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Tan B, Chua J, Wong D, Liu X, Ismail M, Schmetterer L. Techniques for imaging the choroid and choroidal blood flow in vivo. Exp Eye Res 2024; 247:110045. [PMID: 39154819 DOI: 10.1016/j.exer.2024.110045] [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: 05/26/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 08/20/2024]
Abstract
The choroid, which is a highly vascularized layer between the retina and sclera, is essential for supplying oxygen and nutrients to the outer retina. Choroidal vascular dysfunction has been implicated in numerous ocular diseases, including age-related macular degeneration, central serous chorioretinopathy, polypoidal choroidal vasculopathy, and myopia. Traditionally, the in vivo assessment of choroidal blood flow relies on techniques such as laser Doppler flowmetry, laser speckle flowgraphy, pneumotonometry, laser interferometry, and ultrasonic color Doppler imaging. While the aforementioned methods have provided valuable insights into choroidal blood flow regulation, their clinical applications have been limited. Recent advancements in optical coherence tomography and optical coherence tomography angiography have expanded our understanding of the choroid, allowing detailed visualization of the larger choroidal vessels and choriocapillaris, respectively. This review provides an overview of the available techniques that can investigate the choroid and its blood flow in vivo. Future research should combine these techniques to comprehensively image the entire choroidal microcirculation and develop robust methods to quantify choroidal blood flow. The potential findings will provide a better picture of choroidal hemodynamics and its effect on ocular health and disease.
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Affiliation(s)
- Bingyao Tan
- Singapore Eye Research Institute, National Eye Centre, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Jacqueline Chua
- Singapore Eye Research Institute, National Eye Centre, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, National Eye Centre, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Xinyu Liu
- Singapore Eye Research Institute, National Eye Centre, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Munirah Ismail
- Singapore Eye Research Institute, National Eye Centre, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, National Eye Centre, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland; School of Chemical and Biomedical Engineering, Nanyang Technological University (NTU), Singapore; Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria; Rothschild Foundation Hospital, Paris, France.
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2
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Zhao Q, Wei L, Chen Y. Detection of choroidal vascular features in diabetic patients without clinically visible diabetic retinopathy by optical coherence tomography angiography: A systemic review and meta-analysis. Surv Ophthalmol 2024:S0039-6257(24)00100-0. [PMID: 39214238 DOI: 10.1016/j.survophthal.2024.08.007] [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: 01/25/2024] [Revised: 08/23/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
Researchers have explored choroidal features in the eyes of diabetic patients without clinically visible diabetic retinopathy (DM-NoDR) employing optical coherence tomography angiography (OCTA); however, the results are controversial. We systematically searched PubMed, Embase, and Ovid databases for OCTA studies comparing choroidal parameters between DM-NoDR eyes and healthy controls or non-proliferative diabetic retinopathy (NPDR) eyes. Outcomes included choriocapillaris (CC) perfusion density (PD), flow area (FA), and flow deficits (FD). 36 studies were finally included in the quantitative meta-analysis, involving 1,908 DM-NoDR eyes, 792 NPDR eyes, and 1,391 healthy control eyes. DM-NoDR eyes had significantly lower CC PD in the foveal region (P=0.0005) and superior parafoveal region (P=0.003) than healthy control eyes, but no significant difference was found in other parafoveal subregions (P>0.05). DM-NoDR eyes were also associated with increased CC FD (P<0.00001) and decreased CC FA (P<0.0001) in whole OCTA images with a 3×3 mm2 field of view (FOV). Compared with all-stage NPDR eyes, DM-NoDR eyes had higher CC PD in the foveal region (P<0.0001), parafoveal region (P<0.00001), and the whole OCTA images with a 6×6 mm2 FOV (P<0.00001). Early choroidal microvascular changes may precede clinically visible DR and can be detected early using OCTA in DM-NoDR eyes.
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Affiliation(s)
- Qing Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, 100730, China
| | - Linxin Wei
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, 100730, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, 100730, China.
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Zhang W, Kaser-Eichberger A, Fan W, Platzl C, Schrödl F, Heindl LM. The structure and function of the human choroid. Ann Anat 2024; 254:152239. [PMID: 38432349 DOI: 10.1016/j.aanat.2024.152239] [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: 01/16/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
In this manuscript, the structure of the human choroid is reviewed with emphasis of the macro- and microscopic anatomy including Bruch's membrane, choriocapillaris, Sattler's and Haller's layer, and the suprachoroid. We here discuss the development of the choroid, as well as the question of choroidal lymphatics, and further the neuronal control of this tissue, as well as the pathologic angiogenesis. Wherever possible, functional aspects of the various structures are included and reviewed.
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Affiliation(s)
- Weina Zhang
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Alexandra Kaser-Eichberger
- Center for Anatomy and Cell Biology, Institute of Anatomy and Cell Biology -Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Wanlin Fan
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christian Platzl
- Center for Anatomy and Cell Biology, Institute of Anatomy and Cell Biology -Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Falk Schrödl
- Center for Anatomy and Cell Biology, Institute of Anatomy and Cell Biology -Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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Faust CD, Klettner CA, Toso M, Hageman GS, Eames I, Luthert PJ, Zouache MA. The vascular geometry of the choriocapillaris is associated with spatially heterogeneous molecular exchange with the outer retina. J Physiol 2024; 602:1273-1295. [PMID: 38513000 DOI: 10.1113/jp285050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
Vision relies on the continuous exchange of material between the photoreceptors, retinal pigment epithelium and choriocapillaris, a dense microvascular bed located underneath the outer retina. The anatomy and physiology of the choriocapillaris and their association with retinal homeostasis have proven difficult to characterize, mainly because of the unusual geometry of this vascular bed. By analysing tissue dissected from 81 human eyes, we show that the thickness of the choriocapillaris does not vary significantly over large portions of the macula or with age. Assessments of spatial variations in the anatomy of the choriocapillaris in three additional human eyes indicate that the location of arteriolar and venular vessels connected to the plane of the choriocapillaris is non-random, and that venular insertions cluster around arteriolar ones. Mathematical models built upon these anatomical analyses reveal that the choriocapillaris contains regions where the transport of passive elements is dominated by diffusion, and that these diffusion-limited regions represent areas of reduced exchange with the outer retina. The width of diffusion-limited regions is determined by arterial flow rate and the relative arrangement of arteriolar and venular insertions. These analyses demonstrate that the apparent complexity of the choriocapillaris conceals a fine balance between several anatomical and functional parameters to effectively support homeostasis of the outer retina. KEY POINTS: The choriocapillaris is the capillary bed supporting the metabolism of photoreceptors and retinal pigment epithelium, two critical components of the visual system located in the outer part of the retina. The choriocapillaris has evolved a planar multipolar vascular geometry that differs markedly from the branched topology of most vasculatures in the human body. Here, we report that this planar multipolar vascular geometry is associated with spatially heterogenous molecular exchange between choriocapillaris and outer retina. Our data and analyses highlight a necessary balance between choriocapillaris anatomical and functional parameters to effectively support homeostasis of the outer retina.
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Affiliation(s)
- Caitlin D Faust
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah, USA
| | | | - Marc Toso
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Gregory S Hageman
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Ian Eames
- Department of Mechanical Engineering, University College London, London, UK
| | - Philip J Luthert
- Institute of Ophthalmology, University College London, London, UK
| | - Moussa A Zouache
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah, USA
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Risseeuw S, Pilgrim MG, Bertazzo S, Brown CN, Csincsik L, Fearn S, Thompson RB, Bergen AA, ten Brink JB, Kortvely E, Spiering W, Ossewaarde–van Norel J, van Leeuwen R, Lengyel I. Bruch's Membrane Calcification in Pseudoxanthoma Elasticum: Comparing Histopathology and Clinical Imaging. OPHTHALMOLOGY SCIENCE 2024; 4:100416. [PMID: 38170125 PMCID: PMC10758992 DOI: 10.1016/j.xops.2023.100416] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 01/05/2024]
Abstract
Purpose To investigate the histology of Bruch's membrane (BM) calcification in pseudoxanthoma elasticum (PXE) and correlate this to clinical retinal imaging. Design Experimental study with clinicopathological correlation. Subjects and Controls Six postmortem eyes from 4 PXE patients and 1 comparison eye from an anonymous donor without PXE. One of the eyes had a multimodal clinical image set for comparison. Methods Calcification was labeled with OsteSense 680RD, a fluorescent dye specific for hydroxyapatite, and visualized with confocal microscopy. Scanning electron microscopy coupled with energy-dispersive x-ray spectroscopy (SEM-EDX) and time-of-flight secondary ion mass spectrometry (TOF-SIMs) were used to analyze the elemental and ionic composition of different anatomical locations. Findings on cadaver tissues were compared with clinical imaging of 1 PXE patient. Main Outcome Measures The characteristics and topographical distribution of hydroxyapatite in BM in eyes with PXE were compared with the clinical manifestations of the disease. Results Analyses of whole-mount and sectioned PXE eyes revealed an extensive, confluent OsteoSense labeling in the central and midperipheral BM, transitioning to a speckled labeling in the midperiphery. These areas corresponded to hyperreflective and isoreflective zones on clinical imaging. Scanning electron microscopy coupled with energy-dispersive x-ray spectroscopy and TOF-SIMs analyses identified these calcifications as hydroxyapatite in BM of PXE eyes. The confluent fluorescent appearance originates from heavily calcified fibrous structures of both the collagen and the elastic layers of BM. Calcification was also detected in an aged comparison eye, but this was markedly different from PXE eyes and presented as small snowflake-like deposits in the posterior pole. Conclusions Pseudoxanthoma elasticum eyes show extensive hydroxyapatite deposition in the inner and outer collagenous and elastic BM layers in the macula with a gradual change toward the midperiphery, which seems to correlate with the clinical phenotype. The snowflake-like calcification in BM of an aged comparison eye differed markedly from the extensive calcification in PXE. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Sara Risseeuw
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Matthew G. Pilgrim
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Science, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Sergio Bertazzo
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Connor N. Brown
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Science, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Lajos Csincsik
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Science, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Sarah Fearn
- Department of Materials, Imperial College London, London, United Kingdom
| | - Richard B. Thompson
- University of Maryland School of Medicine, Department of Biochemistry and Molecular Biology, Baltimore, Maryland
| | - Arthur A. Bergen
- Departments of Human Genetics and Ophthalmology, Amsterdam UMC, location AMC Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Emma Center for Personalized Medicine, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Jacoline B. ten Brink
- Departments of Human Genetics and Ophthalmology, Amsterdam UMC, location AMC Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Elod Kortvely
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands
| | | | - Redmer van Leeuwen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Imre Lengyel
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Science, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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Moir J, Kaufmann G, Rodriguez SH, Nourian N, Abdul Rasheed M, Vupparaboina KK, Chhablani J, Skondra D. Racial Differences in Choroidal Vascularity Index in Healthy Patients: Novel Insights. Ophthalmic Surg Lasers Imaging Retina 2024; 55:30-38. [PMID: 38189798 DOI: 10.3928/23258160-20231113-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND AND OBJECTIVE Choroidal vascularity index (CVI) measures the ratio of blood vessels in the choroid to the total choroidal area. We aimed to compare CVI between young Black and White patients without a history of ocular or systemic disease. PATIENTS AND METHODS We used a previously validated algorithm for shadow compensation and choroidal vessel binarization to measure CVI across the Early Treatment of Diabetic Retinopathy Study grid. RESULTS Black patients had a lower CVI (ß = -0.05, P < 0.001) compared to White patients. Choroidal volume or luminal volume did not significantly differ with respect to race, whereas there was a trend for Black patients to have a greater stromal volume (ß = 3.08, P = 0.01). CONCLUSIONS Black patients have a lower CVI than do White patients, likely due to a greater proportion of stromal volume. Further study of this parameter is warranted to validate the findings of this exploratory study. [Ophthalmic Surg Lasers Imaging Retina 2024;55:30-38.].
