Cataract progression following lens-sparing pars plana vitrectomy for rhegmatogenous retinal detachment.

Lens-sparing pars plana vitrectomy (PPV) is often followed by cataract development. However, there have been few prospective studies evaluating the timing of cataract progression and potential associated factors. This was an observational study conducted at the Ophthalmology Unit of the University Hospital of Parma (Parma, Italy). Patients presenting with rhegmatogenous retinal detachment (RRD), who underwent PPV with preservation of the lens, were examined according to a scheduled follow-up (3, 6 and 12 months after PPV) and then preoperatively when cataract extraction surgery (CES) was indicated, or at the end of the study follow-up period (May 2021). The primary outcome was the interval between PPV and CES indication (based on predefined refractive criteria). A total of 36 eyes of 36 patients (mean age: 52 ± 10 years) were included in the study. Nineteen eyes (53%) were indicated for CES a median of 14.5 months (IQR: 12.0-24.8) after PPV. The nuclear and posterior subcapsular forms of cataract progressed significantly starting at 6 months after PPV. Older age at the time of PPV, silicone oil tamponade and RRD without macular involvement were significantly and independently associated with an earlier indication for CES. Patient age and the use of silicone oil tamponade must be taken into consideration when evaluating the risk of cataract development after PPV.

Parsplana vitrectomy alone versus parsplana vitrectomy combined with phacoemulsification for the treatment of rhegmatogenous retinal detachment: a randomized study.

BACKGROUND: To compare parsplana vitrectomy (PPV) with and without phacoemulsification to treat rhegmatogenous retinal detachment (RRD). METHODS: Subjects aged 48-65 years with RRD in a phakic eye due to superior retinal tears with an overall extension of retinal breaks < 90° underwent to PPV alone (group A); or PPV plus phacoemulsification (phacovitrectomy, PCV, group B). Post-operative follow-up visits occurred at 1 week, 1 month (m1), 3 months (m3), and 6 months (m6) after surgery. The main outcome was the rate of retinal reattachment. Secondary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), and cataract progression (in the lens-sparing [PPV-alone] group). RESULTS: In this initial phase of the study a total of 59 patients (mean age: 55 years, 59 eyes) were enrolled: 29 eyes in group A and 30 eyes in group B. Both groups had similar gas tamponade. During the follow-up there were three cases of RRD recurrence in group A and one in group B. The relative risk of recurrence in group A was 3.22 times higher but the difference was not significant (p = 0.3). The two groups were also similar in terms of BCVA and IOP variation. At m3, CMT was significantly higher in group B (p = 0.014). In group A, cataract progression was significant at m6 (p = 0.003). CONCLUSIONS: In a cohort of RRD patients selected according to their preoperative clinical characteristics, PPV was comparable to PCV in terms of the rate of retinal reattachment after 6 months. TRIAL REGISTRATION: ISRCTN15940019 . Date registered: 15/01/2021 (retrospectively registered).

RETINAL ARTERIAL DILATION IS IMPAIRED IN EYES WITH DRUSEN AND RETICULAR PSEUDODRUSEN.

PURPOSE: To analyze static characteristics and dynamic functionality of retinal vessels in eyes with drusen and reticular pseudodrusen (RPD) using dynamic vessel analyzer. METHODS: Patients with clinical diagnosis of isolated RPD or medium-large drusen and healthy controls were enrolled in the study between July 2016 and May 2018. Participants underwent complete ophthalmologic examination, including enhanced depth imaging structural optical coherence tomography, dynamic retinal vessel analysis, and static retinal vessel analysis. RESULTS: Twenty-eight eyes of 23 patients with drusen (9 men, mean age 77 ± 6 years), 22 eyes of 16 patients with RPD (7 men, mean age: 76 ± 6 years), and 22 eyes of 22 control subjects (11 men, mean age of 75 ± 6 years) were enrolled. Static retinal vessel analysis did not show any significant difference between the three groups for the central retinal artery equivalent (P = 0.11), the central retinal vein equivalent (P = 0.27), and the arteriovenous ratio (P = 0.30). Dynamic vessel analysis showed significantly reduced arterial dilation in eyes with drusen (P = 0.0001) and RPD (P = 0.015) compared with control subjects. No significant difference was seen between drusen and RPD groups (P = 0.32). Dynamic vessel analysis of retinal veins showed no differences between the three groups (P = 0.10). CONCLUSION: Dynamic vessel analysis in eyes with drusen and RPD revealed an impaired retinal arterial dilation in response to flicker light stimulation, which further supports the relationship between cardiovascular risk and age-related macular degeneration.

