Local ocular surface findings in COVID-19 patients without ocular symptoms / Achados locais de superfície ocular em pacientes com COVID-19 sem sintomas oculares

ABSTRACT Purpose: To investigate subjective ocular symptoms and objectively measure tear secretion in patients with a confirmed diagnosis of coronavirus disease-2019 (COVID-19). Methods: In this prospective cross-sectional study, 24 patients who had survived COVID-19 infection and 27 healthy controls were enrolled. Conjunctival impression cytology, the Schirmer test, tear-film break-up time, corneal staining scores were applied to all the participants. Results: No significant difference was noted with regard to the gender and mean age between the two groups (p=0.484 and p=0.599, respectively). The conjunctival impression cytology analysis revealed that the density of the goblet cells was decreased, while the counts of lymphocytes and neutrophils were increased in the COVID-19 group patients when compared with ethe control group patients. When the Nelson classification was applied to the conjunctival impression cytology samples, 25% of the COVID-19 group patients and 14.8% of the control group patients exhibited changes consistent with ≥grade 2. The mean tear-film break-up time, Schirmer test, and corneal staining score results were determined to differ between the COVID-19 and control groups (p=0.02, p<0.001, and p=0.003, respectively). Conclusions: The present study revealed the pathological conjunctival alterations of patients with a confirmed diagnosis of COVID-19, indicating the possibility of the occurrence of pathological ocular surface alterations to even at the end of COVID-19 infection, without the occurrence of any significant clinical ocular manifestations.

RESUMO Objetivo: Investigar sintomas oculares subjetivos e medir a secreção lacrimal objetivamente em pacientes com diagnóstico confirmado da doença coronavírus 2019 (COVID-19). Métodos: Vinte e quatro pacientes que sobreviveram à infecção pela COVID-19 e 27 controles saudáveis foram incluídos neste estudo transversal prospectivo. Citologia de impressão da conjuntiva, teste de Schirmer, tempo de separação do filme lacrimal, pontuações de coloração da córnea foram aplicados a todos os participantes. Resultados: Concluiu-se que não houve diferença significativa em relação ao gênero e idade média entre os dois grupos (p=0,484 e p=0,599, respectivamente). A análise dos resultados da citologia de impressão da conjuntiva revelou que a densidade das células do cálice diminuiu, enquanto os linfócitos e neutrófilos aumentaram nos pacientes do grupo COVID-19 quando comparados com os do grupo controle. Quando a classificação de Nelson foi aplicada às amostras de citologia de impressão da conjuntiva, determinou-se que 25% dos pacientes do grupo COVID-19 e 14,8% dos pacientes do grupo controle apresentaram alterações consistentes com grau 2 ou superior. O tempo médio de separação do filme lacrimal, teste de Schirmer e os resultados das pontuações de coloração da córnea foram determinados, diferindo entre o grupo COVID-19 e o grupo controle (p=0,02, p<0,001, and p=0,003, respectivamente). Conclusões: As análises realizadas neste estudo revelaram as alterações conjuntivais patológicas de pacientes com diagnóstico confirmado de COVID-19 e mostraram que é possível que alterações patológicas da superfície ocular ocorram mesmo no final da infecção pela COVID-19, sem a ocorrência de manifestações oculares clínicas significativas.

Local ocular surface findings in COVID-19 patients without ocular symptoms.

PURPOSE: To investigate subjective ocular symptoms and objectively measure tear secretion in patients with a confirmed diagnosis of coronavirus disease-2019 (COVID-19). METHODS: In this prospective cross-sectional study, 24 patients who had survived COVID-19 infection and 27 healthy controls were enrolled. Conjunctival impression cytology, the Schirmer test, tear-film break-up time, corneal staining scores were applied to all the participants. RESULTS: No significant difference was noted with regard to the gender and mean age between the two groups (p=0.484 and p=0.599, respectively). The conjunctival impression cytology analysis revealed that the density of the goblet cells was decreased, while the counts of lymphocytes and neutrophils were increased in the COVID-19 group patients when compared with ethe control group patients. When the Nelson classification was applied to the conjunctival impression cytology samples, 25% of the COVID-19 group patients and 14.8% of the control group patients exhibited changes consistent with ≥grade 2. The mean tear-film break-up time, Schirmer test, and corneal staining score results were determined to differ between the COVID-19 and control groups (p=0.02, p<0.001, and p=0.003, respectively). CONCLUSIONS: The present study revealed the pathological conjunctival alterations of patients with a confirmed diagnosis of COVID-19, indicating the possibility of the occurrence of pathological ocular surface alterations to even at the end of COVID-19 infection, without the occurrence of any significant clinical ocular manifestations.

Comparison of radial peripapillary capillary density results of individuals with and without Helicobacter pylori infection.

