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Nouri H, Abtahi SH, Mazloumi M, Samadikhadem S, Arevalo JF, Ahmadieh H. Optical coherence tomography angiography in diabetic retinopathy: A major review. Surv Ophthalmol 2024; 69:558-574. [PMID: 38521424 DOI: 10.1016/j.survophthal.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 02/29/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
Diabetic retinopathy (DR) is characterized by retinal vasculopathy and is a leading cause of visual impairment. Optical coherence tomography angiography (OCTA) is an innovative imaging technology that can detect various pathologies and quantifiable changes in retinal microvasculature. We briefly describe its functional principles and advantages over fluorescein angiography and perform a comprehensive review on its clinical applications in the screening or management of people with prediabetes, diabetes without clinical retinopathy (NDR), nonproliferative DR (NPDR), proliferative DR (PDR), and diabetic macular edema (DME). OCTA reveals early microvascular alterations in prediabetic and NDR eyes, which may coexist with sub-clinical neuroretinal dysfunction. Its applications in NPDR include measuring ischemia, detecting retinal neovascularization, and timing of early treatment through predicting the risk of retinopathy worsening or development of DME. In PDR, OCTA helps characterize the flow within neovascular complexes and evaluate their progression or regression in response to treatment. In eyes with DME, OCTA perfusion parameters may be of predictive value regarding the visual and anatomical gains associated with treatment. We further discussed the limitations of OCTA and the benefits of its incorporation into an updated DR severity scale.
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Affiliation(s)
- Hosein Nouri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed-Hossein Abtahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mehdi Mazloumi
- Eye Research Center, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sanam Samadikhadem
- Department of Ophthalmology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - J Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Wang Y, Yang M, Wang X, Zou H, Chen X, Yuan R. Role of Gpr124 in the Migration and Proliferation of Retinal Microvascular Endothelial Cells and Microangiopathies in Diabetic Retinopathy. Mol Biotechnol 2024:10.1007/s12033-024-01210-w. [PMID: 38862861 DOI: 10.1007/s12033-024-01210-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024]
Abstract
Retinal microangiopathies, such as neovascularization and preretinal and vitreous hemorrhages, are the primary pathological features of diabetic retinopathy (DR). These conditions can worsen visual impairment and may result in blindness. Furthermore, multiple metabolic pathways are associated with microangiopathy in DR. However, the specific underlying pathological mechanisms remain unclear. Several studies have demonstrated the important role of G protein-coupled receptor 124 (Gpr124) in cerebral vascular endothelial cells, but its effect on the retinal endothelium has not been elucidated. In this study, we found that Gpr124 is expressed in both pathological retinal fibrous vascular membranes of DR patients and retinal blood vessels of mice, with elevated protein expression specifically observed in the retinas of DR model mice. Furthermore, Gpr124 expression was elevated after high-glucose treatment of human retinal microvascular endothelial cells (HRMECs). Inhibition of Gpr124 expression affected the high glucose-induced proliferation, migration, and tube-forming ability of HRMECs. We concluded that Gpr124 expression was upregulated in DR and promoted HRMECs angiogenesis in a high-glucose environment. This finding may help to elucidate the pathogenesis of DR and provide a critical research basis for identifying effective treatments.
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Affiliation(s)
- Yuwen Wang
- Department of Ophthalmology, Xinqiao Hospital, Army Medical University, Xinqiao Road, Shapingba District, Chongqing, 400037, China
| | - Mei Yang
- Department of Ophthalmology, Xinqiao Hospital, Army Medical University, Xinqiao Road, Shapingba District, Chongqing, 400037, China
| | - Xuan Wang
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Huan Zou
- Department of Ophthalmology, Xinqiao Hospital, Army Medical University, Xinqiao Road, Shapingba District, Chongqing, 400037, China.
| | - Xiaofan Chen
- Department of Ophthalmology, Xinqiao Hospital, Army Medical University, Xinqiao Road, Shapingba District, Chongqing, 400037, China
| | - Rongdi Yuan
- Department of Ophthalmology, Xinqiao Hospital, Army Medical University, Xinqiao Road, Shapingba District, Chongqing, 400037, China.
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Chen N, Zhu Z, Yang W, Wang Q. Progress in clinical research and applications of retinal vessel quantification technology based on fundus imaging. Front Bioeng Biotechnol 2024; 12:1329263. [PMID: 38456011 PMCID: PMC10917897 DOI: 10.3389/fbioe.2024.1329263] [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: 10/28/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Abstract
Retinal blood vessels are the only directly observed blood vessels in the body; changes in them can help effective assess the occurrence and development of ocular and systemic diseases. The specificity and efficiency of retinal vessel quantification technology has improved with the advancement of retinal imaging technologies and artificial intelligence (AI) algorithms; it has garnered attention in clinical research and applications for the diagnosis and treatment of common eye and related systemic diseases. A few articles have reviewed this topic; however, a summary of recent research progress in the field is still needed. This article aimed to provide a comprehensive review of the research and applications of retinal vessel quantification technology in ocular and systemic diseases, which could update clinicians and researchers on the recent progress in this field.