Retinal vessels functionality in eyes with central serous chorioretinopathy.

PURPOSE: To analyse static characteristics and dynamic functionality of retinal vessels in eyes with central serous chorioretinopathy (CSCR) by means of Dynamic Vessel Analyzer (DVA). METHODS: Patients presenting with treatment-naïve CSCR and normal subjects (controls) matched for age and sex between May 2015 and November 2015 were enrolled in the study. Participants underwent a complete ophthalmological examination, including dynamic and static retinal vessels analysis by DVA. RESULTS: A total of 28 eyes of 28 subjects (14 eyes for each group) were included in the analysis. Dynamic analysis during stimulation by flickering light showed mean venous dilation of 3.3%±2.0% in patients with CSCR and 5.5%±2.6% in controls (p=0.0258); mean arterial dilation did not differ between patients and controls (3.2%±2.5% and 4.2%±1.5%, p=0.2). No differences were reported at static retinal analysis between patients with CSCR and control subjects. Subfoveal choroidal thickness as evaluated by optical coherence tomography was 438.6±86.1 µm in CSCR eyes, significantly increased compared with control subjects (301.5±72.5 µm, p=0.0001). CONCLUSIONS: Dynamic analysis revealed a reduced retinal venous dilation in response to flicker light stimulation in CSCR eyes. The decreased retinal vein response to flicker light stimulation, possibly due to increased sympathetic tone and potentially leading to venous stasis, together with the increased choroidal thickness may help understand CSCR and give insights in its pathogenesis.

Inter-method agreement in retinal blood vessels diameter analysis between Dynamic Vessel Analyzer and optical coherence tomography.

PURPOSE: To analyze the inter-methods agreement in arteriovenous ratio (AVR) evaluation between spectral-domain optical coherence tomography (SD-OCT) and Dynamic Vessel Analyzer (DVA). METHODS: Healthy volunteers underwent DVA and SD-OCT examination. AVR was measured by SD-OCT using the four external lines of the optic nerve head-centered 7-line cube and by DVA using an automated AVR estimation. The mean AVR was calculated, twice, separately by two independent readers for each tool. RESULTS: Twenty-two eyes of 11 healthy subjects (five women and six men, mean age 35) were included. AVR analysis by DVA showed high inter-observer agreement between reader 1 and 2, and high intra-observer agreement for both reader 1 and reader 2. With regard to AVR analysis on SD-OCT, we found high inter-observer agreement between reader 1 and 2, and low intra-observer agreement for reader 2 but high intra-observer agreement for reader 1. Overall, the mean AVR measured on SD-OCT turned out to be significantly higher than mean AVR measured through DVA (reader 1, 0.9023 ± 0.06 vs 0.8036 ± 0.08; p < 0.001, and reader 2, 0.9067 ± 0.06 vs 0.8083 ± 0.05; p= 0.003). CONCLUSIONS: No inter-method agreement in AVR could be detected in the present study due to bias in measurements (shift between DVA and SD-OCT). We found significant difference in the two noninvasive methods for AVR measurement, with a tendency for SD-OCT to overestimate retinal vascular caliber in comparison to DVA. This may be useful for achieving greater accuracy in the evaluation of retinal vessel in ocular as well as systemic diseases.

Optical coherence tomography angiography findings in laser maculopathy.

PURPOSE: Handheld laser pointer thermal injury affects primarily the retinal pigment epithelium (RPE). However, so far no study has reported on the possible effects of laser pointers in the deeper layers, beneath the RPE. Here, we describe the spectral-domain optical coherence tomography angiography findings in the choriocapillaris of a patient with laser maculopathy. METHODS: A 13-year-old boy presented to our department with decreased vision in the left eye 12 hours after having stared at the beam of a laser pointer. RESULTS: Structural optical coherence tomography (OCT) showed 2 focal hyperreflective columns at the fovea extending from the RPE, involving all outer retinal layers, and terminating at the outer plexiform layer. The patient also underwent OCT angiography (OCT-A), which in the choriocapillary segmentation revealed 2 hypointense lesions in correspondence of the focal hyperreflectivities detected on structural OCT. We hypothesize that the OCT-A findings could represent a rarefaction of the choriocapillaris. However, the choriocapillary OCT-A findings could also represent artifacts due to the overlaying hyperreflective lesions. CONCLUSIONS: It is known that the RPE is primarily damaged by the laser injury. Our findings suggest that the thermal injury could involve also the choriocapillaris, and thus not limited to the RPE. Multimodal imaging in laser maculopathy including OCT-A may lead to a better comprehension of the pathogenesis of laser retinal damages.

