and RNFL between glaucoma and controls using ROC analysis and the manufacturer's classification based on the 5th percentile was analyzed. RESULTS: In discriminating between glaucoma and matched healthy controls, global BMO-MRW and global RNFL thickness had comparable areas under the ROC curve for eyes with early glaucoma and both small BMO-As (ROC ± confidence interval [CI] 0.91 [0.87 to 0.95] and 0.88 [0.83 to 0.93]) and large BMO-As (0.86 [0.82 to 0.92] and 0.84 [0.79 to 0.90]), as well as in moderate/advanced glaucoma with small BMO-As (0.99 [0.98 to 1.00] and 0.97 [0.95 to 1.00]) and large BMO-As (0.94 [0.91 to 0.98] and 0.97 [0.94 to 1.00]). Using the calculated 5th percentile as a threshold value, the sensitivities for the detection of early and moderate/advanced glaucoma were comparable for BMO-MRW and RNFL in eyes with small optic discs (early glaucoma: fifty-two percent and 61%; moderate/advanced glaucoma: ninety-one percent and 92%). In eyes with large optic discs, the sensitivity of BMO-MRW was inferior to that of RNFL for both early (38% versus 51%) and moderate/advanced (80% versus 91%) glaucoma. CONCLUSION: Based on an ROC analysis, the discriminative performance of BMO-MRW and RNFL between patients with early and moderate/advanced glaucoma and a healthy control group matched based on optic disc size is comparable in eyes with BMO-As smaller and larger 1.95 mm2. Using a classification based on the 5th percentile, as used in clinical practice, RNFL is shown to be superior to BMO-MRW regarding sensitivity in glaucoma detection with large optic discs. This study underscores the importance of RNFL imaging and measurement in the diagnostic evaluation of glaucoma, especially in cases of large optic discs.
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Lámina Basal de la Coroides , Presión Intraocular , Fibras Nerviosas , Disco Óptico , Curva ROC , Células Ganglionares de la Retina , Tomografía de Coherencia Óptica , Campos Visuales , Humanos , Disco Óptico/patología , Lámina Basal de la Coroides/patología , Fibras Nerviosas/patología , Células Ganglionares de la Retina/patología , Femenino , Masculino , Tomografía de Coherencia Óptica/métodos , Campos Visuales/fisiología , Presión Intraocular/fisiología , Persona de Mediana Edad , Glaucoma/diagnóstico , Glaucoma/fisiopatología , Anciano , Glaucoma de Ángulo Abierto/diagnóstico , Glaucoma de Ángulo Abierto/fisiopatología , Estudios Retrospectivos , Reproducibilidad de los ResultadosRESUMEN
Congenital nasolacrimal duct obstruction (CNLDO) is the most common cause of epiphora in the first year of life. In addition to conservative therapy, there are several invasive methods available. The aim of this retrospective study was to conduct a long-term follow-up of bicanalicular lacrimal duct intubation as the primary intervention in a large cohort of patients with CNLDO. The electronic medical records of 487 patients with CNLDO who underwent bicanalicular tube intubation were reviewed. To determine the long-term outcomes, a telephone interview was conducted. A total of 328 eyes of 235 patients were included in the study. The median average follow-up period was 6.67 (5.58â-â8.67) years. At the time of the survey, 218 patients (92.8%) were symptom free. Mean patient satisfaction with surgical outcome was 10/10. To our knowledge, this study provides the longest follow-up of the largest patient cohort in the literature consisting of patients who underwent probing with bicanalicular lacrimal silicone tube intubation as a primary intervention for CNLDO. This study showed a high long-term postoperative success rate, with high postoperative satisfaction, few complications, and a low need for reintervention.