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Affiliation(s)
- Naimei Chen
- Department of Ophthalmology, Huaian Hospital of Huaian City, Huaian, China
| | - Zhentao Zhu
- Department of Ophthalmology, Huaian Hospital of Huaian City, Huaian, China
| | - Weihua Yang
- Department of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
| | - Qiang Wang
- Department of Ophthalmology, Third Affiliated Hospital, Wenzhou Medical University, Ruian, China
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Wang M, Wang L, Gong Y, Li Q, Shao Y, Li X. Study on the Effects of Different anti-VEGF drugs on Fibrovascular Membranes of Proliferative Diabetic Retinopathy. Photodiagnosis Photodyn Ther 2023; 42:103530. [PMID: 37060987 DOI: 10.1016/j.pdpdt.2023.103530] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/21/2023] [Accepted: 03/21/2023] [Indexed: 04/17/2023]
Abstract
PURPOSE To investigate the effects of different anti-VEGF drugs on fibrovascular membranes (FVM) in proliferative diabetic retinopathy (PDR). In addition, in vitro model was used to simulate the intraocular fibroblasts barrier to explore the penetration of different anti-VEGF drugs. METHODS 24 eyes from 24 PDR patients with FVM were recruited for this prospective observational study. The patients were randomized to receive one of three anti-VEGF drugs (Ranibizumab, Conbercept, or Aflibercept). Then neovascular structures were assessed by optical coherence tomography angiography (OCTA) before intravitreal injection (pre-IVT) and 1, 2, and 3 days after intravitreal injection (post-IVT). The changes in vessels area (VSA), vessels percentage area (VPA), junction density (JD), and average lacunarity (AL) were analyzed by using the image processing software Angiotool. In vitro penetrating model with fibroblasts barrier was used to compare the effects of the three drugs on human retinal vascular endothelial cells (HRVECs) over 3 days by Cell proliferation measurement. Moreover, the drug concentrations in the penetrating model were detected by liquid chromatography-mass spectrometry (LC-MS). RESULTS The VSA, VPA, and JD all decreased, while the AL increased in Ranibizumab group(n=8), Conbercept group (n=8), and Aflibercept group (n=8) within 3 days (P<0.05). Meanwhile, under the condition of the same amount of substance, the inhibition effect of Ranibizumab on HRVEC was the strongest in the penetrating model evaluated by CCK8 absorbance experiments of HRVECs (FCCK8=6.493, PCCK8= 0.0051), and the number of transmembrane molecules in the Ranibizumab group was also the largest within 3 days (F=8.209, P=0.0006) among the three groups. CONCLUSION Angiotool is feasible to reconstruct the neovascular structure on the FVM in OCTA images. The three different anti-VEGF drugs can significantly reduce the vascular area and density on the proliferating membranes, and there is no significant difference in the anti-neovascularization among the three drugs clinically. However, small molecule drug is more penetrating and move faster across membranes in vitro cell model. CLINICAL TRIAL REGISTRATION This trial is registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn, registration number ChiCTR2300067476).
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Affiliation(s)
- Manqiao Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin 300384, China; Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Tianjin 300384, China; Eye Institute and School of Optometry, Tianjin 300384, China; Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Linni Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin 300384, China; Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Tianjin 300384, China; Eye Institute and School of Optometry, Tianjin 300384, China; Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Yi Gong
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin 300384, China; Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Tianjin 300384, China; Eye Institute and School of Optometry, Tianjin 300384, China; Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Qingbo Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin 300384, China; Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Tianjin 300384, China; Eye Institute and School of Optometry, Tianjin 300384, China; Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Yan Shao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin 300384, China; Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Tianjin 300384, China; Eye Institute and School of Optometry, Tianjin 300384, China; Tianjin Medical University Eye Hospital, Tianjin 300384, China.
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin 300384, China; Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Tianjin 300384, China; Eye Institute and School of Optometry, Tianjin 300384, China; Tianjin Medical University Eye Hospital, Tianjin 300384, China.
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Ding Y, Su N, Luan J, Ni Y, Sun Z. Effect of Intravitreal Conbercept Injection on Complications of Pars Plana Vitrectomy in Patients with Proliferative Diabetic Retinopathy. J Pers Med 2023; 13:jpm13040572. [PMID: 37108958 PMCID: PMC10143612 DOI: 10.3390/jpm13040572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The effect of intravitreal conbercept (IVC) before pars plana vitrectomy (PPV) on surgical complications in patients with proliferative diabetic retinopathy (PDR) was observed. METHODS A total of 152 patients with PDR operated on in Jiangsu Provincial People's Hospital from November 2019 to November 2020 were divided into two groups: 124 patients in the preoperative intravitreal conbercept injection + PPV group (IVC group) and 28 patients in the PPV only group (No-IVC group). Vitreous samples were collected in all eyes of patients who underwent vitrectomy, and the content of VEGF-A was measured by Luminex. The effect of conbercept on intraoperative and postoperative complications of PDR was assessed. RESULTS The content of VEGF in the vitreous of the IVC group was significantly lower than that in the No-IVC group (64.50 ± 58.40 pg/mL vs. 805.17 ± 417.60 pg/mL, p < 0.001). During postoperative follow-up, early postoperative vitreous hemorrhage (VH) occurred in 13 of 142 eyes (9.15%). Compared with the No-IVC group, PDR patients with VH and fibrovascular membrane (FVM) or high complexity in the IVC group had lower intraoperative bleeding rates (p < 0.05). The early postoperative hemorrhage rate in the IVC group was lower than in the No-IVC group (6.03% vs. 23.08%, p < 0.05). The number of intraoperative electrocoagulation and iatrogenic retinal holes in the IVC group was significantly lower than in the No-IVC group (p < 0.05). There were no significant differences in intraocular hypertension and NVG numbers between the two groups. Visual acuity in both groups improved after PPV surgery, reaching the highest level in the 3rd month after the operation. CONCLUSIONS IVC before PPV can reduce the level of VEGF-A in the vitreous body and reduce surgical complications.
