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Bacillary Layer Detachment in a Korean Cohort with Neovascular Age-Related Macular Degeneration. Retina 2022; 42:1028-1037. [PMID: 35152248 DOI: 10.1097/iae.0000000000003437] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the incidence and characteristics of bacillary layer detachment (BALAD) in neovascular age-related macular degeneration (AMD). METHODS This retrospective study was performed at Kim's Eye Hospital in South Korea. Patients who were diagnosed with neovascular AMD between January 2017 and December 2017 were included. The incidence of BALAD was compared among different types of macular neovascularization. The best-corrected visual acuity (BCVA) and central retinal thickness (CRT) at diagnosis were compared between patients showing BALAD at diagnosis and those who did not. RESULTS Among the 442 patients included, BALAD was observed in 20 patients(4.5%). There was a significant difference in the incidence of BALAD between type 1 MNV(2.7%), type 2 MNV(12.5%), and type 3 MNV (0%)(P<0.001). The BCVA was significantly worse (mean 1.26±0.79 vs 0.62±0.50, P=0.001), and the CRT was significantly greater (mean 648.2±211.1 µm vs 464.0±175.5 µm, P<0.001) in patients with BALAD than in those without it. After anti-vascular endothelial growth factor therapy, all BALADs resolved. CONCLUSIONS This study first reported the incidence of the BALAD in neovascular AMD in Korean population. The incidence of BALAD was the highest in type 2 MNVs. BALAD generally develops in eyes with great macular thickness and poor visual acuity.
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Kim JH, Kim JW, Kim CG, Lew YJ, Cho HJ. Influence of bevacizumab therapy and intraretinal hemorrhage in long-term outcomes of hemorrhagic retinal arterial macroaneurysm. Sci Rep 2021; 11:14246. [PMID: 34244580 PMCID: PMC8270924 DOI: 10.1038/s41598-021-93811-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
This study aimed to evaluate the long-term visual outcomes of hemorrhagic retinal arterial macroaneurysm (RAM), particularly focusing on the influence of bevacizumab therapy and intraretinal hemorrhage (IRH) on the outcomes. This retrospective study included 49 patients diagnosed with hemorrhagic RAM. Patients were divided into the bevacizumab group and observation group depending on the whether they were administered bevacizumab treatment and the IRH group and the non-IRH group based on the presence of IRH at the fovea. Best-corrected visual acuity (BCVA) at diagnosis was compared with that at the final visit. Further, the BCVA at the final visit was compared between the study groups. Multivariate analysis was also performed to identify factors associated with poor BCVA at the final visit. The mean follow-up period was 24.8 ± 15.3 months. The mean logarithm of minimal angle of resolution BCVA was significantly improved from 1.37 ± 0.70 at diagnosis to 0.72 ± 0.62 at the final visit (P < 0.001). There was no significant difference in the BCVA at the final visit between the bevacizumab group and observation group (P = 0.576). However, the BCVA at the final visit was significantly worse in the IRH group than in the non-IRH group (P = 0.002). In multivariate analysis, the presence of IRH was significantly associated with poor BCVA (P = 0.007). Significant long-term visual improvement was noted in hemorrhagic RAM. However, the presence of IRH at the fovea was associated with poor visual prognosis. Bevacizumab therapy did not significantly influence the outcomes.
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Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea.
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Young Ju Lew
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Han Joo Cho
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
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Baumal CR, Sarraf D, Bryant T, Gui W, Muakkassa N, Pichi F, Querques G, Choudhry N, Teke MY, Govetto A, Invernizzi A, Eliott D, Gaudric A, Cunha de Souza E, Naysan J, Lembo A, Lee GC, Freund KB. Henle fibre layer haemorrhage: clinical features and pathogenesis. Br J Ophthalmol 2020; 105:374-380. [PMID: 32376610 DOI: 10.1136/bjophthalmol-2019-315443] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND To describe the clinical presentation and characteristic imaging features of deep retinal haemorrhages primarily located in the Henle fibre layer (HFL) of the macula. The spectrum of aetiologies and a comprehensive theory of pathogenesis are presented. METHODS This is a retrospective, multicentre case series evaluating eyes with retinal haemorrhage in HFL. Clinical features, underlying aetiology, systemic and ocular risk factors, visual acuity, and multimodal imaging including fundus photography and cross-sectional and en face optical coherence tomography (OCT) are presented. RESULTS Retinal haemorrhages localised to HFL in 33 eyes from 23 patients were secondary to acute blunt trauma to the head (n=2), eye (n=1) and trunk (n=1), ruptured intracranial aneurysm (Terson's syndrome, n=3), general anaesthesia (n=1), epidural anaesthesia (n=1), hypertension with anaemia (n=1), decompression retinopathy (n=1), postvitrectomy with intraocular gas (n=1), retinal vein occlusion (n=7), myopic degeneration (n=2), macular telangiectasia type 2 (n=1), and polypoidal choroidal vasculopathy (n=1). Defining clinical features included deep retinal haemorrhage with feathery margin and petaloid pattern radiating from the fovea. OCT demonstrated characteristic hyper-reflectivity from the haemorrhage delineated by obliquely oriented fibres in the Henle layer. Spontaneous resolution of HFL haemorrhage occurred after 3 months in 15 patients with follow-up. CONCLUSION The characteristic petaloid-shaped, deep intraretinal haemorrhage with a feathery margin localised to HFL is associated with various disorders. The terminology 'Henle fiber layer hemorrhage (HH)' is proposed to describe the clinical and OCT findings, which may result from abnormal retinal venous pressure from systemic or local retinovascular disorders affecting the deep capillary plexus or from choroidal vascular abnormalities.
