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Zarnegar A, Valsecchi N, Sadeghi E, Shah S, Tang A, Yagobian S, Iannetta D, Chhablani J. Choroidal imaging biomarkers as predictors of conversion to exudative age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06611-w. [PMID: 39162805 DOI: 10.1007/s00417-024-06611-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/24/2024] [Accepted: 08/07/2024] [Indexed: 08/21/2024] Open
Abstract
PURPOSE Predicting the progression of intermediate AMD (iAMD) to neovascular AMD (nAMD) will help to identify high-risk patients and improve treatment outcomes. The present study assessed whether choroidal OCT biomarkers could predict conversion to nAMD. METHODS This retrospective study included patients with clinically stable iAMD who either converted to nAMD (C group) or did not convert (NC group) during one year of follow-up. OCT parameters included subfoveal choroidal thickness (SFCT), central macular thickness (CMT), Haller vascular thickness (HVT), inner choroidal thickness (ICT), and double-layer sign (DLS). RESULTS Of 116 total eyes, there were 37 in the NC group and 79 in the C group. Baseline SFCT was significantly lower in the C group compared to the NC group (169.0 ± 63.2 μm vs. 218.0 ± 97.8 μm, p = 0.01). Baseline HVT and ICT were lower in the C group (105.2 ± 40.6 μm vs. 121.0 ± 56.6 μm, p = 0.17 and 61.9 ± 35.5 μm vs. 77.5 ± 41.7 μm, p = 0.09). HVT was decreased at all time points in the C group vs NC (p > 0.05). The ICT was reduced in the C group at each time point except at conversion time (p > 0.05). Of all eight eyes who presented DLS at baseline, 100% converted to nAMD (p < 0.001). CONCLUSION Lower SFCT at baseline may signal conversion to nAMD within 12 months.
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Affiliation(s)
- Arman Zarnegar
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nicola Valsecchi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Ophthalmology Unit, Dipartimento Di Scienze Mediche E Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Elham Sadeghi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Stavan Shah
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anthony Tang
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Shiva Yagobian
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Danilo Iannetta
- Ophthalmology Unit, Dipartimento Di Scienze Mediche E Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Song D, Ni Y, Zhou Y, Niu Y, Wang G, Lv B, Xie G, Liu G. Evaluation of choroid vascular layer thickness in wet age-related macular degeneration using artificial intelligence. Photodiagnosis Photodyn Ther 2024; 47:104218. [PMID: 38777310 DOI: 10.1016/j.pdpdt.2024.104218] [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: 02/29/2024] [Revised: 05/02/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To facilitate the assessment of choroid vascular layer thickness in patients with wet age-related macular degeneration (AMD) using artificial intelligence (AI). METHODS We included 194 patients with wet AMD and 225 healthy participants. Choroid images were obtained using swept-source optical coherence tomography. The average Sattler layer-choriocapillaris complex thickness (SLCCT), Haller layer thickness (HLT), and choroidal thickness (CT) were auto-measured at 7 regions centered around the foveola using AI and subsequently compared between the 2 groups. RESULTS The SLCCT was lower in the AMD group than in the control group (P < 0.05). The HLT was significantly higher in the AMD group than in the control group at the Tparafovea and T-perifovea in the total population (P < 0.05) and in the ≤70-year subgroup (P < 0.05). The CT was higher in the AMD group than in the control group, particularly at the N-perifovea, T-perifovea, and T-parafovea in the ≤70-year subgroup; Interestingly, it was lower in the AMD group than in the control group at the Nparafovea, N-fovea, foveola, and T-fovea in the >70-year subgroup (P < 0.05). CONCLUSION This novel AI-based auto-measurement was more accurate, efficient, and detailed than manual measurements. SLCCT thinning was observed in wet AMD; however, CT changes depended on the interaction between HLT compensatory thickening and SLCCT thinning.