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Affiliation(s)
- Yuzhi Ding
- Department of Ophthalmology, Zhongda Hospital Southeast University, Nanjing 210009, China
| | - Na Su
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jie Luan
- Department of Ophthalmology, Zhongda Hospital Southeast University, Nanjing 210009, China
| | - Yan Ni
- Department of Ophthalmology, Zhongda Hospital Southeast University, Nanjing 210009, China
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing 210009, China
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ALTINTAŞ URAL D, ALTINTAŞ AYKAN D, SEYİTHANOĞLU M, BAHAR AY, KARAKAYA AE, GÜLER AG. Postoperatif peritoneal adhezyonların önlenmesinde saf zeytinyağı ve PRF’nin etkinliği. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1031388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: In this study, we applied platelet rich fibrin (PRF) and pure olive oil on the incision surfaces of rats. We aimed to examine whether PRF may be used safely to prevent peritoneal adhesions.
Materials and Methods: Fourty rats were divided into 4 groups (n=8). Eight rats, not included in the study groups, were used to obtain PRF material. Group 1 had no surgical procedure, Group 2 was operated without medication, Group 3 was operated and received 1cc olive oil, Group 4 was operated and received 1 cc PRF. After 21 days, cecum areas were examined histopathologically. Tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), intercellular adhesion molecule-1 (ICAM-1) and platelet-derived growth factor (PDGF) levels were measured in serum by ELISA.
Results: The adhesion scores and severity of fibrosis in Group 3 and 4 were significantly lower than Group 2. Plasma TNF-α value was significantly higher in Group 2 than Group 4. Plasma PDGF value was significantly higher in Group 2 than Group 3 and 4.
Discussion: PRF reduced intestinal adhesion by inhibiting the proliferation of fibroblasts and inflammatory cells, and promoting the proliferation of mesothelial cells. PRF has anti-inflammatory effect and prevented postop adhesions, based mainly on growth factors and cytokines in its content.
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Xu Q, Gong C, Qiao L, Feng R, Liu H, Liu Y, Yang L, Fan W, Guan L, Li J, Zhang Y, Li S. Downregulation of angiogenic factors in aqueous humor associated with less intraoperative bleeding in PDR patients with NVG receiving conbercept: a randomized controlled trial. BMC Ophthalmol 2022; 22:224. [PMID: 35585570 PMCID: PMC9115965 DOI: 10.1186/s12886-022-02451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To analyze the level changes of 28 cytokines in aqueous humor of patients with proliferative diabetic retinopathy (PDR) coexisting neovascular glaucoma (NVG) after intravitreal injection of conbercept (IVC), and to investigate whether these cytokines are associated with intraoperative bleeding (IOB). METHODS Totally 34 eyes with NVG secondary to PDR were enrolled. Patients were randomized into two groups, and all of them underwent 25-gauge pars plana vitrectomy (PPV) combined with trabeculectomy. Group I, 18 eyes received IVC 3 days before PPV, and 100 µL aqueous humor was collected at the time of IVC pretreatment and 3 days later at the beginning of PPV respectively. Group II, 16 eyes received IVC after PPV, and 100 µL aqueous humor was collected only at the beginning of PPV. Aqueous humor from 19 eyes with age-matched cataract patients served as controls. Luminex bead-based multiplex array was used to measure the levels of 28 cytokines in aqueous humor. The baseline cytokine levels were compared among the three groups. All NVG patients were divided into IOB and non-bleeding (INB) groups. The cytokine levels of aqueous humor at the beginning of PPV were compared between group I and II, also between IOB and INB groups. IOB in NVG patients was graded according to vitreous bleeding amount. The correlation between cytokine levels and the grades of IOB were analyzed. RESULTS Compared with controls, the baseline levels of 18 cytokines associated with inflammation and angiogenesis showed significantly increased in group I and group II (all, P < 0.0167). The IOB rate as well as the levels of IL-4, IL-22, Ang-2, PLGF and VEGF-A in group I were significantly lower than in group II (all, P < 0.05). The levels of IL-4, IL-22, Ang-2, PLGF and VEGF-A were significantly lower in INB group than in IOB group (all, P < 0.05). The levels of IL-4, Ang-2, PLGF and VEGF-A were positively correlated with the grades of IOB in NVG patients (all, rs > 0.4, P < 0.05). CONCLUSIONS IVC 3 days before PPV combined with trabeculectomy reduces IOB in NVG patients, in which the downregulation of IL-4, Ang-2, PLGF and VEGF-A after IVC may be an underlying mechanism. TRIAL REGISTRATION ChiCTR2100048118 , retrospectively registered on 2 July 2021.
