Serum microRNA Levels in Diabetes Mellitus

The aim of our study is to evaluate the serum circulating levels of some miRNA, such as hsa-let-7b-5p, hsa-let-7a-5p, hsa-miR-320b, hsa-miR-23a-3p, hsa-miR-27a-3p, hsa-miR-15a-5p, and hsa-miR-495-3, in diabetic patients without diabetic retinopathy (DR), diabetic patients with DR, and, healthy subjects in order to find reliable and reproducible biomarkers for DR. A total of 45 subjects underwent serum sampling for miRNAs evaluation and a complete ophthalmologic examination, including microperimetry and widefield swept source optical coherence tomography angiography (OCTA). Total circulating RNA was isolated from patients using the miRNeasy Serum/Plasma Kit. Serum miRNA expression levels were significantly different in the three groups. In detail, circulating hsa-miR-15a-5p levels were significantly reduced in both diabetic patients without DR and diabetic patients with DR (p = 0.027). Serum hsa-miR-495-3p was lower in diabetic patients with DR and diabetic patients without DR (p = 0.049). Hsa-miR-23a-3p serum expression levels were significantly lower in diabetic patients with DR and diabetic patients without DR (p = 0.013). Significant associations of miRNAs with anatomical/perfusion parameters and functional parameters were observed in the diabetic groups. We find evidence of damage in progression biomarkers in DR that are evidently early in patients with diabetes without DR. Serum miRNAs levels are considered to have strong potential as a novel biomarker for the early detection of DR in subjects suffering from diabetes and could represent noninvasive target therapies to block the progression of the disease at the early stages.

Choroidal structural changes in different intermediate AMD patterns

PURPOSE

To report variation of choroidal thickness (CT) and choroidal vascularity index (CVI) in subjects with drusen and subjects with reticular pseudodrusen (RPD) compared with healthy individuals using the Spectral-domain (SD)-Optical Coherence Tomography with enhanced depth imaging (EDI) system.

DESIGN

A prospective, observational, cross-sectional study.

SUBJECTS

Eighty-four participants.

METHODS

The patients were imaged using the Heidelberg Spectralis device (Heidelberg Engineering, Heidelberg, Germany) with EDI mode. EDI-OCT images were exported and then imported into image analysis ImageJ software (National Institutes of Health, Bethesda) and a semiautomated algorithm was used for subsequent quantitative analysis.

MAIN OUTCOME MEASURES

This study evaluated two choroidal parameters: (i) choroidal thickness (CT); (ii) choroidal vascularity index (CVI).

RESULTS

CT analysis was performed in three different regions: (i) foveal region, (ii) parafoveal region; (iii) perifoveal region. All the analyzed regions were significantly decreased in RPD pattern, as compared with both the drusen group (p < .005) and healthy eyes (p < .005). CVI was significantly decreased in the RPD pattern, as compared with healthy eyes (p < 0.001). However, the drusenoid pattern did not have statistical significance in comparison with the control group suggesting the lower incidence of this pattern on choroidal vasculopathy.

CONCLUSIONS

We report CT and CVI difference in RPD and drusen eyes. The RPD pattern seems to be a consequence of an alteration in the choroidal vascularity resulting in severe ischemia and excessive hypoxia inducing an increased risk of late AMD compared to the drusenoid pattern.

Choroidal structural changes in different intermediate AMD patterns

PURPOSE

To report variation of choroidal thickness (CT) and choroidal vascularity index (CVI) in subjects with drusen and subjects with reticular pseudodrusen (RPD) compared with healthy individuals using the Spectral-domain (SD)-Optical Coherence Tomography with enhanced depth imaging (EDI) system.

DESIGN

A prospective, observational, cross-sectional study.

SUBJECTS

Eighty-four participants.

METHODS

The patients were imaged using the Heidelberg Spectralis device (Heidelberg Engineering, Heidelberg, Germany) with EDI mode. EDI-OCT images were exported and then imported into image analysis ImageJ software (National Institutes of Health, Bethesda) and a semiautomated algorithm was used for subsequent quantitative analysis.

MAIN OUTCOME MEASURES

This study evaluated two choroidal parameters: (i) choroidal thickness (CT); (ii) choroidal vascularity index (CVI).

RESULTS

CT analysis was performed in three different regions: (i) foveal region, (ii) parafoveal region; (iii) perifoveal region. All the analyzed regions were significantly decreased in RPD pattern, as compared with both the drusen group (p < .005) and healthy eyes (p < .005). CVI was significantly decreased in the RPD pattern, as compared with healthy eyes (p < 0.001). However, the drusenoid pattern did not have statistical significance in comparison with the control group suggesting the lower incidence of this pattern on choroidal vasculopathy.