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AIMS: The aim of this study is to evaluate retinal and optic nerve head (ONH) perfusion in patients with systolic chronic heart failure (CHF) compared to healthy control subjects. METHODS: Twenty-seven eyes of 27 patients with CHF (study group) and 31 eyes of 31 healthy subjects (control group) were prospectively included in this study. CHF Patients had a left ventricular ejection fraction (LVEF) < 50% and were classified by New York Heart Association (NYHA) class. OCT-A was performed using RTVue XR Avanti with AngioVue (Optovue, Inc, Fremont, CA, USA). The area of the foveal avascular zone (FAZ) and flow density (FD) data were extracted and analyzed. RESULTS: There was no significant difference in the signal strength index between the study group (group 1) and the control group (group 2) (ONH: p = 0.015; macula: p = 0.703). The difference in the area of the foveal avascular zone between the two groups was also not significant (p = 0.726). The flow density (whole en face) in the ONH (RPC) in group 1 was significantly lower compared to control (group 1 = 48.40 ± 2.48 (49.0 [46.7, 50.3]); group 2 = 50.15 ± 1.85 (50.6 [48.5, 51.70]); p = 0.008). There was a significant and strong correlation between LVEF and the macular flow density (whole en face) (superficial: rs = 0.605 deep: rs = 0.425, p < 0.01). CONCLUSIONS: Patients with CHF showed reduced flow density compared with healthy controls. The reduced FD correlated with the LVEF and the functional (NYHA) class. Retinal perfusion as measured using OCTA might provide an insight into the global microperfusion and hemodynamic state of heart failure patients.
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Vasos Retinianos , Tomografía de Coherencia Óptica , Angiografía con Fluoresceína , Humanos , Perfusión , Vasos Retinianos/diagnóstico por imagen , Volumen Sistólico , Función Ventricular IzquierdaRESUMEN
Objective: The aim of this study was to evaluate retinal and optic nerve head (ONH) perfusion in patients with inactive Graves ophthalmopathy (GO) and compare it to healthy controls using optical coherence tomography angiography (OCTA). Methods: Twenty-nine eyes of 29 patients with inactive GO (study group) and 29 eyes of 29 healthy subjects (control group) were included in this study. The vessel density (VD) data in the superficial and deep retinal OCT angiogram of the macula and the radial peripapillary capillary network (RPC) were extracted and analyzed. OCTA was performed using RTVue XR Avanti with AngioVue (Optovue Inc, Fremont, CA). Clinical activity was evaluated using the clinical activity score, the severity assessment using the NOSPECS classification. Results: The VD in the superficial OCT angiogram and in the OCT angiogram of the ONH was significantly lower in the GO group when compared to the control group (whole en face, P = .016; parafovea, P = .026; RPC peripapillary, P = .027). There was no significant correlation between VD and functional parameters or the NOSPECS classification. Conclusion: Macular VD and ONH capillary density measured using OCTA were significantly lower in the study group compared to healthy controls. Noninvasive quantitative analysis of retinal perfusion using OCTA could be useful in monitoring patients with GO. Abbreviations: CAS = clinical activity score; GO = Graves ophthalmopathy; OCTA = optical coherence tomography angiography; ONH = optic nerve head; RPC = radial peripapillary capillary; rSp = Spearman's correlation coefficient; VD = vessel density.
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Oftalmopatía de Graves , Tomografía de Coherencia Óptica , Angiografía con Fluoresceína , Humanos , Retina , Vasos RetinianosRESUMEN
BACKGROUND: To compare the expression of motion artifacts in optical coherence tomography angiography (OCT-A) in healthy subjects using two different devices. METHODS: In this study, 25 eyes of 25 healthy volunteers with no history of any ocular disease or ocular surgery were included. OCT-A imaging was performed using the RTVue XR Avanti (Optovue Inc., Fremont, California, USA) and the Spectralis OCT-A (Heidelberg Engineering, Heidelberg, Deutschland). The macula was imaged twice in each proband with active eye tracking (ET) using a 3 × 3 mm2 or a 10 × 10° scan, respectively. The expression of motion artifact was analyzed by two independent readers in the superficial OCT-angiogram using the Motion Artifact Score (MAS). RESULTS: The signal strength index (SSI) was 73.0 ± 7.8 (Optovue) and 39.6 ± 3.6 (Heidelberg), which is equivalent to 73.0% (Optovue SSImax = 100 = 100%) and 79.2% (SSImax = 50 = 100%) of the maximum quality score. Both devices showed a very good image quality (mean MAS Optovue: 1.32 ± 0.551, mean MAS Heidelberg: 1.7 ± 0.789, p = 0.006). Of all measurements, quilting/banding was found in 20% of Optovue patients (10/50) and 6% of Heidelberg patients (3/50). Stretching was found in 4% of Optovue patients (2/50) and in 6% of Heidelberg patients (3/50). Vessel doubling was only seen in one Optovue angiogram (2%) as well as a displacement (2%). Blink lines only existed in three Heidelberg angiograms (6%). CONCLUSION: Despite different software and hardware approaches, both devices were able to take high-quality images with a very low prevalence of motion artifacts. Nevertheless, these artifacts still also occur in healthy subjects with good fixation. With regards to MAS, there was a high agreement between the two readers. However, the analysis of artifacts remains complex and requires experience as well as a precise assessment in evaluating OCT-A images.