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Zhou SW, Zhang Y, Noam N, Rabinovitch D, Bar D, Yousif BS, O'Brien R, Hiya FE, Lin Y, Berni A, Gregori G, Wang RK, Rosenfeld PJ, Trivizki O. The Impact of Carotid Endarterectomy on Choriocapillaris Perfusion. Invest Ophthalmol Vis Sci 2023; 64:42. [PMID: 38153750 PMCID: PMC10756242 DOI: 10.1167/iovs.64.15.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/03/2023] [Indexed: 12/29/2023] Open
Abstract
Purpose The impact of carotid endarterectomy (CEA) on choriocapillaris (CC) perfusion was investigated using swept-source optical coherence tomography angiography (SS-OCTA) imaging before and after surgery in patients with clinically significant carotid artery stenosis (CAS). Methods In this prospective observational study, patients with clinically significant CAS undergoing unilateral CEA had SS-OCTA imaging performed in both eyes before and within 1 week after surgery. The percent CC flow deficits (CC FD%) and CC thickness were assessed using previously validated algorithms. Multivariable regression analysis was conducted to evaluate the impact of variables on the change in CC measurements. Results A total of 112 eyes from 56 patients with an average age of 72.6 ± 6.9 years were enrolled. At baseline, significantly higher CC FD% and thinner CC thickness were observed on the surgical side (eyes ipsilateral to the side of CEA) versus the nonsurgical side (eyes contralateral to the side of CEA) (P = 0.001 and P = 0.03, respectively). Following CEA, a significant reduction in CC FD% and a significant increase in CC thickness were detected on the surgical as compared with the nonsurgical side (P = 0.008 and P = 0.01, respectively). Smoking status positively affected CC FD% change (coefficient of variation [CV] = 0.84, P = 0.01) on the surgical side and negatively affected CC thickness change on both the surgical side (CV = -0.382, P = 0.009) and the nonsurgical side (CV = -0.321, P = 0.04). The degree of stenosis demonstrated a positive influence on CC FD% change (CV = 0.040, P = 0.02) on the surgical side. Conclusions Unilateral CEA on the side of clinically significant CAS increases carotid blood flow, which further results in improved CC perfusion.
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Affiliation(s)
- Sandy W. Zhou
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
- Department of Ophthalmology, Tan Tock Seng Hospital, National Health Group Eye Institute, Singapore
| | - Yi Zhang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Natalie Noam
- Department of Vascular Surgery, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - David Rabinovitch
- Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Davidov Bar
- Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Basheer S. Yousif
- Department of Vascular Surgery, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Robert O'Brien
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Farhan E. Hiya
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Yufen Lin
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Alessandro Berni
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States
| | - Philip J. Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Omer Trivizki
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
- Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
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Hayreh SS, Hayreh SB. Uveal vascular bed in health and disease: uveal vascular bed anatomy. Paper 1 of 2. Eye (Lond) 2023; 37:2590-2616. [PMID: 37142776 PMCID: PMC10482978 DOI: 10.1038/s41433-023-02416-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 05/06/2023] Open
Abstract
The uveal vascular bed is the largest vascular system in the eye and has a role in supplying almost every tissue in the eyeball. This makes it the most important ocular vascular system. This is an up-to-date review of the literature of the entire uveal vascular bed in health based on detailed anatomy of the posterior ciliary arteries (PCAs), anterior ciliary arteries, cilioretinal arteries, and vortex veins. Although postmortem injection cast preparations gave us useful information on the morphology of the choroidal vascular bed; in vivo studies showed that they misled us for centuries about the in vivo situation. According to the postmortem cast studies, the uveal vascular bed has no segmental distribution, the uveal vessels anastomose freely with one another, there are inter-arterial and arteriovenous anastomoses in the choroid, and the choriocapillaris form a freely communicating and an uninterrupted vascular bed in the entire choroid.
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Affiliation(s)
- Sohan Singh Hayreh
- Department of Ophthalmology and Visual, College of Medicine, University of Iowa, Iowa City, IA, USA
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Hayreh SS, Hayreh SB. Uveal vascular bed in health and disease: lesions produced by occlusion of the uveal vascular bed and acute uveal ischaemic lesions seen clinically. Paper 2 of 2. Eye (Lond) 2023; 37:2617-2648. [PMID: 37185956 PMCID: PMC10482881 DOI: 10.1038/s41433-023-02417-y] [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: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 05/06/2023] Open
Abstract
From studies on postmortem anatomical descriptions of the uveal vascular bed, it was generally concluded that occlusion of PCA or its branches should not produce an ischemic lesion. However, in vivo studies have recorded that the PCAs and their branches, right down to the terminal choroidal arterioles, and the choriocapillaris, have a segmental distribution in the choroid, and that PCAs and choroidal arteries function as end-arteries. This explains the basis of the occurrence of isolated inflammatory, ischemic, metastatic, and degenerative choroidal lesions, which are usually localized. Thus, in vivo studies have completely revolutionized our concept of the uveal vascular bed in disease.
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Affiliation(s)
- Sohan Singh Hayreh
- Departments of Ophthalmology and Visual Scence, College of Medicine, University of Iowa, Iowa City, 52242, USA
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Di Pippo M, Santia C, Rullo D, Ciancimino C, Grassi F, Abdolrahimzadeh S. The Choroidal Vascularity Index Versus Optical Coherence Tomography Angiography in the Evaluation of the Choroid with a Focus on Age-Related Macular Degeneration. Tomography 2023; 9:1456-1470. [PMID: 37624109 PMCID: PMC10458084 DOI: 10.3390/tomography9040116] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
The choroid is the most vascularized structure of the eye and it is fundamental for the trophism of the outer retina. Its proper functioning and homeostasis represent key points in maintaining normal retinal physiology. Choroidal alterations may be implicated in the development and progression of numerous pathologies; therefore, in-depth studies using imaging techniques can be of crucial relevance to understanding the pathophysiology of retinal-choroidal diseases. The advent of spectral-domain optical coherence tomography (SDOCT) has enabled the non-invasive study of the choroid in vivo and the most recent development, optical coherence tomography angiography (OCTA), allows for the high-resolution visualization of the choriocapillaris and the choroid in regard to vascularization. The choroidal vascularity index (CVI) is a new parameter calculated on SDOCT scans and is defined as the ratio of the luminal area to the total choroidal area. In this review, a study of the choroid using OCTA and CVI will be evaluated in depth and the pros and cons of these two methods will be analyzed, with a particular focus on age-related macular degeneration.
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Affiliation(s)
| | | | | | | | | | - Solmaz Abdolrahimzadeh
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, St. Andrea Hospital, 00189 Rome, Italy; (M.D.P.); (C.C.)
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11
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Li J, Wang D, Pottenburgh J, Bower AJ, Asanad S, Lai EW, Simon C, Im L, Huryn LA, Tao Y, Tam J, Saeedi OJ. Visualization of erythrocyte stasis in the living human eye in health and disease. iScience 2023; 26:105755. [PMID: 36594026 PMCID: PMC9803835 DOI: 10.1016/j.isci.2022.105755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/25/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Blood cells trapped in stasis have been reported within the microcirculation, but their relevance to health and disease has not been established. In this study, we introduce an in vivo imaging approach that reveals the presence of a previously-unknown pool of erythrocytes in stasis, located within capillary segments of the CNS, and present in 100% of subjects imaged. These results provide a key insight that blood cells pause as they travel through the choroidal microvasculature, a vascular structure that boasts the highest blood flow of any tissue in the body. Demonstration of clinical utility using deep learning reveals that erythrocyte stasis is altered in glaucoma, indicating the possibility of more widespread changes in choroidal microvascular than previously realized. The ability to monitor the choroidal microvasculature at the single cell level may lead to novel strategies for tracking microvascular health in glaucoma, age-related macular degeneration, and other neurodegenerative diseases.
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Affiliation(s)
- Joanne Li
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dongyi Wang
- Bioimaging and Machine Vision Laboratory, Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Jessica Pottenburgh
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew J. Bower
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Samuel Asanad
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eric W. Lai
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Caroline Simon
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lily Im
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laryssa A. Huryn
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yang Tao
- Bioimaging and Machine Vision Laboratory, Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Johnny Tam
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Osamah J. Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
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12
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Moir J, Rodriguez SH, Chun LY, Massamba N, Skondra D. Racial differences in quantitative optical coherence tomography angiography findings between older non-diabetics with co-morbidities. PLoS One 2023; 18:e0285360. [PMID: 37146056 PMCID: PMC10162566 DOI: 10.1371/journal.pone.0285360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 04/22/2023] [Indexed: 05/07/2023] Open
Abstract
This cross-sectional study compared optical coherence tomography angiography (OCTA) parameters between older Black and White adults with systemic comorbidities in an effort to further understand racial differences in the retinal microvasculature. We analyzed vessel density at the superficial (SCP), intermediate (ICP), and deep capillary plexuses (DCP), foveal avascular zone (FAZ) parameters, and blood flow area (BFA) at the choriocapillaris. We used a mixed-effects linear regression model, controlling for hypertension and two eyes from the same subject, to compare OCTA parameters. Black subjects had lower foveal vessel density at the SCP and ICP, while no differences were observed at the parafovea or 3x3 mm macular area of any capillary layer. Black subjects had greater FAZ area, perimeter, and FD-300, a measurement of vessel density in a 300 μm wide ring around the FAZ. Black subjects also had lower BFA at the choriocapillaris. Within a cohort of subjects without hypertension, these differences remained statistically significant, with the exception of foveal vessel density at the SCP and foveal BFA of the choriocapillaris. These findings suggest that normative databases of OCTA parameters must strive to be diverse in nature to adequately capture differences across patient populations. Further study is required to understand if baseline differences in OCTA parameters contribute to epidemiological disparities in ocular diseases.
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Affiliation(s)
- John Moir
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Sarah H Rodriguez
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, United States of America
| | - Lindsay Y Chun
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, United States of America
| | - Nathalie Massamba
- Department of Ophthalmology, Handicap, and Vision, Pitie Salpetriere Hospital, Sorbonne University, Paris, France
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, United States of America
- J. Terry Ernest Ocular Imaging Center, University of Chicago, Chicago, Illinois, United States of America
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13
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Choroidal structural changes in airline pilots and cabin crew. Int Ophthalmol 2022; 43:1819-1823. [DOI: 10.1007/s10792-022-02580-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 11/12/2022] [Indexed: 11/23/2022]
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14
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Zaitoun IS, Song YS, Zaitoun HB, Sorenson CM, Sheibani N. Assessment of Choroidal Vasculature and Innate Immune Cells in the Eyes of Albino and Pigmented Mice. Cells 2022; 11:3329. [PMID: 36291198 PMCID: PMC9600292 DOI: 10.3390/cells11203329] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 12/05/2022] Open
Abstract
The visualization of choroidal vasculature and innate immune cells in the eyes of pigmented mice has been challenging due to the presence of a retinal pigment epithelium (RPE) layer separating the choroid and retina. Here, we established methods for visualizing the choroidal macrophages, mast cells, and vasculature in eyes of albino and pigmented mice using cell type-specific staining. We were able to visualize the choroidal arterial and venous systems. An arterial circle around the optic nerve was found in mice similar to the Zinn-Haller arterial circle that exists in humans and primates. Three different structural patterns of choriocapillaris were observed throughout the whole choroid: honeycomb-like, maze-like, and finger-like patterns. Choroidal mast cells were relatively few but dense around the optic nerve. Mast cell distribution in the middle and periphery was different among strains. Macrophages were found in all layers of the choroid. Thus, utilizing the simple and reliable methods described herein will allow the evaluation of transgenic and preclinical mouse models of ocular diseases that affect the choroid, including age-related macular degeneration (AMD), diabetic choroidopathy, and retinopathy of prematurity. These studies will advance our understanding of the pathophysiology, and molecular and cellular mechanisms that can be targeted therapeutically, in these diseases.
