1
|
Enjalbert A, Giocanti-Auregan A, Fajnkuchen F, Torres-Villaros H. LONGITUDINAL ANALYSIS OF MICROVASCULAR CHANGES IN SICKLE CELL DISEASE USING SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2024; 44:572-580. [PMID: 38029421 DOI: 10.1097/iae.0000000000004013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE To analyze the changes in macular vascular densities (VDs) and foveal avascular zone (FAZ) over a 6-year period using swept-source optical coherence tomography angiography in patients with sickle cell disease compared with unaffected control subjects. METHODS Thirty eyes of patients with sickle cell disease and 12 eyes of unaffected control subjects matched for age and ethnicity were examined at a 6-year interval using the same imaging protocol, including ultra-wide-field angiography, swept-source OCT, and 3 × 3-mm optical coherence tomography angiography. The macular VD and FAZ were measured on ImageJ software according to previously reported algorithms. RESULTS In sickle cell eyes, the mean FAZ significantly increased ( P < 0.01), and the VD decreased in the foveal (within a circle of 1.5 mm in diameter around the foveal center) and temporal areas in both the superficial and the deep capillary plexuses ( P < 0.01). The VD did not change over time in the parafoveal area (annulus between two circles of 1.5 and 3 mm in diameter) and in the superior, inferior, and nasal sectors. No worsening of peripheral retinopathy was observed in the cohort during the follow-up, except for one eye that developed sea-fan. In the control eyes, no microvascular change was observed over time in FAZ size and VD. CONCLUSION These longitudinal optical coherence tomography angiography findings in patients with sickle cell disease showed an enlargement of the FAZ and a decrease in VD in the temporal and perifoveal regions despite the absence of progression of peripheral retinopathy, suggesting a worsening of the macular nonperfusion over time in sickle cell disease.
Collapse
Affiliation(s)
- Aurélie Enjalbert
- Department of Ophthalmology, Avicenne Hospital, APHP and University Paris 13, Bobigny, France; and
| | - Audrey Giocanti-Auregan
- Department of Ophthalmology, Avicenne Hospital, APHP and University Paris 13, Bobigny, France; and
| | - Franck Fajnkuchen
- Department of Ophthalmology, Avicenne Hospital, APHP and University Paris 13, Bobigny, France; and
- Ophthalmology Center for Imaging and Laser, Paris, France
| | - Héloïse Torres-Villaros
- Department of Ophthalmology, Avicenne Hospital, APHP and University Paris 13, Bobigny, France; and
| |
Collapse
|
2
|
Orssaud C, Flammarion E, Michon A, Ranque B, Arlet JB. ATYPICAL FOVEAL AND PARAFOVEAL ABNORMALITIES IN SICKLE CELL DISEASE. Retina 2024; 44:506-514. [PMID: 37948742 DOI: 10.1097/iae.0000000000003987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE The primary aim was to describe the patterns of paramacular involvement, not yet reported but that optical coherence tomography angiography can now detect in patients with sickle cell disease. The secondary aim was to search arguments concerning the physiopathogeny of paramacular involvement. METHODS This institutional cohort retrospective study was conducted in a Referral Center for Ophthalmological Rare Diseases. Follow-up included an ophthalmologic examination with optical coherent tomography and optical coherent tomography angiography. RESULTS One hundred and thirty-two patients with SCD were included. Typical sickle cell maculopathy was observed in temporal area in 84 eyes (40.0%) of SS patients and eight eyes (14.8%) of SC patients ( P < 0.001). Enlargement of the foveal avascular zone was observed in 10 eyes of eight SS patients. Two atypical parafoveal abnormalities were found in SS patients only. The first one consisted of macular thinning with normal vascularization in 15 eyes of 11 patients. The second atypical maculopathy was large areas of loss of vascularization without retinal thinning 10 eyes of six patients. Multivariate analysis did not show a statistically significant relation between the peripheral sickle retinopathy stage and the different type of sickle cell maculopathy ( P = 0.21). CONCLUSION Those atypical sickle cell maculopathy may correspond to early forms preceding a typical sickle cell disease maculopathy (SCDM). This would point toward several physiopathogenic mechanisms. The first one included the existence of ischemia that can be related to anemia. Presence of retinal thinning without vascular involvement point out to a neurogenic mechanism.
Collapse
Affiliation(s)
- Christophe Orssaud
- Functional Unity of Ophthalmology, ERN Eye, Ophthalmological Rare Diseases Center, Georges Pompidou European Hospital, Paris, France
| | - Edouard Flammarion
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, Paris, France; and
| | - Adrien Michon
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, Paris, France; and
| | - Brigitte Ranque
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, Paris, France; and
- Faculté de Médecine Paris Descartes, Université de Paris, Paris, France
| | - Jean-Benoit Arlet
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, Paris, France; and
- Faculté de Médecine Paris Descartes, Université de Paris, Paris, France
| |
Collapse
|
3
|
Hoyek S, Lemire C, Halawa O, Altamirano-Lamarque F, Gonzalez E, Patel NA. Longitudinal Assessment of Macular Thickness and Microvascular Changes in Children with Sickle Cell Disease. Ophthalmol Retina 2024; 8:184-194. [PMID: 37696394 DOI: 10.1016/j.oret.2023.09.005] [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: 04/06/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To longitudinally assess macular thickness and microvascular changes in children with sickle cell disease (SCD). DESIGN A retrospective consecutive series. SUBJECTS Children with SCD aged ≤ 18 years who had an ophthalmic examination at Boston Children's Hospital between January 1998 and August 2022. METHODS Qualitative and quantitative analyses of both OCT and OCT angiography (OCTA) images were performed. MAIN OUTCOME MEASURES Total retinal thickness measured on macular OCT, superficial capillary plexus and deep capillary plexus (DCP) vessel density (VD), and foveal avascular zone (FAZ) area measured on 6- × 6-mm OCTA scans. RESULTS International Classification of Diseases, 10th Revision, code search identified 303 pediatric SCD patients who underwent ophthalmic examination during the study period. OCT and OCTA images were acquired on 104 (17.2%) and 60 (9.9%) eyes at presentation and on 159 (26.2%) and 100 (16.5%) eyes at final visit, respectively. Overall, temporal retinal thinning was noted qualitatively in 35.6% of SCD patients at presentation and 39.6% at final visit. Of those patients with macular thinning, 94.6% and 90.5% had peripheral sickle cell retinopathy (SCR) at presentation and final visit. On quantitative OCT analysis, HbSS eyes had a lower retinal thickness in the fovea and temporal parafovea compared with HbSC (P < 0.05). Eyes with peripheral SCR had a larger FAZ at presentation compared with eyes without peripheral SCR (P = 0.004), a lower DCP VD at final visit in the inferior temporal macula (P = 0.03), and a higher DCP VD at final visit in the superior nasal macula (P = 0.01). Eighty eyes of 40 patients had OCT, and 34 eyes of 20 patients had both OCT and OCTA images acquired at both initial and final visits. At final visit, retinal thickness decreased at the fovea, inferior perifovea, and temporal perifovea compared with presentation (P < 0.05). In parallel, VD DCP in the superonasal quadrant increased at final visit (P = 0.03). CONCLUSIONS Macular retinal thinning was progressive and observed in eyes with and without peripheral SCR. Over time, there was a compensatory increase in DCP VD in the nasal macula on OCTA. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Sandra Hoyek
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Colin Lemire
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Omar Halawa
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Efren Gonzalez
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nimesh A Patel
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
4
|
Bistour A, Mehanna CJ, Chuttarsing B, Colantuono D, Amoroso F, Beaumont W, Matri KE, Souied EH, Miere A. Widefield oct-angiography-based classification of sickle cell retinopathy. Graefes Arch Clin Exp Ophthalmol 2023; 261:2805-2812. [PMID: 37219613 DOI: 10.1007/s00417-023-06115-z] [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: 01/27/2023] [Revised: 04/24/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023] Open
Abstract
PURPOSE To assess the capillary non-perfusion in different concentric sectors on widefield optical coherence tomography angiography (WF-OCTA) and to correlate the ratio of non-perfusion (RNP) to the severity of sickle cell retinopathy (SCR). METHODS This retrospective, cross-sectional study included eyes of patients with various sickle cell disease (SCD) genotypes having undergone WF-OCTA and ultra-widefield color fundus photography (UWF-CFP). Eyes were grouped as no SCR, non-proliferative SCR or proliferative SCR. RNP was assessed on WF-OCTA montage in different field-of-view (FOV) sectors centered on the fovea: 0-10-degrees circle excluding the foveal avascular zone, the 10-30-degrees circle excluding the optic nerve, the 30-60-degrees circle, and the full 60-degrees circle. RESULTS Forty-two eyes of twenty-eight patients were included. Within each SCR group, mean RNP of the FOV 30-60 sector was higher than all other sectors (p < 0.05). Mean RNP of all sectors were significatively different between no SCR group and proliferative SCR group (p < 0.05). To distinguish no SCR versus non-proliferative SCR FOV 30-60 had a good sensitivity and specificity of 41.67% and 93.33%, respectively (cutoff RNP > 22.72%, AUC = 0.75, 95% CI 0.56-0.94, p = 0.028). To differentiate non-proliferative versus proliferative SCR, FOV 0-10 had good sensitivity and specificity of 33.33% and 91.67%, respectively (cutoff RNP > 18.09, AUC = 0.73, 95% CI 0.53 to 0.93, p = 0.041). To discern no SCR versus proliferative SCR, all sectors had optimal sensitivity and specificity (p < 0.05). CONCLUSION WF OCTA-based RNP provides non-invasive diagnostic information regarding the presence and severity of SCR, and correlates with disease stage in certain FOV sectors.
Collapse
Affiliation(s)
- Anna Bistour
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université de Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France
- Faculty of Medicine, Sorbonne University, Paris, France
| | - Carl-Joe Mehanna
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université de Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France
| | | | - Donato Colantuono
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université de Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France
| | - Francesca Amoroso
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université de Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France
| | - William Beaumont
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université de Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France
| | - Khaled El Matri
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université de Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France
- Department B, Institut Hédi Rais D'ophtalmologie de Tunis, 1007, Tunis, Tunisia
| | - Eric H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université de Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université de Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France.
| |
Collapse
|
5
|
Orssaud C, Flamarion E, Michon A, Ranque B, Arlet JB. Relationship between paramacular thinning, cerebral vasculopathy, and hematological risk factors in sickle cell disease. Front Med (Lausanne) 2023; 10:1226210. [PMID: 37700770 PMCID: PMC10493280 DOI: 10.3389/fmed.2023.1226210] [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: 05/20/2023] [Accepted: 07/27/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose To identify risk factors for sickle cell maculopathy due to hematological parameters (especially anemia and hemolysis) or cerebral vasculopathy. Methods This retrospective study was conducted at a Referral Center. The follow-up included optical coherent tomography/optical coherent tomography angiography, neuro-radiological imaging, and a hematological assessment (hemoglobin, hemoglobin S level, reticulocytes, mean corpuscular volume, bilirubin, and lactate dehydrogenase). Results Hundred and thirty-two sickle cell patients were included. Maculopathy was observed in 127 eyes of SS patients and 10 eyes of SC patients (p < 0.001), unrelated to peripheral retinopathy. Cerebral vasculopathy was more frequent in SS patients (p < 0.001) and was also associated with the presence of maculopathy (p = 0.049), and it was related to peripheral retinopathy (p < 0.001). All biological parameters significantly differed according to the genotype (p < 0.001) but not according to the presence of cerebral vasculopathy or maculopathy. In the multivariate analysis, reticulocytes and bilirubin were associated with the presence of cerebral vasculopathy and maculopathy. Conclusion The data obtained were consistent with the role of anemia or hemolysis markers in cerebral vasculopathy and macular involvement. As a trend of hemolysis appears to be a risk factor for these complications, this validates the use of preventive plasmapheresis in these patients.