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Angiografía con Fluoresceína , Tomografía de Coherencia Óptica , Artefactos , Voluntarios Sanos , Humanos , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: This study aimed to investigate the feasibility of optical coherence tomography angiography (OCT-A) for quantitative analysis of flow density to assess changes in retinal perfusion in an experimental model of haemorrhagic shock. METHODS: Haemorrhagic shock was induced in five healthy, anaesthetized sheep by stepwise blood withdrawal of 3 × 10 mlâkg- 1 body weight. OCT-A imaging of retinal perfusion was performed using an OCT device. Incident dark-field illumination microscopy videos were obtained for the evaluation of conjunctival microcirculation. Haemodynamic variables and flow density data in the OCT angiogram were analysed before and during progressive haemorrhage resulting in haemorrhagic shock as well as after fluid resuscitation with 10 mlâkg- 1 body weight of balanced hydroxyethyl starch solution (6% HES 130/0.4). Videos of the conjunctival microcirculation were recorded at baseline, in haemorrhagic shock, and after resuscitation. Data are presented as median with interquartile range. Comparisons between time points were made using Friedman's test and the degree of correlation between two variables was expressed as Spearman's rank correlation coefficient. RESULTS: Mean arterial pressure and cardiac index (CI) decreased and lactate concentration increased after induction of shock, and haemodynamics recovered after resuscitation. The flow density in the superficial retinal OCT angiogram decreased significantly after shock induction (baseline 44.7% (40.3; 50.5) vs haemorrhagic shock 34.5% (32.8; 40.4); P = 0.027) and recovered after fluid resuscitation (46.9% (41.7; 50.7) vs haemorrhagic shock; P = 0.027). The proportion of perfused vessels of the conjunctival microcirculation showed similar changes. The flow density measured using OCT-A correlated with the conjunctival microcirculation (perfused vessel density: Spearman's rank correlation coefficient ρ = 0.750, P = 0.001) and haemodynamic parameters (CI: ρ = 0.693, P < 0.001). CONCLUSIONS: Retinal flow density, measured using OCT-A, significantly decreased in shock and recovered after fluid therapy in an experimental model of haemorrhagic shock. OCT-A is feasible to assess changes in retinal perfusion in haemorrhagic shock and fluid resuscitation.