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Affiliation(s)
| | - David Sarraf
- Retina Department, Jules Stein Eye Institute, UCLA, Los Angeles, California, USA
| | - Tara Bryant
- Ophthalmology, New England Eye Center, Boston, Massachusetts, USA
| | - Wei Gui
- Retina Department, Jules Stein Eye Institute, UCLA, Los Angeles, California, USA
| | - Nora Muakkassa
- Ophthalmology, New England Eye Center, Boston, Massachusetts, USA
| | | | | | - Netan Choudhry
- Vitreoretinal Surgery, Herzig Eye Institute, Toronto, Ontario, Canada
| | - Mehmet Yasin Teke
- Department of Ophthalmology, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Andrea Govetto
- Retina Department, Jules Stein Eye Institute, Los Angeles, California, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Milan, Italy
| | - Dean Eliott
- Retina Department, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Alain Gaudric
- Department of Ophthalmology, Lariboisière Hospital, University of Paris 7 Denis Diderot, Paris, France
| | | | - Jonathan Naysan
- Ophthalmology, North Shore-Long Island Jewish, Great Neck, New York, USA
| | - Andrea Lembo
- University Eye Clinic, San Giuseppe Hospital, Milan, Italy
| | - Grace C Lee
- Department of Ophthalmology, Kaiser Permanente, Woodland Hills, California, USA
| | - K Bailey Freund
- Retina Department, Vitreous Retina Macula Consultants of New York, New York, New York, USA
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Li M, Dolz-Marco R, Messinger JD, Ferrara D, Freund KB, Curcio CA. Neurodegeneration, gliosis, and resolution of haemorrhage in neovascular age-related macular degeneration, a clinicopathologic correlation. Eye (Lond) 2020; 35:548-558. [PMID: 32366998 DOI: 10.1038/s41433-020-0896-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To analyse cellular and spatiotemporal factors of neurodegeneration and gliosis in a patient with submacular haemorrhage (SMH) secondary to type 1 macular neovascularization in neovascular age-related macular degeneration (nAMD). METHODS This is a case study and clinicopathologic correlation of an 84-year-old white man with nAMD treated with antiangiogenic drugs and photodynamic therapy during a 6-year follow-up. Eyes were recovered for histology 8.23 h after death. In vivo multimodal imaging including optical coherence tomography (OCT) and en face modalities was compared with ex vivo OCT and high-resolution histologic images, using a custom image registration procedure. SMH components were defined (intraretinal, subretinal, sub-retinal pigment epithelium (RPE), and dehemoglobinized blood). Neurodegenerative changes in each of these areas were described. One anonymous donor eye with haemorrhagic nAMD was also reviewed as a comparator. RESULTS By in vivo OCT, progressive resolution of the haemorrhage and gradual transformation of sub-RPE fluid to fibrous hyperreflective tissue, progressive macular atrophy, and variation in external limiting membrane (ELM) visibility were observed. Histology showed intense photoreceptor loss with preservation and self-adhesion of macular Müller glia resulting in ELM condensation. The comparator eye exhibited shed cone inner segments among subretinal erythrocytes. CONCLUSION This is the most detailed clinicopathologic correlation of nAMD with SMH resolution to date, and the first in the OCT era. Our results reveal profound macular neurodegeneration and gliosis, signified by condensed ELM, soon after haemorrhage begins. Intensified OCT reflectivity of the ELM, an important retinal barrier, has potential as a biomarker for severe photoreceptor loss and gliosis.