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Affiliation(s)
- Dan Song
- Department of Ophthalmology, Peking University International Hospital, No. 1 Shengmingyuan Road, Zhongguancun Life Science Park, Changping District, Beijing, China
| | - Yuan Ni
- Ping An Technology, 12F Building B, PingAn IFC, No.1-3 Xinyuan South Road, Beijing 100027 China
| | - Ying Zhou
- Department of Ophthalmology, Peking University International Hospital, No. 1 Shengmingyuan Road, Zhongguancun Life Science Park, Changping District, Beijing, China
| | - Yaqian Niu
- Department of Ophthalmology, Peking University International Hospital, No. 1 Shengmingyuan Road, Zhongguancun Life Science Park, Changping District, Beijing, China
| | - Guanzheng Wang
- Ping An Technology, 12F Building B, PingAn IFC, No.1-3 Xinyuan South Road, Beijing 100027 China
| | - Bin Lv
- Ping An Technology, 12F Building B, PingAn IFC, No.1-3 Xinyuan South Road, Beijing 100027 China
| | - Guotong Xie
- Ping An Technology, 12F Building B, PingAn IFC, No.1-3 Xinyuan South Road, Beijing 100027 China; Ping An Health Cloud Company Limited, 12F Building B, PingAn IFC, No. 1-3 Xinyuan South Road, Beijing 100027, China.
| | - Guangfeng Liu
- Department of Ophthalmology, Peking University International Hospital, No. 1 Shengmingyuan Road, Zhongguancun Life Science Park, Changping District, Beijing, China.
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Arrigo A, Saladino A, Aragona E, Barresi C, Mularoni C, Bandello F, Battaglia Parodi M. Clinical and Imaging Biomarkers Associated with Outer Retinal Atrophy Onset in Exudative Age-Related Macular Degeneration: A Real-Word Prospective Study. Ophthalmol Ther 2024; 13:1185-1196. [PMID: 38446282 DOI: 10.1007/s40123-024-00903-4] [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: 11/30/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Macular neovascularization (MNV) secondary to age-related macular degeneration (AMD) is well managed by anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections. However, outer retinal atrophy represents an unavoidable occurrence detected during follow-up. Several imaging metrics have been proposed as clinically relevant in stratifying the risk of onset of outer retinal atrophy. The main goal of this study is to evaluate the impact of noninvasive imaging metrics on the assessment of outer retinal atrophy onset in a large cohort of eyes with neovascular AMD managed in a real-world setting. METHODS This study was a prospective, observational, case series. We included patients affected by newly diagnosed neovascular AMD, requiring anti-VEGF intravitreal injections. We collected clinical and imaging data, with a planned follow-up of 24 months. The multimodal imaging protocol included optical coherence tomography, optical coherence tomography angiography, and fundus autofluorescence. We collected noninvasive imaging metrics and we assessed the relationship with the morphological and functional outcome evaluated at 12-month and 24-month time points. RESULTS We included 370 eyes of 370 patients with exudative AMD (210 male; mean age 79 ± 8 years). MNV were classified as follows: type 1, 198 (54%); type 2, 89 (24%); polypoidal choroidal vasculopathy, 29 (7%); and type 3, 54 (15%). A total of 120 out of 370 eyes (33%) showed complete outer retinal atrophy at the end of the 2-year follow-up. The presence of intraretinal fluid, thinning of the Sattler choroidal layer, late anti-VEGF switch, the overall number of anti-VEGF injections, and the perfusion characteristics of the MNV were found to be the most relevant factors associated with the onset of outer retinal atrophy. The other collected metrics were found to be less clinically relevant, also showing no cumulative effect in the multivariate analysis (p > 0.05). CONCLUSIONS We identified imaging metrics significantly associated with the 2-year risk onset of outer retinal atrophy. These metrics might pave the way for the development of future customized anti-VEGF treatment strategies.
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Affiliation(s)
- Alessandro Arrigo
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Andrea Saladino
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Emanuela Aragona
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Costanza Barresi
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Cecilia Mularoni
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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Roszkowska AM, Leanza R, Aragona E, Gargiulo L, Alibrandi A, Arrigo A, Bottaro A, Barone P, Stagno F, Allegra A. Retinal Vessel Analysis and Microvascular Abnormalities in Patients with Philadelphia-Negative Chronic Myeloproliferative Neoplasms. J Clin Med 2024; 13:2232. [PMID: 38673505 PMCID: PMC11051207 DOI: 10.3390/jcm13082232] [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: 02/20/2024] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Philadelphia-negative chronic myeloproliferative neoplasms are a group of clonal hematopoietic disorders including polycythemia vera, essential thrombocythemia, and primary myelofi-brosis. These neoplasms are characterized by an increased risk of thrombotic complications. Several studies have highlighted that the study of vessels of the retina offers the opportunity to visualize, in vivo, the damage to microcirculation that is common in various systemic pathologies. Methods: in our study, forty patients underwent an ophthalmological examination, using non-invasive imaging tech-niques, for analyses of their retinal vascularization. The objective was to correlate the findings ob-tained from this study of the retina with different markers of thrombotic risk, to demonstrate the usefulness of studying retinal vessels as a possible new prognostic biomarker of thrombotic risk in patients affected by Philadelphia-negative chronic myeloproliferative neoplasms. Results: retinal imaging demonstrated changes in the microcirculation, with a reduced vascular density of the deep and superficial capillary plexuses with respect to a normal group, and a correlation between retinal changes and blood parameters. Conclusions: additional research will allow us to determine whether retinal changes in individuals with chronic myeloproliferative neoplasms could be predictive of the development of thrombotic events in these subjects.