CONCLUSIONS

We report CT and CVI difference in RPD and drusen eyes. The RPD pattern seems to be a consequence of an alteration in the choroidal vascularity resulting in severe ischemia and excessive hypoxia inducing an increased risk of late AMD compared to the drusenoid pattern.

Retinal vascular metrics difference by comparison of two image acquisition modes using a novel OCT angiography prototype

PURPOSE

To assess the different impact of two enface OCTA image simultaneously acquired by means of a new prototype of Spectral-Domain Optical Coherence Tomography Angiography (SD-OCTA) on quantitative retinal vascular metrics.

METHODS

In this prospective observational cross-sectional study 28 healthy subjects were enrolled. Macular (3x3 mm) OCTA images were acquired for all participants using Solix Fullrange OCT (Optovue Inc, Freemont CA, USA). The main outcome measurements were: Perfusion density (PD), vessel length density (VLD), and vessel diameter index (VDI) of both superficial capillary plexus (SCP) and deep capillary plexus (DCP), and choriocapillaris (CC) total flow-deficits area. Quantitative retinal vascular metrics were measured on binarized and skeletonized OCTA images by comparing not averaged and fast automated multiple averaged en face OCTA images.

RESULTS

In both SCP and DCP, PD significantly increased (p = 0,005 and p = 0,030, respectively), and VLD significantly decreased (p<0,001 and p = 0,004, respectively), and VDI increased (p<0,001 and p = 0,068, respectively), and total CC flow deficits area significantly decreased (p<0,001) by averaging multiple OCTA images.

CONCLUSIONS

In this study, we found a significant difference of quantitative retinal metrics by comparing two different image acquisition modes using a novel and fully automated averaging OCTA system in young healthy subjects.

Widefield topographical analysis of the retinal perfusion and neuroretinal thickness in healthy eyes: a pilot study

PURPOSE

In this pilot study we reported variation of superficial (SCP) and deep (DCP) capillary plexuses flow in macular and near/mid periphery regions in healthy subjects using widefield swept source-optical coherence tomography angiography (SS-OCTA).

METHODS

In this prospective, cross-sectional study, enroled subjects were imaged with an SS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). OCTA scans were taken in primary and extremes of gaze and a montage was automatically created. Quantitative analysis was performed in the macular and peripheral regions. In addition, SCP and DCP variables were further investigated in distinct fields within these three different regions.

RESULTS

Fifty-five young healthy subjects (55 eyes) were enroled. The retinal periphery displayed a higher SCP perfusion density (39.6 ± 1.7% and 40.7 ± 1.4%, P < 0.0001) and SCP vessel diameter index (3.5 ± 0.2 and 3.6 ± 0.2, P < 0.0001), in comparison with the macular region. At the DCP level, the retinal periphery was characterized by a lower perfusion density (41.6 ± 3.7% and 37.9 ± 2.9%, P < 0.0001) and vessel length density (14.6 ± 6.0% and 9.9 ± 2.6%, P < 0.0001). In the analysis investigating the DCP in the retinal periphery, the temporal sector was characterized by a reduction in perfusion density, vessel length density, and vessel diameter index. In univariate analysis, the retinal thickness was found to have a significant direct relationship with DCP perfusion density (P < 0.0001), but not with SCP perfusion density (P = 0.712).

CONCLUSIONS

We report quantitative mapping of the SCP and DCP in healthy individuals. The DCP perfusion appears to have a wide topographical variation, which is strictly dependent on the retinal thickness.

Optical Coherence Tomography Angiography in Macular Neovascularization: A Comparison Between Different OCTA Devices

Purpose

The purpose of this study is to compare the ability of 3 optical coherence tomography angiography (OCTA) devices to measure lesion area in patients with macular neovascularization (MNV) with type 1, 2 and mixed neovascularization (NV).

Methods

OCTA, fluorescein angiography (FA), indocyanine green angiography (ICGA), and structural optical coherence tomography (OCT) were performed. NV lesion area measurements were performed by two graders.