PURPOSE: To evaluate the radial peripapillary capillary density using optical coherence tomography angiography in patients with and without Helicobacter pylori infection. METHODS: This prospective, cross-sectional study comprised 52 patients (52 eyes: Group 1) and 38 patients (38 eyes: Group 2) with and without H. pylori infections, respectively. The radial peripapillary capillary density and retinal nerve fiber layer thickness in 4 equal quadrants and 2 equal hemispheres in the peripapillary region were calculated using optical coherence tomography angiography. The optic nerve head parameters of the patients were also assessed. RESULTS: The groups were similar in terms of age, gender, and the optic nerve head parameters. The radial peripapillary capillary densities in the superior hemisphere and quadrant were significantly lower in Group 1 than in Group 2 (p=0.039 and p=0.028, respectively) and were positively correlated with the superior hemisphere's retinal nerve fiber layer thickness (p<0.001 and p<0.001, respectively). Similarly, the radial peripapillary capillary densities in the inferior hemisphere and quadrant were also significantly lower in Group 1 compared to Group 2 (p=0.03 and p=0.017, respectively) and were positively correlated with the inferior hemisphere's retinal nerve fiber layer thickness (p<0.001 and p<0.001, respectively). The retinal nerve fiber layer thickness in the nasal and temporal quadrants were significantly decreased in Group 1 when compared to Group 2 (p=0.013 and p=0.022) and were positively correlated with the corresponding radial peripapillary capillary densities of the 2 quadrants (p=0.002 and p=0.022). CONCLUSION: The decreased radial peripapillary capillary density in the H. pylori-positive patients suggests that H. pylori may play a role in the etiopathogenesis of glaucoma.

Comparison of radial peripapillary capillary density results of individuals with and without Helicobacter pylori infection / Comparação dos resultados da densidade capilar peripapilar radial de indivíduos com e sem infecção por Helicobacter pylori

ABSTRACT Purpose: To evaluate the radial peripapillary capillary density using optical coherence tomography angiography in patients with and without Helicobacter pylori infection. Methods: This prospective, cross-sectional study comprised 52 patients (52 eyes: Group 1) and 38 patients (38 eyes: Group 2) with and without H. pylori infections, respectively. The radial peripapillary capillary density and retinal nerve fiber layer thickness in 4 equal quadrants and 2 equal hemispheres in the peripapillary region were calculated using optical coherence tomography angiography. The optic nerve head parameters of the patients were also assessed. Results: The groups were similar in terms of age, gender, and the optic nerve head parameters. The radial peripapillary capillary densities in the superior hemisphere and quadrant were significantly lower in Group 1 than in Group 2 (p=0.039 and p=0.028, respectively) and were positively correlated with the superior hemisphere's retinal nerve fiber layer thickness (p<0.001 and p<0.001, respectively). Similarly, the radial peripapillary capillary densities in the inferior hemisphere and quadrant were also significantly lower in Group 1 compared to Group 2 (p=0.03 and p=0.017, respectively) and were positively correlated with the inferior hemisphere's retinal nerve fiber layer thickness (p<0.001 and p<0.001, respectively). The retinal nerve fiber layer thickness in the nasal and temporal quadrants were significantly decreased in Group 1 when compared to Group 2 (p=0.013 and p=0.022) and were positively correlated with the corresponding radial peripapillary capillary densities of the 2 quadrants (p=0.002 and p=0.022). Conclusion: The decreased radial peripapillary capillary density in the H. pylori-positive patients suggests that H. pylori may play a role in the etiopathogenesis of glaucoma.

RESUMO Objetivos: Avaliar a densidade capilar peripapilar radial de pacientes com e sem infecção por Helicobacter pylori (H. pylori) por meio de angiotomografia de coerência óptica. Métodos: Cinquenta e dois olhos de 52 pacientes com infecção por H. pylori (Grupo 1) e 38 olhos de 38 pacientes sem infecções por H. pylori (Grupo 2) foram incluídos neste estudo prospectivo e transversal. A densidade capilar peripapilar radial (%) e a espessura da camada de fibra nervosa retiniana (μm) em 4 setores iguais e 2 hemisférios iguais foram calculados automaticamente na região peripapilar por angiotomografia de coerência óptica. Os parâmetros da cabeça do nervo óptico dos pacientes também foram avaliados. Resultados: Os grupos foram semelhantes em relação aos parâmetros: idade, sexo e cabeça do nervo óptico. As densidades capilares peripapilares radiais no hemisfério superior, hemisfério inferior, quadrante superior e quadrante inferior foram significativamente menores no Grupo 1 do que no Grupo 2 (p=0,039, p=0,03, p=0,028 e p=0,017 respectivamente). As densidades capilares peripapilares radiais, tanto no hemisfério superior quanto no quadrante superior, foram correlacionadas positivamente com a espessura da camada de fibra nervosa da retina do hemisfério superior (p<0,001 e p<0,001). As densidades capilares peripapilares radiais no hemisfério inferior e no quadrante inferior foram positivamente correlacionadas com a espessura da camada do nervo retiniano do hemisfério inferior (p<0,001 e p<0,001). A espessura da camada da fibra nervosa retiniana nos quadrantes nasal e temporal diminuiu significativamente no Grupo 1 quando comparado ao Grupo 2 (p=0,013 e p=0,022), e esses valores foram positivamente correlacionados com as densidades capilares peripapilares radiais correspondentes nos quadrantes nasal e temporal (p=0,002 e p=0,022). Conclusão: A diminuição das densidades capilares peripapilares radiais nos olhos de indivíduos positivos para H. pylori sugere que H. pylori pode desempenhar um papel na etiopatogenia do glaucoma.