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Perfusión , Retina , Ovinos , Choque Hemorrágico , Tomografía de Coherencia Óptica , Animales , Angiografía/métodos , Angiografía/veterinaria , Presión Arterial/fisiología , Fluidoterapia/métodos , Fluidoterapia/normas , Fluidoterapia/veterinaria , Microcirculación/fisiología , Perfusión/normas , Perfusión/veterinaria , Retina/patología , Retina/fisiopatología , Ovinos/lesiones , Ovinos/fisiología , Choque Hemorrágico/clasificación , Choque Hemorrágico/diagnóstico , Tomografía de Coherencia Óptica/métodos , Tomografía de Coherencia Óptica/veterinariaRESUMEN
PURPOSE: To evaluate the correlation between flow density, as measured by optical coherence tomography angiography (OCTA), and structural and functional parameters in patients with open-angle glaucoma. METHODS: Thirty-four eyes of 34 patients with open-angle glaucoma and 35 eyes of 35 healthy subjects were prospectively included in this study. OCTA was performed using RTVue XR Avanti with AngioVue. The macula was imaged with a 3 × 3 mm scan and the optic nerve head (ONH) with a 4.5 × 4.5 mm scan. Visual field parameters [mean deviation (MD), pattern standard deviation (PSD) and visual field index (VFI)], Bruch's membrane opening minimal rim width (BMO-MRW), retinal nerve fiber layer thickness (RNFLT) and the stereometric parameters rim area, cup/disc area (HRT III, Heidelberg Retina Tomograph, Heidelberg Engineering) were tested for correlation with flow density data. RESULTS: The flow density (whole en face) in the retinal OCT angiograms (superficial: p = 0.01; deep: p = 0.005), in the radial peripapillary capillary network (p < 0.001) and in the OCT angiograms of the optic nerve head (p = 0.004) were significantly lower in the glaucoma group when compared with the control group. The flow density in the RPC network correlated significantly with all functional and structural parameters tested. The strongest correlation was found between the RPC flow density (inside disc) and the BMO-MRW (Spearman's correlation coefficient = 0.912, p < 0.001). CONCLUSIONS: Glaucoma patients showed a reduced ONH and macular perfusion when compared with healthy controls. The flow density as measured by OCTA correlated with structural damage and visual field loss in glaucoma patients. Non-invasive quantitative analyses of flow density using OCTA provide a new parameter describing a different aspect of glaucoma, which could be useful in clinical practice.
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Humor Acuoso/fisiología , Angiografía con Fluoresceína/métodos , Glaucoma de Ángulo Abierto/diagnóstico , Presión Intraocular/fisiología , Células Ganglionares de la Retina/patología , Tomografía de Coherencia Óptica/métodos , Campos Visuales/fisiología , Femenino , Estudios de Seguimiento , Fondo de Ojo , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios ProspectivosRESUMEN
PURPOSE: To evaluate the effects of exercise on optic nerve and macular perfusion using optical coherence tomography angiography. METHODS: Thirteen eyes of 13 healthy volunteers were examined using a high-speed and high-resolution spectral-domain optical coherence tomography XR Avanti with a split-spectrum amplitude-decorrelation angiography algorithm. Blood pressure, heart rate, the mean area of the foveal avascular zone , and flow density on the optic nerve head and macula, before and after exercise were measured and analyzed. RESULTS: Mean patient age was 27.3 ± 3.5 years. Heart rate, systolic and diastolic blood pressure increased significantly after exercise (P < 0.001). The mean area of the foveal avascular zone did not change significantly after exercise (before: 0.27 ± 0.07 mm; after: 0.26 ± 0.07 mm; P = 0.10). The peripapillary and the parafoveal flow density decreased significantly after exercise (peripapillary: before: 65.1 ± 2.1; after: 62.3 ± 3.0; P < 0.001 and parafoveal: before: 56.7 ± 1.3; after: 55.6 ± 1.5; P = 0.007). CONCLUSION: Increased physical activity induced significant changes in optic nerve and macular perfusion, which were measured using split-spectrum amplitude-decorrelation angiography optical coherence tomography angiography. In studies that aim to evaluate optic nerve and macular perfusion using optical coherence tomography angiography, it should be strongly recommended that patients rest before imaging is performed and that data concerning systemic circulation including blood pressure and pulse is included within the evaluation.