Results

Twenty-eight eyes were included: 20 with NV were classified as type 1, 6 as type 2, and 2 as mixed type. AngioVue and Spectralis detected the NV in 26 out of 28 eyes (92.8%). The intraclass correlation coefficient (ICC) between readers for the three different OCTA with the different slabs was high. The NV area was larger in the outer retina to choriocapillaris (ORCC) and choriocapillaris (CC) images for the AngioVue device and the PLEX Elite device compared to avascular images (P < 0.05). The mean values of the NV area were not significantly different among the three instruments (Friedman test, P > 0.05) for the avascular zone (AV), ORCC, and CC images. Median (interquartile range [IQR]) NV were significantly different among avascular images, ORCC images, and CC images of the AngioVue device (P = 0.046), of the Spectralis device (P = 0.015), and the PLEX Elite device (P < 0.001).

Conclusions

The ORCC slabs showed the highest detection rate for NV detection independently to the device used, and swept source (SS)-OCTA measurements of ORCC slabs showed the highest detection rate of NVs compared to the spectral domain (SD)-OCTA.

Translational Relevance

It is pivotal to realize how much we can rely on OCTA to make a diagnosis of NV.

A Custom-Made Semiautomatic Analysis of Retinal Nonperfusion Areas After Dexamethasone for Diabetic Macular Edema

Purpose

To evaluate the changes of retinal capillary nonperfusion areas and retinal capillary vessel density of the superficial capillary plexus (SCP) and deep capillary plexus in patients with diabetes with diabetic macular edema treated with an intravitreal dexamethasone implant (IDI).

Methods

We enrolled 28 patients with diabetic retinopathy and diabetic macular edema candidates to IDI. All patients underwent widefield optical coherence tomography angiography with PLEX Elite 9000 device with 15 × 9 mm scans centered on the foveal center at baseline, 1 month, 2 months, and 4 months after IDI. In all the patients, the variation of the retinal capillary nonperfusion areas and of the retinal vessel density of the SCP and deep capillary plexus were calculated using an automatic software written in Matlab (MathWorks, Natick, MA).

Results

During follow-up, SCP showed a statistically significant reduction of ischemic areas at 1 month after IDI (P = 0.04) and slightly increased not significantly thereafter (P = 0.15). The percentage of nonperfusion areas changed from 11.4% at baseline, to 6.3% at 1 month, 8.1%, at 2 months, and 10.2% at 4 months. The whole vessel density of SCP slightly increased (not significantly) from 35.30% at baseline to 38.00% at 1 month, and then decreased to 37.85% at 2 months and 36.04% at 4 months (P = 0.29). Retinal capillary nonperfusion areas and retinal vessel density at the deep capillary plexus did not change significantly (P = 0.31 and P = 0.73, respectively).

Conclusions

Widefield optical coherence tomography angiography showed a decrease in retinal capillary nonperfusion areas after dexamethasone implant suggesting a possible drug-related reperfusion of retinal capillaries particularly evident in the early period.

Translational Relevance

A custom-made automatic analysis of retinal nonperfusion areas may allow a better and precise evaluation of ischemic changes after intravitreal therapy.

Vascular changes after vitrectomy for rhegmatogenous retinal detachment: optical coherence tomography angiography study

PURPOSE

To analyse the postoperative foveal avascular zone (FAZ) area, superficial vessel density (SVD) and deep vessel density (DVD) and their correlation with functional (best-corrected visual acuity, BCVA) and anatomical outcomes (foveal macular thickness, FMT) after surgery for rhegmatogenous retinal detachment (RRD) repair.

METHOD

Patients with RRD eyes, successfully treated with a single pars plana vitrectomy (PPV) with gas tamponade and a minimum 12 months follow-up, were re-examined. Foveal avascular zone (FAZ) area, SVD, DVD and FMT were evaluated by using optical coherence tomography angiography (OCTA) and compared to fellow eye.

RESULTS

Fifty-six patients with macula-on and 37 with macula-off RRD were included in the study. In both groups, no difference in FMT and FAZ area was found compared to fellow eyes. In macula-on RRD eyes, a lower parafoveal DVD (p = 0.001) was detected; FAZ area was related to FMT (p = 0.025), and the postoperative BCVA was correlated with parafoveal DVD (p = 0.010) and FAZ area (p = 0.003). In macula-off RRD eyes, lower parafoveal SDV (p = 0.012), and foveal and parafoveal DVD (p = 0.012 and p < 0.001, respectively) were observed. BCVA was related to FAZ area (p = 0.012), foveal SVD (p = 0.005) and parafoveal DVD (p = 0.010).

CONCLUSION

Rhegmatogenous retinal detachment eyes successfully treated with PPV had lower vessel density in the superficial and deep retinal plexus compared to fellow healthy eyes; BCVA was related to FAZ area and vessel density.