Evaluation of the radial peripapillary capillary density in unilateral branch retinal vein occlusion and the unaffected fellow eyes.

Background: Given that unilateral branch retinal vein occlusion (BRVO) and glaucoma share common systemic vascular risk factors, the fellow eyes of patients with BRVO may be at increased risk of glaucoma. Objectives: To analyze the radial peripapillary capillary density (RPCD) in eyes with unilateral BRVO and their unaffected fellow eyes using optical coherence tomography angiography (OCTA). Design: Cross-sectional, prospective study. Methods: The study included 120 eyes of 80 patients: 40 affected eyes of BRVO, 40 fellow eyes of BRVO, and 40 control eyes. The RPCD, retinal nerve fiber layer thickness (RNFLT) were analyzed using OCTA. Results: RPCDs in the whole image, peripapillary region, all the hemispheres, and quadrants were statistically lower in the affected eyes than in both the fellow and control eyes (p < 0.05 for all). RPCD values in the whole image and the peripapillary region were significantly lower in the fellow eyes than in the control eyes (p = 0.013, and p = 0.021, respectively). RNFLTs in the peripapillary region, inferior hemisphere and inferior quadrant were significantly lower in the affected eyes than in the control eyes (p < 0.05 for all). No significant differences were detected between the fellow eyes and the control eyes in term of RNFLT values in any regions (p > 0.05 for all). Conclusion: Lower RPCD values despite similar RNFLT values were observed in the fellow eyes of patients with unilateral BRVO compared with healthy controls. These results may indicate the shared vascular mechanisms and risk factors that account for the development of BRVO and glaucoma.

The Effect of Pathological Retinal Changes on Retinal Capillary Circulation in Myopic Patients.

Objectives: Myopia is a common ocular disorder worldwide, leading to degenerative changes in the retina which is highly susceptible to vascular impairment. The aim of the study was to investigate the effects of pathological retinal changes on the retinal capillary structures using optical coherence tomography angiography (OCTA) in myopic patients. Methods: Thirty-two patients with high myopia (HM), 29 patients with pathological myopia (PM), and 38 healthy subjects with emmetropia (EM) were enrolled in this study. OCTA was performed to measure the following parameters: Foveal avascular zone (FAZ) area; FAZ perimeter; FAZ acircularity index (AI); and superficial, deep, and radial peripapillary capillary (RPC) vessel densities. Axial length (AL), spherical equivalent, and anterior chamber depth were evaluated. Results: Significant differences in the mean AL values were observed between the EM group and the other groups (p<0.001 for all); however, no significant differences were observed between the HM and PM groups (p=0.135). Significant differences in FAZ parameters, except for AI, were found among the three groups (p<0.05 for all). In all regions, except for the fovea and inside disc, the capillary plexus vessel densities were significantly lower in the PM group than in the other groups and were lower in the HM group than in the EM group (p<0.05 for all). Conclusion: Significant differences identified in capillary densities between the HM and PM groups, both of which present similar AL measurements, suggest that pathological retinal findings have significant effects on retinal perfusion independent of the effect of AL.

Objective Assessment of Corneal and Lens Clarity in Patients with COVID-19.

SIGNIFICANCE: The severe acute respiratory syndrome coronavirus 2 virus, which causes the coronavirus disease 2019 (COVID-19) pandemic, can bind to epithelial cells in the human cornea and conjunctiva, which may result in changes of corneal and lenticular densitometry. PURPOSE: We aimed to report the corneal and lenticular clarity of patients who had been diagnosed previously with confirmed infection of COVID-19. METHODS: This was a prospective, cross-sectional study. Fifty-three patients who had recovered from COVID-19 and 51 healthy individuals who had not had COVID-19 (control) were included in this study. Measurement of the corneal (at a corneal diameter of 12 mm) and lens densitometry of participants was performed using a Pentacam HR Scheimpflug imaging system. Three different optimal depths as anterior, central, and posterior layers and four concentric zones, consisting of diameters of 0 to 2, 2 to 6, 6 to 10, and 10 to 12 mm, were chosen to perform the corneal densitometric measurements. The mean lenticular densitometric values were calculated in zone 1 at 2.0 mm, zone 2 at 4.0 mm, and zone 3 at 6.0 mm by taking the central part of the pupil as reference point. RESULTS: When compared with the individuals in the control group, the corneal densitometry measurements in the patients in the COVID-19 group were considerably higher in anterior 0 to 2 mm, 2 to 6 mm, 6 to 10 mm zones and total diameter; center 0 to 2 and 2 to 6 mm zones and total diameter; posterior 0 to 2 mm zone; and total corneal 0 to 2 and 2 to 6 mm zones and total diameter (P < .05, for each). When compared with the individuals in the control group, all of the lens densitometry measurements, except for those located in zone 1, were determined to be significantly higher among the patients in the COVID-19 group (P < .05, for each). CONCLUSIONS: Significant alterations were found in corneal and lenticular densitometric values in patients who had had COVID-19. The virus could adversely affect cornea and lens transparency.