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Affiliation(s)
- Qing Xu
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Chaoju Gong
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Lei Qiao
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Ruifang Feng
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Haiyang Liu
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Yalu Liu
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Liu Yang
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Wei Fan
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Lina Guan
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Jie Li
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Yipeng Zhang
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Suyan Li
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China.
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Foulsham W, Chien J, Lenis TL, Papakostas TD. Optical Coherence Tomography Angiography: Clinical Utility and Future Directions. JOURNAL OF VITREORETINAL DISEASES 2022; 6:229-242. [PMID: 37008547 PMCID: PMC9976135 DOI: 10.1177/24741264221080376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Purpose This work aims to review the principles of optical coherence tomography angiography (OCTA), to survey its clinical utility, and to highlight the strengths of this technology as well as barriers to adoption. Methods A literature review with editorial discussion of the current applications for OCTA is presented. Results There have been recent advances in multiple domains in OCTA imaging, including devices, algorithms, and new observations pertaining to a range of pathologies. New devices have improved the scanning speed, signal-to-noise ratio, and spatial resolution and offer an increased field of view. New algorithms have been proposed to optimize image processing and reduce artifacts. Numerous studies employing OCTA have been published describing changes to the microvasculature in diabetic retinopathy, age-related macular degeneration, central serous chorioretinopathy, retinal vein occlusion, and uveitis. Conclusions OCTA provides noninvasive, high-resolution volumetric scans of the retinal and choroidal vasculature. OCTA can provide valuable data to augment traditional dye-based angiography in a range of chorioretinal diseases.
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Affiliation(s)
- William Foulsham
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA
| | - Jason Chien
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA
| | - Tamara Lee Lenis
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA
| | - Thanos D. Papakostas
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA
- The Retina Institute, St Louis, MO, USA
- Thanos D. Papakostas, MD, The Retina Institute, 2201 S Brentwood Blvd, St Louis, MO 63144, USA.
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Hu Z, Cao X, Chen L, Su Y, Ji J, Yuan S, Fransisca S, Mugisha A, Zou W, Xie P, Liu Q. Monitoring intraocular proangiogenic and profibrotic cytokines within 7 days after adjunctive anti-vascular endothelial growth factor therapy for proliferative diabetic retinopathy. Acta Ophthalmol 2022; 100:e726-e736. [PMID: 34260829 DOI: 10.1111/aos.14957] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE To monitor the intraocular proangiogenic and profibrotic cytokine profiles within 7 days after intravitreous injection of conbercept (IVC) for patients with proliferative diabetic retinopathy (PDR). METHODS This prospective, randomized controlled, consecutive, comparative study included 157 eyes with PDR. Participant eyes underwent sham IVC or IVC and subsequent vitrectomy at days 2, 3, 4, 5, 6, 7 postinjection. The intraocular cytokines profiles were measured using beaded assay methods. RESULTS After IVC, the vascular endothelial growth factor (VEGF)-A level in PDR vitreous decreased rapidly by approximately 10 times at day 2 (p = 0.00001) and kept at a low level at days 3, 4, 5, 6, 7 (p < 0.001, each compared with IVC-sham group). Similar tendency of the change in VEGF-A was observed in aqueous humour. The level of placenta growth factor (PIGF) in aqueous humour decreased 2 days after IVC whereas returned to baseline level after 5 days. The vitreous profibrotic cytokines, tissue growth factor (TGF)-β1, TGF-β2, TGF-β3 and connective tissue growth factor did not increase after IVC in each group. CONCLUSION We observed a remarkable and rapid decrease in intraocular VEGF-A, temporal decrease in PIGF from day 2 to day 4, increase in VEGF-C and VEGF-D from day 2 onwards, but no profibrotic switch in PDR eyes after IVC. The findings might suggest that ideal vitrectomy timing might be around 3 days after IVC.