Changes in Iris Perfusion Following Scleral Buckle Surgery for Rhegmatogenous Retinal Detachment: An Anterior Segment Optical Coherence Tomography Angiography (AS-OCTA) Study

Purpose: To investigate iris vasculature changes following scleral buckling (SB) surgery in eyes with rhegmatogenous retinal detachment (RRD) with anterior-segment (AS) optical coherence tomography angiography (OCTA). Methods: In this prospective study, enrolled subjects were imaged with an SS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). Image acquisition of the iris was obtained using an AS lens and a manual focusing adjustment in the iris using the retina imaging software. The quantitative analysis was performed in eight different iris regions: (i) superior, (ii) supero-temporal, (iii) supero-nasal, (iv) nasal, (v) temporal, (vi) inferior, (vii) infero-temporal, (viii) infero nasal which, were defined as squares with area of 1.5 mm². Results: Fifteen eyes of 15 patients (six females; nine males) were included. Anterior segment optical coherence tomography angiography (AS-OCTA) parameters of the iris were statistically compared at baseline (preoperatively), 1 week, 1 month and 6 months after SB. At post-operative 1 week, perfusion density (PD) showed a significant decrease from 66.8 ± 13.2% to 58.55 ± 12.0% in the iris supero-nasal region (p = 0.016). However, at the 1-month follow-up visit, iris PD was significantly lower in all the analyzed iris regions, apart from the superior one. Conclusions: This study is the first description of AS-OCTA in patients undergoing SB. Our results showed a uniform reduction of the iris vessel network at 1 month after surgery, supporting the clinical use of AS-OCTA to identify early iris perfusion changes as potential predictive biomarkers of vascular disorders.

Eyelashes Artifact in Ultra-Widefield Optical Coherence Tomography Angiography

BACKGROUND AND OBJECTIVE

To describe the presence of eyelashes artifact in ultra-widefield swept-source optical coherence tomography angiography (SS-OCTA) images.

PATIENTS AND METHODS

In this prospective, cross-sectional study, 52 healthy, young subjects were imaged with the SS-OCTA system. OCTA scans were taken in primary and extremes of gaze, and a montage was automatically created. The en face choriocapillaris images were then exported, and a semi-automated algorithm was used for subsequent quantitative analysis.

RESULTS

The authors noted the presence of some linear regions of reduced brightness, which were assumed to represent a shadow effect due to patient eyelashes. In order to quantify this effect, the authors performed a quantitative analysis of the superior and inferior regions in the retinal and choroidal vessels.

CONCLUSIONS

The authors' qualitative and quantitative analysis showed the presence of regions of false-positive hypoperfusion secondary to eyelashes artifacts. To the authors' knowledge, this represents the first description of this new type of shadowing artifact affecting OCTA images. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:740-743.].

Changes in Ocular Blood Flow after Ranibizumab Intravitreal Injection for Diabetic Macular Edema Measured Using Laser Speckle Flowgraphy

PURPOSE

To evaluate the effects of intravitreal ranibizumab (IVR) treatment on the blood flow of the optic nerve head (ONH) and of retinal vessels of the peripapillary region of eyes with diabetic macular edema (DME) assessed using laser speckle flowgraphy (LSFG).

METHODS

Forty eyes of 30 patients treated with IVR for DME were included in this prospective clinical study. Mean blur rate (MBR) and relative flow volume (RFV) of the ONH and of a superior retinal artery and an inferior retinal vein of the peripapillary region were measured using LSFG at baseline, 2 weeks (T1), and 1 month (T2) after IVR injection. In addition, best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured in all cases.

RESULTS

The BCVA improved and CRT decreased significantly during the follow-up period (p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA.

CONCLUSION

IVR injection leads to a reduction of ocular blood flow both in the ONH and in the retinal peripapillary vessels associated with peripapillary vessel constriction. The reduction of CRT and related improvement of vision may be related to the changes in ocular blood flow.

Why Miss the Chance? Incidental Findings while Telescreening for Diabetic Retinopathy

PURPOSE

To report on incidental pathological findings met while screening for Diabetic Retinopathy (DR) in Diabetes Clinics (DC) by ophthalmologist-graded digital fundus imaging.

METHODS

At the DC of Pescara (central Italy), for 3,859 eyes of 1,930 consecutive patients having not undergone fundus examination in the last year, two mydriatic fundus digital images, taken with a CenterVue DRS Digital Retinal Camera, were sent along with Best Corrected Visual Acuity, on a "store-and-forward" basis, to an ophthalmologist trained in DR screening, and graded according to the UK Diabetic Eye Screening Programme. Incidental fundus abnormalities other than DR were reported.