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Ejercicio Físico/fisiología , Mácula Lútea/irrigación sanguínea , Disco Óptico/irrigación sanguínea , Adulto , Velocidad del Flujo Sanguíneo/fisiología , Presión Sanguínea/fisiología , Femenino , Angiografía con Fluoresceína/métodos , Frecuencia Cardíaca/fisiología , Humanos , Mácula Lútea/diagnóstico por imagen , Masculino , Disco Óptico/diagnóstico por imagen , Flujo Sanguíneo Regional/fisiología , Vasos Retinianos/fisiología , Tomografía de Coherencia Óptica/métodos , Adulto JovenRESUMEN
BACKGROUND: Susac syndrome (SS) describes an endotheliopathy of vessels in the central nervous system. Retinal involvement plays a central role in the manifestation of the disease. OBJECTIVE: This case-control study investigated the macular microvasculature in patients with chronic SS compared to controls using optical coherence tomography angiography (OCTA). MATERIAL AND METHODS: 12 eyes of 12 patients with SS were compared with age-matched healthy control subjects with regard to their OCT angiographic parameters. The flow density (FD) of different macular layers, foveal avascular zone (FAZ) parameters and central retinal thickness and volume values were compared between the two groups. RESULTS: The FD of the choriocapillaris was reduced in Susac patients compared to healthy controls. The FD values of the superficial and deep capillary plexus of the inner retina, parameters of the FAZ as well as central retinal thickness and volume showed no significant differences between the two groups. DISCUSSION: Treated chronic SS does not appear to significantly affect the vascular and structural composition of the central inner retina; however, differences in the choriocapillaris indicate changes in deeper, highly vascularized capillary layers.
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Angiografía con Fluoresceína , Vasos Retinianos , Síndrome de Susac , Tomografía de Coherencia Óptica , Humanos , Tomografía de Coherencia Óptica/métodos , Masculino , Vasos Retinianos/diagnóstico por imagen , Vasos Retinianos/patología , Femenino , Adulto , Síndrome de Susac/diagnóstico por imagen , Síndrome de Susac/patología , Angiografía con Fluoresceína/métodos , Persona de Mediana Edad , Estudios de Casos y Controles , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Keratoconus (KC) is the most common corneal ectasia. Optical coherence tomography angiography (OCT-A) is a relatively new non-invasive imaging technique that allows the visualization and quantification of retinal and choriocapillary blood vessels. The aim of this study is to assess retinal and choriocapillary vessel density (VD) differences between KC patients and healthy controls and to investigate correlations between VD and KC severity. Fifty-two eyes were included in this exploratory study: twenty-six eyes from 26 KC patients and twenty-six eyes from 26 age- and gender-matched healthy controls. All patients underwent Scheimpflug corneal topography with Pentacam, axis lengths measurement and optical coherence tomography angiography (OCT-A). The thinnest spot in corneal pachymetry, maximum K (Kmax) and KC severity indices from the Belin/Ambrósio enhanced ectasia display (BAD) were also assessed. There was a distinct reduction particularly in the retinal VD of the superficial capillary plexus (SCP). Correlation analyses showed strong and moderate negative correlations between the VD in the macular SCP and BAD KC scores and between the SCP VD and Kmax. There was no difference in retinal thickness between the KC and healthy controls. With this study, further evidence for altered VD measurements by OCT-A in KC patients is given. For the first time, we demonstrated negative correlations between BAD KC scores and retinal blood vessel alterations. A major limitation of the study is the relatively small sample size. Since an artefactual reduction of the quantitative OCT-A measurements due to irregular corneal topography in KC must be assumed, it remains to be investigated whether there are also actual changes in the retinal microcirculation in KC.