The Impact of Coronavirus Disease 2019 (COVID-19) on Retinal Microcirculation in Human Subjects.

BACKGROUND: The aim of the study was to assess retinal microcirculation in patients with coronavirus disease 2019 (COVID-19) through the use of optical coherence tomography angiography (OCT-A) and compare the results with those obtained in healthy controls. METHODS: The study enrolled 39 patients who had fully recovered from COVID-19 and 40 healthy controls. OCT-A image acquisitions were obtained using AngioVue software (version 2017.1.0.151) and the RTVue XR Avanti imaging system (Optovue Inc., Fremont, CA, USA). Nonflow area in the superficial capillary plexus (SCP), foveal avascular zone (FAZ) area in the whole retinal vasculature, FAZ perimeter, acircularity index of FAZ, and foveal density were automatically obtained with the FAZ assessment tool. Vessel density (VD) at the SCP and deep capillary plexus were also measured. RESULTS: Compared to the control group, the nonflow area and the FAZ area in the whole retina was greater in the COVID-19 group; however no statistically significant difference was observed (p > 0.05 respectively). As for vessel densities, all superficial parafoveal VD parameters were considerably higher in the COVID-19 group compared to the control group (p < 0.05 respectively). Despite the fact that the vessel densities in the remaining zones were lower in the COVID-19 group, those differences were not statistically significant (p > 0.05 respectively). CONCLUSION: VD at the parafoveal area of the SCP was significantly higher among patients in the late post-recovery period of COVID-19 disease compared to healthy controls. These findings show the impact of COVID-19 on the retinal microvasculature and its possible role as a risk factor for the development of ocular diseases.

Quantitative assessment of retinal changes in COVID-19 patients.

CLINICAL RELEVANCE: The SARS-COV 2 virus, which is responsible for the COVID-19 pandemic, acts on the angiotensin converting enzyme 2 (ACE-2) receptor in the host cell. Ocular effects may occur because of the ACE-2 receptor in the retina. BACKGROUND: To investigate the impact of COVID-19 on the retinal layers and optic disc parameters in previously confirmed COVID-19 patients using spectral domain optical coherence tomography (SD-OCT). METHODS: This study included 60 eyes of 60 subjects; 35 of them were in the COVID-19 group and the remaining 25 were in the control group. Patients with the diagnosis of COVID-19 that had a negative result after treatment were included in the study. Macular and peripapillary retinal nerve fiber layer (RNFL) thickness measurements, each retinal layer thickness of all participants were done 14-30 days after COVID-19 symptom onset, following the negative result of real time reverse transcriptase-polymerase chain reaction test using SD-OCT. RESULTS: The mean value of central macular thickness was significantly higher in the COVID-19 group than the control group (p = 0.02). The mean values of the ganglion cell layer and inner nuclear layer thickness in the COVID-19 group were significantly thinner than control group (p = 0.04 and p = 0.04, respectively). Even though mean RNFL thickness measurements in all sections in the COVID-19 group was thinner than controls, there were no significant differences between groups (p > 0.05 for all). CONCLUSION: In the early recovery phase, changes in the macula, ganglion cell layer and inner nuclear layer could be seen. These patients should be followed up closely for the recognition of new pathologies that could be seen in the late recovery phase.

Retinal Microcirculation Alterations in Microalbuminuric Diabetic Patients With and Without Retinopathy.

PURPOSE: To investigate the effect of microalbuminuria (MA) on superficial vessel density (SVD), deep vessel density (DVD), and choriocapillaris vessel density (CVD) in type-2 diabetic patients. METHODS: Twenty patients without diabetic retinopathy (DR) and MA (group 1), 20 patients without DR but with MA (group 2) and 30 patients with mild DR and MA (group 3) were enrolled in this prospective and cross-sectional study. SVD, DVD, and CVD of all patients were screened with optical coherence tomography angiography (OCTA). The relationships between these values and age, diabetes duration and metabolic parameters were also evaluated. RESULTS: The whole macular SVD value was 50.15 ± 4.52 in group 1 and 47.81 ± 4.12 in group 2 (p = .04). The whole macular DVD value was 47.66 ± 2.76 in group 1, 44.37 ± 3.39 in group 3 (p = .02). Parafoveal DVD value was 52.58 ± 3.47 in group 1, 51.84 ± 2.23 in group 2, and 49.23 ± 3.38 in group 3 (p G1&3 = .001, p G2&3 = .02). Perifoveal DVD value was 47.92 ± 3.30 in group 1, 43.96 ± 4.19 in group 2, and 42.85 ± 2.98 in group 3 (p G1&2 = .02 and p G1&3 < .001). There were inverse correlations between diabetes duration, urea, creatinine, albumin, urinary sodium and some DVD values (p < .05, for all). Also, there were inverse correlations between parafoveal and perifoveal DVD values and MA (p = .002 and p = .031). Additionally, inverse correlations were determined between diabetes duration, creatinine, urea, serum Na and some CVD values (p < .05 for all).Conclusion: Decreased SVD and DVD values measured by OCTA in type-2 diabetic patients, whether they have mild DR or not, may be associated with MA causing early retinal microvascular changes.