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Affiliation(s)
- Anna Maria Roszkowska
- Ophthalmology Unit, Department of Biomedical Sciences, University of Messina, 98100 Messina, Italy; (A.M.R.); (L.G.)
- Ophthalmology Department, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland
| | - Rossana Leanza
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (R.L.); (A.B.); (P.B.); (F.S.)
| | - Emanuela Aragona
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, 20132 Milan, Italy; (E.A.); (A.A.)
| | - Ludovica Gargiulo
- Ophthalmology Unit, Department of Biomedical Sciences, University of Messina, 98100 Messina, Italy; (A.M.R.); (L.G.)
| | - Angela Alibrandi
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, 98100 Messina, Italy;
| | - Alessandro Arrigo
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, 20132 Milan, Italy; (E.A.); (A.A.)
| | - Adele Bottaro
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (R.L.); (A.B.); (P.B.); (F.S.)
| | - Paola Barone
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (R.L.); (A.B.); (P.B.); (F.S.)
| | - Fabio Stagno
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (R.L.); (A.B.); (P.B.); (F.S.)
| | - Alessandro Allegra
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (R.L.); (A.B.); (P.B.); (F.S.)
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Arrigo A, Teussink M, Bianco L, Antropoli A, Aragona E, Cappuccio G, Bandello F, Parodi MB. High-resolution/High-Speed Gap Can Distinguish Different Intraretinal Perfusion Signals by Optical Coherence Tomography Angiography. Transl Vis Sci Technol 2023; 12:11. [PMID: 37163285 PMCID: PMC10179578 DOI: 10.1167/tvst.12.5.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Purpose The development of optical coherence tomography angiography (OCTA) has radically changed the diagnostic assessment of the intraretinal vascular network. Two different OCTA acquisition modalities have recently been introduced in clinical practice, namely high-resolution (HR) and high-speed (HS) scans. HR OCTA requires more acquisition time and provides higher quality data, whereas HS OCTA is faster but furnishes lower quality data. The main aim of the present study is to gauge how much extra blood flow perfusion information can be obtained through the combined use of HR and HS OCTA. Methods We compared HR and HS OCTA acquisitions to assess the reliability of both techniques, also putting forward a new set of quantitative metrics to measure the HR/HS OCTA gap and to highlight different perfusion information. Results In essence, both HR and HS OCTA acquisitions proved highly feasible in detecting the intraretinal vascular flow signal, as confirmed by the stability of quantitative OCTA metrics, thus displaying their suitability for use in clinical practice. We detected an HR/HS overlapping gap of 21.6 ± 6.5% for intraretinal capillaries, and 4.3 ± 1.2% for choriocapillaris, highlighting the greater information obtained by HR OCTA. Conclusions This novel HR/HS OCTA gap assessment might pave the way for the development of new quantitative metrics for retinal diseases that would focus on the earlier detection of perfusion impairment and relate it to the stage of the disease and its progression. Translational Relevance This study proposes a new quantitative way to detect different perfusion signals based on OCTA. The findings presented in this paper can lay the foundations for the development of new quantitative metrics focused on the separate analysis of high flow and low flow signals, enabling very early changes in intraretinal perfusion to be detected.