Collapse
Affiliation(s)
- Christophe Orssaud
- Functional Unity of Ophthalmology, ERN EYE, Ophthalmological Rare Diseases Center, Georges Pompidou European Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Edouard Flamarion
- Internal Medicine Department, French National Sickle Cell Referral Center, European Hospital Georges Pompidou, Paris, France
| | - Adrien Michon
- Internal Medicine Department, French National Sickle Cell Referral Center, European Hospital Georges Pompidou, Paris, France
| | - Brigitte Ranque
- Internal Medicine Department, French National Sickle Cell Referral Center, European Hospital Georges Pompidou, Paris, France
- Faculty of Medicine Université Paris Cité, Paris, France
| | - Jean Benoit Arlet
- Internal Medicine Department, French National Sickle Cell Referral Center, European Hospital Georges Pompidou, Paris, France
- Université Paris Cité, INSERM UMR-S970, Paris, France
- Laboratoire d'Excellence sur le globule rouge GR-ex, Paris, France
- INSERM U, CNRS 8254, Institut IMAGINE, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
| |
Collapse
|
6
|
Batıoğlu F, Yanık Ö, Demirel S, Özmert E. Clinical Use of Optical Coherence Tomography Angiography in Retinal Diseases. Diagnostics (Basel) 2023; 13:diagnostics13101820. [PMID: 37238303 DOI: 10.3390/diagnostics13101820] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
The advent of optical coherence tomography angiography (OCTA) is one of the cornerstones of fundus imaging. Essentially, its mechanism depends on the visualization of blood vessels by using the flow of erythrocytes as an intrinsic contrast agent. Although it has only recently come into clinical use, OCTA has become a non-invasive diagnostic tool for the diagnosis and follow-up of many retinal diseases, and the integration of OCTA in multimodal imaging has provided a better understanding of many retinal disorders. Here, we provide a detailed overview of the current applications of OCTA technology in the diagnosis and follow-up of various retinal disorders.
Collapse
Affiliation(s)
- Figen Batıoğlu
- Department of Ophthalmology, Ankara University School of Medicine, 06620 Ankara, Turkey
| | - Özge Yanık
- Department of Ophthalmology, Ankara University School of Medicine, 06620 Ankara, Turkey
| | - Sibel Demirel
- Department of Ophthalmology, Ankara University School of Medicine, 06620 Ankara, Turkey
| | - Emin Özmert
- Department of Ophthalmology, Ankara University School of Medicine, 06620 Ankara, Turkey
| |
Collapse
|
7
|
Martin GC, Brousse V, Connes P, Grevent D, Kossorotoff M, Da Costa L, Bourdeau H, Charlot K, Boutonnat-Faucher B, Allali S, De Montalembert M, Bremond-Gignac D, Vidal PP, Robert MP. Retinal atrophy and markers of systemic and cerebrovascular severity in homozygous sickle cell disease. Eur J Ophthalmol 2022; 32:3258-3266. [DOI: 10.1177/11206721221090794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction While paramacular retinal atrophy (PRA) is known to be found in 48% of eyes of adults and 42% of eyes of children with homozygous SCD (SS-SCD), the aim of this study is to assess the association between PRA and red blood cell (RBC) deformability, hematological markers and brain imaging abnormalities in SS-SCD. Methods This study is a subset of DREAM2, a prospective observational study performed between August 2015 and August 2016. Children (5–17 years) with SS-SCD and no history of large vessel vasculopathy, were included. Ophthalmological characteristics including visual acuity, fundus examination, OCT of central and temporal retina (with several retinal thickness measurements) were explored in relation with RBC deformability (ektacytometry), hematological and biochemical (hemolysis parameters), and neurological (cerebral oxygenation estimated by Near Infrared Spectroscopy, brain magnetic resonance imaging) investigations. Results 17 children (5 boys; mean age: 13 years) with complete ophthalmological investigations were included in the analysis; 8 exhibited PRA. RBC deformability was found to be significantly lower in children with PRA for measurements made at 1.69 Pa (0.16 a.u ± 0.02 vs 0.21 a.u ± 0.03, p = 0.02) and above, as well as cerebral oxygenation (59.25% ± 9.9 vs 71.53% ± 4.9, p = 0.02). A significant positive correlation was found between temporal retinal thickness and hemoglobin level (ρ = 0.65, p = 0.007), hematocrit (ρ = 0.53, p = 0.04) and RBC deformability at 3 Pa (ρ = 0.75, p = 0.005) and above. Conclusions These results suggest that PRA could be an early marker of systemic severity and cerebral oxygenation in SCD. Whether it could help predicting cerebral vasculopathy requires further investigations.
Collapse
Affiliation(s)
- Gilles C. Martin
- Ophthalmology Department and Rare Ophthalmological Diseases Reference Centre (OPHTARA), Necker-Enfants Malades University Hospital, APHP, Paris, France
- Borelli Centre, CNRS-SSA-ENS Paris Saclay-Paris University, Paris, France
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| | - Valentine Brousse
- General Pediatrics Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
- Institut National de la transfusion sanguine, UMR_S1134, Inserm, Paris, France
- LABEX GR-Ex, France
| | - Philippe Connes
- Faculté de Médecine Rockefeller, Laboratoire inter-universitaire de Biologie de la Motricité (LIBM EA7424), Equipe « Biologie Vasculaire et du Globule Rouge », Université Claude Bernard Lyon 1, Lyon, France
| | - David Grevent
- Radiology Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Manoelle Kossorotoff
- Pediatric Neurology Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Lydie Da Costa
- Institut National de la transfusion sanguine, UMR_S1134, Inserm, Paris, France
- LABEX GR-Ex, France
- AP-HP, Hôpital Robert Debré, service d’Hématologie Biologique, Paris, France
| | - Hélène Bourdeau
- Pediatric Neurology Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Keyne Charlot
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels Institut de Recherche Biomédicale des Armées, France
| | | | - Slimane Allali
- General Pediatrics Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
- LABEX GR-Ex, France
| | - Mariane De Montalembert
- General Pediatrics Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
- LABEX GR-Ex, France
| | - Dominique Bremond-Gignac
- Ophthalmology Department and Rare Ophthalmological Diseases Reference Centre (OPHTARA), Necker-Enfants Malades University Hospital, APHP, Paris, France
- INSERM UMRS 1138, Team 17, Centre de Recherche des Cordeliers, Sorbonne Paris University, France
| | - Pierre-Paul Vidal
- Borelli Centre, CNRS-SSA-ENS Paris Saclay-Paris University, Paris, France
| | - Matthieu P. Robert
- Ophthalmology Department and Rare Ophthalmological Diseases Reference Centre (OPHTARA), Necker-Enfants Malades University Hospital, APHP, Paris, France
- Borelli Centre, CNRS-SSA-ENS Paris Saclay-Paris University, Paris, France
| |
Collapse
|
8
|
Thangamathesvaran L, Ong SS, Wang J, Lance E, Tekes A, Scott AW. EVALUATION OF MACULAR FLOW VOIDS ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AS POTENTIAL BIOMARKERS FOR SILENT CEREBRAL INFARCTION IN SICKLE CELL DISEASE. Retina 2022; 42:340-347. [PMID: 34608107 DOI: 10.1097/iae.0000000000003309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the relationship between macular microvascular abnormalities on optical coherence tomography angiography and silent cerebral infarctions (SCIs) on cerebral magnetic resonance imaging in sickle cell disease. METHODS Patients (age <18 years old) from our previous pediatric sickle cell disease study cohort who had prior optical coherence tomography angiography and brain magnetic resonance imaging were identified. Brain magnetic resonance imaging images were compared with macular optical coherence tomography angiography scans to identify macular vascular density differences between patients with SCI and without SCI. RESULTS Sixty-eight eyes from 34 patients who underwent optical coherence tomography angiography were evaluated, of whom 28 eyes from 14 patients met the inclusion criteria for this study. Eight patients (57%) with SCI and 6 patients (43%) without SCI were identified. The mean age (17 years in SCI and 16.3 years in non-SCI) was comparable between groups. There was no statistically significant difference in systemic complications. Deep capillary plexus vessel density was lower in the temporal quadrant in patients with SCI (49.3% vs. 53.7%, P = 0.014). CONCLUSION Patients with SCI were found to have lower vessel density in the deep capillary plexus compared with those without SCI. This finding suggests that deep capillary plexus vessel density may have utility as an imaging biomarker to predict the presence of SCI.
Collapse
Affiliation(s)
- Loka Thangamathesvaran
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sally S Ong
- Department of Ophthalmology and Visual Science, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Jiangxia Wang
- Department of Biostatistics, Wilmer Biostats Center, Johns Hopkins University, Baltimore, Maryland
| | - Eboni Lance
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Aylin Tekes
- Department of Pediatric Radiology and Pediatric Neuroradiology, Russell Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adrienne W Scott
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
9
|
Abdelkader A, Shaaban M, Zahran MM, Mohammed MF, Ebrahim AM, Galhoom AI. The Impact of Optical Coherence Tomography in the Early Identification of Children with Sickle Cell Retinopathy. Int J Clin Pract 2022; 2022:9131423. [PMID: 36105789 PMCID: PMC9444431 DOI: 10.1155/2022/9131423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/15/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Sickle cell disease is characterized by the production of abnormal hemoglobin, which affects hemoglobin molecule stability during hypoxia and leads to the formation of sickle cells, resulting in increased hematic viscosity, hemolysis, and microvascular blockage. Vasoocclusion is assumed to be the primary cause of vision-threatening retinopathy in sickle cell disease. The aim of this study was to improve the early detection of sickle cell retinopathy (SCR) in children with sickle cell disease (SCD) and investigate the link between systemic and ocular symptoms. METHODS This cross-sectional study comprised children with SCD. The patient files provided a detailed medical history. The laboratory tests included a blood count, reticulocyte count, and Hb electrophoresis. The slit lamp, fundus, optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) were all part of the ophthalmological examination. RESULTS The study comprised 15 children with sickle cell disease who met the inclusion and exclusion criteria, with a mean age of 11.15 ± 1.29 years. Nine of the children were males (60%) and six were females (40%). 8 (53.3%) of the children had Hb SS, three (20%) had Hb SC, three (20%) had Hb SB+, and one (6.7%) had Hb SB0. Four children (26.7%) had poor visual acuity. A fundus examination revealed significant abnormal findings in 12 of the 7 children's eyes (40 percent). Macular thinning was detected by OCT in 10 eyes of 7 children (33.3%). Flow voids at the deep retinal capillary plexus were detected by OCTA in 10 eyes of 7 children (33.3%). Longer disease duration, higher reticulocytic percent, more painful crises, and noncompliance with hydroxyurea medication were all linked to the existence of eye abnormalities on fundus examination and OCT. CONCLUSION OCTA can show early retinal damage in sickle cell patients with macular changes. Sickle cell retinopathy is usually associated with more severe disease.