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Affiliation(s)
- Zizhong Hu
- Department of Ophthalmology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Xin Cao
- Department of Ophthalmology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Lu Chen
- Department of Ophthalmology The First Affiliated Hospital of Nanjing Medical University Nanjing China
- Xuzhou Key Laboratory of Ophthalmology The Municipal Affiliated Hospital of Xuzhou Medical University Eye Institute of Xuzhou Xuzhou China
| | - Yun Su
- Department of Ophthalmology The First Affiliated Hospital of Nanjing Medical University Nanjing China
- Eye Hospital Department of Ophthalmology The Fourth School of Clinical Medicine Nanjing Medical University Nanjing China
| | - Jiangdong Ji
- Department of Ophthalmology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Songtao Yuan
- Department of Ophthalmology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Silvia Fransisca
- Department of Ophthalmology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Aime Mugisha
- Department of Ophthalmology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Wenjun Zou
- Department of Ophthalmology The First Affiliated Hospital of Nanjing Medical University Nanjing China
- Department of Ophthalmology The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University Wuxi China
| | - Ping Xie
- Department of Ophthalmology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Qinghuai Liu
- Department of Ophthalmology The First Affiliated Hospital of Nanjing Medical University Nanjing China
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Hu Z, Mao X, Chen M, Wu X, Zhu T, Liu Y, Zhang Z, Fan W, Xie P, Yuan S, Liu Q. Single-Cell Transcriptomics Reveals Novel Role of Microglia in Fibrovascular Membrane of Proliferative Diabetic Retinopathy. Diabetes 2022; 71:762-773. [PMID: 35061025 DOI: 10.2337/db21-0551] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022]
Abstract
Vitreous fibrovascular membranes (FVMs), the hallmark of proliferative diabetic retinopathy (PDR), cause retinal hemorrhage, detachment, and eventually blindness. However, little is known about the pathophysiology of FVM. In this study, we used single-cell RNA sequencing on surgically harvested PDR-FVMs and generated a comprehensive cell atlas of FVM. Eight cellular compositions were identified, with microglia as the major cell population. We identified a GPNMB+ subpopulation of microglia, which presented both profibrotic and fibrogenic properties. Pseudotime analysis further revealed the profibrotic microglia was uniquely differentiated from retina-resident microglia and expanded in the PDR setting. Ligand-receptor interactions between the profibrotic microglia and cytokines upregulated in PDR vitreous implicated the involvement of several pathways, including CCR5, IFNGR1, and CD44 signaling, in the microglial activation within the PDR microenvironment. Collectively, our description of the novel microglia phenotypes in PDR-FVM may offer new insight into the cellular and molecular mechanism underlying the pathogenesis of DR, as well as potential signaling pathways amenable to disease-specific intervention.
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Sun H, Zou W, Zhang Z, Huang D, Zhao J, Qin B, Xie P, Mugisha A, Liu Q, Hu Z. Vitreous Inflammatory Cytokines and Chemokines, Not Altered After Preoperative Adjunctive Conbercept Injection, but Associated With Early Postoperative Macular Edema in Patients With Proliferative Diabetic Retinopathy. Front Physiol 2022; 13:846003. [PMID: 35309074 PMCID: PMC8928061 DOI: 10.3389/fphys.2022.846003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the influence of preoperative adjunctive anti-VEGF drug (Conbercept) on vitreous inflammatory cytokines and chemokines profiles and whether those cytokines were associated with early macular edema (ME) after surgery for patients with proliferative diabetic retinopathy (PDR). Methods In this post hoc analysis of the CONCEPT clinical trial, subjects with PDR underwent vitrectomy were included and vitreous samples were collected at the start of vitrectomy. Levels of vitreous VEGF, 17 inflammatory cytokines, and 11 chemokines were measured using Luminex multiplex technology. Subjects were then divided into groups based on with (Pre-IV) or without (No-Pre-IV) preoperative intravitreous injection of Conbercept; with or without early ME after surgery. Results There was no difference between Pre-IV (13/30) and No-Pre-IV (7/29) concerning the ratio of patients with early ME (p = 0.17). After preoperative intravitreous injection of Conbercept, VEGF level dramatically decreased (p = 0.001), TNF-α (p = 0.002), and IP-10 (p = 0.018) increased in Pre-IV group. In patients with early ME after surgery, however, a number of cytokines increased, including IL-1β (p = 0.008), IL-2 (p = 0.023), IL-4 (p = 0.030), IL-9 (p = 0.02), IL-10 (p = 0.002), IL-12 (p = 0.001), IL-13 (p = 0.031), IL-17A (p = 0.008), TNF-α (p = 0.012), CXCL9 (p = 0.023), G-CSF (p = 0.019), MCP-1 (p = 0.048), and RANTES (p = 0.016). Conclusion We found the preoperative adjunctive Conbercept injection has limited influence on the levels of vitreous inflammatory cytokines and chemokines in PDR. The elevated levels of a series of cytokines might be associated with early inflammation after vitrectomy, which may lead to postoperative ME.
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Affiliation(s)
- Hongyan Sun
- The Affiliated Suqian First People’s Hospital of Nanjing Medical University, Suqian, China
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenjun Zou
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Ophthalmology, The Affiliated Wuxi No. 2 People’s Hospital of Nanjing Medical University, Wuxi, China
| | - Zhengyu Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Darui Huang
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Ophthalmology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, China
| | - Jinxiang Zhao
- The Affiliated Suqian First People’s Hospital of Nanjing Medical University, Suqian, China
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bing Qin
- The Affiliated Suqian First People’s Hospital of Nanjing Medical University, Suqian, China
| | - Ping Xie
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Aime Mugisha
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qinghuai Liu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Qinghuai Liu,
| | - Zizhong Hu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Zizhong Hu,
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Update on Optical Coherence Tomography and Optical Coherence Tomography Angiography Imaging in Proliferative Diabetic Retinopathy. Diagnostics (Basel) 2021; 11:diagnostics11101869. [PMID: 34679567 PMCID: PMC8535055 DOI: 10.3390/diagnostics11101869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/22/2021] [Accepted: 10/07/2021] [Indexed: 12/29/2022] Open
Abstract
Proliferative diabetic retinopathy (PDR) is a major cause of blindness in diabetic individuals. Optical coherence tomography (OCT) and OCT-angiography (OCTA) are noninvasive imaging techniques useful for the diagnosis and assessment of PDR. We aim to review several recent developments using OCT and discuss their present and potential future applications in the clinical setting. An electronic database search was performed so as to include all studies assessing OCT and/or OCTA findings in PDR patients published from 1 January 2020 to 31 May 2021. Thirty studies were included, and the most recently published data essentially focused on the higher detection rate of neovascularization obtained with widefield-OCT and/or OCTA (WF-OCT/OCTA) and on the increasing quality of retinal imaging with quality levels non-inferior to widefield-fluorescein angiography (WF-FA). There were also significant developments in the study of retinal nonperfusion areas (NPAs) using these techniques and research on the impact of PDR treatment on NPAs and on vascular density. It is becoming increasingly clear that it is critical to use adequate imaging protocols focused on optimized segmentation and maximized imaged retinal area, with ongoing technological development through artificial intelligence and deep learning. These latest findings emphasize the growing applicability and role of noninvasive imaging in managing PDR with the added benefit of avoiding the repetition of invasive conventional FA.