Evaluation of Corneal and Lenticular Parameters in Iron Deficiency Anemia.

OBJECTIVES: The aim of this study was to investigate the effects of iron deficiency anemia on corneal and lenticular densitometry. METHODS: Thirty-two patients with iron deficiency anemia and 38 healthy participants were enrolled. The Pentacam HR imaging system (Oculus Optikgeräte GmbH, Wetzlar, Germany) was used to record keratometry, corneal densitometry (12-mm corneal diameter), lens densitometry measurements. Endothelial parameters were evaluated using specular microscopy. RESULTS: The corneal densitometry values in the anterior 0-2 mm and 2-6 mm zone were significantly higher in the iron deficiency anemia group than in the control group (p=0.044 and p=0.021, respectively). There was a statistically significant difference in the mean values of the standard deviation and maximum lens densitometry measurements of the iron deficiency anemia group when compared with the control group (p=0.012 and p=0.011, respectively). There were statistically significant correlations between the anterior 2-6 mm zone corneal densitometry and ferritin, iron, and total iron binding capacity (r=-0.275, r=-0.243, r=0.240, respectively). However, ferritin, iron, and total iron binding capacity showed no significant correlation with the lens densitometry values (p>0.05 for all). CONCLUSION: Iron deficiency anemia had several effects on corneal and lenticular densitometry measurements. Evaluation of the corneal and lenticular changes at an ophthalmology clinic might be recommended for patients with iron deficiency anemia.

Comparison of optical coherence tomography angiography features in type 1 versus type 2 choroidal neovascular membranes secondary to age-related macular degeneration.

Background: Optical coherence tomography angiography (OCTA) is an advanced imaging modality that provides high resolution images at the level of different retinal layers. This study aime to evaluate choroidal neovascular membranes (CNVMs) secondary to age-related macular degeneration (AMD) quantitatively and qualitatively, according to their classification, morphological features, and flow areas, using OCTA. Methods: In this descriptive, comparative, cross-sectional study, CNVMs were divided into 2 groups according to their classification as type 1 or type 2 neovascularization. Mied CNVMs were excluded from the study. The size (mm2) and the flow area (mm2) of the CNVMs were calculated via OCTA and the presence of the perivascular halo and loop anastomoses were analyzed. The morphological appearance of the CNVMs were classified as: medusa, sea-fan, lacy-wheel, glomerular, dead tree, and mature vascular networks. Results: Of the 85 eyes assessed for eligibility, 45 eyes of 34 individuals with CNVM were enrolled in this retrospective study. Twenty-eight eyes had type 1 and 17 eyes had type 2 CNVMs. The mean size and flow area were greater in type 1 than in type 2 CNVMs (mean [standard deviation], 6.69 [4.54] and 3.61 [3.56] mm2 versus 3.04 [1.98] and 1.77 [1.62] mm2; P = 0.044 and 0.046, respectively). Among the 22 eyes with type 1 CNVMs and the 9 eyes with type 2 CNVMs, 31 eyes had exudative membranes. Among the eyes with exudative CNVMs, 22 eyes had a perivascular halo and 22 eyes had loop anastomoses; this was significantly more than in the non-exudative eyes (P = 0.042 and 0.041, respectively). The lacy-wheel (38.7%) and dead tree (71.4%) patterns were the most frequent morphological appearance of the CNVMs in the exudative and non-exudative membranes, respectively. Conclusions: OCTA provides objective documantation about CNVMs. A perivascular dark halo around CNVMs could be a criterion to define exudative membranes activity.

Evaluation of radial peripapillary capillary density in patients with newly diagnosed iron deficiency anemia.

PURPOSE: To investigate the effects of iron deficiency anemia (IDA) on radial peripapillary capillary vessel density (RPCvd) and retinal nerve fiber layer (RNFL) thickness. METHODS: Forty patients with IDA, and 46 healthy participants, were enrolled in this study. Optical coherence tomography angiography was used to determine RNFL thickness and RPCvd measurements. In addition, hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and ferritin laboratory values were evaluated. RESULTS: Analysis of retinal regions (whole images, peripapillary, superior-hemi, inferior-hemi, inferior-nasal, inferior-temporal, temporal-inferior, temporal-superior, superior-nasal) showed that RPCvd values were significantly lower in patients with IDA compared to the control group values (p < 0.05 for all). However, there were no significant differences in RNFL thickness values between the IDA patient group and the control group (p > 0.05 for all). In addition, there were significant positive correlations between RPCvd values and hematological values for Hb, HCT, MCV, MCH, MCHC, and ferritin. CONCLUSION: It is important to identify changes in retinal vascularity to prevent possible ocular problems in patients with IDA. Specifically, the significant positive correlations between RPCvd values and hematological values suggest that anemia treatment is important for optic nerve perfusion.