Collapse
Affiliation(s)
- Ashraf Abdelkader
- Department of Pediatrics, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- Scientific Research and Continuous Medical Education Unit, Al Ansari Specialist Hospital, Yanbu, Saudi Arabia
| | - Mohamed Shaaban
- Department of Pediatrics, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
| | - Mahmoud M. Zahran
- Department of Pediatrics, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
| | - Mostafa F. Mohammed
- Department of Ophthalmology, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
| | - Anas M. Ebrahim
- Department of Ophthalmology, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
| | - Ahmed I. Galhoom
- Department of Ophthalmology, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
| |
Collapse
|
10
|
Seafans to Sunbursts: From History to the Horizon in Sickle Cell Retinopathy: Reflections on 50 Years Since Goldberg Staging. Retina 2021; 41:1361-1363. [PMID: 33990117 DOI: 10.1097/iae.0000000000003206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Lim JI, Niec M, Sun J, Cao D. Longitudinal Assessment of Retinal Thinning in Adults With and Without Sickle Cell Retinopathy Using Spectral-Domain Optical Coherence Tomography. JAMA Ophthalmol 2021; 139:330-337. [PMID: 33538815 DOI: 10.1001/jamaophthalmol.2020.6525] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance Determination of retinal thinning rates may help to identify patients who are at risk of progression of sickle cell retinopathy. Objective To assess the rates of macular thinning in adults with and without sickle cell retinopathy using spectral-domain optical coherence tomography (OCT) and to identify ocular and systemic risk factors associated with retinal thinning. Design, Setting, and Participants This longitudinal prospective case-control study enrolled adult participants from a university-based retina subspecialty clinic between February 11, 2009, and July 3, 2019. The study was designed in autumn 2008 and conducted from February 2, 2009, to July 3, 2020. Participants with sickle cell retinopathy (sickle cell group) were matched by age and race with participants without sickle cell retinopathy (control group). Participants received annual spectral-domain OCT and clinical examinations. Those with at least 1 year of follow-up by July 3, 2020, were included in the analysis. Data were analyzed from February 2, 2009, to July 3, 2020. Main Outcomes and Measures The primary outcome was comparison of spectral-domain OCT measurements from early-treatment diabetic retinopathy study subfield rates of retinal thinning between eyes with and without sickle cell retinopathy and between different sickle cell hemoglobin subtypes. The secondary outcome was identification of ocular and systemic risk factors associated with rates of retinal thinning. Results Among 370 adults (711 eyes) enrolled in the study, 310 participants (606 eyes) had sickle cell retinopathy, and 60 participants (105 eyes) did not. Of those, 175 of 310 participants (56.5%; 344 of 606 eyes [56.8%]; mean [SD] age, 37.8 [12.8] years; 126 women [72.0%]) in the sickle cell group and 31 of 60 participants (51.7%; 46 of 105 eyes [43.8%]; mean [SD] age, 59 [15.4] years; 22 women [71.0%]) in the control group had at least 1 year of clinical and spectral-domain OCT follow-up data from baseline. The mean (SD) follow-up was 53.7 (32.6) months for the sickle cell group and 54.6 (34.9) months for the control group. Rates of macular thinning in the sickle cell group were significantly higher than those in the control group for the inner nasal (difference, -1.18 μm per year; 95% CI, -1.71 to -0.65 μm per year), inner superior (difference, -1.03 μm per year; 95% CI, -1.78 to -0.29 μm per year), inner temporal (difference, -0.61 μm per year; 95% CI, -1.16 to -0.07 μm per year), and outer nasal (difference, -0.41 μm per year; 95% CI, -0.80 to -0.03 μm per year) quadrants. Patients with sickle cell hemoglobin SC and sickle cell hemoglobin β-thalassemia subtypes had higher rates of retinal thinning than those with the sickle cell hemoglobin SS subtype. Risk factors associated with greater rates of retinal thinning included participant age, stage of retinopathy, previous stroke, and presence of hypertension, acute chest syndrome, or diabetes. Hydroxyurea therapy was associated with decreased rates of retinal thinning and may be a protective factor. Conclusions and Relevance In this study, rates of retinal thinning were higher among participants with sickle cell retinopathy compared with those without sickle cell retinopathy, and thinning rates increased with participant age and stage of retinopathy. These findings suggest that identifying anatomic worsening of sickle cell maculopathy through spectral-domain OCT may be a useful parameter to evaluate the progression of sickle cell retinopathy.
Collapse
Affiliation(s)
- Jennifer I Lim
- Department of Ophthalmology, University of Illinois at Chicago, Chicago.,Associate Deputy Editor, JAMA Ophthalmology
| | - Marcia Niec
- Department of Ophthalmology, University of Illinois at Chicago, Chicago
| | - Jie Sun
- Department of Ophthalmology, University of Illinois at Chicago, Chicago
| | - Dingcai Cao
- Department of Ophthalmology, University of Illinois at Chicago, Chicago
| |
Collapse
|
12
|
Zhou DB, Castanos MV, Pinhas A, Gillette P, Migacz JV, Rosen RB, Glassberg J, Chui TYP. Quantification of intermittent retinal capillary perfusion in sickle cell disease. BIOMEDICAL OPTICS EXPRESS 2021; 12:2825-2840. [PMID: 34123506 PMCID: PMC8176806 DOI: 10.1364/boe.418874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 05/22/2023]
Abstract
Pathophysiology of sickle cell disease (SCD) features intermittent vaso-occlusion of microcirculatory networks that facilitate ischemic damage. Past research has, however, relied on static images to characterize this active disease state. This study develops imaging metrics to more fully capture dynamic vascular changes, quantifying intermittent retinal capillary perfusion in unaffected controls and SCD patients using sequential optical coherence tomography angiography (OCT-A) scans. The results reveal significant dynamic variation of capillary perfusion in SCD patients compared to controls. This measurement of vaso-occlusive burden in patients would provide utility in monitoring of the disease state and in evaluating treatment efficacy.
Collapse
Affiliation(s)
- Davis B. Zhou
- Ophthalmology, New York Eye
and Ear Infirmary of Mount Sinai, 310 East 14th St.,
Suite 500, S. Bldg., New York, NY 10003, USA
- Ophthalmology, Icahn School of
Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York,
NY 10029, USA
| | - Maria V. Castanos
- Ophthalmology, New York Eye
and Ear Infirmary of Mount Sinai, 310 East 14th St.,
Suite 500, S. Bldg., New York, NY 10003, USA
| | - Alexander Pinhas
- Ophthalmology, New York Eye
and Ear Infirmary of Mount Sinai, 310 East 14th St.,
Suite 500, S. Bldg., New York, NY 10003, USA
| | - Peter Gillette
- Internal Medicine, SUNY
Downstate Medical Center, 450 Clarkson Avenue Brooklyn,
NY 11203, USA
| | - Justin V. Migacz
- Ophthalmology, New York Eye
and Ear Infirmary of Mount Sinai, 310 East 14th St.,
Suite 500, S. Bldg., New York, NY 10003, USA
| | - Richard B. Rosen
- Ophthalmology, New York Eye
and Ear Infirmary of Mount Sinai, 310 East 14th St.,
Suite 500, S. Bldg., New York, NY 10003, USA
- Ophthalmology, Icahn School of
Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York,
NY 10029, USA
| | - Jeffrey Glassberg
- Emergency Medicine, Icahn
School of Medicine at Mount Sinai, 3 East 101st Street,
Box 1620, New York, NY 10029, USA
| | - Toco Y. P. Chui
- Ophthalmology, New York Eye
and Ear Infirmary of Mount Sinai, 310 East 14th St.,
Suite 500, S. Bldg., New York, NY 10003, USA
- Ophthalmology, Icahn School of
Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York,
NY 10029, USA
| |
Collapse
|
13
|
Fares S, Hajjar S, Romana M, Connes P, Acomat M, Zorobabel C, Zuber K, Boulanger-Scemama E, Etienne-Julan M, David T, Beral L. Sickle Cell Maculopathy: Microstructural Analysis Using OCTA and Identification of Genetic, Systemic, and Biological Risk Factors. Am J Ophthalmol 2021; 224:7-17. [PMID: 33412123 DOI: 10.1016/j.ajo.2020.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE To identify genetic, systemic, and biological factors associated with the occurrence of sickle cell maculopathy (SCM). To evaluate microvascular macular alterations using optical coherence tomography angiography (OCTA) in sickle cell disease (SCD). DESIGN Cross-sectional study. METHODS One hundred fifty-one eyes of 78 adult SCD patients (43 HbSS, 30 HbSC, 4 S/β+, and 1 HbS Lepore) and 40 eyes of 20 healthy controls underwent spectral-domain optical coherence tomography (SDOCT) and OCTA using Spectralis HRA+OCT (Heidelberg Engineering, Heidelberg, Germany). We analyzed the occurrence of SCM, the foveal avascular zone (FAZ) area, and the severity of macular ischemia and studied their relationships with genetic, systemic, and biological parameters using multivariate logistic regression analysis. RESULTS Maculopathy occurred in 66 eyes (44%), and more frequently in HbSS patients (71%, P = .004). Multivariate analysis identified HbSS genotype and lower prothrombin ratio (PR) as independently associated with SCM (P = .01). Proliferative sickle cell retinopathy was also associated with SCM (P = .02). FAZ enlargement was associated with higher lactate dehydrogenase level (P = .02). Macular ischemia was more severe in patients with lower hemoglobin level (P = .004) and lower PR (P = .01). No flow areas were identified with OCTA even in eyes with no macular thinning (36 eyes, 42%) and appeared more frequently in the temporal superior subfield (36%). CONCLUSIONS HbSS genotype, abnormal coagulation and hemolysis increase the risk of SCM. OCTA provides valuable criteria to identify potential risk factors of SCM. OCTA also improves detection of early microvascular changes before the onset of macular thinning.
Collapse
Affiliation(s)
- Selim Fares
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France.
| | - Sophie Hajjar
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France
| | - Marc Romana
- Université de Paris, UMR_S1134, BIGR, INSERM, Paris, France; Université des Antilles, UMR_S1134, BIGR, Pointe-à-Pitre, Guadeloupe, France; Laboratoire d'Excellence GR-Ex, Paris, France
| | - Philippe Connes
- Laboratoire d'Excellence GR-Ex, Paris, France; Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard Lyon 1, Université de Lyon, France
| | - Malik Acomat
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France
| | - Coralie Zorobabel
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France
| | - Kevin Zuber
- Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | | | - Maryse Etienne-Julan
- Unité Transversale de la Drépanocytose, CHU de Pointe-à- Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France
| | - Thierry David
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France; Université des Antilles, Guadeloupe (FWI), France
| | - Laurence Beral
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France; Université de Paris, UMR_S1134, BIGR, INSERM, Paris, France; Université des Antilles, UMR_S1134, BIGR, Pointe-à-Pitre, Guadeloupe, France; Université des Antilles, Guadeloupe (FWI), France
| |
Collapse
|
14
|
Marques JH, Coelho J, Malheiro J, Pessoa B, Beirão JM. Subclinical retinal angiopathy associated with hereditary transthyretin amyloidosis - assessed with optical coherence tomography angiography. Amyloid 2021; 28:66-71. [PMID: 32996337 DOI: 10.1080/13506129.2020.1827381] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Retinal angiopathy is a known ocular manifestation of hereditary transthyretin amyloidosis (ATTRv). Optical coherence tomography angiography (OCT-A) is a recent noninvasive imaging technique, used in other retinal vascular diseases. Our purpose was to analyse subclinical changes in retinal vessels, with OCT-A, in patients with ATTRv amyloidosis. METHODS Observational cross-sectional study in Centro Hospitalar e Universitário do Porto in the cohort of patients with genetic diagnosis of ATTRv. Patients were included if they had just one eye with scalloped iris (the other eye without scalloped iris), postulating eyes were at different stages, in the same patient. Patients were excluded if they had other manifestations of ocular ATTRv amyloidosis, namely clinical retinal angiopathy and/or vitreous opacities. The group of eyes with scalloped iris were compared with eyes without scalloped iris, using paired tests. Values are shown as Δ = mean difference between groups; p = p-value, d = Cohen's d for effect size measurement. RESULTS Twenty-four patients (24 eyes in each group) were included. Mean age was 46.5 ± 5.0 years. Eyes with scalloped iris showed attenuated retinal vascular network: larger foveal avascular zone (FAZ) area (Δ = +0.02 mm2, p = 0.002, d = 0.70); decreased foveal vascular density (Δ = -3.57%, p = 0.001, d = -0.75); superficial (Δ = -1.50%, p = 0.049, d = -0.43) and deep (Δ = -2.53%, p = 0.023, d = -0.50) plexus vascular density. Acircularity index was superior in scalloped iris eyes (Δ = 0.04, p = 0.004, d = -0.65), representing an abnormal FAZ morphology. CONCLUSION Scalloped iris in ATTRv eyes are associated with a more advanced subclinical retinal angiopathy, than eyes without scalloped iris. Our results identify for the first time and in vivo, early changes in retinal vessels in ATTRv amyloidosis. Henceforward, OCT-A may play a role in the evaluation of ATTRv patients oculopathy and the effectiveness of future eye targeting treatments.