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13
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Characterizing Flow and Structure of Diabetic Retinal Neovascularization after Intravitreal Anti-VEGF Using Optical Coherence Tomography Angiography: A Pilot Study. J Ophthalmol 2021; 2021:2942197. [PMID: 34336255 PMCID: PMC8294978 DOI: 10.1155/2021/2942197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background/Aims. This study evaluates changes of flow and structure of diabetic retinal neovascularization (NV) treated with intravitreal antivascular endothelial growth factor (VEGF) agents using optical coherence tomography angiography (OCTA). With OCTA, retinal blood vessels are visualized at high resolution to separately look at flow and structure information without the need for dye injection. We introduce a new measurement method including and combining information of flow and structure. Methods. Retrospective observational case series. Patients with proliferative diabetic retinopathy (PDR) were treated with intravitreal antiVEGF injections. Retinal NV were repeatedly imaged using swept-source OCTA (Zeiss PlexElite 9000) at baseline, after initial treatment block with 3-4 monthly injections, and during a follow-up period of up to 51 weeks. Change of size and flow density of the structural and angio area of NV was assessed. Results. Nine NV in eight eyes of five patients were analyzed with a median follow-up time of 45 weeks. After the initial treatment block, en face structural area regressed, 18.7% ± 39.0% (95% CI 44.2–6.8%, p=0.26), and en face angio area regressed, 51.9% ± 29.5% (95% CI 32.6 to 71.2%, p=0.007). Flow density within the en face structural area decreased by 33% ± 19.2% (95% CI 20.5–45.5%, p=0.0077). Flow density within the en face angio area decreased by mean 17.9% ± 25.2% (95% CI 1.4–34.4%, p=0.066). In two fellow eyes, NV recurrence could be observed before the onset of vitreous bleeding in one. Conclusion. Our study introduces a new quantitative measurement for NV in PDR, combining structure and flow measurement. The structure area remained after treatment, while its flow density and angio area regressed. We propose this measurement method as a more physiological and possibly more comparable metrics.
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14
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Zhang W, Zhao G, Fan W, Zhao T. Panretinal photocoagulation after or prior to intravitreal conbercept injection for diabetic macular edema: a retrospective study. BMC Ophthalmol 2021; 21:160. [PMID: 33789617 PMCID: PMC8015169 DOI: 10.1186/s12886-021-01920-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/12/2021] [Indexed: 12/30/2022] Open
Abstract
Background Panretinal photocoagulation treatment (PRP) have been known as a standard treatment for proliferative diabetic retinopathy (PDR) or severe nonproliferative diabetic retinopathy (sNPDR). However, there is no consensus on when PRP should be administrated if anti-VEGF treatment is needed for the concurrent diabetic macular edema (DME). This study is to evaluate the difference between two groups of PRP prior to, or after intravitreal conbercept (IVC) for patients with PDR or sNPDR combined with DME. Methods This was a retrospective study. Fifty-eight eyes with DME secondary to PDR or sNPDR were divided into two groups; the PRP after (PRP-after group), or prior to (PRP-prior group), IVC. Changes in number of IVC injections, best corrected visual acuity (BCVA), and central subfield macular thickness (CSMT) were compared after 4 weeks, 12 weeks, 1 year, and 2 years from the first IVC injection. Results The mean number of injections in PRP-after group was 4.8 (1 year) and 6.4 (2 year), lower than 6.4 (1 year) and 8.5 (2 year) in PRP-prior group (both p = 0.002). There was no significant difference in change in BCVA and CSMT between two groups after each follow-up. Conclusion PRP after IVC requires less injections but also yields similar visual and anatomic outcome comparing with PRP prior to IVC in patients with diabetic retinopathy combined with DME. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-01920-8.