RESULTS

No adverse event to mydriasis was reported. One hundred and eighty eyes (4.66%) were ungradable. Among the 3,679 gradable ones, 1,105 (30.04%) showed different degrees of DR (R1 to R3), and 126 (3.42%) maculopathy (M1). Any Age-Related Macular Degeneration was present in 387 eyes (10.52%), any optic disc and parapapillary area features suspect for glaucoma in 562 eyes (15.27%), any hypertensive retinopathy in 1,263 eyes (34.33%), vitreoretinal interface disease in 252 eyes (6.84%), myopic choroidopathy in 92 eyes (2.50%), disc pallor in 31 eyes (0.84%). Mean time was 5 min for screening, 2 min for grading.

CONCLUSION

Teleretinography is a well-established, cost-effective procedure in DR screening. Along with increased attendance, locating a digital camera in a DC with a retina-specialist grader results in finding fundus pathologies also beyond DR, very similarly to fundus examination in an outpatient ophthalmic setting.

Widefield Swept Source OCTA in Retinitis Pigmentosa

(1) Background: To evaluate superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC), perfusion density (PD), and vessel length density (VLD) in macular and near/mid periphery regions in patients with retinitis pigmentosa (RP) using widefield swept source optical coherence tomography angiography (WSS-OCTA). (2) Methods: Twelve RP patients (20 eyes) and 20 age-matched subjects (20 eyes) were imaged with the SS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). Quantitative analysis was performed in the macular and peripheral regions. The main outcome measures were SCP, DCP, CC, PD, and VLD in central and peripheral areas. (3) Results: Mean visual acuity, central macular thickness, and microperimetry were significantly reduced in RP patients compared to normal subjects (p < 0.05). The perfusion density and VLD of SCP, DCP, and CC were significantly reduced in RP patients compared to normal controls both in the central and peripheral retina (p < 0.05). A significant direct correlation was found in RP patients between PD of the 1.5 mm central retina both in DCP and CC and microperimetry at 4° and 8°. (4) Conclusions: Widefield SS-OCTA shows an impairment of retinal and choroidal perfusion density and vessel length density in central and peripheral retina of RP patients. The reduction of flow features correlates with the macular function.

In Vivo Mapping of the Choriocapillaris in High myopia: a Widefield Swept Source Optical Coherence Tomography Angiography

To report variation of choriocapillaris (CC) flow in widefield in high in myopic subjects compared with an age-matched normal control group using ultra widefield optical coherence tomography angiography (UW-OCTA). This is a Prospective, cross-sectional study. Thirty high myopia subjects and fifty healthy subjects were enrolled. Healthy and high myopia subjects were imaged with the SS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). For each eye, five 12 × 12-mm OCTA volume scans were acquired. The en face CC images were then exported to imageJ and a semi-automated algorithm was used for subsequent quantitative analysis. The main outcome was a quantitative analysis of the CC. This analysis was performed in three different regions: (i) peripapillary, (ii) macular, and (iii) periphery. In addition, CC variables were further investigated in distinct fields within these three different regions. Thirty myopic eyes (32 subjects; myopic group) and fifty eyes (50 subjects; control group) without elevated myopia were included in the analysis. Mean ± SD age was 26.9 ± 2.9 years [median: 27 years; range: 20.0–40.0 years]. Mean ± SD axial length was 26.6 ± 0.6 mm [median: 26.2 mm; range: 26.1 to 28.0 mm]. Mean ± SD axial length was 26.6 ± 0.6 mm [median: 26.2 mm; range: 26.1 to 28.0 mm] in the myopic group and 23.9 ± 1.1 mm [median: 23.9 mm; range: 21.8 to 25.9 mm] in the control group. The total signal void area was significantly greater in myopic eyes compared with control group. The peripapillary region exhibited the greatest total signal void area (p < 0.0001 vs macular region, p < 0.0001 vs peripheral region). Within the macular region, the foveal area exhibited a greater total signal void area in comparison with both the parafoveal area (p < 0.0001) and the perifoveal area (p < 0.0001). In conclusion we report quantitative mapping of the choriocapillaris in myopic eyes compared with an age-matched normal control group. The CC perfusion appears to have a wide topographical variation.