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BACKGROUND: Optical coherence tomography angiography (OCT-A) provides detailed visualization of the perfusion of the vascular network of the eye. While in other forms of dementia, such as Alzheimer's disease and mild cognitive impairment, reduced retinal perfusion was frequently reported, data of patients with frontotemporal dementia (FTD) are lacking. OBJECTIVE: Retinal and optic nerve head perfusion was evaluated in patients with FTD with OCT-A. Quantitative OCT-A metrics were analyzed and correlated with clinical markers and vascular cerebral lesions in FTD patients. METHODS: OCT-A was performed in 18 eyes of 18 patients with FTD and 18 eyes of 18 healthy participants using RTVue XR Avanti with AngioVue. In addition, patients underwent a detailed ophthalmological, neurological, and neuropsychological examination, cerebral magnetic resonance imaging (MRI), and lumbar puncture. RESULTS: The flow density in the optic nerve head (ONH) and in the superficial capillary plexus (SCP) of the macula of patients was significantly lower compared to that of healthy controls (p < 0.001). Similarly, the VD in the deep capillary plexus (DCP) of the macula of patients was significantly lower compared to that of healthy controls (p < 0.001). There was no significant correlation between the flow density data, white matter lesions in brain MRI, cognitive deficits, and cerebrospinal fluid markers of dementia. CONCLUSIONS: Patients with FTD showed a reduced flow density in the ONH, and in the superficial and deep retinal capillary plexus of the macula, when compared with that of healthy controls. Quantitative analyses of retinal perfusion using OCT-A may therefore help in the diagnosis and monitoring of FTD. Larger and longitudinal studies are necessary to evaluate if OCT-A is a suitable biomarker for patients with FTD.
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Background/Objectives: This study aims to investigate the long-term effect of inactive systemic lupus erythematosus (SLE) on the retinal microcirculation measured via optical coherence tomography angiography (OCT-A). Methods: Twenty-four eyes of 24 patients with inactive SLE under hydroxychloroquine (HCQ) therapy were included. The OCT-A data (mainly vessel density (VD) and foveal avascular zone (FAZ) data of the superficial and of the deep capillary plexus (SCP, DCP) and the choriocapillaris (CC)) were analyzed and compared between the baseline examination (t0) and 2 years later (t1). Results: At t1, VD in the whole en face SCP and in the CC was notably reduced compared to t0 (SCP: p = 0.001, CC: p = 0.013). VD in the DCP, CRT and FAZ area showed no difference at t1 compared to t0 (DCP: p = 0.128, FAZ: p = 0.332, CRT fovea: p = 0.296). Correlation analysis between the increase in cumulative doses of HCQ between t0 and t1 and the VD of the whole en face SCP did not show any correlation (Spearman r = 0.062 (95% CI -0.367; 0.477). Conclusions: SLE patients demonstrated a decrease in the retinal VD of the SCP and CC over a 2-year period. There was no correlation with the change in cumulative doses of HCQ. These results suggest an ongoing effect of the disease on the retinal and choriocapillary microcirculation.
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Fuchs' endothelial corneal dystrophy (FECD) is the occurrence of corneal edema due to endothelial cell dystrophy. Descemet membrane endothelial keratoplasty (DMEK) is considered to be the gold standard of treatment. The aim of this study was to investigate the changes in the corneal epithelial thickness of FECD patients before and after DMEK and to compare these results with a healthy control cohort. In this retrospective analysis, 38 eyes of patients with FECD that were treated with DMEK and 35 healthy control eyes received anterior segment optical coherence tomography (OCT; Optovue, XR-Avanti, Fremont, CA, USA). The corneal epithelial thicknesses in different locations were analyzed and compared between the preoperative, postoperative, and control cohorts. The median follow-up time was 9 months. There was a significant degression of the mean epithelial thickness after DMEK in the central, paracentral, and mid-peripheral zones (p < 0.01) of the cornea. The total corneal thickness and stromal thickness decreased significantly as well. No significant differences were observed between the postoperative and control cohorts. In conclusion, the FECD patients had an increased epithelial thickness compared to the healthy controls, which decreased significantly after DMEK and reached thickness levels comparable to those of healthy control eyes. This study emphasized the importance of distinguishing between the corneal layers in anterior segment pathologies and surgical procedures. Moreover, it accentuated the fact that the structural alterations in FECD extend beyond the corneal stroma.