Dynamic functionality and static changes of retinal vessels in diabetic patients treated with intravitreal ranibizumab.

AIMS: To investigate the short-term effects of intravitreal ranibizumab on retinal vessel functionality in patients with diabetic macular edema (DME) by Dynamic Vessel Analyzer (DVA). METHODS: Patients presenting with DME were enrolled in the study. All patients underwent a complete ophthalmic evaluation, including optical coherence tomography and dynamic and static vessel analysis, using the DVA before (baseline), 1 week and 1 month after administration of intravitreal ranibizumab. DME subject were compared with diabetic retinopathy (DR) without DME subjects, and with normal non diabetic subjects (controls) matched for age and sex. RESULTS: A total of 45 eyes of 45 subjects (15 eyes for each group) were included in the analysis. In DME patients, dynamic analysis showed a significant decrease in mean arterial dilation from baseline to 1 week. Mean central retinal artery equivalent (CRAE) of DR patients without DME was significantly different from baseline and week 1 of DME eyes. In healthy control subjects, CRAE was significantly different from CRAE at baseline and 1 week on DME patients, but not significantly different from DR patients without DME. CONCLUSIONS: Using DVA in patients with DME, dynamic analysis showed a significant decrease in mean arterial dilation from baseline to 1 week in DME eyes. A significant reduction in arterial vessels could be demonstrated in DME patients compared to DR patients without DME and controls.

Choroidal structure in eyes with drusen and reticular pseudodrusen determined by binarisation of optical coherence tomographic images.

PURPOSE: To compare luminal and stromal area of the choroid in eyes with drusen and reticular pseudodrusen (RPD) and to investigate their changes over 24 months. METHODS: In eyes with drusen and RPD and control subjects, total choroidal, luminal and stromal area were measured on optical coherence tomography B-scans converted to binary images, at baseline and after 24 months. RESULTS: Eighteen eyes of 18 subjects for each group were included. In drusen and RPD, we found reduction of mean total choroidal (p=0.0005 and p<0.0001, respectively), luminal (p=0.003 and p<0.0001, respectively) and stromal area (p=0.007 and p=0.0002, respectively) from baseline to month 24; no change of ratio between luminal-stromal and the choroidal area was recorded. Mean luminal, stromal and total choroidal areas were reduced in RPD, as compared with drusen and controls at both baseline and month 24 (p<0.05 for all). In RPD, the stromal area was more represented, as we found lower mean ratio of luminal and total choroidal area compared with drusen and control at both baseline and month 24 (p<0.05 for all). CONCLUSIONS: Mean total choroidal, luminal and stromal area decreased over 24 months similarly in eyes with drusen and RPD. Mean total choroidal, luminal and stromal area were more reduced in eyes with RPD, as compared with eyes with drusen and controls; however, stromal area was more represented in eyes with RPD suggesting a possible role of choroidal vascular depletion and fibrotic replacement in the pathogenesis and disease progression.

Impact of combined hormonal contraceptives on vessels functionality.

PURPOSE: To evaluate the dynamic and static retinal vascular functionality in young females using combined hormonal contraceptive (CHC). METHODS: Thirty-eight consecutive young female subjects were enrolled in this study between January 2015 and December 2015. Subjects were divided in two groups: CHC group, defined as CHC use for ≥6 months, and control group, defined as no current and prior CHC use. Participants underwent a dynamic and static retinal vessel analysis using the Dynamic Vessel Analyzer (DVA, Imedos, Jena, Germany). RESULTS: Seventeen subjects continuously took CHC for 54.6 ± 29.3 months, while 21 subjects belonged to control group. No difference was found between the CHC and control groups for age (p = 0.1), smoking status (p = 0.6), and systolic (p = 0.3) and diastolic (p = 0.1) blood pressure. With regard to dynamic analysis, women taking CHC exhibited a marked significant vasoconstriction following flicker stimulation in comparison with control group (-2.43 ± 2.5 vs 0.63 ± 2.1, respectively; p = 0.0002). No significant difference was observed between groups for mean arterial (p = 0.2) and venous dilatations (p = 0.3), arteriovenous ratio (p = 0.09), central retinal artery equivalent (p = 0.4), and central retinal venous equivalent (p = 0.5). CONCLUSIONS: CHC may affect vessel reactivity to flicker light by increasing arteries constriction. This may reflect systemic changes in vascular functionality in subjects using CHC. Moreover, CHC should be considered as a confounding bias in studies involving DVA.

Atypical Presentation of Chorioretinal Folds-Related Maculopathy.