Collapse
Affiliation(s)
- João Heitor Marques
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - João Coelho
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Jorge Malheiro
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Bernardete Pessoa
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - João Melo Beirão
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| |
Collapse
|
15
|
Bachmeier I, Blecha C, Föll J, Wolff D, Jägle H. [Maculopathy in sickle cell disease]. Ophthalmologe 2021; 118:1013-1023. [PMID: 33502544 PMCID: PMC8492597 DOI: 10.1007/s00347-020-01319-8] [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: 09/25/2020] [Revised: 12/17/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Abstract
Hintergrund Die Sichelzellerkrankung (SZE) ist eine hereditäre Hämoglobinopathie, die durch rezidivierende vasookklusive Episoden zur Mikrozirkulationsstörung verschiedener Organsysteme mit teils letalem Ausgang führt. Bei der okulären Manifestation der SZE ist am bekanntesten die periphere Sichelzellretinopathie (SZR). Unabhängig davon kann es bereits früh im Krankheitsverlauf zur Sichelzellmakulopathie (SZM) kommen. Methoden Review der internationalen und deutschsprachigen Literatur zur okulären Beteiligung bei SZE mit Fokus auf die SZR und SZM sowie Überblick über aktuelle systemische Therapieansätze bei SZE anlässlich der Vorstellung zweier Patienten mit HbSS-SZE. Ergebnis und Schlussfolgerung Im Gegensatz zur SZR ist die SZM mit temporaler Verdünnung der inneren Netzhautschichten erst in den letzten 5 Jahren mit der Einführung von SD-OCT und OCTA vermehrt in die Literatur eingegangen. Unabhängig vom Vorliegen einer SZR kann es immerhin bei etwa der Hälfte der Patienten bereits früh im Krankheitsverlauf zu einer SZM kommen. Das Krankheitsbild wird auch in Deutschland durch den Fortschritt der systemischen Therapiemöglichkeiten und aufgrund von Migration präsenter werden. Durch Wissen um diese Komplikation der SZE kann eine frühzeitige Diagnosestellung erfolgen und unnötige Diagnostik vermieden werden.
Collapse
Affiliation(s)
- Isabel Bachmeier
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - Christiane Blecha
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Jürgen Föll
- Abteilung für Pädiatrische Hämatologie, Onkologie und Stammzelltransplantation, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Daniel Wolff
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Herbert Jägle
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| |
Collapse
|
16
|
Ong SS, Ahmed I, Scott AW. Association of Acute Macular Neuroretinopathy or Paracentral Acute Middle Maculopathy with Sickle Cell Disease. ACTA ACUST UNITED AC 2021; 5:1146-1155. [DOI: 10.1016/j.oret.2021.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/31/2020] [Accepted: 01/11/2021] [Indexed: 12/11/2022]
|
17
|
Hormel TT, Jia Y, Jian Y, Hwang TS, Bailey ST, Pennesi ME, Wilson DJ, Morrison JC, Huang D. Plexus-specific retinal vascular anatomy and pathologies as seen by projection-resolved optical coherence tomographic angiography. Prog Retin Eye Res 2021; 80:100878. [PMID: 32712135 PMCID: PMC7855241 DOI: 10.1016/j.preteyeres.2020.100878] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 12/22/2022]
Abstract
Optical coherence tomographic angiography (OCTA) is a novel technology capable of imaging retinal vasculature three-dimensionally at capillary scale without the need to inject any extrinsic dye contrast. However, projection artifacts cause superficial retinal vascular patterns to be duplicated in deeper layers, thus interfering with the clean visualization of some retinal plexuses and vascular pathologies. Projection-resolved OCTA (PR-OCTA) uses post-processing algorithms to reduce projection artifacts. With PR-OCTA, it is now possible to resolve up to 4 distinct retinal vascular plexuses in the living human eye. The technology also allows us to detect and distinguish between various retinal and optic nerve diseases. For example, optic nerve diseases such as glaucoma primarily reduces the capillary density in the superficial vascular complex, which comprises the nerve fiber layer plexus and the ganglion cell layer plexus. Outer retinal diseases such as retinitis pigmentosa primarily reduce the capillary density in the deep vascular complex, which comprises the intermediate capillary plexus and the deep capillary plexus. Retinal vascular diseases such as diabetic retinopathy and vein occlusion affect all plexuses, but with different patterns of capillary loss and vascular malformations. PR-OCTA is also useful in distinguishing various types of choroidal neovascularization and monitoring their response to anti-angiogenic medications. In retinal angiomatous proliferation and macular telangiectasia type 2, PR-OCTA can trace the pathologic vascular extension into deeper layers as the disease progress through stages. Plexus-specific visualization and measurement of retinal vascular changes are improving our ability to diagnose, stage, monitor, and assess treatment response in a wide variety of optic nerve and retinal diseases. These applications will be further enhanced with the continuing improvement of the speed and resolution of the OCT platforms, as well as the development of software algorithms to reduce artifacts, improve image quality, and make quantitative measurements.
Collapse
Affiliation(s)
- Tristan T Hormel
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Yifan Jian
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Thomas S Hwang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Mark E Pennesi
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - David J Wilson
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - John C Morrison
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA.
| |
Collapse
|
18
|
Sahak H, Saqalain M, Lott PW, McKibbin M. Sickle Cell Maculopathy: Prevalence, Associations and Impact on Visual Acuity. Ophthalmologica 2020; 244:159-164. [PMID: 33120391 DOI: 10.1159/000512636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022]
Abstract
AIMS To investigate the prevalence of sickle cell maculopathy (SCM), and associations with age, sex, genotype, proliferative sickle cell retinopathy (PSR) stage, and the impact on visual acuity. METHODS Age, sex, and visual acuity were recorded and spectral domain OCT and ultra-wide-field images of the macula and retina were reviewed in a consecutive series of 74 adults with sickle cell disease. RESULTS The median age was 37 years (range 19-73 years) and 36 cases (48.6%) were male. SCM was present in at least 1 eye of 40 cases (54.1%) or in 67 of all eyes (42.3%). SCM prevalence was 54.8%, 62.5%, and 25% for the HbSS, HbSC, and HbS/BThal or other genotypes, respectively. SCM was observed in 41 (39.4%) of the eyes with PSR stages 0, 1, and 2, and in 21 (51.2%) of the eyes with PSR stages 3, 4, and 5, respectively. Mild visual impairment or worse was present in 3 eyes (4.8%) with SCM but this was secondary to other pathology. CONCLUSION SCM is a frequent finding in the eyes of adults with sickle cell disease. The prevalence is similar for the HbSS and HbSC genotypes and is not related to the PSR stage. High-contrast distance visual acuity is typically preserved.
Collapse
Affiliation(s)
- Haroen Sahak
- School of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Mohammed Saqalain
- School of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Pooi Wah Lott
- University Malaya Eye Research Centre, Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia
| | - Martin McKibbin
- School of Medicine and Health, University of Leeds, Leeds, United Kingdom, .,Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom,
| |
Collapse
|
19
|
Manara R, Dalla Torre A, Lucchetta M, Ermani M, Favaro A, Baracchini C, Favaretto S, Viaro F, Munaretto V, Sartori S, Ponticorvo S, Russo AG, Biffi A, Sainati L, Colombatti R. Visual cortex changes in children with sickle cell disease and normal visual acuity: a multimodal magnetic resonance imaging study. Br J Haematol 2020; 192:151-157. [PMID: 32789861 DOI: 10.1111/bjh.17042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/22/2020] [Indexed: 11/29/2022]
Abstract
The visual system is primarily affected in sickle cell disease (SCD), and eye examination is recommended starting in late childhood. So far, to our knowledge, all studies have focused on the retina, neglecting the changes that might be present in the cortical portion of the visual system. We performed a multimodal magnetic resonance imaging (MRI) evaluation of the visual cortex in 25 children with SCD (mean age: 12·3 ± 1·9 years) and 31 controls (mean age: 12·7 ± 1·6 years). At ophthalmologic examination, 3/25 SCD children had mild visual acuity deficits and 2/25 had mild tortuosity of the retinal vessels. None showed optic pathway infarcts at MRI or Transcranial Doppler abnormal blood velocities, and 6/25 disclosed posterior cerebral artery stenosis (five mild and one severe) at MR-angiography. Compared to controls, SCD children had increased posterior pericalcarine cortical thickness, with a different trajectory of cortical maturation and decreased connectivity within medial and ventral visual neural networks. Our findings suggest that SCD affects the development and the tuning of the visual cortex, leading to anatomical and functional changes in childhood even in the absence of retinopathy, and set the basis for future studies to determine if these changes can represent useful predictors of visual impairment in adulthood, biomarkers of disease progression or treatment response.
Collapse
Affiliation(s)
- Renzo Manara
- Neuroradiology, Department of Neurosciences, University of Padova, Padova, Italy
| | - Alice Dalla Torre
- Department of Neurosciences, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Marta Lucchetta
- Department of Neurosciences, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Mario Ermani
- Department of Neurosciences, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Angela Favaro
- Department of Neurosciences, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Claudio Baracchini
- Department of Neurosciences, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Silvia Favaretto
- Department of Neurosciences, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Federica Viaro
- Department of Neurosciences, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Vania Munaretto
- Department of Child and Woman's Health, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Stefano Sartori
- Neurology Unit, Department of Child and Woman's Health, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Sara Ponticorvo
- Department of Neuroradiology, University of Salerno, Salerno, Italy
| | - Andrea G Russo
- Department of Neuroradiology, University of Salerno, Salerno, Italy
| | - Alessandra Biffi
- Department of Child and Woman's Health, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Laura Sainati
- Department of Child and Woman's Health, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Raffaella Colombatti
- Department of Child and Woman's Health, Azienda Ospedaliera-Università di Padova, Padova, Italy
| |
Collapse
|
20
|
Analysis of the foveal microvasculature in sickle cell disease using swept-source optical coherence tomography angiography. Sci Rep 2020; 10:11795. [PMID: 32678184 PMCID: PMC7366709 DOI: 10.1038/s41598-020-68625-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 06/19/2020] [Indexed: 01/31/2023] Open
Abstract
Ischemic microangiopathy was clearly identified in sickle cell disease (SCD) using fluorescein angiography. A prospective observational clinical study was conducted to assess the foveal avascular zone (FAZ) area and explore perifoveal microvasculature changes in the superficial (SCP) and deep (DCP) capillary plexus using optical coherence tomography angiography (OCTA) and compare two genotypes—HbS/HbS (HbSS) and HbS/HbC (HbSC)-to control. All consecutive patients with electrophoretic confirmation of SCD were included. Swept-source OCTA scans (Triton Plus, Topcon, Tokyo, Japan) with a 3 × 3-mm scanning area and ultra-wide field (UWF) retinography (California, Optos, Fife, Scotland) were recorded for all patients. For OCTA analysis, preset parameters were used to segment the SCP and DCP. The FAZ area was manually assessed. The number of vascular branching points was automatically assessed based on the vascular skeletonization using ImageJ software. Eyes were staged based on Goldberg’s classification of SCD retinopathy (SCDR) using UWF imaging. Forty-six eyes of 24 patients were included in the HbSS (n = 27) and HbSC (n = 19) groups and 16 eyes of 8 unaffected patients in a control group. In the DCP, the FAZ was significantly larger in the HbSC (p = 0.0001) and HbSS (p = 0.0004) groups compared to controls. The FAZ area in the SCP, CRT and number of superficial vascular branching points did not significantly differ between both genotypes. There were less branching points in the HbSC (p = 0.034) and HbSS (p = 0.0014) groups than in controls. The Goldberg stage was significantly higher in the HbSC group than in the HbSS group (2.21 vs. 1.22, p = 0.0062). OCTA provides useful information on macular microvasculature and structural alterations associated with SCDR. Ischemic abnormalities are more predominant in the DCP in case of SCDR and no difference was found between genotypes of patients visually asymptomatic.