Widefield optical coherence tomography angiography in diabetic retinopathy

AIMS

To evaluate superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC) perfusion in macular and near/mid periphery regions in diabetic patients using widefield swept-source optical coherence tomography angiography (WSS-OCTA).

METHODS

Ninety-four diabetic patients (94 eyes) classified as diabetics without diabetic retinopathy (no DR) (25 eyes), mild DR (23 eyes), moderate/severe DR (26 eyes), proliferative DR (20 eyes) and a control group of 25 healthy subjects (25 eyes) were imaged with the WSS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). Quantitative analysis was performed in the macular and peripheral regions. The main outcome measures were perfusion density (PD) and vessel length density of SCP, DCP and CC.

RESULTS

Peripheral retina (all sectors) showed lower SCP and DCP PD compared to the macular region (p  < 0.001). In diabetics without DR and DR in different stages, SCP and DCP PD significantly decreased at advancing stages of DR (p  < 0.001). At DCP level, central PD was significantly directly related to peripheral PD (superior, R = 0.682 and 0.479; temporal, R  = 0.918 and 0.554; inferior, R  = 0.711). A good sensitivity and an excellent specificity were found in terms of prediction of disease worsening, especially for central and temporal sectors in all plexuses and for all sectors both central and peripheral of DCP.

CONCLUSIONS

The widefield OCTA is useful for the study of central and peripheral retina in diabetic patients with or without diabetic retinopathy, assessing good correlation between central and peripheral retina.

Early retinal flow changes after vitreoretinal surgery in idiopathic epiretinal membrane using swept source optical coherence tomography angiography

(1) Background: The aim of this observational cross-sectional work was to investigate early retinal vascular changes in patients undergoing idiopathic epiretinal membrane (iERM) surgery using swept source optical coherence tomography angiography (SS-OCTA); (2) Methods: 24 eyes of 24 patients who underwent vitrectomy with internal limiting membrane (ILM) peeling were evaluated pre- and postoperatively using SS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). For each eye, five 6x6-mm OCTA volume scans were acquired by two observers independently. The en face images of superficial capillary plexus (SCP) were then exported to imageJ and a semi-automated algorithm was used for subsequent quantitative analysis. Perfusion density (PD), vessel length density (VLD), vessel diameter index (VDI) and vessel tortuosity (VT) of SCP were evaluated in both the parafoveal (2.5 mm diameter) and perifoveal areas (5.5 mm diameter); (3) Results: At OCTA analysis statistically significant differences were found between controls and diseased eyes for all parameters in parafoveal and perifoveal regions (p < 0.001; p < 0.05) except for perifoveal VLD. During 6-month follow up, both anatomical/perfusion and functional parameters showed a statistically significant improvement if compared to preoperative values. In detail, at one-month post vitrectomy, VLD and VT significantly changed in parafoveal region (p = 0.043; p = 0.045), while PD and VDI showed a trend of increase in both parafoveal and perifoveal region. At 6 months after surgery, PD, VLD and VT of parafoveal region significantly improved (p = 0.021, p = 0.018, p = 0.047 respectively). (4) Conclusions: SS-OCTA provides a quantitative and qualitative analysis of the superficial capillary plexus allowing for early vascular changes assessment after vitrectomy with iERM and ILM peeling.

Pharmacotherapy of Central Serous Chorioretinopathy: A Review of the Current Treatments

BACKGROUND

Central serous chorioretinopathy (CSC) is the fourth most frequent retinal disorder in terms of prevalence. It typically occurs in young subjects and affects men more often than women. CSC is characterized by serous retinal detachment (SRD) involving mainly the macular area. The clinical course is usually selflimited, with spontaneous resolution within 3 months. The persistence of SRD or multiple relapse may result in a chronic form of CSC distinguished by permanent retinal pigment epithelium (RPE) and photoreceptor damage. As the pathogenetic mechanism of CSC primarily involves RPE and choroidal vascularization, the current therapeutic approaches aim to restore the normal functions of RPE and normal choroidal vascular permeability. In this review, the authors aim to summarize the current therapeutic approach to CSC.

METHODS

A comprehensive review of the literature was conducted in PubMed by searching for relevant studies on the current therapeutic options for CSC, including simple observation, conventional laser treatment, subthreshold laser treatment (SLT), photodynamic therapy (PDT) with verteporfin, treatment with mineralocorticoid receptor (MR) antagonists and treatment with anti-vascular endothelial growth factor drugs.