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Affiliation(s)
- Ismail S. Zaitoun
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
- McPherson Eye Research Institute, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
| | - Yong-Seok Song
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
- McPherson Eye Research Institute, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
| | - Hammam B. Zaitoun
- Faculty of Medicine, Yarmouk University in Irbid, Irbid 21163, Jordan
| | - Christine M. Sorenson
- McPherson Eye Research Institute, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
| | - Nader Sheibani
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
- McPherson Eye Research Institute, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
- Department of Cell and Regenerative Biology, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI 53706, USA
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15
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Tagawa M, Ooto S, Yamashiro K, Tamura H, Oishi A, Uji A, Miyata M, Miyake M, Takahashi A, Ichioka A, Tsujikawa A. Choriocapillaris flow deficit in a pachychoroid spectrum disease using en face optical coherence tomography angiography averaging. PLoS One 2022; 17:e0271747. [PMID: 36094941 PMCID: PMC9467345 DOI: 10.1371/journal.pone.0271747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/06/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose
To investigate the choriocapillaris changes associated with pachychoroid pigment epitheliopathy (PPE) in comparison with healthy eyes.
Methods
Nine 3 × 3 mm macular optical coherence tomography angiography images were acquired in patients with PPE and age-matched healthy participants. Multiple en face image averaging of the choriocapillaris was binarized for quantitative image analysis of the flow voids. In PPE eyes, we evaluated the presence of pachyvessels and the association between the location of the choriocapillaris flow deficit and pachyvessels.
Results
Thirty-two eyes with PPE and 30 eyes of healthy participants were included. In PPE eyes, the mean total area (1.16 ± 0.18 vs. 0.91 ± 0.16, p < 0.001) and average size of the flow voids (790 ± 144 vs. 520 ± 138; p < 0.001) were significantly larger than those in control eyes. Composite images of the choriocapillaris and choroid showed choriocapillaris flow deficits just above and outside the pachyvessels. The mean proportion of the flow void area overlying the pachyvessels against the whole flow void area of the choriocapillaris was 21.3% ± 10.2% (9.38%-44.42%) in PPE eyes.
Conclusions
In PPE eyes, the blood flow area of the choriocapillaris decreased diffusely within the macular area compared to control eyes, and the choriocapillaris flow deficit was not necessarily related to pachyvessel location.
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Affiliation(s)
- Miho Tagawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- * E-mail:
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Oishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ai Ichioka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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16
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Singh RB, Perepelkina T, Testi I, Young BK, Mirza T, Invernizzi A, Biswas J, Agarwal A. Imaging-based Assessment of Choriocapillaris: A Comprehensive Review. Semin Ophthalmol 2022:1-22. [PMID: 35982638 DOI: 10.1080/08820538.2022.2109939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
PURPOSE Over the past two decades, advancements in imaging modalities have significantly evolved the diagnosis and management of retinal diseases. Through these novel platforms, we have developed a deeper understanding of the anatomy of the choroidal vasculature and the choriocapillaris. The recently developed tools such as optical coherence tomography (OCT) and OCT angiography (OCTA) have helped elucidate the pathological mechanisms of several posterior segment diseases. In this review, we have explained the anatomy of the choriocapillaris and its close relationship to the outer retina and retinal pigment epithelium. METHODS A comprehensive search of medical literature was performed through the Medline/PubMed database using search terms: choriocapillaris, choroid, quantification, biomarkers, diabetic retinopathy, age-related macular degeneration, choroidal blood flow, mean blur rate, flow deficit, optical coherence tomography, optical coherence tomography angiography, fluorescein angiography, indocyanine green angiography, OCTA, Doppler imaging, uveitis, choroiditis, white dot syndrome, tubercular serpiginous-like choroiditis, choroidal granuloma, pachychoroid, toxoplasmosis, central serous chorioretinopathy, multifocal choroiditis, choroidal neovascularization, choroidal thickness, choroidal vascularity index, choroidal vascular density, and choroidal blood supply. The search terms were used either independently or combined with choriocapillaris/choroid. RESULTS The imaging techniques which are used to qualitatively and quantitatively analyze choriocapillaris are described. The pathological alterations in the choriocapillaris in an array of conditions such as diabetes mellitus, age-related macular degeneration, pachychoroid spectrum of diseases, and inflammatory disorders have been comprehensively reviewed. The future directions in the study of choriocapillaris have also been discussed. CONCLUSION The development of imaging tools such as OCT and OCTA has dramatically improved the assessment of choriocapillaris in health and disease. The choriocapillaris can be delineated from the stromal choroid using the OCT and quantified by manual or automated methods. However, these techniques have inherent limitations due to the lack of an anatomical distinction between the choriocapillaris and the stromal choroid, which can be overcome with the use of predefined segmentation slabs on OCT and OCTA. These segmentation slabs help in standardizing the choriocapillaris imaging and obtain repeatable measurements in various conditions such as diabetic retinopathy, age-related macular degeneration, pachychoroid spectrum, and ocular inflammations. Additionally, Doppler imaging has also been effectively used to evaluate the choroidal blood flow and quantifying the choriocapillaris and establishing its role in the pathogenesis of various retinochoroidal diseases. As tremendous technological advancements such as wide-field and ultra-wide field imaging take place, there will be a significant improvement in the ease and accuracy of quantifying the choriocapillaris.
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Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.,Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Tatiana Perepelkina
- Department of Ophthalmology, Louisiana State University Health Sciences, Shreveport, LA, USA
| | - Ilaria Testi
- Department of Ophthalmology, Moorfields Eye Hospital, London, UK
| | - Benjamin K Young
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Tuba Mirza
- Department of Ophthalmology, Ascension Macomb Oakland Eye Institute, Warren, MI, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Nethralaya, Chennai, India
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.,Department of Ophthalmology, Maastricht University Medical Center, Maastricht, The Netherlands
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17
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Zouache MA. Variability in Retinal Neuron Populations and Associated Variations in Mass Transport Systems of the Retina in Health and Aging. Front Aging Neurosci 2022; 14:778404. [PMID: 35283756 PMCID: PMC8914054 DOI: 10.3389/fnagi.2022.778404] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/13/2022] [Indexed: 11/17/2022] Open
Abstract
Aging is associated with a broad range of visual impairments that can have dramatic consequences on the quality of life of those impacted. These changes are driven by a complex series of alterations affecting interactions between multiple cellular and extracellular elements. The resilience of many of these interactions may be key to minimal loss of visual function in aging; yet many of them remain poorly understood. In this review, we focus on the relation between retinal neurons and their respective mass transport systems. These metabolite delivery systems include the retinal vasculature, which lies within the inner portion of the retina, and the choroidal vasculature located externally to the retinal tissue. A framework for investigation is proposed and applied to identify the structures and processes determining retinal mass transport at the cellular and tissue levels. Spatial variability in the structure of the retina and changes observed in aging are then harnessed to explore the relation between variations in neuron populations and those seen among retinal metabolite delivery systems. Existing data demonstrate that the relation between inner retinal neurons and their mass transport systems is different in nature from that observed between the outer retina and choroid. The most prominent structural changes observed across the eye and in aging are seen in Bruch's membrane, which forms a selective barrier to mass transfers at the interface between the choroidal vasculature and the outer retina.
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Affiliation(s)
- Moussa A. Zouache
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, United States
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18
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Cerquaglia A, Lupidi M, Chhablani J, Gujar R, Iaccheri B, Fiore T, Fruttini D, Ramundo A, Vupparaboina KK, Castellani L, Simonetti E, De Carolis L, Tiacci E, Falini B, Cagini C. Choroidal vasculature analysis in MEK inhibitor-associated retinopathy. Eur J Ophthalmol 2022; 32:3564-3573. [PMID: 35195471 DOI: 10.1177/11206721221081471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate choroidal vascularity index (CVI) in patients developing mitogen-activated protein kinase kinase (MEK) inhibitor-associated retinopathy (MEKAR). METHODS In this prospective observational study, extensive ophthalmic examination was performed, including enhanced-depth-imaging-optical coherence tomography (EDI-OCT). EDI-OCT scans of patients receiving Cobimetinib, taken at baseline and at MEKAR manifestation, were considered for choroid analysis. Choroidal thickness (CT) was measured on high-resolution b-scans passing through the fovea at three different locations. Same scans were therefore imported for binarization into a previously reported software and CVI was calculated as the ratio of luminal area (LA) to total choroid area (TCA). RESULTS When compared to baseline, eyes with MEKAR (14 eyes) did not show significative CT variation in subfoveal region (p = 0,57), 750-µm-nasal to the fovea (p = 0,08) and 750-µm-temporal to the fovea (p = 0,07). Similarly, there were no statistically significant differences for TCA (p = 0.54), LA (p = 0.85), stromal area (SA) (p = 0.13), LA/SA (p = 0.34) and CVI (p = 0.47). Best-corrected visual acuity was significantly reduced at fluid accumulation when compared to baseline values (p = 0.03), with complete recovery after fluid resolution (p = 0.73). CONCLUSION Multiple parameters reflecting the status of the choroid seemed not influenced by Cobimetinib administration. Retinal pigment epithelium toxic disfunction likely represents the crucial step in MEKAR pathogenesis.
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Affiliation(s)
- Alessio Cerquaglia
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
| | - Marco Lupidi
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
| | - Jay Chhablani
- Department of Ophthalmology, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ramkailash Gujar
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
| | - Barbara Iaccheri
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
| | - Tito Fiore
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
| | - Daniela Fruttini
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
| | - Antonello Ramundo
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
| | | | - Luca Castellani
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
| | - Edoardo Simonetti
- Hematology, Center for Research in Hemato-Oncology (CREO), 9309University of Perugia, Perugia, Italy
| | - Luca De Carolis
- Hematology, Center for Research in Hemato-Oncology (CREO), 9309University of Perugia, Perugia, Italy
| | - Enrico Tiacci
- Hematology, Center for Research in Hemato-Oncology (CREO), 9309University of Perugia, Perugia, Italy
| | - Brunangelo Falini
- Hematology, Center for Research in Hemato-Oncology (CREO), 9309University of Perugia, Perugia, Italy
| | - Carlo Cagini
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
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19
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Waxman S, Brazile BL, Yang B, Lee PY, Hua Y, Gogola AL, Lam P, Voorhees AP, Rizzo JF, Jakobs TC, Sigal IA. Lamina cribrosa vessel and collagen beam networks are distinct. Exp Eye Res 2022; 215:108916. [PMID: 34973204 PMCID: PMC8923914 DOI: 10.1016/j.exer.2021.108916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/29/2021] [Accepted: 12/23/2021] [Indexed: 02/03/2023]
Abstract
Our goal was to analyze the spatial interrelation between vascular and collagen networks in the lamina cribrosa (LC). Specifically, we quantified the percentages of collagen beams with/without vessels and of vessels inside/outside of collagen beams. To do this, the vasculature of six normal monkey eyes was labeled by perfusion post-mortem. After enucleation, coronal cryosections through the LC were imaged using fluorescence and polarized light microscopy to visualize the blood vessels and collagen beams, respectively. The images were registered to form 3D volumes. Beams and vessels were segmented, and their spatial interrelationship was quantified in 3D. We found that 22% of the beams contained a vessel (range 14%-32%), and 21% of vessels were outside beams (13%-36%). Stated differently, 78% of beams did not contain a vessel (68%-86%), and 79% of vessels were inside a beam (64%-87%). Individual monkeys differed significantly in the fraction of vessels outside beams (p < 0.01 by linear mixed effect analysis), but not in the fraction of beams with vessels (p > 0.05). There were no significant differences between contralateral eyes in the percent of beams with vessels and of vessels outside beams (p > 0.05). Our results show that the vascular and collagenous networks of the LC in monkey are clearly distinct, and the historical notions that each LC beam contains a vessel and all vessels are within beams are inaccurate. We postulate that vessels outside beams may be relatively more vulnerable to mechanical compression by elevated IOP than are vessels shielded inside of beams.