PURPOSE: Chorioretinal folds are undulations that anatomically include the inner choroid, Bruch's membrane, and the retinal pigment epithelium, and secondarily affect the overlying neurosensory retina. We analyzed clinical data and management of six patients diagnosed with chorioretinal folds-related maculopathy with atypical presentations. CASE REPORT: The mean age of the six patients (five women) was 77 years. Best-corrected visual acuity (BCVA) ranged between 20/200 and 20/80. None of the patients had history of hypertension, cardiovascular diseases, or autoimmune disease, and they were all diagnosed with idiopathic chorioretinal folds. Case 1, 2, and 3 received intravitreal antivascular endothelial growth factor (VEGF) therapy; case 4 received intravitreal anti-VEGF and photodynamic therapy; case 5 received only photodynamic therapy; and case 6 received intravitreal injections of sustained-release dexamethasone implant (Ozurdex). In case 1 and 2, the use of ranibizumab resulted in BCVA improvement and resolution of sub-/intraretinal exudation. In case 3, ranibizumab led to a mild reduction of the intraretinal exudation but no changes in BCVA. In case 4 and 5, six intravitreal injections of ranibizumab with two photodynamic therapies and three photodynamic therapies, respectively, led to a mild reduction of the sub-/intraretinal exudation but no changes in BCVA. In case 6, five intravitreal injections of Ozurdex in both eyes led to reduction of the subretinal or intraretinal fluid accumulation and BCVA improvement. DISCUSSION: Choroidal vessel dilation and hyperpermeability may be involved in atypical presentations of chorioretinal folds-related maculopathy characterized by sub-/intraretinal fluid accumulation. Dilated and hyperpermeable choroidal vessels may result in focal retinal pigment epithelium alterations that can progress to choroidal neovascularization or chronic central serous chorioretinopathy-like maculopathy with or without telangiectatic retinal capillaries. Intravitreal anti-VEGF administration seems effective to treat choroidal neovascularization in stage 3 chorioretinal folds-related maculopathy, both anti-VEGF and photodynamic therapy seem to have only limited efficacy on chronic central serous chorioretinopathy-like maculopathy (and telangiectatic retinal capillaries), whereas intravitreal injection of Ozurdex seems efficacious to treat chronic central serous chorioretinopathy-like maculopathy.

Comparison of the Performance of Two Different Spectral-Domain Optical Coherence Tomography Angiography Devices in Clinical Practice.

PURPOSE: To compare the performance of two different spectral-domain optical coherence tomography angiography (OCTA) devices in clinical practice by evaluating examination execution time and the number of motion artifacts per image. METHODS: Seventy-six patients affected by different ocular diseases and 13 healthy subjects consecutively underwent assessments by two different OCTA devices: AngioPlex (Zeiss Meditec, Inc., Dublin, Calif., USA) and AngioVue (OptoVue, Inc., Fremont, Calif., USA). Two different operators (L.A.D.V. and L.B.) measured execution times, excluded low-quality images, and counted the number of motion artifacts per image. RESULTS: The mean execution time was shorter with AngioPlex than with AngioVue for all subjects (3 min 32 s ± 1 min 45 s vs. 4 min 35 s ± 1 min 11 s; p < 0.0001), for the healthy subjects (2 min 31 s ± 45 s vs. 4 min 1 s ± 53 s; p = 0.003), and for the patients (3 min 44 s ± 1 min 48 s vs. 4 min 42 s ± 1 min 13 s; p < 0.0001). The percentages of available images, low-signal-strength images, and images impossible to analyze of the total acquired images obtained using AngioPlex or AngioVue were 85, 6, and 9% and 56, 29, and 15%, respectively. The mean number of motion artifacts was significantly lower in images obtained using AngioPlex than in images obtained using AngioVue for all patients (6.5 ± 5.9 vs. 12.6 ± 8.5; p < 0.0001), for the healthy subjects (6.5 ± 4.6 vs. 10.9 ± 7.9; p = 0.0009), and for the patients (6.6 ± 6.3 vs. 13.1 ± 8.7; p < 0.0001). There was no correlation between the number of artifacts and execution time or patients' age. CONCLUSION: AngioPlex and AngioVue are useful devices in clinical practice. AngioPlex requires a shorter execution time and provides a higher number of images available for analysis with fewer motion artifacts.

Photobleaching by Spectralis Fixation Target.