Collapse
|
21
|
UTILITY OF ULTRA-WIDEFIELD RETINAL IMAGING FOR THE STAGING AND MANAGEMENT OF SICKLE CELL RETINOPATHY. Retina 2020; 39:836-843. [PMID: 29384996 DOI: 10.1097/iae.0000000000002057] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine whether ultra-widefield (UWF) retinal imaging changes the staging or management of sickle cell retinopathy compared with clinical examination. METHODS Prospective, observational study including patients with sickle cell disease. All patients underwent dilated fundus examination by a fellowship-trained retina specialist, as well as UWF fundus photography (FF) and fluorescein angiography (FA). Sickle retinopathy stage and treatment recommendation per eye were determined after clinical examination, UWF-FF, and UWF-FA, respectively, and differences in retinopathy stage and treatment recommendation were compared. RESULTS A total of 70 eyes from 35 patients (17 women, 48.6%), mean age 30.4 years, were included. Sickle genotypes included 26 patients with sickle SS (74.3%), 7 SC (20.0%), and 2 β(+)thalassemia (5.7%). Based on examination, most eyes (42/70; 60.0%) had no visible retinopathy. Based on UWF-FF, about half of the eyes were found to be Goldberg Stage 2 or above (36/70; 51.4%). Based on UWF-FA, nearly all eyes were Goldberg Stage 2 or above (63/70; 90%). However, clinical examination reliably detected neovascularization, and in no case did the addition of UWF imaging change management relative to examination alone. CONCLUSION Ultra-widefield imaging detects a higher stage of sickle cell retinopathy compared with clinical examination alone, but these differences may not be clinically significant.
Collapse
|
22
|
Zhou DB, Scott AW, Linz MO, Han IC, Castanos MV, Lynch G, Andrade Romo JS, Linderman RE, Carroll J, Rosen RB, Chui TY. Interocular asymmetry of foveal avascular zone morphology and parafoveal capillary density in sickle cell retinopathy. PLoS One 2020; 15:e0234151. [PMID: 32520956 PMCID: PMC7286490 DOI: 10.1371/journal.pone.0234151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/19/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To examine interocular asymmetry of foveal avascular zone (FAZ) and parafoveal capillary density metrics in sickle cell retinopathy (SCR) using optical coherence tomography angiography (OCT-A). METHODS This cross-sectional, retrospective study evaluated SCR patients and unaffected controls who underwent 3x3mm macular OCT-A imaging using a spectral domain-OCT system. FAZ (area, perimeter, and acircularity index) and parafoveal capillary density metrics were computed for both eyes of each participant. In unaffected controls, interocular difference in FAZ and parafoveal capillary density metrics were evaluated using Bland-Altman plots. SCR patients with interocular difference outside the upper 97.5% and lower 2.5% limits of agreement from controls were defined as having interocular asymmetry. Area under receiver operating characteristic curve (AROC) was also performed to determine the ability of the absolute interocular difference to differentiate between subjects with SCR-including non-proliferative SCR (NP-SCR) and proliferative SCR (P-SCR)-and unaffected controls. RESULTS Thirty-one patients with SCR (21 NP-SCR and 10 P-SCR) and 14 race-matched and age-matched controls were included for analysis. Interocular asymmetry was seen for all FAZ and parafoveal capillary density metrics in NP-SCR and P-SCR subjects. SCR subjects showed greater disease severity in the left-eye for FAZ and parafoveal capillary density metrics. CONCLUSIONS NP-SCR and P-SCR patients demonstrated quantifiable interocular asymmetry in FAZ and parafoveal capillary density metrics compared to unaffected subjects, with left-eye predominance in disease severity.
Collapse
Affiliation(s)
- Davis B. Zhou
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Adrienne W. Scott
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Marguerite O. Linz
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Ian C. Han
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Ophthalmology and Visual Sciences, Institute for Vision Research, University of Iowa, Iowa City, Iowa, United States of America
| | - Maria V. Castanos
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States of America
| | - Giselle Lynch
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Jorge S. Andrade Romo
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States of America
| | - Rachel E. Linderman
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Joseph Carroll
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Richard B. Rosen
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Toco Y. Chui
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- * E-mail:
| |
Collapse
|
23
|
Grego L, Pignatto S, Alfier F, Arigliani M, Rizzetto F, Rassu N, Samassa F, Prosperi R, Barbieri F, Dall'Amico R, Cogo P, Lanzetta P. Optical coherence tomography (OCT) and OCT angiography allow early identification of sickle cell maculopathy in children and correlate it with systemic risk factors. Graefes Arch Clin Exp Ophthalmol 2020; 258:2551-2561. [PMID: 32518974 DOI: 10.1007/s00417-020-04764-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To determine the presence of sickle cell retinopathy and maculopathy and to identify associations between markers of hemolysis and systemic and ocular manifestations in children affected by sickle cell disease. METHODS Eighteen children with sickle cell disease, aged 5-16 years, underwent complete eye examination including best-corrected visual acuity, slit-lamp biomicroscopy, ophthalmoscopy after pharmacological mydriasis, spectral-domain optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCTA). Blood test results and clinical history information were collected for each child, including fetal hemoglobin (HbF), hemoglobin (Hb), hematocrit (Htc), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), reticulocytes percentage (%ret), lactic dehydrogenase (LDH), total and direct bilirubin, glomerular filtration rate, number of painful crises, acute chest syndromes, and splenic sequestration. Therapeutic regimen and transfusion therapy were also evaluated. RESULTS Sixteen of 36 eyes (44.4%) had non-proliferative sickle cell retinopathy on ophthalmoscopic evaluation. No patients had proliferative sickle cell retinopathy. In 13 of 36 eyes (36.1%), SD-OCT and OCTA detected signs of sickle cell maculopathy. Nine eyes (25%) presented sickle cell retinopathy and maculopathy, 7 eyes (19.4%) sickle cell retinopathy alone, and 4 eyes (11.1%) sickle cell maculopathy alone. A statistically significant association was found between sickle cell retinopathy; lower levels of HbF, Hb, and Htc; and higher MCV and percentage of reticulocytes. Sickle cell maculopathy was associated with lower values of H and Htc and higher levels of reticulocytes and total bilirubin. CONCLUSIONS We identified early signs of sickle cell retinopathy and maculopathy in a pediatric population with SD-OCT and OCTA. These two retinal complications were more frequent in children with higher hemolytic rates.
Collapse
Affiliation(s)
- L Grego
- Department of Medicine- Ophthalmology, University of Udine, Udine, Italy
| | - S Pignatto
- Department of Medicine- Ophthalmology, University of Udine, Udine, Italy
| | - F Alfier
- Department of Medicine- Ophthalmology, University of Udine, Udine, Italy
| | - M Arigliani
- Department of Medicine- Paediatrics, University of Udine, Udine, Italy
| | - F Rizzetto
- Department of Ophthalmology, Hospital of Pordenone, Pordenone, Italy
| | - N Rassu
- Department of Medicine- Ophthalmology, University of Udine, Udine, Italy
| | - F Samassa
- Department of Medicine- Ophthalmology, University of Udine, Udine, Italy
| | - R Prosperi
- Department of Medicine- Ophthalmology, University of Udine, Udine, Italy
| | - F Barbieri
- Department of Paediatrics, Hospital of Pordenone, Pordenone, Italy
| | - R Dall'Amico
- Department of Paediatrics, Hospital of Pordenone, Pordenone, Italy
| | - P Cogo
- Department of Medicine- Paediatrics, University of Udine, Udine, Italy
| | - P Lanzetta
- Department of Medicine- Ophthalmology, University of Udine, Udine, Italy.
| |
Collapse
|
24
|
Ong SS, Linz MO, Li X, Liu TA, Han IC, Scott AW. Retinal Thickness and Microvascular Changes in Children With Sickle Cell Disease Evaluated by Optical Coherence Tomography (OCT) and OCT Angiography. Am J Ophthalmol 2020; 209:88-98. [PMID: 31473216 DOI: 10.1016/j.ajo.2019.08.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE To compare the severity of macular vascular changes in children with sickle cell disease (SCD) vs age- and race-matched controls. DESIGN Cross-sectional study. METHODS Children (<18 years old) with HbSS and HbS variant (HbSC and HbS thalassemia) genotypes, and their age- and race-matched controls, were recruited between January 2017 and December 2018. All subjects underwent optical coherence tomography angiography (OCTA) scans centered on the fovea and temporal macula. Retinal thickness, superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density (VD), and foveal avascular zone (FAZ) size were measured and compared between HbSS and HbS variant vs controls. RESULTS Thirty-four HbSS, 34 HbS variant (Goldberg staging 0-3 for SCD eyes), and 24 control eyes (total 48 children, aged 5-17 years) were included. Total VD (3-mm ETDRS circle) was lower in HbS variant eyes than in controls for both the SCP (42.9% vs 47.7%, P = .02) and DCP (47.4% vs 52.6%, P = .01). In HbSS eyes, VD was lower in the DCP (47.7%, P = .008) but not in the SCP (45.5%, P = .5), compared to controls. A higher proportion of HbSS (n = 18, 55%) than HbS variant eyes (n = 9, 26%) had pathologic areas of retinal thinning associated with SCP and DCP flow loss (P = .03). However, retinal thickness measurements and FAZ size did not differ between either HbSS or HbS variant group vs controls. CONCLUSIONS Children with SCD have similar retinal thickness but less dense vasculature on OCTA compared to age and race-matched controls, suggesting that microvascular insult may precede structural thinning.
Collapse
|
25
|
Abstract
Background Wide-field imaging is a newer retinal imaging technology, capturing up to 200 degrees of the retina in a single photograph. Individuals with sickle cell retinopathy commonly exhibit peripheral retinal ischemia. Patients with proliferative sickle cell retinopathy develop pathologic retinal neovascularization of the peripheral retina which may progress into sight-threatening sequelae of vitreous hemorrhage and/or retinal detachment. The purpose of this review is to provide an overview of current and future applications of wide-field retinal imaging for sickle cell retinopathy, and recommend indications for best use. Main body There are several advantages to wide-field imaging in the clinical management of sickle cell disease patients. Retrospective and prospective studies support the success of wide-field imaging in detecting more sickle cell induced retinal microvascular abnormalities than traditional non-wide-field imaging. Clinicians can easily capture a greater extent of the retinal periphery in a patient's clinical baseline imaging to follow the changes at an earlier point and determine the rate of progression over time. Wide-field imaging minimizes patient and photographer burden, necessitating less photos and technical skill to capture the peripheral retina. Minimizing the number of necessary images can be especially helpful for pediatric patients with sickle cell retinopathy. Wide-field imaging has already been successful in identifying new biomarkers and risk factors for the development of proliferative sickle cell retinopathy. While these advantages should be considered, clinicians need to perform a careful risk-benefit analysis before ordering this test. Although wide-field fluorescein angiography successfully detects additional pathologic abnormalities compared to traditional imaging, a recent research study suggests that peripheral changes differentially detected by wide-field imaging may not change clinical management for most sickle cell patients. Conclusions While wide-field imaging may not carry a clinically significant direct benefit to all patients, it shows future promise in expanding our knowledge of sickle cell retinopathy. Clinicians may monitor peripheral retinal pathology such as retinal ischemia and retinal neovascularization over progressive time points, and use sequential wide-field retinal images to monitor response to treatment. Future applications for wide-field imaging may include providing data to facilitate machine learning, and potential use in tele-ophthalmology screening for proliferative sickle retinopathy.
Collapse
Affiliation(s)
- Marguerite O Linz
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 719, Baltimore, MD 21287 USA
| | - Adrienne W Scott
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 719, Baltimore, MD 21287 USA
| |
Collapse
|
26
|
[Role of OCT-angiography in the management of sickle cell retinopathy]. J Fr Ophtalmol 2019; 43:7-17. [PMID: 31831271 DOI: 10.1016/j.jfo.2019.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/05/2019] [Accepted: 06/26/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Sickle cell retinopathy is the main ophthalmologic complication of sickle cell syndrome. Optical coherence tomography (OCT) and optical coherence tomography-angiography (OCT-A) permit demonstration of central retinal involvement. The goal of this study is to determine whether central retinal involvement is predictive of peripheral retinal ischemia. MATERIALS AND METHODS We carried out a retrospective study of 31 patients with sickle cell disease who underwent a complete ophthalmologic examination. We focused on capillary density of the superficial and deep plexuses and the central avascular surface by OCT-A, and retinal layer thickness by OCT. All of the findings obtained by OCT-A and OCT were classified according to the Goldberg stages on fluorescein angiography. RESULTS A thinning of the mean and temporal deep plexus capillary layer as well as a loss of the temporal density of the superficial plexus capillaries are significantly higher in the case of proliferative sickle cell retinopathy (P=<0.05). A significant negative correlation is observed between the mean and temporal density of the superficial (R=-0.31; P=0.02 and R=-0.43; P=0.0009) and deep plexus capillaries (R=-0.39; P=0.003 et R=-0.43; P=0.0009) and the Goldberg stage in fluorescein angiography. CONCLUSION The study of the temporal capillary densities of the superficial and deep plexuses on OCT angiography may prove to be a useful tool for the ophthalmologist in order to diagnose patients at risk for proliferative sickle cell retinopathy.