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Affiliation(s)
- Miaoling Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rosa Dolz-Marco
- Vitreous Retina Macula Consultants of New York, New York, NY, USA.,LuEsther T Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA.,Unit of Macula, Oftalvist Clinic, Valencia, Spain
| | - Jeffrey D Messinger
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA.,LuEsther T Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA.,Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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Kim JH, Chang YS, Kim JW, Kim CG, Lee DW. Abrupt visual loss during anti-vascular endothelial growth factor treatment for type 3 neovascularization. Int J Ophthalmol 2019; 12:480-487. [PMID: 30918819 DOI: 10.18240/ijo.2019.03.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 01/02/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the incidence of abrupt visual loss and its associated factors, during anti-vascular endothelial growth factor (VEGF) treatment for type 3 neovascularization. METHODS This retrospective study included 137 eyes that were newly diagnosed with type 3 neovascularization. All eyes were treated with anti-VEGF therapy. Abrupt visual loss was defined as loss of 5 or more lines in best-corrected visual acuity (BCVA) in comparison to the previous visit. The incidence and timing of abrupt visual loss as well as the factors associated with it, were determined. In addition, the BCVA at the final follow-up was compared between the eyes with and those without abrupt visual loss. RESULTS The mean follow-up period was 42.4±18.9mo after diagnosis, and abrupt visual loss was noted in 22 eyes (16.1%) at a mean of 19.6±13.9mo. Abrupt visual loss was found to be associated with subretinal hemorrhage in 11 eyes (50.0%), development of or increase in the height of pigment epithelial detachment with fluid in 8 eyes (36.4%), and tears in the retinal pigment epithelium in 3 eyes (13.6%). The logarithm of minimum angle of resolution (logMAR) mean BCVA at the final follow-up was 2.07±0.67 (Snellen equivalents: 20/2349) and 1.00±0.55 (20/200) in eyes with and without abrupt visual loss, respectively. BCVA was significantly worse in the eyes with abrupt visual loss (P<0.001). CONCLUSION Abrupt visual loss is noted in 16.1% of patients with type 3 neovascularization and is associated with poor visual outcome. Additional studies are needed to determine how abrupt visual loss can be prevented.
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Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul 150-034, Korea
| | - Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon 35365, Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul 150-034, Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul 150-034, Korea
| | - Dong Won Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul 150-034, Korea
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Kim JH, Chang YS, Lee DW, Kim CG, Kim JW. Quantification of retinal changes after resolution of submacular hemorrhage secondary to polypoidal choroidal vasculopathy. Jpn J Ophthalmol 2017; 62:54-62. [PMID: 29188462 DOI: 10.1007/s10384-017-0549-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 10/26/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate changes in the thickness of retinal layers after resolution of submacular hemorrhage secondary to polypoidal choroidal vasculopathy (PCV). STUDY DESIGN Retrospective, observational study. METHODS This study included 21 patients (21 eyes) who had been diagnosed with submacular hemorrhage secondary to PCV and treated using anti-vascular endothelial growth factor monotherapy. After the hemorrhage had resolved, the thicknesses of the retinal layers were measured on horizontal- and vertical-crosshair optical coherence tomography scan images. The thickness of each layer in the region affected by the hemorrhage was compared with the thickness of the layer in the corresponding region in the fellow eye, as well as between an unaffected region in the eye with the hemorrhage and the corresponding region in the fellow eye. RESULTS Optical coherence tomography (OCT) was performed 5.5±2.8 months after diagnosis. In the horizontal OCT images, the outer plexiform layer (OPL) and outer nuclear layer (ONL) + photoreceptor layer (PRL) were significantly thinner in the affected region than in the corresponding region (P = 0.019 and P <0.001, respectively). In the vertical OCT image, the ONL+PRL was significantly thinner in the affected region than in the corresponding region (P <0.001). The thickness of the retinal layer in the unaffected region did not differ from that in the corresponding region of the fellow eye. CONCLUSIONS The significant thinning of the outer retinal layers in the regions affected by submacular hemorrhage suggests that the hemorrhage induces marked damage in the outer retinal layers, explaining the poor visual prognosis of submacular hemorrhage.
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Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea.
| | - Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea
| | - Dong Won Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
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MORPHOLOGIC FEATURES ASSOCIATED WITH FIBROTIC SCARRING AFTER ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY IN POLYPOIDAL CHOROIDAL VASCULOPATHY. Retina 2017; 38:2168-2176. [PMID: 28930802 DOI: 10.1097/iae.0000000000001845] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate morphologic features associated with fibrotic scarring after anti-vascular endothelial growth factor therapy in polypoidal choroidal vasculopathy (PCV). METHODS This retrospective study included 293 patients who had been diagnosed with PCV and treated with anti-vascular endothelial growth factor monotherapy during a 12-month follow-up period. Associations of morphologic features, including type of PCV, location of the polypoidal lesion, greatest linear dimension, largest polyp diameter, choroidal vascular hyperpermeability, pigment epithelial detachment, intraretinal fluid, and subretinal hyperreflective material (SHRM) with fibrotic scar at 12 months were analyzed. RESULTS Fibrotic scars were noted in 15 eyes (5.1%). The incidence of fibrotic scars was higher in Type 1 PCV (8 of 76 eyes) than in Type 2 PCV (7 of 217 eyes, P = 0.028). The incidence was also higher in eyes with SHRM (14 of 124 eyes) than in eyes without SHRM (1 of 169 eyes, P < 0.001). In multivariate analysis, SHRM was associated with fibrotic scar (P = 0.005). Among the SHRM cases, the incidence of the scar was 12.9% in eyes with submacular hemorrhage and 8.5% in eyes without hemorrhage. CONCLUSION Although fibrotic scar is an infrequent finding in PCV, the possibility of scarring should be considered in eyes with SHRM, particularly in submacular hemorrhage cases.
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