RESULTS

Since most cases resolve spontaneously, the most common initial CSC treatment is observation. Current evidence suggests that PDT and SLT are valuable in improving visual acuity, reducing subretinal fluid and maintaining long-term effectiveness. No clear evidence of efficacy has been achieved for anti-VEGF. MR antagonists might be a viable choice for the treatment of chronic CSC.

CONCLUSION

The pathophysiology of CSC remains poorly understood and as a consequence, the gold standard of care for CSC is yet to be defined. To date, PDT and SLT continue to offer good clinical outcomes. Positive preliminary results seem to emerge from the studies of MR antagonists.

Anatomical and functional changes after dexamethasone implant and ranibizumab in diabetic macular edema: a retrospective cohort study

AIM

To investigate the efficacy and safety of ranibizumab (RZB group) and dexamethasone implant (DEX group) intravitreal treatments in patients with treatment-naïve center involved diabetic macular edema (DME) by means of functional and morphological assessments.

METHODS

This retrospective cohort study included 50 eyes of 50 patients with DME treated either with RBZ or DEX. Best-corrected visual acuity (BCVA) and microperimetry were evaluated at baseline and during a 6-month follow-up. In addition, central macular thickness (CMT) by means of structural optical coherence tomography (OCT) and retinal capillary plexus density and choriocapillary density by means of OCT angiography were assessed in all cases.

RESULTS

Functional and morphological parameters significantly improved during the study period in both groups. BCVA improved significantly in both groups with a greater increase in the DEX group compared to the RBZ group (P=0.030). Microperimetry significantly differed during follow-up between the two treatments (P=0.031). In both groups CMT significantly decreased (P<0.001) without statistically significant differences between the two groups. A statistically significant increase of deep capillary plexus density was detected in both groups at 30d after therapy. The retreatment rate was 0.70±0.10 and 0.65±0.10 in the RBZ group and 0.65±0.10 and 0.50±0.11 in DEX group at 120 and 180d respectively. Two out of 25 patients in DEX group showed intraocular pressure increase requiring hypotonic eye drops.

CONCLUSION

Both treatments are very effective for DME treatment during 6mo of follow-up with a lower retreatment rate in DEX group.

Correlation between Choriocapillaris Density and Retinal Sensitivity in Stargardt Disease

The aim of this work was to characterize the choriocapillaris (CC) in patients with Stargardt disease (STGD) using the swept source widefield optical coherence tomography angiography (SS WF OCTA) and to compare CC perfusion density to retinal sensitivity, analyzed using microperimetry (MP). This cross-sectional study included 9 patients (18 eyes) with STGD and central CC atrophy (stage 3 STGD). The CC was analyzed using SS WF OCTA and areas of different CC impairment were quantified and correlated with retinal sensitivity analyzed using MP. The main outcome measures were the percent perfused choriocapillaris area (PPCA), retinal sensitivity, and correlation between PPCA and retinal sensitivity. Seventeen eyes of 9 patients suffering from stage 3 STGD were analyzed. SS WF OCTA revealed a vascular rarefaction in central atrophic zones and a near atrophy halo of choriocapillaris impairment. In all eyes were noticed a central atrophy (CA) area with absolute absence of CC that corresponded to 0 dB points at MP, a near atrophy (NA) zone of PPCA impairment that included points with decreased sensitivity at MP and a distant from atrophy (DA) zone with higher PPCA and retinal sensitivity values. The mean difference of PPCA and retinal sensitivity between NA and CA and DA and CA was statistical significantly different (p < 0.01), the latter showing higher values. A direct relationship between PPCA and retinal sensitivity was found (p < 0.001). Choriocapillaris damage evaluated using SS WF OCTA correlates with MP, these data suggest that CC impairment may be a predictor of retinal function in patients with STGD.

In Vivo Mapping of the Choriocapillaris in Healthy Eyes: A Widefield Swept-Source OCT Angiography Study

PURPOSE

To report variation of choriocapillaris flow in peripapillary, macular, and near- and mid-periphery regions in healthy participants using widefield swept-source (SS) OCT angiography (OCTA).

DESIGN

Prospective, cross-sectional study.

PARTICIPANTS

Fifty healthy participants.

METHODS

Healthy young participants were imaged with the SS OCTA system (PLEX Elite 9000; Carl Zeiss Meditec, Inc, Dublin, CA). OCT angiography scans were obtained in primary and extreme gazes and a montage was created automatically. The en face choriocapillaris images then were exported to ImageJ software version 1.50 (National Institutes of Health, Bethesda, MD), and a semiautomated algorithm was used for subsequent quantitative analysis.