Collapse
|
27
|
Liu TYA, Han IC, Goldberg MF, Linz MO, Chen CJ, Scott AW. Multimodal Retinal Imaging in Incontinentia Pigmenti Including Optical Coherence Tomography Angiography: Findings From an Older Cohort With Mild Phenotype. JAMA Ophthalmol 2019; 136:467-472. [PMID: 29566114 DOI: 10.1001/jamaophthalmol.2018.0475] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Incontinentia pigmenti (IP) is a rare, X-linked dominant disease with potentially severe ocular complications that predominantly affect the peripheral retina. However, little is known about its effects on the macula. Objective To describe the structural and vascular abnormalities observed in the maculas of patients with IP and to correlate these findings with peripheral pathologies. Design, Setting, and Participants Prospective, cross-sectional study at Wilmer Eye Institute, Johns Hopkins University. Five participants with a clinical diagnosis of IP were included and underwent multimodal imaging with ultra-wide-field fluorescein angiography (FA), spectral-domain optical coherence tomography (OCT), and OCT angiography. Main Outcomes and Measures The structural and vascular abnormalities observed on spectral-domain OCT and OCT angiography and their correlation with peripheral pathologies seen on ultra-wide-field FA. Results A total of 9 eyes from 5 patients (median age, 20.5 years; range, 8.4-54.2 years) were included. Median Snellen visual acuity was 20/32 (range, 20/16 to 20/63). ultra-wide-field FA-identified retinal vascular abnormalities in all 7 eyes in which FA was obtained. These abnormalities included microaneurysms, areas of nonperfusion, and vascular anastomoses, most of which were peripheral to the standard view of 30° FA with peripheral sweeps. Structural abnormalities were observed in 6 eyes on spectral-domain OCT, including inner retinal thinning and irregularities in the outer plexiform layer. Optical coherence tomography angiography abnormalities were noted in all 9 eyes, including decreased vascular density, abnormal vascular loops, and flow loss in the superficial and deep plexuses, which corresponded to areas of retinal thinning on spectral-domain OCT. Conclusions and Relevance Although our study is limited by the small sample size, the findings suggest that multimodal imaging is useful for detecting structural and vascular abnormalities that may not be apparent on ophthalmoscopy in patients with IP. Macular pathologies, especially a decrease in vascular density on OCT angiography, are common. Further studies are needed to characterize further the association between macular and peripheral abnormalities in patients with IP.
Collapse
Affiliation(s)
| | - Ian C Han
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.,Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City
| | | | | | - Connie J Chen
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.,Virginia Mason Medical Center, Seattle, Washington
| | - Adrienne W Scott
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
28
|
Relating retinal blood flow and vessel morphology in sickle cell retinopathy. Eye (Lond) 2019; 34:886-891. [PMID: 31558825 PMCID: PMC7182580 DOI: 10.1038/s41433-019-0604-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/14/2019] [Indexed: 01/20/2023] Open
Abstract
Purpose The purpose of the current study was to determine associations between retinal blood flow and vessel morphology metrics in sickle cell retinopathy (SCR) and healthy normal control (NC) subjects. Methods Optical coherence tomography angiography (OCTA) and Doppler OCT imaging were performed in 12 SCR (15 eyes) and 19 NC (26 eyes) subjects. Vessel tortuosity was measured using a dedicated image analysis algorithm applied to OCTA images. Vessel density and spacing between vessels were determined from OCTA images by a fractal dimension analysis method. Retinal blood flow was quantified using a phase-resolved technique applied to en face Doppler OCT images. Results There was a significant association between increased retinal blood flow and increased vessel tortuosity (P = 0.03). Furthermore, increased retinal blood flow was associated with increased vessel density (P = 0.03) and decreased spacing between small vessels (P = 0.01). There was no significant association between retinal blood flow and spacing between large vessels (P = 0.11). Vessel tortuosity and blood flow were increased, whereas spacing between small vessels was decreased in SCR compared to NC group (P ≤ 0.03). There were no significant differences in vessel density or spacing between large vessels between the SCR and NC groups (P ≥ 0.31). Conclusions Associations between retinal hemodynamics and vessel morphology were reported, providing better understanding of retinal pathophysiology and insight into potential quantitative biomarkers to evaluate SCR.
Collapse
|
29
|
Retinal oximetry and fractal analysis of capillary maps in sickle cell disease patients and matched healthy volunteers. Graefes Arch Clin Exp Ophthalmol 2019; 258:9-15. [PMID: 31529320 DOI: 10.1007/s00417-019-04458-0] [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: 02/13/2019] [Revised: 08/19/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Fractal analysis can be used to quantitatively analyze the retinal microvasculature and might be a suitable method to quantify retinal capillary changes in sickle cell disease (SCD) patients. Retinal oximetry measurements might function as a proxy for the pathophysiology of cerebrovascular diseases. Moreover, hypoxia has an important role in the pathophysiology of diabetic and other retinopathies. However, little is known about the oximetry around the macula in SCD patients. With this study, we explored the feasibility to perform these quantified measurements in SCD patients. METHODS Retinal microvascular and oximetry measurements were performed in eight SCD patients and eight healthy matched controls. Oximetry pictures and non-invasive capillary perfusion maps (nCPM) were obtained by the retinal function imager. Measurements were conducted twice on two different study days. Measured variables included monofractal dimension (Dbox), relative saturation, deoxygenated hemoglobin (deoxyHb), and oxygenated hemoglobin (oxyHb) concentration. RESULTS No statistically significant differences in vessel density were found in the different annular zones (large vessels, p = 0.66; small vessels, p = 0.66) and anatomical quadrants (large vessels, p = 0.74; small vessels, p = 0.72). Furthermore, no significant between-group differences were found in the other different anatomical quadrants and annular zones around the fovea for relative saturation levels and deoxygenated Hb. However, the oxyHb levels were significantly lower in SCD patients, compared with those in matched controls in the temporal quadrants (p = 0.04; p = 0.02) and the superior nasal quadrant (p = 0.05). CONCLUSIONS Our study demonstrated the feasibility of multispectral imaging to measure retinal changes in oxygenation in both SCD patients and matched volunteers. The results suggest that in SCD patients before any structural microvascular changes in the central retina are present, functional abnormalities can be observed with abnormal oximetry measurements.
Collapse
|
30
|
Lynch G, Scott AW, Linz MO, Han I, Andrade Romo JS, Linderman RE, Carroll J, Rosen RB, Chui TY. Foveal avascular zone morphology and parafoveal capillary perfusion in sickle cell retinopathy. Br J Ophthalmol 2019; 104:473-479. [PMID: 31337609 PMCID: PMC6980907 DOI: 10.1136/bjophthalmol-2019-314567] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/03/2019] [Accepted: 07/06/2019] [Indexed: 11/30/2022]
Abstract
Background/aims To assess foveal avascular zone (FAZ) morphology and parafoveal capillary perfusion in patients with various stages of sickle cell retinopathy (SCR) using optical coherence tomography angiography (OCT-A). Methods This is a multi-institutional retrospective study of patients with various stages of SCR compared with healthy controls. Parafoveal OCT-A images obtained using a commercial spectral domain-OCT system were reviewed. Foveal-centred 3×3 mm full vascular slab OCT-As were used for image processing and data analysis. FAZ area, perimeter, and acircularity index were determined on the OCT-A image after manual delineation of the FAZ border. Quadrant-based parafoveal capillary density and per cent area deviating from normal distribution were also measured. Results Fifty-two patients with SCR (33 non-proliferative and 19 proliferative) and 20 age and race-matched healthy controls were included. One randomly selected eye per study participant was analysed. FAZ perimeter and acircularity index were significantly greater in SCR eyes when compared with the controls. While parafoveal capillary density was significantly lower, per cent area deviated from normal distribution was significantly higher in SCR eyes than that of the control. However, no statistically significant difference between the two SCR stages was observed. In quadrant-based analysis, the temporal quadrant showed greater parafoveal capillary dropout due to SCR, with the most profound effect in patients with proliferative SCR. Conclusions Abnormal FAZ morphology and altered parafoveal capillary perfusion were found in patients with SCR. Our customised OCT-A image analysis method uniquely highlights significant quantitative alterations in perfusion density mapping in a qualitative display, with minimal obscuration of OCT-A image detail.
Collapse
Affiliation(s)
- Giselle Lynch
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA.,Ophthalmology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Adrienne W Scott
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, Maryland, USA
| | - Marguerite O Linz
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, Maryland, USA
| | - Ian Han
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, Maryland, USA.,Ophthalmology & Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Jorge S Andrade Romo
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA
| | - Rachel E Linderman
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joseph Carroll
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Richard B Rosen
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA.,Ophthalmology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Toco Y Chui
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA .,Ophthalmology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| |
Collapse
|
31
|
Beral L, Romana M, Lemonne N, Garnier Y, Billaud M, Acomat M, Zorobabel C, Etienne-Julan M, David T, Connes P. Multifocal electroretinogram findings in sickle cell maculopathy. Eye (Lond) 2019; 33:1939-1945. [PMID: 31289356 DOI: 10.1038/s41433-019-0499-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 04/04/2019] [Accepted: 04/30/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of the present work was to describe and compare multifocal electroretinogram findings (mfERG) between patients with sickle cell disease (SCD) without clinical sign of maculopathy and controls (HbAA). METHODS Both HbSS (homozygous SCD) and HbSC (compound heterozygous SCD) patients, the two most frequent SCD genotypes, were included. All individuals underwent a full ophthalmologic examination (with a fundoscopy), a spectral domain ocular coherence tomography (SD-OCT) and a mfERG. RESULTS A total of 86 subjects were included: 54 SCD patients (107 eyes) with 32 HbSS (63 eyes) and 22 HbSC (44 eyes) and 32 controls (64 eyes). None of the eyes showed retinal clinical abnormalities. SD-OCT analysis showed that macular thickness was statistically lower in SCD eyes than in controls. mfERG analysis demonstrated a significant reduction of N1 (initial-negative deflection), and P1 (positive peak) response amplitude densities of HbSS eyes compared to HbAA eyes from the centre (<2°) and to the periphery (>15°). Implicit time response was also reduced in the centre (<2°). N1 and P1 response amplitude densities of HbSC eyes were significantly lower than those of HbAA eyes from the centre (<2°) to the periphery (>15°). N1 implicit time was statistically reduced in HbSS compared to HbSC eyes. CONCLUSION Our study is the first one to describe macular electrophysiological dysfunction in SCD patients. Moreover, we confirm that SCD maculopathy is equally frequent in HbSS and HbSC.