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Hemodialysis (HD) is known to affect ocular blood flow. This case-control study aims to evaluate macular and peripapillary vasculature in patients with end-stage renal disease (ESRD) receiving HD in comparison to matched controls. A total of 24 eyes of 24 ESRD patients receiving HD and 24 eyes of 24 healthy, age- and gender-matched control subjects were prospectively included in this study. Optical coherence tomography angiography was used to image the superficial (SCP), deep (DCP), and choriocapillary (CC) macular vascular plexus, as well as the radial peripapillary capillaries (RPC) of the optic disc. In addition, retinal thickness (RT) and retinal volume (RV) were compared between both groups. Flow density (FD) values of each retinal layer and data of parameters related to the foveal avascular zone (FAZ), as well as RT and RV, were analyzed using Mann-Whitney U tests. There was no significant difference in FAZ parameters between the two groups. Whole en face FD of the SCP and CC was noticeably reduced in the HD group in comparison to the control group. FD was negatively correlated with the duration of HD treatment. RT and RV were significantly smaller in the study group than in controls. Retinal microcirculation appears altered in patients with ESRD undergoing HD. Concurrently, the DCP appears more resilient towards hemodynamic changes in comparison to the other microvascular retinal layers. OCTA is a useful, non-invasive tool to investigate retinal microcirculation in ESRD patients.
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Intraocular pressure (IOP) lowering surgery has been shown to alter microvascular density in glaucoma patients. The aim of this study is to report changes in retinal flow density (FD) over the course of treatment with the Preserflo MicroShunt, using optical coherence tomography angiography (OCTA). 34 eyes from 34 patients who underwent Preserflo MicroShunt implantation were prospectively enrolled in this study. OCTA imaging was conducted at the superficial (SCP), deep (DCP) and radial peripapillary plexus (RPC) levels. The progression of FD and IOP was assessed at different time points from baseline to six months postoperatively for the entire patient population, as well as disease severity subgroups. The Preserflo MicroShunt achieved a significant reduction in IOP over the course of six months (median: 8 mmHg; p < 0.01). FD values of the SCP and DCP did not show significant fluctuations, even after adjusting for disease severity. FD of the RPC decreased significantly over the course of six months postoperatively from 42.31 at baseline to 39.59 at six months postoperatively (p < 0.01). The decrease in peripapillary FD was strongest in patients with advanced glaucoma (median: -3.58). These observations hint towards dysfunctional autoregulatory mechanisms in capillaries surrounding the optic nerve head in advanced glaucoma. In comparison, the microvascular structure of the macula appeared more resilient to changes in IOP.
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Nowadays, transcanalicular endoscopic dacryoplasty represents the majority of lacrimal duct surgery procedures performed in adults in specialised centers. However, there are still hardly any data available regarding the intra- and postoperative care, particularly regarding the duration of silicone tube intubation (STI). Our aim was to evaluate the relation between tube duration and recurrence of symptoms in patients who underwent transcanalicular microdrill dacryoplasty (MDP) in a long-term setting. Medical records of 576 adult patients after MDP were retrospectively reviewed. A total of 256 eyes of 191 patients could be included. The median follow-up time was 7.83 [7.08; 9.25] years. In 57.0% of the cases there was still full resolution of symptoms at the time of the survey. The median duration of the STI was 6 [3.00; 6:00] months. When distinguishing between a tube duration < 3 months and ≥ 3 months there was a significant difference in the long-term success rate (< 3 months: 38%; ≥ 3 months: 61%; p = 0.011). In conclusion, an early removal of the STI (< 3 months) after transcanalicular MDP seems to be associated with a higher incidence of recurrence of symptoms. This should be considered in the intra- and postoperative care of patients following this minimally invasive first-step procedure.
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Endoscopía , Conducto Nasolagrimal , Adulto , Humanos , Estudios de Seguimiento , Estudios Retrospectivos , Conducto Nasolagrimal/cirugía , Párpados , SiliconasRESUMEN
BACKGROUND: In keratoconus (KC) a progressive deformation and thinning of the cornea occurs. In contrast to Scheimpflug-based examinations, optical coherence tomography (OCT) can precisely measure the corneal layers separately, allowing separate analyses of corneal epithelial and corneal stromal thicknesses. AIM OF THIS WORK: The aim of this work was to analyze the corneal epithelial thickness measured by optical coherence tomography (OCT) in patients with KC in comparison to the corneal epithelial thickness in healthy subjects. The diagnostic value of the observed changes was evaluated. MATERIAL AND METHODS: In a retrospective analysis 125 eyes of patients with KC and 140 eyes of healthy subjects were included. Corneal measurements were performed by OCT (Optovue, XR-Avanti, Fremont, CA, USA). Corneal stromal thicknesses and corneal epithelial thicknesses in different locations were measured and analyzed. RESULTS: There were significant differences in stromal and epithelial thickness measurements. Of the derived epithelial thickness parameters four showed a good discriminatory power between healthy controls and KC patients (area under the curve in the receiver operating characteristic analysis >â¯0.7). CONCLUSION: Patients with KC showed an altered epithelial thickness compared to healthy controls. The derived calculated parameters based on corneal epithelial thickness can distinguish between KC and a healthy cornea.
