ABSTRACT
Objetivos Desarrollar y evaluar un método automático de medición del área de la zona avascular foveal (ZAF) en ojos sanos en angiografía por tomografía de coherencia óptica de dominio espectral Heidelberg (HS-OCTA). Este método se denomina Macro Kanno-Saitama modificado (KSMm) y es una evolución de la aproximación Macro Kanno-Saitama (KSM). Métodos Este estudio transversal incluyó 29 ojos de 25 voluntarios sanos a los que se les realizaron dos HS-OCTA de la zona macular en el mismo momento. Se incluyeron todas las imágenes a pesar de su calidad. Los datos de la zona macular del plexo vascular superficial, del plexo capilar intermedio (PCI) y del plexo capilar profundo fueron procesados usando KSMm. El área ZAF se midió dos veces automáticamente usando KSMm y KSM y dos veces manualmente por dos examinadores independientes. Resultados De 174 imágenes, KSM no pudo medir correctamente el 31%, mientras que KSMm pudo medir con éxito todas las imágenes. El coeficiente intraclase intraescaneo varió entre 0,948 y 0,993 para medidas manuales y fue 1 con el método KSMm. Aunque según los gráficos de Bland-Altman la diferencia entre examinadores humanos es menor que entre examinadores humanos y KSMm, los gráficos de dispersión muestran una fuerte correlación entre las medidas realizadas por humanos y las automáticas. Los mejores resultados se obtienen en PCI. Conclusiones Usando KSMm, la medida automática del área ZAF en HS-OCTA es factible y menos humano-dependiente. Resuelve la incapacidad de KSM de medir el área ZAF en imágenes de calidad subóptima que son frecuentes en la práctica clínica diaria. Por lo tanto, el procesamiento KSMm podría contribuir a nuestra comprensión de los tres plexos vasculares (AU)
Purpose To develop and evaluate an automated method to measure the foveal avascular zone (FAZ) area in healthy eyes on Heidelberg Spectralis Optical Coherence Tomography Angiography (HS-OCTA). This method is referred to as the modified Kanno-Saitama macro (mKSM) which is an evolution of the Kanno-Saitama macro (KSM) approach. Methods This cross-sectional study included 29 eyes of 25 healthy volunteers who underwent HS-OCTA at the macular area twice at the same time. Regardless of the quality of the images, all of them were included. Macular data on the superficial vascular plexus, intermediate capillary plexus (ICP) and deep capillary plexus were processed by mKSM. The FAZ area was measured twice automatically using the mKSM and KSM and twice manually by two independent examiners. Results From 174 images, KSM could not measure correctly 31% while mKSM could successfully measure all of them. Intrascan intraclass coefficient ranged from 0.948 to 0.993 for manual measurements and was 1 for mKSM method. Despite that the difference between human examiners is smaller than between human examiners and mKSM according to Bland-Altman plots, the scatterplots show a strong correlation between human and automatic measurements. The best results are obtained in ICP. Conclusions With mKSM, the automated determination of the FAZ area in HS-OCTA is feasible and less human-dependent. It solves the inability of KSM to measure the FAZ area in suboptimal quality images which are frequent in daily clinical practice. Therefore, the mKSM processing could contribute to our understanding of the three vascular plexuses (AU)
Subject(s)
Humans , Fovea Centralis/diagnostic imaging , Tomography, Optical Coherence/methods , Cross-Sectional Studies , Fluorescein Angiography/methods , Retinal Vessels/diagnostic imagingABSTRACT
PURPOSE: To develop and evaluate an automated method to measure the foveal avascular zone (FAZ) area in healthy eyes on Heidelberg Spectralis Optical Coherence Tomography Angiography (HS-OCTA). This method is referred to as the modified Kanno-Saitama macro (mKSM) which is an evolution of the Kanno-Saitama macro (KSM) approach. METHODS: This cross-sectional study included 29 eyes of 25 healthy volunteers who underwent HS-OCTA at the macular area twice at the same time. Regardless of the quality of the images, all of them were included. Macular data on the superficial vascular plexus, intermediate capillary plexus (ICP) and deep capillary plexus were processed by mKSM. The FAZ area was measured twice automatically using the mKSM and KSM and twice manually by two independent examiners. RESULTS: From 174 images, KSM could not measure correctly 31% while mKSM could successfully measure all of them. Intrascan intraclass coefficient ranged from 0,948 to 0,993 for manual measurements and was 1 for mKSM method. Despite that the difference between human examiners is smaller than between human examiners and mKSM according to Bland-Altman plots, the scatterplots show a strong correlation between human and automatic measurements. The best results are obtained in ICP. CONCLUSIONS: With mKSM, the automated determination of the FAZ area in HS-OCTA is feasible and less human-dependent. It solves the inability of KSM to measure the FAZ area in suboptimal quality images which are frequent in daily clinical practice. Therefore, the mKSM processing could contribute to our understanding of the three vascular plexuses.