Association between disorganization of the retinal inner layers and capillary nonperfusion area in patients with retinal vein occlusion / Associação entre a desorganização das camadas internas da retina e areas sem perfusão capilar em pacientes com oclusão de veia retiniana

ABSTRACT Purpose: To determine the correlation between the extent of disorganization of the retinal inner layers (a parameter of spectral domain optical coherence tomography) and optical coherence tomography angiography parameters in eyes with center-involved macular edema associated with retinal vein occlusion. Methods: This retrospective observational study included 34 eyes of 34 patients with newly diagnosed macular edema associated with retinal vein occlusion and evidence of center-involved macular edema. Optical coherence tomography angiography and spectral domain optical coherence tomography were evaluated after resolution of the macular edema. Disorganization of the retinal inner layers was determined via spectral domain optical coherence tomography and optical coherence tomography angiography parameters, including foveal avascular zone area in the superficial capillary plexus and capillary nonperfusion areas, foveal avascular zone area in full retinal vasculature, foveal avascular zone perimeter, acircularity index of the foveal avascular zone, and foveal density. Results: The mean disorganization of the retinal inner layers extent was 512.72 ± 238.47 microns, and the mean capillary nonperfusion area was 4.98 ± 2.85 mm2. There was a positive correlation between the extent of disorganization of the retinal inner layers and capillary nonperfusion area (p<0.001, r=0.901). Greater extent of disorganization of the retinal inner layers and the capillary nonperfusion area was correlated with wider foveal avascular zone area (p=0.014 and p=0.036, respectively) in the superficial capillary plexus and decreased foveal density (vessel density in 300 microns around the foveal avascular zone) (p=0.031 and p=0.022, respectively). These parameters were also correlated with decreased vessel density in both the superficial capillary plexus and deep capillary plexus in the parafoveal and peri­foveal regions (p<0.05 for all). Conclusions: Disorganization of the retinal inner layers appears to be a correlated biomarker of capillary ischemia in retinal vein occlusion. The extent of disorganization of the retinal inner layers was strongly correlated with the capillary nonperfusion area. This may support the notion that the extent of disorganization of the retinal inner layers can be used as an easily obtainable and crucial surrogate marker of capillary ischemia.

RESUMO Objetivo: Determinar a correlação entre a ex­tensão da desorganização das camadas internas da retina, que constitui um parâmetro da tomografia de coerência óptica de domínio espectral, e os parâmetros da angiografia por tomografia de coerência óptica em olhos com edema macular com envolvimento central associado à oclusão da veia retiniana. Métodos: Este estudo retrospectivo observacional incluiu 34 olhos de 34 pacientes com edema macular recém-diag­nosticado associado à oclusão da veia retiniana e com evidência de edema macular com envolvimento central. Após a resolução do edema macular, foram avaliadas a tomografia de coerência óptica de domínio espectral e a angiografia por tomografia de coerência óptica. A desorganização das camadas internas da retina foi determinada através de parâmetros da tomografia de coerência óptica de domínio espectral e da angiografia por tomografia de coerência óptica, incluindo a área da zona avascular foveal no plexo capilar superficial e nas regiões sem perfusão capilar, a área da zona avascular foveal na vascularização total da retina, o perímetro da zona avascular foveal, o índice de não circularidade da zona avascular foveal e a densidade foveal. Resultados: A extensão média da desorganização das camadas internas da retina foi de 512,72 ± 238,47 mm e a área média da região sem perfusão capilar foi de 4,98 ± 2,85 mm2. Houve uma correlação positiva entre a extensão da desorganização das camadas internas da retina e a área da região sem perfusão capilar (p<0,001, r=0,901). Maior extensão da desorganização das camadas internas da retina e da região sem perfusão capilar correlacionaram-se a uma área maior da zona avascular foveal (respectivamente, p=0,014 e p=0,036) no plexo capilar superficial e a uma menor densidade foveal (a densidade vascular nos 300 μm à volta da zona avascular foveal; respectivamente, p=0,031 e p=0,022), e também se correlacionaram a uma menor densidade vascular tanto no plexo capilar superficial como no profundo, nas regiões parafoveal e perifoveal (p<0,05 em todas as correlações). Conclusão: A desorganização das camadas internas da retina parece ser um biomarcador correlacionado com a isquemia capilar na oclusão da veia retiniana. O fato de que a extensão dessa desorganização se correlacionou fortemente com a área sem perfusão capilar sugere o uso da extensão da desorganização das camadas internas da retina como um marcador substituto de isquemia capilar, sendo este um marcador importante e facilmente obtido.

Normative Data Assessment of Peripapillary and Macular Vessel Density and Foveal Avascular Zone Metrics Using Optical Coherence Tomography Angiography in Children.