MAIN OUTCOME MEASURES

Quantitative analysis of the choriocapillaris performed in 3 different regions: (1) peripapillary, (2) macular, and (3) periphery. In addition, choriocapillaris variables were investigated further in distinct fields within these 3 different regions.

RESULTS

Fifty eyes (50 participants) were included in the analysis. Mean age ± standard deviation was 25.2±5.1 years (median, 24.5 years; range, 20.0-40.0 years). The peripapillary region exhibited the greatest total signal void area (P < 0.0001 vs. the macular region; P < 0.0001 vs. the peripheral region). Within the macular region, the foveal area exhibited a greater total signal void area in comparison with both the parafoveal area (P = 0.009) and the perifoveal area (P = 0.015). In the analysis investigating the near- and mid-periphery region, the temporal sector was characterized by a lower total signal void area compared with both the superior and inferior areas (P = 0.016 and P = 0.003, respectively).

CONCLUSIONS

We report quantitative mapping of the choriocapillaris in healthy individuals. Choriocapillaris perfusion seems to have a wide topographic variation.

Anatomical and Functional Changes of the Retina and the Choroid after Resolved Chronic CSCR

Background: To investigate anatomical/functional changes after oral eplerenone therapy for chronic central serous chorioretinopathy (CCSC) in successfully treated eyes and fellow eyes and assess timing of foveal subretinal fluid (SRF) resolution. Methods: Twenty-one eyes of 21 patients suffering from CCSC with monolateral foveal SRF successfully treated with oral eplerenone were enrolled in this retrospective study (group 1). The fellow eyes (21 eyes; group 2), healthy or affected by CCSC, without foveal SRF were considered in the analysis. A control healthy group was enrolled as well (healthy controls; n = 21). Main outcome measures during follow-up included changes of best corrected visual acuity (BCVA, logMAR), central macular thickness (CMT; µm), SRF (µm), subfoveal choroidal thickness (SFCT; µm), superficial capillary plexus density (SCPD, %), deep capillary plexus density (DCPD, %), and choriocapillaris density (CCD, %) and percentage of eyes showing foveal SRF resolution at different time points. Results: Functional and anatomical parameters significantly improved during the study in group 1. BCVA increased significantly (p < 0.001), while CMT, SFCT, and SRF decreased significantly (p < 0.001; p < 0.001, and p = 0.037, respectively). SCPD, DCPD, and CCD did not show any statistically significant difference during follow-up. In 71.4% of eyes, resolution of SRF was observed within 60 days and in the remaining 28.6%, at 120 days. In fellow eyes, SFCT decreased significantly (p < 0.001), whilst all other parameters did not modify. Conclusions: Eplerenone treatment in chronic CSCR potentially improves recovery of retinal and choroidal morphology as well as visual acuity gain. A complete resolution of foveal SRF was observed in all eyes during a 4-month follow-up, with most eyes healing at 2 months.

Relationship between aqueous humor cytokine level changes and retinal vascular changes after intravitreal aflibercept for diabetic macular edema

The aim of this work was to investigate the changes in aqueous humor cytokine levels after intravitreal injection of aflibercept in diabetic macular edema (DME) and to evaluate the relationship between cytokines modifications and central macular thickness (CMT) and retinal/choroidal vascular changes using structural and functional optical coherence tomography (OCT). Aqueous concentrations of 38 cytokines were measured via multiplex bead assay. In addition, spectral domain OCT and OCT angiography with SSADA software (XR Avanti® AngioVue) were performed at baseline and after intravitreal injections. VEGF, IL-6, IL-5, IL-1β, Eotaxin, GRO, IL-12p40, IL-12p70, IL-1RA, Flt-3L and IP-10 showed a statistically significant decrease through the follow-up (p < 0.05; p < 0.001), while Fraktalkine and GM-CSF significantly increased (p < 0.05). Best corrected visual acuity significantly increased and CMT significantly decreased during follow-up (p < 0.001 and p = 0.013). Superficial capillary plexus and deep capillary plexus density significantly increased (p < 0.001 and p = 0.014). A positive relation was found between GRO, VEGF, Fraktalkine, IP-10, IL-12p70 aqueous humor levels and CMT (p < 0.05; p < 0.001). Aflibercept is a primary anti-VEGF treatment producing a decrease of DME due to the reduction of vascular permeability, nevertheless other inflammatory cytokines showed modification after aflibercept intravitreal injections probably related to edema modification or to an interaction of aflibercept with other inflammatory cytokines.