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Affiliation(s)
- Susannah Waxman
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Bryn L. Brazile
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Bin Yang
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA,Department of Engineering, Duquesne University, Pittsburgh, PA, USA
| | - Po-Yi Lee
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh PA, USA
| | - Yi Hua
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Alexandra L. Gogola
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Po Lam
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Andrew P. Voorhees
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Joseph F. Rizzo
- Neuro-Ophthalmology Service, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA,Neuro-Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Tatjana C. Jakobs
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary/Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
| | - Ian A. Sigal
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh PA, USA,Correspondence: Ian A. Sigal, Ph.D., Laboratory of Ocular Biomechanics, Department of Ophthalmology, University of Pittsburgh Medical Center, 203 Lothrop St. Rm. 930, Pittsburgh, PA, USA. 15213, Phone: (412) 864-2220; fax: (412) 647-5880, www.OcularBiomechanics.org
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20
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Corvi F, Corradetti G, Sadda SR. Comparison Between Different Segmentation Strategies for the Choriocapillaris Using Optical Coherence Tomography Angiography. Ophthalmic Surg Lasers Imaging Retina 2021; 52:642-649. [PMID: 34908487 DOI: 10.3928/23258160-20211123-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess the relationship between retinal pigment epithelium (RPE) and RPE fit-based segmentations of the choriocapillaris (CC) and its expected anatomic location. PATIENTS AND METHODS Consecutive healthy participants' eyes were imaged with optical coherence tomography angiography (PLEX Elite) with 3 × 3-mm and 6 × 6-mm scan. Ground-truth images were generated using 16-μm-thick slabs starting from 4 μm below the automatically segmented Bruch's membrane (BM) band. A series of slabs positioned below the RPE band and RPE fit were also generated, and CC flow deficit percentage was compared with the ground-truth segmentation. RESULTS Twenty-six eyes of 26 participants were analyzed. For both scans, the 21 to 37-μm slab offset from the RPE band most closely matched the BM-based ground-truth slab with mean differences of 0.78% and 0.36%. CONCLUSION The CC flow deficit percentage from the RPE band correlated strongly with BM-based CC slabs, with the closest approximation observed with slab offset 21 to 37 μm from the RPE band centerline. [Ophthalmic Surg Lasers Imaging. 2021;52:642-649.].
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21
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Bartol-Puyal FDA, Isanta C, Calvo P, Méndez-Martínez S, Ruiz-Moreno Ó, Pablo L. Mapping of choriocapillaris vascular density in young and aged healthy subjects. Eur J Ophthalmol 2021; 32:2789-2800. [PMID: 34881677 DOI: 10.1177/11206721211067019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare macular vascular density (VD) of the choriocapillaris (CC) between young and aged healthy individuals. METHODS A cross-sectional study was performed enrolling young and senior healthy individuals of Caucasian race and an axial length (AL) lower than 26 mm, and without systemic or ophthalmological diseases. CC VD was imaged with DRI Triton OCTA using a 6 × 6 mm macular analysis. Internal software delimited CC boundaries and gave colour pictures, which were analysed and codified into numbers, and a grid of 30 × 30 VD values was obtained. Two-dimension (2D) and three-dimension (3D) representations were created. RESULTS 53 eyes of 53 young healthy individuals and 30 eyes of 30 senior healthy individuals were enrolled. Mean age was 27.17 ± 3.90 years, and 67.00 ± 7.41 years, respectively (p < 0.001). There were no differences in intraocular pressure (IOP) or AL (23.73 ± 0.79 mm, 23.18 ± 0.80 mm, respectively, p = 0.24). There were differences in foveal VD and in temporal perifoveal macula, but not in nasal perifoveal macula. Foveal VD was the highest in both groups. CONCLUSIONS Foveal CC VD has been found to be considerably high with this method, and it is the area which most decreases with age. Nasal perifoveal VD is not reduced in older individuals. These outcomes are opposite to other studies using different methods but they are in line with previous histological findings.
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Affiliation(s)
- Francisco de Asís Bartol-Puyal
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Carlos Isanta
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Pilar Calvo
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Silvia Méndez-Martínez
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Óscar Ruiz-Moreno
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain.,16765Universidad de Zaragoza, Zaragoza, Spain
| | - Luis Pablo
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain.,16765Universidad de Zaragoza, Zaragoza, Spain.,Biotech Vision SLP, University of Zaragoza, Spain
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22
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Xie R, Qiu B, Chhablani J, Zhang X. Evaluation of Choroidal Thickness Using Optical Coherent Tomography: A Review. Front Med (Lausanne) 2021; 8:783519. [PMID: 34926529 PMCID: PMC8677938 DOI: 10.3389/fmed.2021.783519] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 10/18/2021] [Indexed: 12/21/2022] Open
Abstract
The choroid is the main source of blood and nourishment supply to the eye. The dysfunction of the choroid has been implicated in various retinal and choroidal diseases. The identification and in-depth understanding of pachychoroid spectrum disorders are based on the tremendous progress of optical coherence tomography (OCT) technology in recent years, although visibility of choroid is challenging in the era of the time or spectral domain OCT. The recent rapid revolution of OCTs, such as the enhanced depth imaging OCT and the swept-source OCT, has greatly contributed to the significant improvement in the analysis of the morphology and physiology of the choroid precisely, especially to the choroid-scleral boundary and vasculature. The present review highlights the recently available evidence on the measurement methodology and the clinical significance of choroidal thickness in retinal or choroidal disorders.
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Affiliation(s)
- Rui Xie
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China
| | - Bingjie Qiu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China
| | - Jay Chhablani
- The University of Pittsburgh Medical Center Eye Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Xinyuan Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China
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Wu H, Sugano Y, Itagaki K, Kasai A, Shintake H, Sekiryu T. The characteristics of choriocapillaris flow void in the unilateral polypoidal choroidal vasculopathy fellow eyes. Sci Rep 2021; 11:23059. [PMID: 34845281 PMCID: PMC8629998 DOI: 10.1038/s41598-021-02377-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/08/2021] [Indexed: 11/09/2022] Open
Abstract
To evaluate the morphological characteristics of flow void (FV) in the fellow eyes of the unilateral polypoidal choroidal vasculopathy (PCV). Fifty PCV fellow eyes (PCVF) and 31 age-matched normal ocular circulation controls were recruited in this retrospective study. The number of FV was analyzed according to the size in a centered 5 × 5 mm swept source optical coherence tomography angiography scans. We used indocyanine green angiography images to determine whether choroidal vascular hyperpermeability (CVH) has occurred. For the PCVF, the prevalence rate of CVH was 70% (35 of 50) The number of FVs was significantly lower in 400-25,000 μm2 (P = 0.005), 400-500 μm2 (P = 0.001), 525-625 μm2 (P = 0.001) and 650-750 μm2 (P = 0.018). compared to the controls. And showed no difference in size from 775 to 1125 μm2 between the two groups. The area under the receiver operating characteristic curve of PCVF with CVH and controls was 0.94 (95% CI 0.88-1.00) (P < 0.001). We found that the number of small FVs was significantly lower in the PCV fellow eyes than that in the eyes with control group.
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Affiliation(s)
- Huajui Wu
- Department of Ophthalmology, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, Japan
| | - Yukinori Sugano
- Department of Ophthalmology, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, Japan
| | - Kanako Itagaki
- Department of Ophthalmology, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, Japan
| | - Akihito Kasai
- Department of Ophthalmology, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, Japan
| | - Hiroaki Shintake
- Department of Ophthalmology, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, Japan.
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Correlations among age, sex, axial length, and subfoveal choroidal thickness in the choriocapillaris structure analyzed using multiple en face image averaging optical coherence tomography angiography. PLoS One 2021; 16:e0259880. [PMID: 34780537 PMCID: PMC8592481 DOI: 10.1371/journal.pone.0259880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To analyze the structure of the choriocapillaris in healthy eyes by using averaged en face images acquired using swept source optical coherence tomography angiography and to examine the changes in the macular profile in relation to age, sex, axial length, and choroidal thickness. Methods This prospective, cross-sectional study included 81 eyes of 81 subjects without ophthalmologic or systemic diseases who underwent a full ophthalmologic examination, including 3 × 3-mm macular optical coherence tomography angiography. Four to nine choriocapillaris en face images were registered and averaged. The averaged images were then binarized and analyzed. Results The averaged choriocapillaris images showed a continuous capillary meshwork, whereas the unaveraged images had a granular appearance. The mean total area and size of flow voids were 0.99 ± 0.20 mm2 and 567.8 ± 201.5 μm2, respectively, and these values correlated positively with age (p = 0.002, R = 0.336 and p = 0.026, R = 0.247, respectively). Age-related gains in the mean total area and flow void size were 4.20 × 10−3 mm2 and 3.07 μm2 per year, respectively. However, the mean total area and flow void size had no significant correlation with axial length, subfoveal choroidal thickness, or sex. Conclusions Multiple averaged en face swept source optical coherence tomography angiography is more effective than a single optical coherence tomography angiography scan for better visualizing the choriocapillaris. The total area and size of flow voids within a 3 × 3-mm macular area positively correlated with age. This technique can be useful for investigating the changes arising in macular diseases.
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25
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Abstract
Advances in retinal imaging are enabling researchers and clinicians to make precise noninvasive measurements of the retinal vasculature in vivo. This includes measurements of capillary blood flow, the regulation of blood flow, and the delivery of oxygen, as well as mapping of perfused blood vessels. These advances promise to revolutionize our understanding of vascular regulation, as well as the management of retinal vascular diseases. This review provides an overview of imaging and optical measurements of the function and structure of the ocular vasculature. We include general characteristics of vascular systems with an emphasis on the eye and its unique status. The functions of vascular systems are discussed, along with physical principles governing flow and its regulation. Vascular measurement techniques based on reflectance and absorption are briefly introduced, emphasizing ways of generating contrast. One of the prime ways to enhance contrast within vessels is to use techniques sensitive to the motion of cells, allowing precise measurements of perfusion and blood velocity. Finally, we provide a brief introduction to retinal vascular diseases.