Collapse
Affiliation(s)
- Laurence Beral
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/ Abymes, r de Chauvel, Pointe-à-Pitre, Guadeloupe, France.,UMR Inserm 1134, Biologie Intégrée du Globule Rouge, INSERM/Université Paris Diderot-Université Sorbonne Paris Cité/INTS/Université des Antilles, Guadeloupe, France
| | - Marc Romana
- UMR Inserm 1134, Biologie Intégrée du Globule Rouge, INSERM/Université Paris Diderot-Université Sorbonne Paris Cité/INTS/Université des Antilles, Guadeloupe, France.,Laboratoire d'Excellence GR-Ex « The red cell: from genesis to death », PRES Sorbonne Paris Cité, Paris, France
| | - Nathalie Lemonne
- Unité transversale de la Drépanocytose, CHU de Pointe-à-Pitre/ Abymes, r de Chauvel, Pointe-à-Pitre, Guadeloupe, France
| | - Yoann Garnier
- UMR Inserm 1134, Biologie Intégrée du Globule Rouge, INSERM/Université Paris Diderot-Université Sorbonne Paris Cité/INTS/Université des Antilles, Guadeloupe, France.,Laboratoire d'Excellence GR-Ex « The red cell: from genesis to death », PRES Sorbonne Paris Cité, Paris, France
| | - Marie Billaud
- Unité transversale de la Drépanocytose, CHU de Pointe-à-Pitre/ Abymes, r de Chauvel, Pointe-à-Pitre, Guadeloupe, France
| | - Malik Acomat
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/ Abymes, r de Chauvel, Pointe-à-Pitre, Guadeloupe, France
| | - Coralie Zorobabel
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/ Abymes, r de Chauvel, Pointe-à-Pitre, Guadeloupe, France
| | - Maryse Etienne-Julan
- Unité transversale de la Drépanocytose, CHU de Pointe-à-Pitre/ Abymes, r de Chauvel, Pointe-à-Pitre, Guadeloupe, France
| | - Thierry David
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/ Abymes, r de Chauvel, Pointe-à-Pitre, Guadeloupe, France.,Université des Antilles, Guadeloupe (FWI), France
| | - Philippe Connes
- UMR Inserm 1134, Biologie Intégrée du Globule Rouge, INSERM/Université Paris Diderot-Université Sorbonne Paris Cité/INTS/Université des Antilles, Guadeloupe, France. .,Laboratoire d'Excellence GR-Ex « The red cell: from genesis to death », PRES Sorbonne Paris Cité, Paris, France. .,Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM), EA7424, Equipe Biologie Vasculaire et du Globule Rouge, Université Claude Bernard Lyon 1, COMUE Lyon, Villeurbanne, France. .,Institut Universitaire de France, Paris, France.
| |
Collapse
|
32
|
Beral L, Lemonne N, Romana M, Charlot K, Billaud M, Acomat M, Zorobabel C, Nader E, Etienne-Julan M, David T, Connes P. Proliferative retinopathy and maculopathy are two independent conditions in sickle cell disease: Is there a role of blood rheology?1. Clin Hemorheol Microcirc 2019; 71:337-345. [DOI: 10.3233/ch-180412] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Laurence Beral
- Service d’Ophtalmologie, CHU de Pointe-à-Pitre/Abymes, route de Chauvel, Pointe-à-Pitre, Guadeloupe, France
- Université des Antilles, CHU dePointe-à-Pitre, Guadeloupe, Université Sorbonne Paris Cité, Université Paris Diderot, Inserm, INTS, Unité Biologie Intégrée du Globule Rouge UMR_S1134, Paris, France
| | - Nathalie Lemonne
- Unité transversale de la Drépanocytose, CHU de Pointe-à-Pitre/Abymes, route deChauvel, Pointe-à-Pitre, Guadeloupe, France
| | - Marc Romana
- Université des Antilles, CHU dePointe-à-Pitre, Guadeloupe, Université Sorbonne Paris Cité, Université Paris Diderot, Inserm, INTS, Unité Biologie Intégrée du Globule Rouge UMR_S1134, Paris, France
- Laboratoire d’Excellence GR-Ex «TheRed Cell: From Genesis to Death», PRES Sorbonne Paris Cité, Paris, France
| | - Keyne Charlot
- Université des Antilles, CHU dePointe-à-Pitre, Guadeloupe, Université Sorbonne Paris Cité, Université Paris Diderot, Inserm, INTS, Unité Biologie Intégrée du Globule Rouge UMR_S1134, Paris, France
- Laboratoire d’Excellence GR-Ex «TheRed Cell: From Genesis to Death», PRES Sorbonne Paris Cité, Paris, France
- UnitéPhysiologie des Exercices et Activités en Conditions Extrêmes, Institut de Recherche Biomédicale desArmées, Brétigny-sur-Orge, France
| | - Marie Billaud
- Unité transversale de la Drépanocytose, CHU de Pointe-à-Pitre/Abymes, route deChauvel, Pointe-à-Pitre, Guadeloupe, France
| | - Malik Acomat
- Service d’Ophtalmologie, CHU de Pointe-à-Pitre/Abymes, route de Chauvel, Pointe-à-Pitre, Guadeloupe, France
| | - Coralie Zorobabel
- Service d’Ophtalmologie, CHU de Pointe-à-Pitre/Abymes, route de Chauvel, Pointe-à-Pitre, Guadeloupe, France
| | - Elie Nader
- Laboratoire d’Excellence GR-Ex «TheRed Cell: From Genesis to Death», PRES Sorbonne Paris Cité, Paris, France
- Laboratoire Interuniversitaire de Biologie de laMotricité (LIBM), EA7424, Equipe Biologie Vasculaire et du Globule Rouge, Université Claude BernardLyon 1, COMUE Lyon, Villeurbanne, France
| | - Maryse Etienne-Julan
- Unité transversale de la Drépanocytose, CHU de Pointe-à-Pitre/Abymes, route deChauvel, Pointe-à-Pitre, Guadeloupe, France
| | - Thierry David
- Service d’Ophtalmologie, CHU de Pointe-à-Pitre/Abymes, route de Chauvel, Pointe-à-Pitre, Guadeloupe, France
| | - Philippe Connes
- Université des Antilles, CHU dePointe-à-Pitre, Guadeloupe, Université Sorbonne Paris Cité, Université Paris Diderot, Inserm, INTS, Unité Biologie Intégrée du Globule Rouge UMR_S1134, Paris, France
- Laboratoire d’Excellence GR-Ex «TheRed Cell: From Genesis to Death», PRES Sorbonne Paris Cité, Paris, France
- Laboratoire Interuniversitaire de Biologie de laMotricité (LIBM), EA7424, Equipe Biologie Vasculaire et du Globule Rouge, Université Claude BernardLyon 1, COMUE Lyon, Villeurbanne, France
- Institut Universitaire de France, Paris, France
| |
Collapse
|
33
|
Leitão Guerra RL, Leitão Guerra CL, Bastos MG, de Oliveira AHP, Salles C. Sickle cell retinopathy: What we now understand using optical coherence tomography angiography. A systematic review. Blood Rev 2019; 35:32-42. [DOI: 10.1016/j.blre.2019.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/01/2019] [Accepted: 03/01/2019] [Indexed: 12/20/2022]
|
34
|
Mameli C, Invernizzi A, Bolchini A, Bedogni G, Giani E, Macedoni M, Zuccotti G, Preziosa C, Pellegrini M. Analysis of Retinal Perfusion in Children, Adolescents, and Young Adults with Type 1 Diabetes Using Optical Coherence Tomography Angiography. J Diabetes Res 2019; 2019:5410672. [PMID: 31205952 PMCID: PMC6530197 DOI: 10.1155/2019/5410672] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/02/2019] [Accepted: 04/23/2019] [Indexed: 12/15/2022] Open
Abstract
We performed a cross-sectional study to analyze the retinal vasculature in children, adolescent, and young adults with type 1 diabetes using optical coherence tomography angiography (OCTA). Patients underwent funduscopic examination for diabetic retinopathy (DR) screening during an annual visit for the screening of diabetes-related complications which included the evaluation of glycated hemoglobin (HbA1c), microalbuminuria, lipid profile, arterial pressure, and neurological assessment. In addition, OCTA of the retinal vasculature was performed. Quantitative analysis of the OCTA images evaluated the vessel density at the superficial (SCP) and deep (DCP) capillary plexus of the retina. Structural vascular alterations were evaluated qualitatively. Results were compared to those obtained in a group of healthy age-, sex-, and pubertal stage-matched controls. The effect of age, disease duration, age at the disease onset, mean HbA1c since the onset, and lipid profile on vascular density was tested. Fifty-three patients (median age 15.5, IQR 12.4-19.4 years; 57% females) with type 1 diabetes and 48 controls were enrolled. The median (IQR) HbA1c was 7.6% (60 mmol/mol) (6.9-8.1%, 52-65 mmol/mol), and the median (IQR) duration of disease was 6.0 (3.3-10.3) years. Mean vessel density measured with OCTA was lower in patients compared to controls with the temporal sector showing the highest difference both in the SCP (0.55 vs. 0.57, p < 0.001) and the DCP (0.63 vs. 0.65, p < 0.001). None of the predictors was associated with the superficial and deep vascular densities. Only 2 patients had clinically detectable DR. Microvascular structural changes were found on OCTA in both of these patients and in one without funduscopic alterations. In conclusion, patients with type 1 diabetes without clinically detectable DR had decreased capillary density compared to controls on OCTA images. These findings may provide useful information for the screening and the management of patients with type 1 diabetes. Further studies are needed to confirm our results and their clinical relevance.
Collapse
Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Save Sight Institute, University of Sydney, Sydney, Australia
| | - Alice Bolchini
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Giorgio Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Basovizza, Trieste, Italy
| | - Elisa Giani
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Maddalena Macedoni
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Chiara Preziosa
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Marco Pellegrini
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| |
Collapse
|
35
|
|
36
|
|
37
|
Cai CX, Han IC, Tian J, Linz MO, Scott AW. Progressive Retinal Thinning in Sickle Cell Retinopathy. ACTA ACUST UNITED AC 2018; 2:1241-1248.e2. [DOI: 10.1016/j.oret.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/08/2018] [Accepted: 07/10/2018] [Indexed: 02/05/2023]
|
38
|
Mathew R, Sivaprasad S. Advances in the diagnosis of sickle cell retinopathy. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1523007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Center, London, United Kingdom
| |
Collapse
|
39
|
Martin GC, Albuisson E, Brousse V, de Montalembert M, Bremond-Gignac D, Robert MP. Paramacular temporal atrophy in sickle cell disease occurs early in childhood. Br J Ophthalmol 2018; 103:906-910. [DOI: 10.1136/bjophthalmol-2018-312305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/04/2018] [Accepted: 08/03/2018] [Indexed: 11/04/2022]
Abstract
Background/aimsInitially reported in a few patients with homozygous sickle cell disease (SCD), atrophic areas of the retina temporal from the macula are now known to be present in about 48% of eyes of adult patients with SS-SCD and in 35% of eyes of adult patients with SC-SCD. The aim of this study is to describe this paramacular atrophy in children affected with SCD.MethodsIn this retrospective series, spectral-domain optical coherence tomography images of 81 children with SCD, acquired with specific patterns including one evaluating the retina temporal to the macula, were reviewed, in order to look for retinal atrophy. Fundus examination status for SCD peripheral retinopathy was also reviewed.ResultsMean age was 12.0 years (SD: 3.56). The genotype distribution was: 64 HbSS (79%), 10 HbSC (12%) and 7 HbS/β0 thalassaemia (9%). Using a usual fovea-centred programme, retinal atrophy was found in 38% of eyes (52% of children). Using a specific temporal pattern, retinal atrophy was found in 53% of eyes (64% of children), with no significant difference in the prevalence between HbSS and HbSC genotype (p=0.92), and no effect of age (mean 12.3 years (SD=3.61) vs11.9 (3.56), p=0.65). Peripheral retinopathy was found in 11% of children, with a significant relation between the HbSC genotype and the severity of the retinopathy (p=0.003).ConclusionParamacular temporal atrophy occurs early in the course of SCD, which suggests distinct mechanisms from those of peripheral retinopathy.