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Affiliation(s)
- Wei Zhang
- Department of Ophthalmology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing, 210006, China
| | - Guiyang Zhao
- Department of Ophthalmology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing, 210006, China
| | - Weijie Fan
- Department of Ophthalmology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing, 210006, China
| | - Taihong Zhao
- Department of Ophthalmology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing, 210006, China
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15
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Wu S, Wu S, Feng H, Hu Z, Xie Y, Su Y, Feng T, Li L. An optimized segmentation and quantification approach in microvascular imaging for OCTA-based neovascular regression monitoring. BMC Med Imaging 2021; 21:13. [PMID: 33482750 PMCID: PMC7825210 DOI: 10.1186/s12880-021-00546-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background Quantification of neovascularization changes in terms of neovascular complex (NVC) acquired from the optical coherence tomography angiography (OCTA) imaging is extremely important for diagnosis and treatment monitoring of proliferative diabetic retinopathy (PDR). However, only few vessel extraction methods have so far been reported to quantify neovascular changes in NVC with proliferative diabetic retinopathy PDR based on OCTA images. Methods Here we propose an optimized approach to segment blood vessels, which is based on an improved vascular connectivity analysis (VCA) algorithm and combined with morphological characterization and elimination of noise and artifacts. The length and width of vessels are obtained in the quantitative assessment of microvascular network. The feasibility of the proposed method is further studied by a treatment monitoring and statistical analysis process, as we have monitored and statistically analyzed the changes of NVC based on sampled OCTA images of PDR patients (N = 14) after treatment by intravitreal injection of conbercept. Results The proposed method has demonstrated better performance in accuracy compared with existing algorithms and can thus be used for PRD treatment monitoring. Following the PDR treatment monitoring study, our data has shown that from the 1st day to 7th day of treatment, the averaged (arithmetic mean) length of NVC has been substantially shortened by 36.8% (P < 0.01), indicating significant effects of treatment. Meanwhile, the averaged (arithmetic mean) width of NVC from the 1st day to 7th day of treatment has been increased by 10.2% (P < 0.05), indicating that most of the narrow neovascularization has been reduced. Conclusion The results and analysis have confirmed that the proposed optimization process by the improved VCA method is both effective and feasible to segment and quantify the NVC with lower noise and fewer artifacts. Thus, it can be potentially applied to monitor the fibrovascular regression during the treatment period. Clinical Trial Registration This trial is registered with the Chinese Clinical Trial Registry (Registered 27 December 2017, http://www.chictr.org.cn, registration number ChiCTR-IPR-17014160).
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Affiliation(s)
- Sheng Wu
- Medical Supplies Center, Chinese PLA General Hospital, Beijing, 100039, China
| | - Shaowei Wu
- School of Electronic and Optical Engineering, Nanjing University of Science and Technology, Nanjing, 210094, China
| | - Hui Feng
- Zhongda Hospital Affiliated to Southeast University, Nanjing, 210009, China
| | - Zizhong Hu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.,Eye Hospital, Department of Ophthalmology, The Fourth School of Clinical Medicine, Nanjing, 210029, China
| | - Yejing Xie
- School of Electronic and Optical Engineering, Nanjing University of Science and Technology, Nanjing, 210094, China
| | - Yun Su
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.,Eye Hospital, Department of Ophthalmology, The Fourth School of Clinical Medicine, Nanjing, 210029, China
| | - Ting Feng
- School of Electronic and Optical Engineering, Nanjing University of Science and Technology, Nanjing, 210094, China.
| | - Li Li
- School of Electronic and Optical Engineering, Nanjing University of Science and Technology, Nanjing, 210094, China
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16
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Greig EC, Duker JS, Waheed NK. A practical guide to optical coherence tomography angiography interpretation. Int J Retina Vitreous 2020; 6:55. [PMID: 33292740 PMCID: PMC7666474 DOI: 10.1186/s40942-020-00262-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/05/2020] [Indexed: 12/16/2022] Open
Abstract
Background Optical coherence tomography angiography (OCTA) can image the retinal vasculature in vivo, without the need for contrast dye. This technology has been commercially available since 2014, however, much of its use has been limited to the research setting. Over time, more clinical practices have adopted OCTA imaging. While countless publications detail OCTA’s use for the study of retinal microvasculature, few studies outline OCTA’s clinical utility. Body This review provides an overview of OCTA imaging and details tips for successful interpretation. The review begins with a summary of OCTA technology and artifacts that arise from image acquisition. New methods and best practices to prevent image artifacts are discussed. OCTA has the unique ability among retinovascular imaging modalities to individually visualize each retinal plexus. Slabs offered in standard OCTA devices are reviewed, and clinical uses for each slab are outlined. Lastly, the use of OCTA for the clinical interpretation of retinal pathology, such as diabetic retinopathy and age-related macular degeneration, is discussed. Conclusion OCTA is evolving from a scientific tool to a clinical imaging device. This review provides a toolkit for successful image interpretation in a clinical setting.
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Affiliation(s)
- Eugenia Custo Greig
- New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.,Yale School of Medicine, New Haven, CT, USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.
