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Diterlizzi A, Tropea A, Angelini E, Cestrone V, Fasciani R, Merola A, Notaristefano G, Policriti MA, Polimeno T, Ranalli M, Savastano MC, Tannous G, Versace V, Rizzo S, Scambia G, Lanzone A, Apa R. Chorio-retinal vessel density in women affected by functional hypothalamic amenorrhea: a monocentric observational cross-sectional study to evaluate the impact of hypoestrogenism on chorio-retinal vascularization. Arch Gynecol Obstet 2024:10.1007/s00404-024-07603-1. [PMID: 38963584 DOI: 10.1007/s00404-024-07603-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE Functional hypothalamic amenorrhea (FHA) is characterized by an estrogen deficiency which in turn can cause vascular dysfunction. The aim of this study is to evaluate any changes in the chorio-retinal circulation in patients affected by FHA. 24 patients with FHA and 24 age-matched controls underwent a gynecological evaluation and an OCT angiography (OCTA) to study chorio-retinal vascularization. RESULTS OCTA in FHA patients showed an increase in vessel density in the choriocapillaris (CC) layer (both in the fovea area, at 5% p value = 0.037 and in the whole area, at 5% p value = 0.028) and an increase in vascular density in the deep fovea (DVP) (at 10% p value = 0.096) in the whole district compared to controls. Simple linear regressions show a significant negative association between CC vessel density and insulin (p = 0.0002) and glucose values (p = 0.0335) for the fovea district and a negative association between DVP vessel density and endometrial thickness (at 10%, p value: 0.095) in the whole district. CONCLUSION Our study shows that CC vessel density is increased in women affected by FHA. This could represent a compensation effort to supply the vascular dysfunction caused by estrogen deficiency. We also found an increasing trend in vascular density in DVP associated with the decrease of endometrial thickness, an indirect sign of estrogenization. Considering that these changes occur in absence of visual defects, they could be used as a biomarker to estimate hypoestrogenism-induced microcirculation changes before clinical appearance.
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Affiliation(s)
- Alice Diterlizzi
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.Go Agostino Gemelli, 8, 00168, Rome, Italy.
| | - Anna Tropea
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.Go Agostino Gemelli, 8, 00168, Rome, Italy
| | - Emanuela Angelini
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Valentina Cestrone
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
- Department of Ophthalmology, Fondazione Policlinico Universitario A Gemelli, IRCSS, L.Go Agostino Gemelli, 8, 00168, Rome, Italy
| | - Romina Fasciani
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
- Department of Ophthalmology, Fondazione Policlinico Universitario A Gemelli, IRCSS, L.Go Agostino Gemelli, 8, 00168, Rome, Italy
| | - Annamaria Merola
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.Go Agostino Gemelli, 8, 00168, Rome, Italy
| | | | | | - Teresa Polimeno
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Monia Ranalli
- Department of Statistical Sciences, Sapienza University of Rome, 00185, Rome, Italy
| | - Maria Cristina Savastano
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
- Department of Ophthalmology, Fondazione Policlinico Universitario A Gemelli, IRCSS, L.Go Agostino Gemelli, 8, 00168, Rome, Italy
| | - Ghazal Tannous
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Valeria Versace
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.Go Agostino Gemelli, 8, 00168, Rome, Italy
| | - Stanislao Rizzo
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
- Department of Ophthalmology, Fondazione Policlinico Universitario A Gemelli, IRCSS, L.Go Agostino Gemelli, 8, 00168, Rome, Italy
- National Research Council (CNR), "Istituto Di Neuroscienze", Pisa, Italy
| | - Giovanni Scambia
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.Go Agostino Gemelli, 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Antonio Lanzone
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.Go Agostino Gemelli, 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Rosanna Apa
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.Go Agostino Gemelli, 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
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Steffen S, Buscher L, Leclaire MD, Nelis P, Alnawaiseh M, Schneider G, Conrad R, Eter N, Brücher VC. Originalbeiträge (Originals). Altered microvascular density in patients with anorexia nervosa – an optical coherence tomography angiography (OCTA) pilot study. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2024; 70:24-34. [PMID: 38598705 DOI: 10.13109/zptm.2024.70.1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVES To investigate macular and peripapillary vascular density (VD) in patients with anorexia nervosa (AN) compared to healthy controls. Methods:Whole face scans of the superficial and deep macular layers and whole face and peripapillary scans of the radial peripapillary capillaries (RPC) were obtained using optical coherence tomography angiography (OCTA, AngioVueR, Optovue) in ten patients with AN and ten age-matched controls.The primary objective was to determine whether there was a difference between the vessel density (VD) in the above areas in AN and controls. P-values ≤ 0.0125 were considered statistically significant. Results: VD in the superficialmacular en-face OCTA image was significantly lower in the study group compared to the control group. Neither the deepmacula nor the radial peripapillary capillary (RPC) in the whole-face image nor the RPC-peripapillary imaging appeared to be significantly different. Conclusion: Patients with AN showed reduced VD in the superficialmacular layers compared to healthy controls, which can be discussed as a consequence of the malnutrition. OCTA could be a useful non- invasive tool to detect reduced peripheral blood supply to show vascular changes that occur before ocular symptoms.