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Affiliation(s)
- Stephen A Burns
- Indiana University School of Optometry, Bloomington, Indiana 47405, USA; , ,
| | - Ann E Elsner
- Indiana University School of Optometry, Bloomington, Indiana 47405, USA; , ,
| | - Thomas J Gast
- Indiana University School of Optometry, Bloomington, Indiana 47405, USA; , ,
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26
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Ng DSC, Chan LKY, Ng CM, Lai TYY. Visualising the choriocapillaris: Histology, imaging modalities and clinical research - A review. Clin Exp Ophthalmol 2021; 50:91-103. [PMID: 34387023 DOI: 10.1111/ceo.13984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/09/2021] [Indexed: 01/02/2023]
Abstract
The choriocapillaris plays a considerable role in the normal physiology of the eye as well as in various diseases. Assessing the changes in the choriocapillaris can therefore provide important information about normal ageing and pathogenesis of visual impairment, and even some systemic diseases. In vivo imaging of the choriocapillaris has evolved from non-depth resolved, dye-based angiography to advanced, high-resolution optical coherence tomography angiography (OCTA). However, the intricate microvascular networks within the choriocapillaris are still beyond the resolving limits of most OCTA instruments. Knowledge of histology, meticulous image acquisition methods, recognition of artefact and post-acquisition processing techniques are necessary for optimising OCTA choriocapillaris images. Qualitative and quantitative analyses of the choriocapillaris provide clinical information in age-related macular degeneration (AMD), diabetic retinopathy (DR), pathologic myopia and central serous chorioretinopathy (CSC). Furthermore, studies have revealed choriocapillaris changes in posterior uveitis that are correlated with treatment outcome and have important prognostic significance. In addition to retinal diseases, choriocapillaris changes have been observed in systemic vascular diseases and complications associated with pregnancy.
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Affiliation(s)
- Danny Siu-Chun Ng
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Mong Kok, Hong Kong
| | - Leo Ka-Yu Chan
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Mong Kok, Hong Kong
| | - Ching Man Ng
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,2010 Retina & Macula Centre, Kowloon, Hong Kong
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27
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Zhao M, Lam AK, Cheong AM. Structural and haemodynamic properties of ocular vasculature in axial myopia. Clin Exp Optom 2021; 105:247-262. [PMID: 34343434 DOI: 10.1080/08164622.2021.1943320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The high prevalence of myopia has become a global concern, especially in East and Southeast Asia. Alarmingly, the prevalence of high myopia is increasing. Mechanical stretching caused by excessive eyeball elongation leads to various anatomical changes in the fundus. This stretching force may also lead to the development of vascular abnormalities, which tend to be subtle and easily overlooked. A healthy ocular vasculature is a prerequisite of adequate oxygen supply for normal retinal functions. This review summarises previous findings on structural and haemodynamic aspects of myopia-related vascular changes.
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Affiliation(s)
- Mei Zhao
- Centre for Myopia Research, School of Optometry, Faculty of Health and Social Science, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Andrew Kc Lam
- Centre for Myopia Research, School of Optometry, Faculty of Health and Social Science, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Allen My Cheong
- Centre for Myopia Research, School of Optometry, Faculty of Health and Social Science, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
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28
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Bhalla M, Heisler M, Mammo Z, Ju MJ, Sarunic MV, Navajas EV, Warner S, Schendel S, Gill KS. Investigation of the Peripapillary Choriocapillaris in Normal Tension Glaucoma, Primary Open-angle Glaucoma, and Control Eyes. J Glaucoma 2021; 30:682-689. [PMID: 33927150 DOI: 10.1097/ijg.0000000000001861] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/01/2021] [Indexed: 11/26/2022]
Abstract
PRECIS The peripapillary choriocapillaris (CC) was observed to be significantly impaired in normal tension glaucoma (NTG) subjects compared with normal controls using optical coherence tomography angiography (OCTA). PURPOSE The aim was to quantitatively evaluate the peripapillary CC in NTG, primary open-angle glaucoma (POAG), and control eyes using OCTA. MATERIALS AND METHODS Ninety eyes (30 controls, 30 NTG, and 30 POAG) from 73 patients were imaged using the Zeiss Plex Elite 9000. Five repeat 3×3 mm OCTA scans were acquired both nasally and temporally to the optic disc and subsequently averaged. Four CC flow deficit (FD) measures were calculated using the fuzzy C-means approach: FD density (FDD), mean FD size (MFDS), FD number (FDN), and FD area (FDA). RESULTS Temporal NTG CC parameters were associated with visual field index and mean deviation (P<0.05). The control group showed a significantly lower nasal FDD (nasal: 3.79±1.26%, temporal: 4.48±1.73%, P=0.03), FDN (nasal: 156.43±38.44, temporal: 178.40±45.68, P=0.02), and FDA (nasal: 0.22±0.08, temporal: 0.26±0.10, P=0.03) when compared with temporal optic disc. The NTG group showed a significantly higher FDD (NTG: 5.04±2.38%, control: 3.79±1.26%, P=0.03), FDN (NTG: 185.90±56.66, control: 156.43±38.44, P=0.04), and FDA (NTG: 0.30±0.14 mm2, control: 0.22±0.08 mm2, P=0.03) nasal to the optic disc compared with controls. CONCLUSIONS Association between CC parameters and glaucoma severity in NTG, but not POAG subjects, suggests vascular abnormalities may be a potential factor in the multifactorial process of glaucoma damage in NTG patients.
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Affiliation(s)
| | - Morgan Heisler
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
| | - Zaid Mammo
- Department of Ophthalmology and Visual Sciences
| | - Myeong Jin Ju
- Department of Ophthalmology and Visual Sciences
- School of Biomedical Engineering, University of British Columbia, Vancouver
| | - Marinko V Sarunic
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
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Lejoyeux R, Benillouche J, Ong J, Errera MH, Rossi EA, Singh SR, Dansingani KK, da Silva S, Sinha D, Sahel JA, Freund KB, Sadda SR, Lutty GA, Chhablani J. Choriocapillaris: Fundamentals and advancements. Prog Retin Eye Res 2021; 87:100997. [PMID: 34293477 DOI: 10.1016/j.preteyeres.2021.100997] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 12/19/2022]
Abstract
The choriocapillaris is the innermost structure of the choroid that directly nourishes the retinal pigment epithelium and photoreceptors. This article provides an overview of its hemovasculogenesis development to achieve its final architecture as a lobular vasculature, and also summarizes the current histological and molecular knowledge about choriocapillaris and its dysfunction. After describing the existing state-of-the-art tools to image the choriocapillaris, we report the findings in the choriocapillaris encountered in the most frequent retinochoroidal diseases including vascular diseases, inflammatory diseases, myopia, pachychoroid disease spectrum disorders, and glaucoma. The final section focuses on the development of imaging technology to optimize visualization of the choriocapillaris as well as current treatments of retinochoroidal disorders that specifically target the choriocapillaris. We conclude the article with pertinent unanswered questions and future directions in research for the choriocapillaris.
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Affiliation(s)
| | | | - Joshua Ong
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Marie-Hélène Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15213, USA
| | - Sumit R Singh
- Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, San Diego, CA, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Susana da Silva
- Department of Ophthalmology and Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Debasish Sinha
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Cell Biology and Center for Biologic Imaging, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - José-Alain Sahel
- Rothschild Foundation, 75019, Paris, France; Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France; CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, Paris, France
| | - K Bailey Freund
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University of Medicine, New York, NY, USA; Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, 90033, USA; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gerard A Lutty
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, 21287, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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30
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Zhou H, Bacci T, Freund KB, Wang RK. Three-dimensional segmentation and depth-encoded visualization of choroidal vasculature using swept-source optical coherence tomography. Exp Biol Med (Maywood) 2021; 246:2238-2245. [PMID: 34259053 DOI: 10.1177/15353702211028540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The choroid provides nutritional support for the retinal pigment epithelium and photoreceptors. Choroidal dysfunction plays a major role in several of the most important causes of vision loss including age-related macular degeneration, myopic degeneration, and pachychoroid diseases such as central serous chorioretinopathy and polypoidal choroidal vasculopathy. We describe an imaging technique using depth-resolved swept-source optical coherence tomography (SS-OCT) that provides full-thickness three-dimensional (3D) visualization of choroidal anatomy including topographical features of individual vessels. Enrolled subjects with different clinical manifestations within the pachychoroid disease spectrum underwent 15 mm × 9 mm volume scans centered on the fovea. A fully automated method segmented the choroidal vessels using their hyporeflective lumens. Binarized choroidal vessels were rendered in a 3D viewer as a vascular network within a choroidal slab. The network of choroidal vessels was color depth-encoded with a reference to the Bruch's membrane segmentation. Topographical features of the choroidal vasculature were characterized and compared with choroidal imaging obtained with indocyanine green angiography (ICGA) from the same subject. The en face SS-OCT projections of the larger choroid vessels closely resembled to that obtained with ICGA, with the automated SS-OCT approach proving additional depth-encoded 3D information. In 16 eyes with pachychoroid disease, the SS-OCT approach added clinically relevant structural details, including choroidal thickness and vessel depth, which the ICGA studies could not provide. Our technique appears to advance the in vivo visualization of the full-thickness choroid, successfully reveals the topographical features of choroidal vasculature, and shows potential for further quantitative analysis when compared with other choroidal imaging techniques. This improved visualization of choroidal vasculature and its 3D structure should provide an insight into choroid-related disease mechanisms as well as their responses to treatment.
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Affiliation(s)
- Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
| | - Tommaso Bacci
- Vitreous Retina Macula Consultants of New York, New York 10022, USA.,Department of Ophthalmology, New York University Grossman School of Medicine, New York 10016, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York 10022, USA.,Department of Ophthalmology, New York University Grossman School of Medicine, New York 10016, USA
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA.,Department of Ophthalmology, University of Washington, Seattle, WA 98105, USA
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31
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Brazile BL, Yang B, Waxman S, Lam P, Voorhees AP, Hua Y, Loewen RT, Loewen NA, Rizzo JF, Jakobs T, Sigal IA. Lamina Cribrosa Capillaries Straighten as Intraocular Pressure Increases. Invest Ophthalmol Vis Sci 2021; 61:2. [PMID: 33001158 PMCID: PMC7545063 DOI: 10.1167/iovs.61.12.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Purpose The purpose of this study was to visualize the lamina cribrosa (LC) capillaries and collagenous beams, measure capillary tortuosity (path length over straight end-to-end length), and determine if capillary tortuosity changes when intraocular pressure (IOP) increases. Methods Within 8 hours of sacrifice, 3 pig heads were cannulated via the external ophthalmic artery, perfused with PBS to remove blood, and then perfused with a fluorescent dye to label the capillaries. The posterior pole of each eye was mounted in a custom-made inflation chamber for control of IOP with simultaneous imaging. Capillaries and collagen beams were visualized with structured light illumination enhanced imaging at IOPs from 5 to 50 mm Hg at each 5 mm Hg increment. Capillary tortuosity was measured from the images and paired two-sample t-tests were used to assess for significant changes in relation to changes in IOP. Results Capillaries were highly tortuous at 15 mm Hg (up to 1.45). In all but one eye, tortuosity decreased significantly as IOP increased from 15 to 25 mm Hg (P < 0.01), and tortuosity decreased significantly in every eye as IOP increased from 15 to 40 mm Hg (P < 0.01). In only 16% of capillaries, tortuosity increased with elevated IOP. Capillaries had a surprisingly different topology from the collagen beams. Conclusions Although high capillary tortuosity is sometimes regarded as potentially problematic because it can reduce blood flow, LC capillary tortuosity may provide slack that mitigates against reduced flow and structural damage caused by excessive stretch under elevated IOP. We speculate that low capillary tortuosity could be a risk factor for damage under high IOP.