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Epitelio Corneal , Queratocono , Córnea/diagnóstico por imagen , Sustancia Propia , Epitelio Corneal/diagnóstico por imagen , Humanos , Queratocono/diagnóstico , Estudios RetrospectivosRESUMEN
The vascular hypothesis of systemic sclerosis (SSc) would predict microvascular alterations should also affect anatomical regions like ocular microvasculature. The objective of this study was to evaluate retinal and choriocapillary vessel density (VD) in patients with definite SSc and very early disease of systemic sclerosis (VEDOSS) using optical coherence tomography angiography (OCTA). 22 eyes of 22 patients and 22 eyes of 22 healthy subjects were included in this study. Patients were classified into patients with definite SSc and patients with VEDOSS. VD data of the superficial OCT angiogram (OCTA-SCP), deep OCT angiogram (OCTA-DCP) and choriocapillaris (OCTA-CC) were analysed. VD in the OCTA-SCP and OCTA-CC was lower in patients with SSc (p < 0.05). In VEDOSS patients, VD in the OCTA-CC was still reduced compared to controls (p < 0.05). Correlation analysis revealed a positive correlation between nailfold capillaroscopy and VD of OCTA-CC (Spearman correlation coefficient (rSp) 0.456, p < 0.05) and a negative correlation between skin score and VD of OCTA-SCP (p < 0.05). Ocular perfusion seems to be impaired in patients with SSc and even VEDOSS. VD correlated with disease severity. OCTA could be a new useful diagnostic and predictive parameter for monitoring patients with different stages of the disease.
Asunto(s)
Esclerodermia Sistémica , Tomografía de Coherencia Óptica , Angiografía con Fluoresceína/métodos , Humanos , Microvasos/diagnóstico por imagen , Vasos Retinianos/diagnóstico por imagen , Esclerodermia Sistémica/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodosRESUMEN
BACKGROUND/AIM: Dacryocystorhinostomy (DCR) remains the gold standard therapy for nasolacrimal duct obstruction (NLDO), but is invasive and does not maintain the physiology of the lacrimal pathway. With transcanlicular microdrill dacryoplasty (MDP), there is a minimally invasive alternative surgical approach. This study aimed to present this modern lacrimal duct surgery technique and to evaluate its long-term success rate in a large study population. METHODS: The medical records of 1010 patients with acquired NLDO were retrospectively reviewed. Adult patients who had undergone transcanalicular MDP were included. The evaluation included the following parameters: age, gender, success rate, complication rate, obstruction grade and patient satisfaction. Long-term results regarding patient satisfaction and success rate were evaluated by a telephone survey. Only a complete resolution of symptoms was defined as success. RESULTS: 793 eyes of 576 patients after transcanalicular MDP could be included in the study. The mean follow-up time was 8.7±0.9 years. Initial surgical success rate was 84.0%. At the time of the follow-up, 57.5% (n=229) still had full resolution of symptoms. The mean patient satisfaction with the procedure was 6.9±3.2 out of 10 points. Heavy bleeding occurred in two cases only (0.25%). CONCLUSION: This is the first study to show the success rate of microendoscopic lacrimal duct surgery after such a long follow-up period and in such a large study population. Transcanalicular MDP is a minimally invasive technique with a very low complication rate and can be used as an alternative procedure before performing more invasive lacrimal duct surgery such as DCR.