IMPORTANCE: The aim of this study is to determine whether the cross-shaped fixation target in a spectral-domain optical coherence tomography instrument (Spectralis; Heidelberg Engineering) could produce a cross-shaped increase fundus autofluorescence artifact on subsequent imaging. OBSERVATIONS: Thirty eyes of 15 healthy volunteers (8 women and 7 men; mean [SD] age 24 [3] years) were included in the study, which was conducted between October 2015 and December 2015. In all eyes, a cross-shaped increase in macular autofluorescence with variable intensity occurred after Spectralis spectral-domain optical coherence tomography acquisition. This peculiar pattern was also detected on confocal scanning laser ophthalmoscope infrared reflectance and MultiColor imaging. Interestingly, no changes in macular fundus autofluorescence pattern were evident after optical coherence tomography acquisition with either Cirrus HD-OCT 5000 or RTVue XR Avanti. CONCLUSIONS AND RELEVANCE: In an era characterized by extensive use of optical coherence tomography examination in clinical practice, the potential deleterious effects related to photopigments consumption by Spectralis optical coherence tomography fixation point deserve further investigation.

Outcomes of intravitreal anti-VEGF therapy in eyes with both neovascular age-related macular degeneration and diabetic retinopathy.

PURPOSE: To investigate the outcomes of intravitreal antivascular endothelial growth factor (VEGF) therapy in eyes with both neovascular age-related macular degeneration (AMD) and diabetic retinopathy (DR). METHODS: Patients from four high-volume referral centres who presented with neovascular AMD and DR, and received intravitreal anti-VEGF therapy, were included. Data retrieved from medical records and multimodal imaging were analysed. RESULTS: Forty-one eyes of 38 patients (21 male, 17 female; mean age 78±8 years) were enrolled. Median follow-up was 28±19 (12-72) months with a mean of 9.2±7.4 intravitreal anti-VEGF injections per eye were administrated. Best-corrected visual acuity (BCVA) was 0.5±0.3 logMAR; it improved significantly at 1 year (0.3±0.3 logMAR; p=0.02) and returned to baseline values at last follow-up visit (0.6±0.4 logMAR; p=0.26). Mean central macular thickness (CMT) significantly decreased from 408±150 µm to 328±104 µm at 1 year (p=0.021) and to 335±127 µm at last follow-up visit (p=0.032). The baseline severity of DR was graded as mild non-proliferative DR (NPDR) in 21 (51%) eyes, moderate NPDR in 14 (34%), severe NPDR in 4 (10%) and inactive proliferative DR in 2 (5%). At last follow-up visit, one eye graded as moderate NPDR improved to mild, one eye graded as severe NPDR improved to mild and one eye graded as severe NPDR was inactivated due to panretinal photocoagulation. CONCLUSIONS: Outcomes analysis of intravitreal anti-VEGF therapy for eyes with both neovascular AMD and DR showed stabilisation of BCVA and reduction of CMT, along with stable or improved DR stage throughout follow-up.

Impact of Intravitreal Ranibizumab on Vessel Functionality in Patients With Retinal Vein Occlusion.

PURPOSE: To investigate the short-term effects of intravitreal ranibizumab on retinal vessel functionality in patients with retinal vein occlusion (RVO). DESIGN: Prospective, interventional case series. METHODS: We enrolled 11 eyes of 11 consecutive treatment-naïve patients with macular edema secondary to RVO. All patients underwent a complete ophthalmic evaluation, including optical coherence tomography and dynamic and static retinal vessel analysis, using the Dynamic Vessel Analyzer (Imedos, Jena, Germany) before (baseline) and 1 week and 1 month after administration of intravitreal ranibizumab. Investigations of RVO patients were compared to 11 eyes of age- and sex-matched control subjects. RESULTS: In RVO patients, dynamic analysis showed a significant increase of mean venous dilation from +2.46% ± 1.03% at baseline to +3.96% ± 1.3% at 1 week (P = .001). At 1 week mean maximum venous and arterial dilations did not differ from those of control subjects. Static analysis showed a mean overall significant decrease of central retinal artery equivalent and central retinal vein equivalent from baseline to 1 week (from 174.8 ± 22.5 measurement units [MU] to 167.2 ± 26.7 MU [P = .04], and from 228.4 ± 20.7 MU to 217.3 ± 22.8 [P = .0002]). Mean central retinal artery equivalent in healthy control subjects was 175.9 ± 10.45 MU, not significantly different from baseline, week 1, and month 1 of RVO eyes. Conversely, mean central retinal vein equivalent was 195.5 ± 9.91 MU in healthy control subjects, significantly different from baseline, week 1, and month 1 of RVO eyes. CONCLUSIONS: Using the Dynamic Vessel Analyzer in patients with RVO, we found that intravitreal ranibizumab increased vein dilation (dynamic analysis) and had a vasoconstrictive effect on both arteries and veins (static analysis).