Collapse
|
40
|
Dell’Arti L, Barteselli G, Riva L, Carini E, Graziadei G, Benatti E, Invernizzi A, Cappellini MD, Viola F. Sickle cell maculopathy: Identification of systemic risk factors, and microstructural analysis of individual retinal layers of the macula. PLoS One 2018; 13:e0193582. [PMID: 29494697 PMCID: PMC5832302 DOI: 10.1371/journal.pone.0193582] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/14/2018] [Indexed: 12/27/2022] Open
Abstract
Purpose To identify systemic risk factors for sickle cell maculopathy, and to analyze the microstructure of the macula of Sickle Cell Disease (SCD) patients by using automated segmentation of individual retinal layers. Methods Thirty consecutive patients with SCD and 30 matched controls underwent spectral-domain optical coherence tomography (SD-OCT) and automated thickness measurement for each retinal layer; thicknesses for SCD patients were then compared to normal controls. Demographic data, systemic data, and lab results were collected for each SCD patient; multivariate logistic regression analysis was used to identify potential risk factors for sickle cell maculopathy. Results Ongoing chelation treatment (p = 0.0187) was the most predictive factor for the presence of sickle cell maculopathy; the odds were 94.2% lower when chelation was present. HbF level tended to influence sickle cell maculopathy (p = 0.0775); the odds decreased by 12.9% when HbF increased by 1%. Sickle cell maculopathy was detected in 43% of SCD patients as patchy areas of retinal thinning on SD-OCT thickness map, mostly located temporally to the macula, especially in eyes with more advanced forms of sickle cell retinopathy (p = 0.003). In comparison to controls, SCD patients had a subtle thinning of the overall macula and temporal retina compared to controls (most p<0.0001), involving inner and outer retinal layers. Thickening of the retinal pigment epithelium was also detected in SCD eyes (p<0.0001). Conclusions Chronic chelation therapy and, potentially, high levels of HbF are possible protective factors for the presence of sickle cell maculopathy, especially for patients with more advanced forms of sickle cell retinopathy. A subtle thinning of the overall macula occurs in SCD patients and involves multiple retinal layers, suggesting that ischemic vasculopathy may happen in both superficial and deep capillary plexi. Thinning of the outer retinal layers suggests that an ischemic insult of the choriocapillaris may also occur in SCD patients.
Collapse
Affiliation(s)
- Laura Dell’Arti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ophthalmological Unit, Ca’ Granda Foundation, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulio Barteselli
- Genentech Inc, South San Francisco, California, United States of America
| | - Lorenzo Riva
- Ophthalmological Unit, Ca’ Granda Foundation, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Carini
- Ophthalmological Unit, Ca’ Granda Foundation, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Graziadei
- Rare Diseases Center, Department of Medicine and Medical Specialties, Ca’ Granda Foundation, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleonora Benatti
- Ophthalmological Unit, Ca’ Granda Foundation, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Maria D. Cappellini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Rare Diseases Center, Department of Medicine and Medical Specialties, Ca’ Granda Foundation, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Viola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ophthalmological Unit, Ca’ Granda Foundation, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
- * E-mail:
| |
Collapse
|
41
|
Lim WS, Magan T, Mahroo OA, Hysi PG, Helou J, Mohamed MD. Retinal thickness measurements in sickle cell patients with HbSS and HbSC genotype. Can J Ophthalmol 2017; 53:420-424. [PMID: 30119799 PMCID: PMC6117475 DOI: 10.1016/j.jcjo.2017.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Temporal macula thinning has been reported in sickle cell patients, but it remains unclear if there is a difference between HbSS and HbSC genotypes. We aimed to quantitatively compare macular thickness between eyes with HbSS and HbSC genotype. DESIGN Retrospective descriptive study. METHODS Consecutive patients seen over a 5.5-year period in the Ophthalmology Department at St Thomas' Hospital, London, were identified. Macular optical coherence tomography images were retrospectively analyzed. The retinal thickness in all 9 subfields of the Early Treatment Diabetic Retinopathy Study (ETDRS) grid was compared between HbSS and HbSC eyes. Right eyes and left eyes were analyzed independently, as well as averaged measurements from both eyes. Comparison was made between the 2 genotypes, adjusting for age and sex, and for multiple testing. Scans were excluded in cases of poor fixation or ocular comorbidity affecting retinal thickness. RESULTS 132 HbSC and 120 HbSS patients were identified. Scans from 166 right and 153 left eyes were included (with approximately equal numbers of HbSS and HbSC genotypes). Mean retinal thickness was lower in HbSS eyes compared with HbSC eyes in all subfields of the ETDRS grid, but in most subfields the difference was <10 microns. Differences reached statistical significance for outer superior, inferior, and temporal subfields and the inner temporal subfield (p < 0.05). CONCLUSION Although the HbSC genotype is more strongly associated with proliferative retinopathy, HbSS patients had on average more macular thinning.
Collapse
Affiliation(s)
- Wei S Lim
- Ophthalmology Department, St Thomas' Hospital, London, United Kingdom.
| | - Tejal Magan
- Ophthalmology Department, St Thomas' Hospital, London, United Kingdom
| | - Omar A Mahroo
- Ophthalmology Department, St Thomas' Hospital, London, United Kingdom; NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology, London; Section of Academic Ophthalmology, School of Life Course Sciences(,) Faculty of Life Course Sciences and Medicine, King's College London, St Thomas' Hospital Campus, London, United Kingdom
| | - Pirro G Hysi
- Section of Academic Ophthalmology, School of Life Course Sciences(,) Faculty of Life Course Sciences and Medicine, King's College London, St Thomas' Hospital Campus, London, United Kingdom
| | - Juliana Helou
- Ophthalmology Department, St Thomas' Hospital, London, United Kingdom
| | - Moin D Mohamed
- Ophthalmology Department, St Thomas' Hospital, London, United Kingdom
| |
Collapse
|
42
|
Correlation of Ultra-Widefield Fluorescein Angiography and OCT Angiography in Sickle Cell Retinopathy. Ophthalmol Retina 2017; 2:599-605. [PMID: 31047613 DOI: 10.1016/j.oret.2017.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine whether the degree of peripheral nonperfusion seen on ultra-widefield (UWF) fluorescein angiography (FA) correlates with measures of macular vascular flow as seen on OCT angiography (OCTA) in sickle cell retinopathy. DESIGN Prospective, observational study. PARTICIPANTS Patients with sickle cell disease undergoing an eye examination at an urban, tertiary medical center. METHODS All patients underwent dilated fundus examination as well as UWF FA and macular OCTA imaging on the same day. The peripheral nonperfusion seen on UWF FA was measured to calculate an ischemic index (visualized nonperfusion/total visualized retinal area × 100%), and OCTA measurements of macular vessel density were recorded. The degree of peripheral nonperfusion and vessel density were then correlated. MAIN OUTCOME MEASURES Correlation between ischemic index as seen on UWF FA and macular vessel density on OCTA. RESULTS Thirty-six eyes from 19 patients (10 women, 9 men) with a mean age of 30.8 years were included. Sickle genotypes included 14 patients with SS (73.7%), 4 with SC (21.1%), and 1 with β-thalassemia (5.2%). Average ischemic index was 4.4% for all eyes and was found to be higher in patients with sickle SC (8.0%) than in those with sickle SS (3.2%; P = 0.01). Ischemic index also was higher in those with proliferative sickle cell retinopathy (9.3%) than in those without (2.8%; P < 0.01). Ischemic index on UWF FA showed a statistically significant correlation (P < 0.05) with vessel density on OCTA in the temporal subfield of the superficial capillary plexus and in all subfields of the deep capillary plexus. CONCLUSIONS Peripheral nonperfusion seen on UWF FA is greater in those with sickle SC disease and proliferative retinopathy and is correlated with macular vessel density on OCTA, especially the deep retinal plexus.
Collapse
|
43
|
Abstract
PURPOSE OF REVIEW To review recent literature pertaining to sickle cell retinopathy (SCR) and, in particular, sickle cell maculopathy. RECENT FINDINGS Several recent studies suggest that macular perfusion abnormalities seen in patients with sickle cell disease of various genotypes may affect both the superficial and deep capillary plexi, with a predilection for the deep capillary plexus. Further, these changes may be associated with areas of macular thinning, as well as with peripheral retinal ischemia, even in individuals without visual symptoms, contrary to what has previously been described in both diabetic retinopathy and retinal vein occlusion. Several cases also suggest that paracentral acute middle maculopathy may be the pathophysiologic mechanism by which microvascular occlusion leads to macular thinning. SUMMARY Sickle cell disease can manifest in a number of ways within the orbit as well as intraocularly because of its nonspecific vasoocclusive episodes. However, SCR is the most common ophthalmic manifestation of this disease. Historically, SCR has been considered a peripheral retinopathy, but the development and use of spectral-domain optical coherence tomography and optical coherence tomography angiography suggest that significant macular vascular changes occur early in this disease, even in asymptomatic individuals.
Collapse
|
44
|
Menaa F, Khan BA, Uzair B, Menaa A. Sickle cell retinopathy: improving care with a multidisciplinary approach. J Multidiscip Healthc 2017; 10:335-346. [PMID: 28919773 PMCID: PMC5587171 DOI: 10.2147/jmdh.s90630] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Sickle cell retinopathy (SCR) is the most representative ophthalmologic complication of sickle cell disease (SCD), a hemoglobinopathy affecting both adults and children. SCR presents a wide spectrum of manifestations and may even lead to irreversible vision loss if not properly diagnosed and treated at the earliest. Over the past decade, multidisciplinary research developments have focused upon systemic, genetic, and ocular risk factors of SCR, enabling the clinician to better diagnose and manage these patients. In addition, newer imaging and testing modalities, such as spectral domain-optical coherence tomography angiography, have resulted in the detection of subclinical retinopathy related to SCD. Innovative therapy includes intravitreal injection of an anti-vascular endothelial growth factor (eg, Lucentis® [ranibizumab] or Eylea® [aflibercept]) which appears comparatively safe and efficient, and may be combined with laser photocoagulation (LPC) for proliferative SCR. The effect of LPC alone does not significantly lead to the regression of advanced SCR, although it helps in avoiding hemorrhage and sight loss. This comprehensive article is based on 10-years retrospective (2007–2017) studies. It aims to present advances and recommendations in SCR theranostics while pointing out the requirement of combinatorial approaches for better management of SCR patients. To reach this goal, we identified and analyzed randomized original and review articles, clinical trials, non-randomized intervention studies, and observational studies using specified keywords in various databases (eg, Medline, Embase, Cochrane, ClinicalTrials.gov).
Collapse
Affiliation(s)
- Farid Menaa
- Department of Pharmaceutical Sciences and Nanomedicine, California Innovations Corporation, San Diego, CA, USA.,Departments of Clinical Medicine and Laser Therapy, Centre Médical des Guittières, Saint-Philbert-de-Grand-Lieu, Loire-Atlantique, France
| | - Barkat Ali Khan
- Faculty of Pharmacy and Alternative Medicine, The Islamia University of Bahawalpur, Bahawalpur
| | - Bushra Uzair
- Department of Bioinformatics and Biotechnology, International Islamic University, Islamabad, Pakistan
| | - Abder Menaa
- Departments of Clinical Medicine and Laser Therapy, Centre Médical des Guittières, Saint-Philbert-de-Grand-Lieu, Loire-Atlantique, France
| |
Collapse
|
45
|
Khan HA, Mehmood A, Khan QA, Iqbal F, Rasheed F, Khan N, Pizzimenti JJ. A major review of optical coherence tomography angiography. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1356229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Hashim Ali Khan
- Ophthalmology, SEHHAT Foundation Hospital, Main KKH, Danyore, Gilgit, Pakistan
| | - Asim Mehmood
- Ophthalmology, Multan Medical & Dental College, Multan, Pakistan
| | - Qaim Ali Khan
- Ophthalmology, Poonch Medical College, AJK, Pakistan
| | - Fatima Iqbal
- School of Optometry, The University of Faisalabad, Faisalabad, Pakistan
| | - Faisal Rasheed
- Ophthalmology, Sheikh Zayd Medical College, Rahim Yar Khan, Pakistan
| | - Naeemullah Khan
- Ophthalmology, SEHHAT Foundation Hospital, Main KKH, Danyore, Gilgit, Pakistan
| | - Joseph J. Pizzimenti
- Rosenberg School of Optometry, University of the Incarte Word, San Antonio, TX, USA
| |
Collapse
|