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Affiliation(s)
- Bryn L Brazile
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh Pennsylvania, United States
| | - Bin Yang
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh Pennsylvania, United States.,Department of Engineering, Duquesne University, Pittsburgh Pennsylvania, United States
| | - Susannah Waxman
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh Pennsylvania, United States
| | - Po Lam
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh Pennsylvania, United States
| | - Andrew P Voorhees
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh Pennsylvania, United States
| | - Yi Hua
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh Pennsylvania, United States
| | - Ralitsa T Loewen
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh Pennsylvania, United States
| | - Nils A Loewen
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany
| | - Joseph F Rizzo
- Neuro-Ophthalmology Service, Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, United States
| | - Tatjana Jakobs
- Department of Ophthalmology, Harvard Medical School, Boston Massachusetts, United States
| | - Ian A Sigal
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh Pennsylvania, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh Pennsylvania, United States
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SPATIAL DISTRIBUTION OF CHORIOCAPILLARIS IMPAIRMENT IN EYES WITH CHOROIDAL NEOVASCULARIZATION SECONDARY TO AGE-RELATED MACULAR DEGENERATION: A Quantitative OCT Angiography Study. Retina 2021; 40:428-445. [PMID: 31415449 DOI: 10.1097/iae.0000000000002556] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To develop an optical coherence tomography angiography (OCTA)-based framework for quantitatively analyzing the spatial distribution of choriocapillaris (CC) impairment around choroidal neovascularization (CNV) secondary to age-related macular degeneration. METHODS In a retrospective, cross-sectional study, 400-kHz swept-source OCTA images from 7 eyes of 6 patients with CNV secondary to age-related macular degeneration were quantitatively analyzed using custom software. A lesion-centered zonal OCTA analysis technique-which portioned the field-of-view into zones relative to CNV boundaries-was developed to quantify the spatial dependence of CC flow deficits. RESULTS Quantitative, lesion-centered zonal analysis of CC OCTA images revealed highest flow-deficit percentages near CNV boundaries, decreasing in zones farther from the boundaries. Optical coherence tomography angiography using shorter (1.5 ms) interscan times revealed more severe flow deficits than OCTA using longer (3.0 ms) interscan times; however, spatial trends were similar for both interscan times. A detailed description of the OCTA processing steps and parameters was provided so as to elucidate their influence on quantitative measurements. CONCLUSION Impairment of the CC, assessed by flow-deficit percentages, was most prominent closest to CNV boundaries. The lesion-centered zonal analysis technique enabled quantitative CC measurements relative to focal lesions. Understanding how processing steps, imaging/processing parameters, and artifacts can affect quantitative CC measurements is important for longitudinal, OCTA-based studies of disease progression, and treatment response.
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Optical Coherence Tomography Angiography of the Choriocapillaris in Age-Related Macular Degeneration. J Clin Med 2021; 10:jcm10040751. [PMID: 33668537 PMCID: PMC7918036 DOI: 10.3390/jcm10040751] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/11/2022] Open
Abstract
The advent of optical coherence tomography angiography (OCTA) has allowed for remarkable advancements in our understanding of the role of the choriocapillaris in age-related macular degeneration (AMD). As a relatively new imaging modality, techniques to analyze and quantify choriocapillaris images are still evolving. Quantification of the choriocapillaris requires careful consideration of many factors, including the type of OCTA device, segmentation of the choriocapillaris slab, image processing techniques, and thresholding method. OCTA imaging shows that the choriocapillaris is impaired in intermediate non-neovascular AMD, and the severity of impairment may predict the advancement of disease. In advanced atrophic AMD, the choriocapillaris is severely impaired underneath the area of geographic atrophy, and the level of impairment surrounding the lesion predicts the rate of atrophy enlargement. Macular neovascularization can be readily identified and classified using OCTA, but it is still unclear if neovascularization features with OCTA can predict the lesion’s level of activity. The choriocapillaris surrounding macular neovascularization is impaired while the more peripheral choriocapillaris is spared, implying that choriocapillaris disruption may drive neovascularization growth. With continued innovation in OCTA image acquisition and analysis methods, advancement in clinical applications and pathophysiologic discoveries in AMD are set to follow.
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34
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Chu Z, Zhang Q, Gregori G, Rosenfeld PJ, Wang RK. Guidelines for Imaging the Choriocapillaris Using OCT Angiography. Am J Ophthalmol 2021; 222:92-101. [PMID: 32891694 DOI: 10.1016/j.ajo.2020.08.045] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/12/2020] [Accepted: 08/28/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE To provide guidance on how to appropriately quantitate various choriocapillaris (CC) parameters with optical coherence tomography angiography (OCTA). DESIGN Evidence-based perspective. METHODS Review of literature and experience of authors. RESULTS Accurate and reliable quantification of CC using OCTA requires that CC can be visualized and that the measurements of various CC parameters are validated. For accurate visualization, the selected CC slab must be physiologically sound, must produce images consistent with histology, and must yield qualitatively similar images when viewing repeats of the same scan or scans of different sizes. For accurate quantification, the measured intercapillary distances (ICDs) should be consistent with known measurements using histology and adaptive optics and/or OCTA, the selected CC parameters must be physiologically and physically meaningful based on the resolution of the instrument and the density of the scans, the selected algorithm for CC binarization must be appropriate and generate meaningful results, and the CC measurements calculated from multiple scans of the same and different sizes should be quantitatively similar. If the Phansalkar local thresholding method is used, then its parameters must be optimized for CC based on the OCTA instrument and scan patterns used. It is recommended that the window radius used in the Phansalkar method should be related to the expected average ICD in normal eyes. CONCLUSIONS Quantitative analysis of CC using commercially available OCTA instruments is complicated, and researchers need to tailor their strategies based on the instrument, scan patterns, anatomy, and thresholding strategies to achieve accurate and reliable measurements.
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Estawro RG, Fayed AE, Gerges TK, Baddar DN. Choriocapillaris Island: an optical coherence tomography angiography finding observed in central serous chorioretinopathy. Int J Retina Vitreous 2021; 7:3. [PMID: 33413670 PMCID: PMC7792298 DOI: 10.1186/s40942-020-00275-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/28/2020] [Indexed: 11/10/2022] Open
Abstract
Purpose To report the observation of the choriocapillaris island (CCI) on optical coherence tomography angiography (OCTA) in eyes with active central serous chorioretinopathy (CSCR), and to investigate its associated clinical features. Design Retrospective observational study. Methods Patients diagnosed with active CSCR underwent OCTA imaging (Optovue Inc, Fremont, California, USA), and the software built-in en face choriocapillaris slab was examined to demonstrate CCI, defined as an area of detectable choriocapillaris flow surrounded by an area of undetectable or diminished flow. Electronic medical records (EMR) were reviewed for demographics, clinical data, other imaging modalities and any intervention, and these parameters were correlated with CCI findings. Results 25 eyes of 25 patients were recruited. CCI was detected in all examined eyes and was best elucidated on the en face choriocapillaris density maps. 24 eyes had focal retinal pigment epithelium (RPE) alterations overlying CCI. All 14 eyes with simultaneous fundus fluorescein angiography (FA) showed actively leaking point(s) well corresponding to the CCI location. Resolution of sub-retinal fluid in 4 eyes was associated with disappearance of CCI on follow-up OCTA scans. 1 eye showed complicating neovascularization 5 months after the initial presentation at the same location of the CCI. Conclusion We demonstrate the observation of the “choriocapillaris island” an OCTA finding in eyes with active CSCR underneath the area of neurosensory detachment. CCI may constitute an angiographic representation of the focal area of choriocapillaris structural and functional affection, with secondary RPE alteration jeopardizing its barrier function. Larger longitudinal studies are needed to further elucidate this finding.
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Affiliation(s)
| | - Alaa E Fayed
- Watany Eye Hospital, Cairo, 11775, Egypt.,Department of Ophthalmology, Kasr Al-Ainy School of Medicine, Cairo University, Giza, Egypt
| | | | - Dina N Baddar
- Watany Eye Hospital, Cairo, 11775, Egypt.,Research Institute of Ophthalmology, Giza, Egypt
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Maltsev DS, Fomin AV, Kulikov AN, Vasiliev AS. [Evaluation of choriocapillaris with high-speed spectral-domain optical coherence tomography angiography and image averaging]. Vestn Oftalmol 2021; 137:76-84. [PMID: 34156781 DOI: 10.17116/oftalma202113703176] [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] [Indexed: 06/13/2023]
Abstract
PURPOSE To study the capabilities of high-speed spectral-domain optical coherence tomography angiography (SD-OCTA) with image averaging in the evaluation of choriocapillaries in healthy individuals and patients with central serous chorioretinopathy (CSC). MATERIAL AND METHODS All participants underwent OCTA examination on the SOLIX tomograph (Optovue, USA) using quadruplicate 3×3 mm scan with image averaging. Image analysis was performed in 9-µm custom slab with Phansalkar auto local threshold algorithm and calculation of flow voids larger than 5000 µm2 and 10 000 µm2. The optimal slab depth was determined in healthy eyes by consecutive analysis of the slabs with a 3-µm shift from zero position to 33 µm below Bruch's membrane. RESULTS The study included 18 eyes of 18 healthy volunteers (40.4±6.0 years old) and 18 fellow eyes of 18 unilateral CSC patients (37.4±10.7 years old). The slab 12 µm below the Bruch's membrane showed the minimal number of flow voids (23.1±7.0 of >5000 µm2 voids per scan) and was chosen for further analysis. The number of flow voids of >5000 µm2 in healthy paired eyes of CSC patients was statistically significantly higher than in the eyes of healthy individuals (32.7±10.7 and 25.3±8.1 voids/scan, respectively; p=0.022). The number of flow voids of >10000 µm2 was also statistically significantly higher in CSC eyes compared to healthy eyes (5.6±3.3 and 3.5±1.9 voids/scan, respectively; p=0.045). There was no statistically significant difference in total area of the voids between the eyes of healthy individuals and CSC patients (96406.1±3924.5 µm2 and 95395.7 ± 3615.1 µm2, respectively; p=0.42). CONCLUSION The optimal settings for choriocapillaris imaging on the SOLIX tomograph include 9-µm slab 9 to 18 µm below the Bruch's membrane. Using a 9-µm slab 12 µm below the Bruch's membrane, a substantial difference was found in choriocapillaris perfusion between eyes of healthy individuals and CSC patients.
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Affiliation(s)
- D S Maltsev
- S.M. Kirov Military Medical Academy, Saint Petersburg, Russia
| | | | - A N Kulikov
- S.M. Kirov Military Medical Academy, Saint Petersburg, Russia
| | - A S Vasiliev
- S.M. Kirov Military Medical Academy, Saint Petersburg, Russia
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Schottenhamml J, Moult EM, Ploner SB, Chen S, Novais E, Husvogt L, Duker JS, Waheed NK, Fujimoto JG, Maier AK. OCT-OCTA segmentation: combining structural and blood flow information to segment Bruch's membrane. BIOMEDICAL OPTICS EXPRESS 2021; 12:84-99. [PMID: 33520378 PMCID: PMC7818963 DOI: 10.1364/boe.398222] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/28/2020] [Accepted: 11/11/2020] [Indexed: 05/13/2023]
Abstract
In this paper we present a fully automated graph-based segmentation algorithm that jointly uses optical coherence tomography (OCT) and OCT angiography (OCTA) data to segment Bruch's membrane (BM). This is especially valuable in cases where the spatial correlation between BM, which is usually not visible on OCT scans, and the retinal pigment epithelium (RPE), which is often used as a surrogate for segmenting BM, is distorted by pathology. We validated the performance of our proposed algorithm against manual segmentation in a total of 18 eyes from healthy controls and patients with diabetic retinopathy (DR), non-exudative age-related macular degeneration (AMD) (early/intermediate AMD, nascent geographic atrophy (nGA) and drusen-associated geographic atrophy (DAGA) and geographic atrophy (GA)), and choroidal neovascularization (CNV) with a mean absolute error of ∼0.91 pixel (∼4.1 μm). This paper suggests that OCT-OCTA segmentation may be a useful framework to complement the growing usage of OCTA in ophthalmic research and clinical communities.