PURPOSE: To quantify the vessel density of the macula and optic disc and foveal avascular zone (FAZ) in healthy children and to evaluate the effects of age, gender, axial length, body mass index (BMI), and refractive errors on vessel density and FAZ. METHODS: This study enrolled 92 eyes of 92 participants (42 boys and 50 girls). Optical coherence tomography angiography (OCTA) was performed using AngioVue (Avanti; Optivue). FAZ area, nonflow area, superficial and deep vessel density, FAZ perimeter, acircularity index of FAZ, foveal density, and radial peripapillary capillary vessel density were analyzed by gender. Correlations between the investigated OCTA parameters and age, axial length, and BMI were evaluated. RESULTS: Girls had significantly larger nonflow and FAZ area than boys (P = .01 and .02). Superficial and deep vessel density at the fovea was significantly higher in boys compared to girls (P = .01 and .03). Inferior temporal and superior temporal Radial peripapillary capillary vessel densities were significantly higher in girls than boys (P = .01 and .03). No significant difference was found in the macular and optic disc vessel density measurements within refractive groups (P > .05, for all). Regarding the correlation of age with FAZ and vessel density parameters, only nonflow area was positively correlated with age (r = 0.22, P = .03). CONCLUSIONS: This study provides normative data for children. Although boys had greater foveal vessel density, girls had greater FAZ area and nonflow area. Refractive status of the eye and BMI did not influence the OCTA parameters. Although nonflow area was positively correlated with age, other parameters were steady within the ages of 7 to 18 years. [J Pediatr Ophthalmol Strabismus. 2020;57(6):388-398.].

Direct and crossover effects of Phenylephrine and Cyclopentolate on foveal avascular zone and vessel density of macular capillary plexuses: an optical coherence tomography angiography study.

Purpose: To determine the influence of phenylephrine and cyclopentolate on foveal avascular zone (FAZ) and vessel density of macular capillary plexus measurements via optical coherence tomography angiography (OCTA). Materials and Methods: The participants were separated into 2 groups according to the administration of drops. One drop of phenylephrine 2.5% was administered on one eye of each subject in the phenylephrine group (n=30) and one drop of cyclopentolate 1% in the cyclopentolate group (n=30). FAZ parameters and vessel density values of both superficial (SCP) and deep capillary plexuses (DCP) were calculated via OCTA priorly and at 45 min following the drop administration in both eyes. Vessel density, acircularity index of FAZ, FAZ area, perimeter of FAZ and foveal density-300 were evaluated via OCTA. Results: The vessel density values of fovea in SCP and DCP was 18.51±7.14% and 36.05±8.76% and significantly decreased to 16.16±6.26% and 33.29±9.47% respectively after drop instillation in dilated eyes in phenylephrine group (p=0.041 and p=0.032). Likewise, the vessel density values in SCP and DCP were 21.56±7.74% and 39.27±8.76% and significantly decreased to 18.89±7.32% and 35.36±5.75% respectively, after drop instillation in dilated eyes in cyclopentolate group (p=0.035 and p=0.028). However, there was no significant difference between before and after instillation of drops in terms of foveal density-300 value via FAZ assessment tool in both dilated and nondilated contralateral eyes in both groups (p>0.05 for all). Conclusions: Mydriasis with phenylephrine and/ or cyclopentolate did not affect the foveal density-300 values while analyzing the perfusion of macula. Vessel density in foveal region should be evaluated via FAZ evaluation software of the OCTA.

Quantitative analysis of radial peripapillary capillary plexuses in patients with clinically unilateral pseudoexfoliation syndrome.

PURPOSE: The aim of this study was to image the radial peripapillary capillary vessel densities (RPCvds) of the affected eyes and fellow unaffected eyes of individuals with unilateral pseudoexfoliation syndrome (PES) using optical coherence tomography angiography (OCTA) and to compare the RPCvds with those of normal age-matched individuals. METHODS: The eyes were divided into three groups: the pseudoexfoliative material (PXM)-positive eyes of patients with clinically unilateral PES (study eyes), the fellow eyes of the PXM-positive patients (fellow eyes), and the eyes of healthy patients (control eyes). Those patients with glaucomatous findings, including peripapillary hemorrhaging, cupping, notching, focal thinning of the neuroretinal rim, or intraocular pressure readings greater than 21 mmHg, were excluded from the study. The RPCvd (%), peripapillary retinal nerve fiber layer (RNFL) thickness (µm), cup/disc area ratio, rim area (mm2), disc area (mm2), and cup volume (mm3) were automatically calculated via OCTA. RESULTS: This cross-sectional comparative prospective study included 128 eyes of 88 patients: 40 PXM-positive eyes, 40 fellow eyes, and 48 control eyes. The RPCvds and RNFL thicknesses in the peripapillary region were significantly lower in the study eyes than in the fellow eyes and the control eyes (p = 0.011 and p = 0.011, p = 0.009 and p = 0.004, respectively). There were no significant differences between the fellow eyes and the control eyes with regard to the RPCvd and RNFL values in any region (p > 0.05 for all). CONCLUSION: Lower RPCvds could provoke capillary deficiency and deterioration of the perfusion of the optic nerve head in patients with PES.

Association between disorganization of the retinal inner layers and capillary nonperfusion area in patients with retinal vein occlusion.