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17
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Lupidi M, Gujar R, Cerquaglia A, Chablani J, Fruttini D, Muzi A, Corbucci R, Fiore T, Coscas F, Coscas G, Parravano M, Cagini C. OCT-Angiography as a reliable prognostic tool in laser-treated proliferative diabetic retinopathy: The RENOCTA Study. Eur J Ophthalmol 2020; 31:2511-2519. [PMID: 33135494 DOI: 10.1177/1120672120963451] [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] [Indexed: 12/14/2022]
Abstract
PURPOSE To quantitatively assess retinal neovascularizations (RNVs) in proliferative diabetic retinopathy (PDR) before and after photocoagulative laser treatment (PLT) using Optical Coherence Tomography Angiography (OCT-A). METHODS Consecutive patients with PDR were examined with fluorescein angiography (FA) and OCT-A before and after PLT. Baseline and after-treatment FA images were quantitatively analyzed to assess both the RNVs area and leakage area. On OCT-A RNVs area, vascular perfusion density (VPD), vessel length density (VLD) and fractal dimension were computed. VPD of the full-retina OCT-A underneath the RNV was determined to evaluate potential laser-induced changes in vascular perfusion. RESULTS Fifteen eyes of 13 patients with PDR were enrolled. The mean area of the RNVs was 0.47 ± 0.50 mm2 in the baseline OCT-A and 0.32 ± 0.40 mm2 in the post-treatment assessment (p = 0.0002). The mean RNV VPD of RNV was 2% ± 4% in pre-treatment and 1% ± 1% for the post-treatment (p = 0.0001). The mean VLD of RNV was 7.26 ± 1.53 at baseline and 6.64 ± 1.65 in the post treatment (p = 0.0002). A significant difference in terms of mean RNVs area and VPD reduction between eyes that needed additional treatment and those that did not (~40% vs ~20%; p < 0.05), was observed. Mean VPD of full-retinal thickness OCT-angiogram was 55% ± 10% for the pre-treatment and 53% ± 8% for the post treatment scan (p = 0.02). CONCLUSION The quantitative OCT-A assessment of laser-induced changes of RNVs can be a useful non-invasive approach for determining treatment efficacy. A reduction of RNVs area or VPD ⩾ 40% might reveal those eyes that won't require additional treatment. Retinal perfusion impairment seemed to progress independently from the treatment.
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Affiliation(s)
- Marco Lupidi
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy.,Fondazione per la Macula Onlus, Di.N.O.G.Mi., University Eye Clinic, Genova, Italy.,Centre de l'Odéon, Paris, France
| | - Ramkailash Gujar
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Alessio Cerquaglia
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Jay Chablani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Daniela Fruttini
- Department of Internal Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Alessio Muzi
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Roberta Corbucci
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Tito Fiore
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Florence Coscas
- Centre de l'Odéon, Paris, France.,Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris-Est, Créteil, France
| | - Gabriel Coscas
- Centre de l'Odéon, Paris, France.,Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris-Est, Créteil, France
| | | | - Carlo Cagini
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
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18
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Vaz-Pereira S, Morais-Sarmento T, Esteves Marques R. Optical coherence tomography features of neovascularization in proliferative diabetic retinopathy: a systematic review. Int J Retina Vitreous 2020; 6:26. [PMID: 32612851 PMCID: PMC7322867 DOI: 10.1186/s40942-020-00230-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/21/2020] [Indexed: 01/03/2023] Open
Abstract
Background Diabetic retinopathy (DR) is a leading cause of blindness due to diabetic macular edema (DME) or complications of proliferative diabetic retinopathy (PDR). Optical coherence tomography (OCT) is a noninvasive imaging technique well established for DME but less used to assess neovascularization in PDR. Developments in OCT imaging and the introduction of OCT angiography (OCTA) have shown significant potential in PDR. Objectives To describe the tomographic features of PDR, namely of neovascularization, both of the optic disc (NVD) and elsewhere (NVE), intraretinal microvascular abnormalities (IRMA), retinal nonperfusion areas (NPA), status of the posterior vitreous, vitreoschisis and vitreous and subhyaloid/sub-ILM hemorrhages. Data sources Electronic database search on PubMed and EMBASE, last run on December 19th 2019. Study eligibility criteria, participants and interventions Publications assessing OCT and/or OCTA findings in PDR patients. All study designs were allowed except for case-reports, conference proceedings and letters. Study appraisal Newcastle–Ottawa Scale for observational studies was used for purposes of risk of bias assessment. Results From the 1300 studies identified, 283 proceeded to full-text assessment and 60 were included in this comprehensive review. OCT was useful in detecting NVD and NVE, such as in characterizing disease activity and response to laser and/or anti-VEGF therapies. The absence of posterior vitreous detachment seemed determinant for neovascular growth, with the posterior hyaloid acting as a scaffold. OCTA allowed a more detailed characterization of the neovascular complexes, associated NPA and disease activity, allowing the quantification of neovessel area and flow index. However, changes in OCTA blood flow signal following local therapies did not necessarily correlate with structural regression. Widefield and ultra-widefield OCTA were highly sensitive in the detection of PDR, adding value to disease staging and monitoring. Compared to fluorescein angiography, OCTA was more sensitive in detecting microvascular changes indicating disease progression. Limitations Publication languages were restricted. Most included studies were observational and non-comparative. Risk of bias regarding case representativeness. Conclusions OCT-based retinal imaging technologies are advancing rapidly and the trend is to be noninvasive and wide-field. OCT has proven invaluable in diagnosing, staging and management of proliferative diabetic disease with daily application in clinical and surgical practices.
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Affiliation(s)
- Sara Vaz-Pereira
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte, EPE-Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal.,Department of Ophthalmology, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Tiago Morais-Sarmento
- Department of Ophthalmology, Hospital do Espírito Santo de Évora EPE, Évora, Portugal
| | - Raquel Esteves Marques
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte, EPE-Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal.,Department of Ophthalmology, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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