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Affiliation(s)
- Julia Schottenhamml
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, 91058, Germany
| | - Eric M. Moult
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Stefan B. Ploner
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, 91058, Germany
| | - Siyu Chen
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Eduardo Novais
- New England Eye Center, Tufts Medical Center, Boston, MA 02116, USA
- Federal University of São Paulo, School of Medicine, São Paulo - SP, 04021-001, Brazil
| | - Lennart Husvogt
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, 91058, Germany
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jay S. Duker
- New England Eye Center, Tufts Medical Center, Boston, MA 02116, USA
| | - Nadia K. Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA 02116, USA
| | - James G. Fujimoto
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Andreas K. Maier
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, 91058, Germany
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Corvi F, Corradetti G, Sadda SR. Correlation between the Angiographic Choriocapillaris and the Structural Inner Choroid. Curr Eye Res 2020; 46:871-877. [PMID: 33317343 DOI: 10.1080/02713683.2020.1846756] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose: To assess the correlation between the choriocapillaris (CC) on optical coherence tomography (OCT) angiography and the inner choroid (IC) on structural OCT.Methods: In this prospective, cross-sectional, observational, pilot study, consecutive healthy subjects were imaged with a 6x6mm macular scan using OCTA PlexElite. Angiographic images of the CC were isolated using 10 μm-thick slab starting 21 μm posterior to the automatically segmented retinal pigment epithelium (RPE) band centerline. The structural en face OCT images of the IC were isolated using five 10 μm-thick slabs starting 11 to 51 μm posterior to the automatically segmented RPE band centerline. Retinal vessels masking was obtained by two methods: automated OCTA superficial vessel slab and automated structural OCT outer retina to CC (ORCC) slab. The en face OCT images were binarized for computation of the stromal index (SI). The flow deficits (FD) of the angiographic CC were correlated with the SI of the structural en face OCTs of the IC.Results: Twenty eyes of 20 subjects were enrolled. The strongest correlation was observed between the CC FD and the inner choroid SI of the 31-41 slab (IC SI31-41) using the ORCC mask (R = 0.603, p = .005). Similar results were observed when the analysis was repeated when using IC SI31-41 values obtained with the superficial vessels mask (R = 0.561, p = .01).Conclusions: The angiographic CC FD was significantly correlated with the structural inner choroidal stromal index. These findings suggest that there may be an opportunity to use structural OCT data to analyze the CC, which may allow longitudinal assessment from historical structural OCT datasets.
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Affiliation(s)
- Federico Corvi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Milan, Italy.,Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA.,Doheny Eye Institute, University of California, Los Angeles, California, USA
| | - Giulia Corradetti
- Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA.,Doheny Eye Institute, University of California, Los Angeles, California, USA
| | - SriniVas R Sadda
- Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA.,Doheny Eye Institute, University of California, Los Angeles, California, USA
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Dai Y, Zhou H, Zhang Q, Chu Z, Olmos de Koo LC, Chao JR, Rezaei KA, Saraf SS, Wang RK. Quantitative assessment of choriocapillaris flow deficits in diabetic retinopathy: A swept-source optical coherence tomography angiography study. PLoS One 2020; 15:e0243830. [PMID: 33306736 PMCID: PMC7732066 DOI: 10.1371/journal.pone.0243830] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/26/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose To quantitatively assess choriocapillaris (CC) flow deficits in eyes with diabetic retinopathy (DR) using swept-source optical coherence tomography angiography (SS-OCTA). Methods Diabetic subjects with different stages of DR and age-matched healthy subjects were recruited and imaged with SS-OCTA. The en face CC blood flow images were generated using previously published and validated algorithms. The percentage of CC flow deficits (FD%) and the mean CC flow deficit size were calculated in a 5-mm-diameter circle centered on the fovea from the 6×6-mm scans. Results Forty-five diabetic subjects and 27 control subjects were included in the study. The CC FD% in diabetic eyes was on average 1.4-fold greater than in control eyes (12.34±4.14% vs 8.82±2.61%, P < 0.001). The mean CC FD size in diabetic eyes was on average 1.4-fold larger than in control eyes (2151.3± 650.8μm2 vs 1574.4±255.0 μm2, P < 0.001). No significant difference in CC FD% or mean CC FD size was observed between eyes with nonproliferative DR and eyes with proliferative DR (P = 1.000 and P = 1.000, respectively). Conclusions CC perfusion in DR can be objectively and quantitatively assessed with FD% and FD size. In the macular region, both CC FD% and CC FD size are increased in eyes with DR. SS-OCTA provides new insights for the investigations of CC perfusion status in diabetes in vivo.
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Affiliation(s)
- Yining Dai
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
| | - Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Qinqin Zhang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Lisa C. Olmos de Koo
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
| | - Jennifer R. Chao
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
| | - Kasra A. Rezaei
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
| | - Steven S. Saraf
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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40
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Optical coherence tomography angiography in diabetic retinopathy: an updated review. Eye (Lond) 2020; 35:149-161. [PMID: 33099579 DOI: 10.1038/s41433-020-01233-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/27/2020] [Accepted: 10/15/2020] [Indexed: 12/17/2022] Open
Abstract
Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus. Optical coherence tomography angiography (OCTA) has been developed to visualize the retinal microvasculature and choriocapillaris based on the motion contrast of circulating blood cells. Depth-resolved ability and non-invasive nature of OCTA allow for repeated examinations and visualization of microvasculature at the retinal capillary plexuses and choriocapillaris. OCTA enables quantification of microvascular alterations in the retinal capillary network, in addition to the detection of classical features associated with DR, including microaneurysms, intraretinal microvascular abnormalities, and neovascularization. OCTA has a promising role as an objective tool for quantifying extent of microvascular damage and identify eyes with diabetic macular ischaemia contributed to visual loss. Furthermore, OCTA can identify preclinical microvascular abnormalities preceding the onset of clinically detectable DR. In this review, we focused on the applications of OCTA derived quantitative metrics that are relevant to early detection, staging and progression of DR. Advancement of OCTA technology in clinical research will ultimately lead to enhancement of individualised management of DR and prevention of visual impairment in patients with diabetes.
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41
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Corvi F, Su L, Sadda SR. Evaluation of the inner choroid using OCT angiography. Eye (Lond) 2020; 35:110-120. [PMID: 33046831 DOI: 10.1038/s41433-020-01217-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/16/2020] [Accepted: 09/29/2020] [Indexed: 12/26/2022] Open
Abstract
The advent of optical coherence tomography angiography (OCTA) has allowed a qualitative and quantitative analysis of the retinal vasculature and the choriocapillaris. With the use of OCTA, several studies evaluated the changes in the choriocapillaris showing how this vascular structure plays a significant role in the pathogenesis of different conditions. This article reviews the current methods of analysis of the choriocapillaris and the relevant findings in different chorioretinal diseases.
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Affiliation(s)
- Federico Corvi
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, USA.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Milan, Italy
| | - Li Su
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, USA.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of medicine, Shanghai, China
| | - Srinivas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, USA. .,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Laiginhas R, Cabral D, Falcão M. Evaluation of the different thresholding strategies for quantifying choriocapillaris using optical coherence tomography angiography. Quant Imaging Med Surg 2020; 10:1994-2005. [PMID: 33014731 PMCID: PMC7495317 DOI: 10.21037/qims-20-340] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND In this paper, we evaluate the different thresholding strategies that have been used for the quantification of the choriocapillaris (CC) and explore their repeatability and the interchangeability of the measurements resulting from its application. METHODS Observational study. Eighteen eyes from nine healthy volunteers aged >18 years were imaged four consecutive times with a SD-OCTA system (Heidelberg Engineering, Germany) using a 10°×10° high-resolution protocol centered on the fovea. Projection artifacts were removed, and the CC was bracketed between 10 and 30 µm below Bruch's membrane. For the quantification of CC, we used four flow deficits (FD) parameters: FD number, mean FD size, total FD area and FD density. We performed a systematic review of literature to collect the thresholding methods that have been used for the quantification of CC. The CC quantification parameters were then evaluated after applying each of the thresholding strategies. Intraclass correlation coefficient (ICC) and Pearson's correlation analysis were used to compare the repeatability and interchangeability among the different thresholding strategies for quantifying the CC. RESULTS A total of 72 optical coherence tomography angiography (OCTA) examinations were considered. The systematic review allowed us to conclude that three local thresholding strategies (Phansalkar, mean and Niblack) and three global thresholding strategies (mean, default, Otsu) have been used for CC quantification. These strategies were evaluated in our observational study. We found a high agreement within the same method in the quantification of FD number, mean FD size, total FD area and FD density but a poor agreement with different strategies. Local strategies achieved a significantly superior ICC than global ones in CC quantification. CONCLUSIONS In conclusion, the interchangeability of the CC quantification using different thresholding strategies is low, and direct comparisons should not be performed. Local thresholding strategies are significantly superior to global ones for quantifying CC and should be preferred. There is an unmet need for a uniform strategy to quantify CC in future studies.
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Affiliation(s)
- Rita Laiginhas
- Department of Ophthalmology, CHEDV, Portugal
- PDICSS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Diogo Cabral
- CEDOC, NOVA Medical School I Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
- Instituto de Oftalmologia Dr. Gama Pinto, Lisboa, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
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Chu Z, Weinstein JE, Wang RK, Pepple KL. Quantitative Analysis of the Choriocapillaris in Uveitis Using En Face Swept-Source Optical Coherence Tomography Angiography. Am J Ophthalmol 2020; 218:17-27. [PMID: 32413411 DOI: 10.1016/j.ajo.2020.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To perform a quantitative analysis of choriocapillaris (CC) flow deficits (FDs) in patients with uveitis. DESIGN Retrospective cross-sectional study. METHODS Swept-source optical coherence tomography based angiography (SS-OCTA) macular volume scans (3 × 3 mm and 6 × 6 mm) were obtained using the Plex Elite 9000. En face CC images were generated and analyzed using an automated FD identification algorithm. Three quantitative metrics were determined for each eye: FD number (FDN), mean FD size (MFDS), and FD density (FDD). Quantitative metrics were compared between uveitis and control eyes. The uveitis cohort was further subdivided by the presence or absence of choroidal involvement, and quantitative metrics were compared between subgroups and normal control subjects. RESULTS A total of 38 eyes from 38 control subjects and 73 eyes from 73 uveitis subjects were included in this study. Eyes with uveitis have significantly larger CC MFDS (3- × 3-mm scans; P < .0001; 6- × 6-mm scans; P < .0001) and higher FDD (P = .0002; P = .0076, respectively) compared to control eyes. Additional analysis determined that these differences were due to the choroidal disease subgroup, which demonstrates significantly larger MFDS (3 × 3 = 1,108 μm2; 6 × 6 = 1,104 μm2) compared to both normal control eyes (752 μm2; P < .0001; 802 μm2; P < .0001, respectively) and uveitis patients without choroidal involvement (785 μm2; P < .0001; 821 μm2; P < .0001, respectively). No significant differences were found between the quantitative metrics of control subjects and patients without choroidal involvement. CONCLUSIONS Automated quantification of CC can identify pathological FDs and provide quantitative metrics describing such lesions in patients with uveitis. Posterior uveitis patients have significantly larger CC FDs than patients with other forms of uveitis.