PURPOSE: To determine the correlation between the extent of disorganization of the retinal inner layers (a parameter of spectral domain optical coherence tomography) and optical coherence tomography angiography parameters in eyes with center-involved macular edema associated with retinal vein occlusion. METHODS: This retrospective observational study included 34 eyes of 34 patients with newly diagnosed macular edema associated with retinal vein occlusion and evidence of center-involved macular edema. Optical coherence tomography angiography and spectral domain optical coherence tomography were evaluated after resolution of the macular edema. Disorganization of the retinal inner layers was determined via spectral domain optical coherence tomography and optical coherence tomography angiography parameters, including foveal avascular zone area in the superficial capillary plexus and capillary nonperfusion areas, foveal avascular zone area in full retinal vasculature, foveal avascular zone perimeter, acircularity index of the foveal avascular zone, and foveal density. RESULTS: The mean disorganization of the retinal inner layers extent was 512.72 ± 238.47 microns, and the mean capillary nonperfusion area was 4.98 ± 2.85 mm2. There was a positive correlation between the extent of disorganization of the retinal inner layers and capillary nonperfusion area (p<0.001, r=0.901). Greater extent of disorganization of the retinal inner layers and the capillary nonperfusion area was correlated with wider foveal avascular zone area (p=0.014 and p=0.036, respectively) in the superficial capillary plexus and decreased foveal density (vessel density in 300 microns around the foveal avascular zone) (p=0.031 and p=0.022, respectively). These parameters were also correlated with decreased vessel density in both the superficial capillary plexus and deep capillary plexus in the parafoveal and peri-foveal regions (p<0.05 for all). CONCLUSIONS: Disorganization of the retinal inner layers appears to be a correlated biomarker of capillary ischemia in retinal vein occlusion. The extent of disorganization of the retinal inner layers was strongly correlated with the capillary nonperfusion area. This may support the notion that the extent of disorganization of the retinal inner layers can be used as an easily obtainable and crucial surrogate marker of capillary ischemia.

Effects of Topical Nepafenac and Fluorometholone on Macular Thickness After Posterior Capsulotomy Using Neodymium-doped Yttrium-Aluminum-Garnet Laser.

OBJECTIVES: The aim of this study was to assess the effects of topical 0.1% nepafenac and 0.1% fluorometholone on macular thickness (MT) after a neodymium: yttrium-aluminum-garnet (Nd: YAG) laser posterior capsulotomy and to compare the findings with those of untreated patients. METHODS: This prospective study included 75 eyes of 75 patients with posterior capsule opacification. The patients were divided into 3 groups according to the medications administered after a capsulotomy procedure. Group 1 comprised 25 patients who were prescribed 0.1% nepafenac for a week, Group 2 consisted of 25 patients who were prescribed 0.1% fluorometholone for a week, and Group 3 consisted of 25 patients who were not prescribed any medication. A circular-shaped capsulotomy was performed in all cases. MT was measured before the capsulotomy and at the first day, first week, and first month after the procedure using spectral domain-optical coherence tomography and the change values were compared within and between groups. RESULTS: In Group 1, the superior and nasal parafoveal MT, temporal, and nasal perifoveal MT values at the first month were statistically significantly greater than those observed in the first week (p<0.05 for all values). In Group 2, the superior and nasal parafoveal MT and inferior perifoveal MT measurements in the first month were greater than those recorded the first week (p<0.05 for all values). In Group 3, there was a gradual increase seen in the first day, first week, and first month in the superior and temporal parafoveal MT value (p<0.05 for all). The change value in the parafoveal temporal quadrant was significant between groups, indicating a greater increase in the untreated group compared with the nepafenac and fluorometholone groups (p=0.04). CONCLUSION: An increase in MT can occur after an Nd: YAG laser posterior capsulotomy. Both topical 0.1% nepafenac and 0.1% fluorometholone can prevent this increase. The 2 drugs were comparable; neither demonstrated apparent superiority to the other.

Evaluation of radial peripapillary capillary density in patients with Fuchs uveitis syndrome.

PURPOSE: To quantitatively analyze the microcirculation in the peripapillary sectors in the affected eyes and fellow unaffected eyes of individuals with unilateral Fuchs uveitis syndrome (FUS) using optical coherence tomography angiography (OCTA), and to compare the radial peripapillary capillary vessel density (RPCvd) with normal and age-matched individuals. METHODS: Eyes were divided into three groups based on the involvement of the FUS: FUS-positive eye of patients (study eye), fellow eye of FUS-positive patients (fellow eye), and the control eye for the control group (control eye). RPCvd (%) and peripapillary retinal nerve fiber layer (RNFL) thickness (µm) at eight equal sectors and two equal hemispheres were automatically calculated in peripapillary region via OCTA. RESULTS: This study included 105 eyes of 71 patients: 34 FUS-positive eyes of 34 patients, 34 fellow eyes of FUS-positive patients, and 37 control eyes of 37 patients. RPCvd was significantly lower in study eyes than in fellow and control eyes in the peripapillary region (p = 0.044 and p = 0.005, respectively). There was no significant difference between fellow eyes and control eyes regarding RPCvd in any region (p > 0.05 for all). There were no significant differences between the three groups regarding peripapillary RNFL values (p > 0.05 for all). CONCLUSION: OCTA is a novel technology for imaging of the RPC network in patients with FUS. Lower radial peripapillary capillary vessel density in FUS could induce capillary insufficiency and impairment of ocular blood flow to optic nerve head.