Subject(s)
Fovea Centralis , Tomography, Optical Coherence , Cross-Sectional Studies , Fluorescein Angiography/methods , Fovea Centralis/diagnostic imaging , Humans , Retinal Vessels/diagnostic imaging , Tomography, Optical Coherence/methodsABSTRACT
Mujer de 80 años con mieloma múltiple (MM) de tipo IgA, que desarrolló cambios retinianos semejantes a los de retinopatía diabética no proliferativa leve, objetivándose microaneurismas y fluido intrarretiniano. La paciente fue tratada con quimioterapia para MM e inyecciones intravítreas de bevacizumab, siendo controlada durante 22 meses. La terapia antiangiogénica puede ser útil en el control de retinopatía secundaria a MM siempre y cuando se realice el control de la enfermedad sistémica
The case is presented on an 80-year-old woman with IgA multiple myeloma (MM), who developed retinal changes similar to mild non-proliferative diabetic retinopathy, with micro-aneurysms and intraretinal fluid. The patient was treated with systemic chemotherapy for MM, and with bevacizumab intravitreal injections, with control of her ocular disorder for 22 months. Anti-angiogenic therapy can be useful in the control of retinopathy secondary to MM, as long as the systemic disease has been controlled
Subject(s)
Humans , Female , Aged, 80 and over , Multiple Myeloma/diagnosis , Multiple Myeloma/drug therapy , Microaneurysm/diagnostic imaging , Bevacizumab/therapeutic use , Intravitreal Injections/methods , Macular Edema/complications , Tomography, Optical Coherence , Fundus Oculi , Visual Acuity/drug effects , Immunoglobulin A/analysisABSTRACT
The case is presented on an 80-year-old woman with IgA multiple myeloma (MM), who developed retinal changes similar to mild non-proliferative diabetic retinopathy, with micro-aneurysms and intraretinal fluid. The patient was treated with systemic chemotherapy for MM, and with bevacizumab intravitreal injections, with control of her ocular disorder for 22 months. Anti-angiogenic therapy can be useful in the control of retinopathy secondary to MM, as long as the systemic disease has been controlled.