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Affiliation(s)
- Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Jessica E Weinstein
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, USA; Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Kathryn L Pepple
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA.
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Maruyama S, Akanuma SI, Kubo Y, Hosoya KI. Characteristics of Hemichannel-Mediated Substrate Transport in Human Retinal Pigment Epithelial Cells under Deprivation of Extracellular Ca 2. Biol Pharm Bull 2020; 43:1241-1247. [PMID: 32741944 DOI: 10.1248/bpb.b20-00290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Retinal pigment epithelial (RPE) cells form the outer blood-retinal barrier (BRB) and regulate drug/compound exchange between the neural retina and blood in the fenestrated blood vessels of retinal choroid via membrane transporters. Recent studies have elucidated that RPE cells express hemichannels, which are opened by extracellular Ca2+ depletion and accept several drugs/compounds as a transporting substrate. The objective of this study was to elucidate the hemichannel-mediated compound transport properties of the outer BRB. In human RPE cells, namely ARPE-19 cells, time-dependent uptake of fluorescent hemichannel substrates, such as Lucifer Yellow, sulforhodamine-101 (SR-101), and propidium iodide (PI) was promoted under Ca2+-depleted conditions. The uptake of these substrates under Ca2+-depleted conditions exhibited saturable kinetics with a Michaelis-Menten constant (Km) of 87-109 µM. In addition, SR-101 and PI uptake by ARPE-19 cells was dependent of extracellular Ca2+ concentration, and that under Ca2+-depleted conditions was significantly decreased by typical substrates and/or inhibitors for hemichannels. Moreover, Ca2+-depleted conditions promoted the efflux transport of calcein from ARPE-19 cells, and the promoted calcein efflux transport was significantly inhibited by a typical hemichannel inhibitor. These results suggested that hemichannels at the outer BRB were involved in the influx and efflux transport of drugs/compounds.
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Affiliation(s)
- Souhei Maruyama
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Shin-Ichi Akanuma
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Yoshiyuki Kubo
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Ken-Ichi Hosoya
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
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Dai Y, Zhou H, Chu Z, Zhang Q, Chao JR, Rezaei KA, Wang RK. Microvascular Changes in the Choriocapillaris of Diabetic Patients Without Retinopathy Investigated by Swept-Source OCT Angiography. Invest Ophthalmol Vis Sci 2020; 61:50. [PMID: 32232345 PMCID: PMC7401698 DOI: 10.1167/iovs.61.3.50] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose To investigate the microvascular changes in macular retina and choriocapillaris (CC) in diabetic eyes without retinopathy using swept-source optical coherence tomography angiography (SS-OCTA). Methods A commercial SS-OCTA system was used to collect 6 × 6-mm macular scans from patients. Three depth-resolved retinal slabs and a CC slab were segmented by a validated semiautomated algorithm. Retinal vessel area density, vessel skeleton density, and nonperfusion area were calculated on segmented retinal slabs. Foveal avascular zone was automatically measured based on en face image of the whole retinal layer. For CC quantification, the percentage of flow deficits (FD%) and the flow deficit (FD) sizes were measured. Results Sixteen eyes from 16 diabetic patients without clinically detectable retinopathy and 16 eyes from 16 age-matched nondiabetic controls were included. There was no significant difference between the two groups in all retinal vessel quantitative parameters (all P > 0.05). However, the mean FD% and mean FD sizes were significantly increased in CC in the central 1.0-mm disk (P = 0.011 and P = 0.017, respectively), the central 1.5-mm rim (P = 0.003 and P = 0.009, respectively), the central 2.5-mm rim (P = 0.018 and P = 0.020, respectively), and the entire 5.0-mm disk (P = 0.009 and P = 0.008, respectively) in diabetic eyes compared with controls. Conclusions CC perfusion in the macula is decreased in diabetic patients without retinopathy as compared to age-matched normal controls. Decreased CC perfusion in the macula may be an early indicator of otherwise clinically undetectable diabetic vasculopathy.
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Borrelli E, Gabela MC, Sacconi R, Querques L, Vella G, Zuccaro B, Gelormini F, Bandello F, Querques G. Choroidal luminal and stromal areas and choriocapillaris perfusion are characterised by a non-linear quadratic relation in healthy eyes. Br J Ophthalmol 2020; 105:567-572. [PMID: 32493761 DOI: 10.1136/bjophthalmol-2020-316479] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE To assess the associations among different optical coherence tomography (OCT) structural and angiography quantitative metrics used to characterise the choroid in healthy subjects. METHODS In this cross-sectional study, macular structural OCT and OCT angiography (OCTA) images were acquired from healthy subjects. The main outcome measures were: (i) choriocapillaris (CC) flow deficits percentage (FD%), (ii) choroidal luminal (LA) and stromal (SA) areas and (iii) choroidal vascularity index (CVI), which was calculated as the LA divided by the total choroidal area. These measurements were generated using previously published algorithms and were separately computed in the foveal and extrafoveal regions. RESULTS Eighty-five eyes from 85 subjects (44 males, 41 females) were included in the analysis. Mean±SD age was 47.9±22.4 years (range: 19.0 to 85.0 years). Linear regression analysis displayed no significant associations between CC FD% and other parameters (LA, SA and CVI). Importantly, non-linear regression analysis showed that the relations of LA and SA to CC FD% were all best fitted by a quadratic function. Compared with the linear models, the use of the quadratic function allowed a relative increase in the R2 coefficients. No significant non-linear associations were found between CC FD% and CVI. CONCLUSION Based on our models, changes in the luminal and stromal areas in the choroid lead to an initial increase in CC perfusion. Subsequently, further increases in LA and SA amounts are accompanied by a progressive increment in CC FD%.
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Affiliation(s)
- Enrico Borrelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lea Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giovanna Vella
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy.,Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Biancamaria Zuccaro
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Gelormini
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
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Thabsuwan K, Chantarasorn Y. Essential thrombocythemia manifesting as ophthalmic artery occlusion. Am J Ophthalmol Case Rep 2020; 18:100724. [PMID: 32373760 PMCID: PMC7195516 DOI: 10.1016/j.ajoc.2020.100724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 03/30/2020] [Accepted: 04/21/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To report the first case of a patient with essential thrombocythemia (ET) who presented with unilaterally extensive choroidal ischemia coinciding with central retinal artery occlusion (CRAO). Observations: A 64-year-old man presented with a classic sign of short posterior ciliary artery (SPCA) occlusion, Amalric triangular choroidal infarction, coinciding with CRAO in the left eye. He was later diagnosed as having ET due to a massive platelet count of 1,100,000 cells/mm3 and confirmed genetic testing. The magnetic resonance angiogram subsequently revealed severe occlusions of neuro-ophthalmic circulation. Interestingly, occult choriocapillaris occlusions were detected in the right eye despite being visually asymptomatic. Conclusion and importance Patients with ET can present with concurrent CRAO and SPCA occlusion. Identifying the causes of such events is crucial as these can precede systemic thrombocytosis or hemorrhagic complications.
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Affiliation(s)
- Kittipong Thabsuwan
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, 681 Samsen Street, Dusit Bangkok, 10300, Thailand
| | - Yodpong Chantarasorn
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, 681 Samsen Street, Dusit Bangkok, 10300, Thailand
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Chu Z, Cheng Y, Zhang Q, Zhou H, Dai Y, Shi Y, Gregori G, Rosenfeld PJ, Wang RK. Quantification of Choriocapillaris with Phansalkar Local Thresholding: Pitfalls to Avoid. Am J Ophthalmol 2020; 213:161-176. [PMID: 32059979 DOI: 10.1016/j.ajo.2020.02.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE To demonstrate the proper use of the Phansalkar local thresholding method (Phansalkar method) in choriocapillaris (CC) quantification with optical coherence tomography angiography (OCTA). DESIGN Retrospective, observational case series. METHODS Swept source OCTA imaging was performed using 3×3 mm and 6×6 mm scanning patterns. The CC slab was extracted after semiautomatic segmentation of the retinal pigment epithelium/Bruch membrane complex. Retinal projection artifacts were removed before further analysis, and CC OCTA images from drusen eyes were compensated using a previously published strategy. CC flow deficits (FDs) were segmented with 2 previously published algorithms: the fuzzy C-means approach (FCM method) and the Phansalkar method. With the Phansalkar method, different parameters were tested and a local window radius of 1 to 15 pixels was used. FD density, mean FD size, and FD number were calculated for comparison. RESULTS Six normal eyes from 6 subjects and 6 eyes with drusen secondary to age-related macular degeneration from 6 subjects were analyzed. With both 3×3 mm and 6×6 mm scans from all eyes, the FD metrics were highly dependent on the selection of the local window radius when using the Phansalkar method. Larger window radii resulted in higher FD density values. FD number increased with the increase in the window radius but then decreased, with an inflection point at about 1 to 2 intercapillary distances. Mean FD size decreased then increased with increasing window radii. CONCLUSIONS Multiple parameters, especially the local window radius, should be optimized before using the Phansalkar method for the quantification of CC FDs with OCTA imaging. It is recommended that the proper use of the Phansalkar method should include the selection of the window radius that is related to the expected intercapillary distance in normal eyes.
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Affiliation(s)
- Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Yuxuan Cheng
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Qinqin Zhang
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Yining Dai
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Yingying Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, USA; Department of Ophthalmology, University of Washington, Seattle, Washington, USA.
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RELATIONSHIP BETWEEN CHOROIDAL VASCULAR HYPERPERMEABILITY, CHORIOCAPILLARIS FLOW DENSITY, AND CHOROIDAL THICKNESS IN EYES WITH PACHYCHOROID PIGMENT EPITHELIOPATHY. Retina 2020; 40:657-662. [DOI: 10.1097/iae.0000000000002635] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee JS, Kim JY, Jung C, Woo SJ. Iatrogenic ophthalmic artery occlusion and retinal artery occlusion. Prog Retin Eye Res 2020; 78:100848. [PMID: 32165219 DOI: 10.1016/j.preteyeres.2020.100848] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/19/2023]
Abstract
Iatrogenic ophthalmic artery occlusion (IOAO) is a rare but devastating ophthalmic disease that may cause sudden and permanent visual loss. Understanding the possible etiologic modalities and pathogenic mechanisms of IOAO may prevent its occurrence. There are numerous medical etiologies of IOAO, including cosmetic facial filler injection, intravascular procedures, intravitreal gas or drug injection, retrobulbar anesthesia, intraarterial chemotherapy in retinoblastoma. Non-ocular surgeries and vascular events in arteries that are not directly associated with the ophthalmic artery, can also cause IOAO. Since IOAO has a limited number of treatment modalities, which lead to poor final visual prognosis, it is imperative to acknowledge the information regarding medical procedures that are etiologically associated with IOAO. We accumulated all searchable and available IOAO case reports (our cases and previous reported cases from the literature), classified them according to their mechanisms of pathogenesis, and summarized treatment options and responses of each of the causes. Various sporadic cases of IOAO can be categorized into three mechanisms as follows: intravascular event, orbital compartment syndrome, and increased intraocular pressure. Embolic IOAO, which is considered the primary cause of the condition, was classified into three subgroups according to the pathway of embolic movement (retrograde pathway, anterograde pathway, pathway through collateral channels). Despite the practical limitations of treating spontaneous (non-iatrogenic) retinal artery occlusion, this article will contribute in predicting and improving the prognosis of IOAO by recognizing the treatable factors. Furthermore, it is expected to provide clues to future research associated with the treatment of retinal artery occlusion.
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Affiliation(s)
- Jong Suk Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jun Yup Kim
- Department of Neurology, Seoul National University College of Medicine, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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