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Ayyildiz D, Ayyildiz T. Central choroidal thickness in children and adolescents with anxiety disorders: enhanced depth imaging optical coherence tomography findings. Int J Ophthalmol 2020; 13:1580-1585. [PMID: 33078108 PMCID: PMC7511390 DOI: 10.18240/ijo.2020.10.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/22/2020] [Indexed: 12/22/2022] Open
Abstract
AIM To measure the central choroidal thickness (ChT) in children and adolescents with anxiety disorders. METHODS Totally 41 anxiety patients (8-16y) and 35 healthy controls (age-matched) were evaluated. Complete ophthalmic examination was performed. Inclusion criteria were best corrected visual acuity ≥20/20, normal intraocular pressure (IOP; 10-21 mm Hg), and no systemic or ocular diseases according to history. The diagnosis of psychiatric disorders was determined using Schedule for Affective Disorders and Schizophrenia for School Aged Children Present-Lifetime Version (K-SADS-PL). Enhanced depth imaging optical coherence tomography (EDI-OCT) was used to measure the central ChT. RESULTS The mean age was 12.18±3.24y in the patient group and 12.86±3.15y in the control group. Age and gender distribution of the two groups was similar. Central ChT mean value was 353.26±31.9 µm in anxiety patients while 318.75±60.9 µm in the control group. Mean central ChT was statistically significantly higher in the children and adolescents with anxiety disorders than healthy controls (P=0.002). CONCLUSION The children and adolescents with anxiety disorders have significantly thicker central ChT than controls. In the larger sample, longitudinal studies will contribute to the use of choroidal differences as a clinical marker for monitoring anxiety disorders.
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Affiliation(s)
- Didem Ayyildiz
- Child and Adolescent Psychiatry Department, Bursa Dörtçelik Child Hospital, Bursa 16120, Turkey
| | - Taha Ayyildiz
- Ophthalmology Department, Bursa City Hospital, Bursa 16110, Turkey
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Youssef P, Nath S, Chaimowitz GA, Prat SS. Electroretinography in psychiatry: A systematic literature review. Eur Psychiatry 2019; 62:97-106. [PMID: 31553929 DOI: 10.1016/j.eurpsy.2019.09.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 09/07/2019] [Indexed: 02/01/2023] Open
Abstract
This review aims to consolidate the available information on use of electroretinography as a diagnostic tool in psychiatry. The electroretinogram (ERG) has been found to have diagnostic utility in cocaine withdrawal (reduced light-adapted b-wave response), major depressive disorder (reduced contrast gain in pattern ERG), and schizophrenia (reduced a- and b-wave amplitudes). This review examines these findings as well as the applicability of ERG to substance use disorder, Alzheimer's disease, autism spectrum disorder, panic disorder, eating disorders, attention deficit hyperactivity disorder, and medication use. While there have been promising results, current research suffers from a lack of specificity. Further research that quantifies anomalies in ERG present in psychiatric illness is needed.