ABSTRACT
OBJETIVO: Estudiar la eficacia y seguridad a nivel local del implante de dexametasona intravítreo como tratamiento del edema macular diabético (EMD) refractario a ranibizumab intravítreo en monoterapia o en combinación de tratamientos. MÉTODOS: Estudio retrospectivo de pacientes con EMD refractario a inyecciones intravítreas de ranibizumab, en monoterapia o en combinación con otros tratamientos, a quienes se ha administrado un implante de dexametasona intravítreo. Los parámetros analizados fueron la agudeza visual (AV) medida en optotipos según el Early Treatment Diabetic Retinopathy Study (ETDRS) y el grosor foveal determinado mediante tomografía de coherencia óptica de dominio espectral (SD-OCT) previos al tratamiento, 2 meses después y al final del período de seguimiento. RESULTADOS: Se incluyeron 14 ojos de 14 pacientes con una edad media de 64 años (DE: 9,5; rango 41-78) y un seguimiento medio de 7,6 meses. La AV media aumentó de 53 a 59 letras a los 2 meses (p = 0,03), con 57 letras al final del período de seguimiento (p = 0,3). El grosor foveal medio disminuyó de 502 a 304 μ a los 2 meses (p = 0,001), con 376 μ al final del período de seguimiento (p = 0,009). El 43% de los pacientes fueron tratados con un nuevo implante intravítreo de dexametasona. El 21,4% de los pacientes presentaron hipertensión ocular que se pudo controlar con medicación tópica. CONCLUSIONES: El implante de dexametasona intravítreo es eficaz y seguro localmente para el tratamiento del EMD en pacientes refractarios al ranibizumab en monoterapia o en combinación con otros tratamientos
OBJECTIVE: To determine the effectiveness and local safety of dexamethasone intravitreal implants as a treatment in diabetic macular edema (DME) refractory to intravitreal injections of ranibizumab monotherapy or combination therapy. METHODS: A retrospective study conducted on patients with DME refractory to ranibizumab monotherapy or combined with other treatments treated with dexamethasone intravitreal implants. The parameters analyzed were visual acuity (VA) by ETDRS (Early Treatment Diabetic Retinopathy Study) charts and foveal thickness by spectral-domain optical coherence tomography (SD-OCT) before the treatment, 2 months after treatment, and at the end of the follow-up. RESULTS: A total of 14 eyes of 14 patients were included, with a mean age of 64 years (SD: 9.5; range 41-78) and a mean follow-up of 7.6 months. The mean VA improved from 53 letters to 59 letters at 2 months (P=.03), and 57 at the end of the follow-up period (P=.3). The mean foveal thickness decreased from 502 μ to 304 μ at 2 months (P=.001), and 376 μ at the end of the follow-up period (P=.009). Further treatment with intravitreal dexamethasone was required in 43% of the patients, and 21% had increased intraocular pressure, which was controlled with topical medication. CONCLUSIONS: Intravitreal dexamethasone implant is an effective and locally safe treatment for the management of DME refractory to ranibizumab monotherapy or combined with other treatments
Subject(s)
Adult , Female , Humans , Male , Drug Implants/administration & dosage , Drug Implants , Drug Implants/pharmacology , Macula Lutea , Macula Lutea/pathology , Visual Acuity , Dexamethasone/administration & dosage , Dexamethasone/therapeutic use , Drug Implants/adverse effects , Drug Implants/toxicity , Drug Implants/therapeutic use , Diabetes Mellitus/pathology , Diabetes Mellitus/prevention & control , Diabetes Mellitus/therapyABSTRACT
OBJECTIVE: To determine the effectiveness and local safety of dexamethasone intravitreal implants as a treatment in diabetic macular edema (DME) refractory to intravitreal injections of ranibizumab monotherapy or combination therapy. METHODS: A retrospective study conducted on patients with DME refractory to ranibizumab monotherapy or combined with other treatments treated with dexamethasone intravitreal implants. The parameters analyzed were visual acuity (VA) by ETDRS (Early Treatment Diabetic Retinopathy Study) charts and foveal thickness by spectral-domain optical coherence tomography (SD-OCT) before the treatment, 2 months after treatment, and at the end of the follow-up. RESULTS: A total of 14 eyes of 14 patients were included, with a mean age of 64 years (SD: 9.5; range 41-78) and a mean follow-up of 7.6 months. The mean VA improved from 53 letters to 59 letters at 2 months (P=.03), and 57 at the end of the follow-up period (P=.3). The mean foveal thickness decreased from 502 µ to 304 µ at 2 months (P=.001), and 376 µ at the end of the follow-up period (P=.009). Further treatment with intravitreal dexamethasone was required in 43% of the patients, and 21% had increased intraocular pressure, which was controlled with topical medication. CONCLUSIONS: Intravitreal dexamethasone implant is an effective and locally safe treatment for the management of DME refractory to ranibizumab monotherapy or combined with other treatments.