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Affiliation(s)
- Alessandro Arrigo
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan, Italy
| | | | - Lorenzo Bianco
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan, Italy
| | - Alessio Antropoli
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan, Italy
| | - Emanuela Aragona
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan, Italy
| | - Giuseppe Cappuccio
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan, Italy
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan, Italy
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Arrigo A, Aragona E, Battaglia Parodi M, Bandello F. Quantitative approaches in multimodal fundus imaging: State of the art and future perspectives. Prog Retin Eye Res 2023; 92:101111. [PMID: 35933313 DOI: 10.1016/j.preteyeres.2022.101111] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 02/01/2023]
Abstract
When it first appeared, multimodal fundus imaging revolutionized the diagnostic workup and provided extremely useful new insights into the pathogenesis of fundus diseases. The recent addition of quantitative approaches has further expanded the amount of information that can be obtained. In spite of the growing interest in advanced quantitative metrics, the scientific community has not reached a stable consensus on repeatable, standardized quantitative techniques to process and analyze the images. Furthermore, imaging artifacts may considerably affect the processing and interpretation of quantitative data, potentially affecting their reliability. The aim of this survey is to provide a comprehensive summary of the main multimodal imaging techniques, covering their limitations as well as their strengths. We also offer a thorough analysis of current quantitative imaging metrics, looking into their technical features, limitations, and interpretation. In addition, we describe the main imaging artifacts and their potential impact on imaging quality and reliability. The prospect of increasing reliance on artificial intelligence-based analyses suggests there is a need to develop more sophisticated quantitative metrics and to improve imaging technologies, incorporating clear, standardized, post-processing procedures. These measures are becoming urgent if these analyses are to cross the threshold from a research context to real-life clinical practice.
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Affiliation(s)
- Alessandro Arrigo
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
| | - Emanuela Aragona
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy
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Resch MD, Balogh A, Kurth T, Nagy ZZ, DeBuc DC, Papp A. Atrophy of retinal vessels in neovascular age-related macular degeneration following long-term treatment with 20 intravitreal anti-VEGF injections. BMC Ophthalmol 2022; 22:469. [PMID: 36471292 PMCID: PMC9721060 DOI: 10.1186/s12886-022-02700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/22/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The study aimed to evaluate the changes in retinal vascular density in exudative age-related macular degeneration (AMD) after long-term anti-VEGF treatment using optical coherence tomography angiography (OCT-A), and to compare these changes with the vascular density in AMD treated for one year and healthy eyes. METHODS In our cross-sectional study OCT-A was performed on 60 eyes of 60 patients. Group AMD 20 × consisted of patients receiving long-term (minimum 20 injections) aflibercept therapy (n = 17), and Group AMD one year consisted of patients treated for one year with a treat & extend protocol (n = 25). The vascular density values obtained with OCT-A were compared with an age-matched control group of 18 healthy eyes. We examined the central retinal thickness (CRT), the vascular density of the fovea and parafovea in the superficial and deep retinal plexus, and evaluated the extent of the non-flow area and the foveal avascular zone (FAZ) on a 3 × 3 mm macular region. Kruskal-Wallis test was performed for statistical analysis. RESULTS In Group AMD 20x, the vascular density of superficial retinal plexus in the fovea (p = 0.0022) and parafovea (p < 0.0001) was significantly lower compared to Group one year and control group. In the deep retinal plexus, vascular density in the fovea (p = 0.0033) was significantly lower in both AMD groups compared to the control group, with no difference in the parafoveal region (p = 0.0774). The extent of non-flow area (p = 0.0003) and FAZ (p = 0.0008) were significantly larger in both AMD groups compared to the control group. There was a significant difference in CRT between those treated for one year and control eyes (p = 0.0036). CONCLUSIONS In our study, we demonstrated that macular vessel density was lower in the foveal area in the superficial retinal plexus in AMD patients after one year and long-term anti-VEGF treatment. These vascular density changes were absent in the parafoveal and whole areas of the deep retinal plexus. Our results indicate that long-term anti-VEGF treatment reduces the vascular density of the superficial retinal plexus to a greater extent compared to the deep retinal plexus.
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Affiliation(s)
- Miklós D. Resch
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Aniko Balogh
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary ,grid.417105.60000 0004 0621 6048Department of Ophthalmology Uzsoki Hospital, Budapest, Hungary
| | - Tilmann Kurth
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Zoltán Z. Nagy
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Delia Cabrera DeBuc
- grid.26790.3a0000 0004 1936 8606Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL USA
| | - András Papp
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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