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Affiliation(s)
- Peter Youssef
- Bachelor of Health Sciences Program, McMaster University, Hamilton, Ontario, Canada
| | - Siddharth Nath
- MD/PhD Program, McMaster University, Hamilton, Ontario, Canada
| | - Gary A Chaimowitz
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Forensic Psychiatry Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Sebastien S Prat
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Forensic Psychiatry Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
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Mukherjee C, Al-Fahad Q, Elsherbiny S. The role of optical coherence tomography in therapeutics and conditions, which primarily have systemic manifestations: a narrative review. Ther Adv Ophthalmol 2019; 11:2515841419831155. [PMID: 30923793 PMCID: PMC6431765 DOI: 10.1177/2515841419831155] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 01/22/2019] [Indexed: 12/22/2022] Open
Abstract
Optical coherence tomography is designed to evaluate in vivo qualitative and quantitative changes of the anterior segment, optic nerve and the retina. Initial applications of this technology were confined mainly to ophthalmic diseases. However recently, numerous studies have evaluated its use in systemic conditions and in therapeutics where, optic nerve and retinal architecture can be assessed to monitor progression of systemic conditions and its response to treatment. This is a narrative review aimed at evaluating the debate surrounding the role of spectral domain optical coherence tomography, in systemic conditions where optic nerve affection can be measured and be used in the diagnosis, monitoring and assessment of treatment effect as a non-invasive, quick, novel technique.
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Affiliation(s)
| | - Qusay Al-Fahad
- Birmingham Midland Eye Centre, Birmingham, UK; Machen Eye Unit, South Warwickshire Foundation Trust, Warwick, UK
| | - Samer Elsherbiny
- Birmingham Midland Eye Centre, Birmingham, UK; Machen Eye Unit, South Warwickshire Foundation Trust, Warwick, UK
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Dalhoff AW, Romero Frausto H, Romer G, Wessing I. Perceptive Body Image Distortion in Adolescent Anorexia Nervosa: Changes After Treatment. Front Psychiatry 2019; 10:748. [PMID: 31681048 PMCID: PMC6803517 DOI: 10.3389/fpsyt.2019.00748] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/18/2019] [Indexed: 11/13/2022] Open
Abstract
One key symptom of anorexia nervosa (AN) is body image distortion (BID). For example, AN patients who are asked to perform body size estimation tasks tend to overestimate their body size; this is thought to indicate a distortion of the perceptive component of body image. Although BID is an important treatment objective, only few treatment approaches explicitly target body image, and even fewer target the perceptive component. Moreover, very little is known about how patients' perceptive body image changes after treatment and related weight gain. Consequently, we investigated changes of the perceptive BID in adolescent AN patients at the beginning (T1) and the end (T2) of inpatient treatment using a body size estimation task. A total of 38 AN patients performed the test for Body Image Distortion in Children and Adolescents (BID-CA) within the first 2 weeks of inpatient treatment and at the end of treatment. The results were compared to 48 healthy control (HC) participants performing the same task once. At T1, AN patients overestimated their body size more than HC, i.e., a total overestimation of 33% in AN patients vs. 11% in HC. At T2, AN patients overestimated their arm size to the same degree that they did at TI, but overestimations for the thigh and waist were reduced, and their overestimations for the waist no longer differed from the HC group. Thus, after treatment, AN patients were partly able to more realistically estimate their body size. Several factors may have influenced the observed changes in body size estimation, including task repetition, deliberate adjustment, growing into their preexisting perceptive body image through weight gain, as well as targeted and non-specific psychotherapeutic treatments. In conclusion, the perceptive BID in adolescent AN patients is persistent but also modifiable. Although diverse factors presumably play a role in changing BID, these findings suggest that AN patients may benefit from targeted treatment of BID.
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Affiliation(s)
- Anke W Dalhoff
- Department of Child and Adolescent Psychiatry, University Hospital, Münster, Germany
| | - Hugo Romero Frausto
- Department of Child and Adolescent Psychiatry, University Hospital, Münster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University Hospital, Münster, Germany
| | - Ida Wessing
- Department of Child and Adolescent Psychiatry, University Hospital, Münster, Germany.,Institute for Biomagnetism and Biosignalanalysis, University Hospital, Münster, Germany
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