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Parravano M, Cennamo G, Di Antonio L, Grassi MO, Lupidi M, Rispoli M, Savastano MC, Veritti D, Vujosevic S. Multimodal imaging in diabetic retinopathy and macular edema: An update about biomarkers. Surv Ophthalmol 2024; 69:893-904. [PMID: 38942124 DOI: 10.1016/j.survophthal.2024.06.006] [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: 01/23/2024] [Revised: 06/18/2024] [Accepted: 06/24/2024] [Indexed: 06/30/2024]
Abstract
Diabetic macular edema (DME), defined as retinal thickening near, or involving the fovea caused by fluid accumulation in the retina, can lead to vision impairment and blindness in patients with diabetes. Current knowledge of retina anatomy and function and DME pathophysiology has taken great advantage of the availability of several techniques for visualizing the retina. Combining these techniques in a multimodal imaging approach to DME is recommended to improve diagnosis and to guide treatment decisions. We review the recent literature about the following retinal imaging technologies: optical coherence tomography (OCT), OCT angiography (OCTA), wide-field and ultrawide-field techniques applied to fundus photography, fluorescein angiography, and OCTA. The emphasis will be on characteristic DME features identified by these imaging technologies and their potential or established role as diagnostic, prognostic, or predictive biomarkers. The role of artificial intelligence in the assessment and interpretation of retina images is also discussed.
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Affiliation(s)
| | - Gilda Cennamo
- Eye Clinic, Public Health Department, University of Naples Federico II, Naples, Italy
| | - Luca Di Antonio
- UOC Ophthalmology and Surgery Department, ASL-1 Avezzano-Sulmona, L'Aquila, Italy
| | - Maria Oliva Grassi
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Bari, Italy
| | - Marco Lupidi
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | | | - Maria Cristina Savastano
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Catholic University "Sacro Cuore", Rome, Italy
| | - Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | - Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Eye Clinic, IRCCS MultiMedica, Milan, Italy.
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Nagel I, Mueller A, Freeman WR, Kozak I. Laser-Based Therapy Approaches in the Retina: A Review of Micropulse Laser Therapy for Diabetic Retinopathy. Klin Monbl Augenheilkd 2024. [PMID: 39389554 DOI: 10.1055/a-2418-5173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
PURPOSE This review aims to elucidate the mechanisms and clinical utility of subthreshold micropulse laser (SML) therapy in the context of retinal care. Subthreshold or "nondestructive" laser therapy encompasses treatment modalities that induce minimal or no harm to retinal or choroidal tissue and leave no visible sings post-application, while achieving clinical efficacy. METHODS A comprehensive review of literature sourced from databases including PubMed, Medline, Embase, Cochrane, and Web of Science was conducted, focusing on articles published before February 2024, and discussing the contemporary use of SML therapy in treating diabetic retinopathy (DR). RESULTS The review presents evidence from scientific literature supporting SML therapy as a viable therapeutic approach for management of DR. Across numerous studies, SML therapy has demonstrated safety and additional therapeutic efficacy without causing damage to underlying retinal tissue. CONCLUSION Subthreshold laser treatment emerges as a safe strategy for addressing DR. Numerous studies have shown its additional efficacy to anti-VEGF pharmacotherapy, which is the currently approved monotherapy for complications of DR. Ongoing research and clinical investigations aim to further elucidate the mechanisms and optimize the therapeutic advantages of this technology.
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Affiliation(s)
- Ines Nagel
- Jacobs Retina Center, University of California San Diego, La Jolla, California, United States
| | | | - William R Freeman
- Jacobs Retina Center, University of California San Diego, La Jolla, California, United States
| | - Igor Kozak
- Ophthalmology, Moorfields Eye Hospital Dubai, Abu Dhabi, United Arab Emirates
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Dai L, Huang F, Jiang Q, Guo S, Tan S, Su G, Yang P. Sensitive optical coherence tomography angiography parameters detecting retinal vascular changes in Behcet's uveitis. Photodiagnosis Photodyn Ther 2024; 49:104353. [PMID: 39362511 DOI: 10.1016/j.pdpdt.2024.104353] [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: 06/20/2024] [Revised: 09/01/2024] [Accepted: 10/01/2024] [Indexed: 10/05/2024]
Abstract
PURPOSE To compare the retinal parameters in Behcet's uveitis (BU) patients with wide-field swept-source optical coherence tomography angiography (SS-OCTA) and find a sensitive OCTA parameter. METHODS Fifty-two eyes from 52 quiescent BU patients and 50 healthy eyes were included. All subjects underwent SS-OCTA examinations with 12 × 12 mm region. Vessel density (VD) and flow area (FA) in nerve fiber layer (NFL), superficial vascular plexus (SVP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP) were analyzed and compared in central, parafoveal, and peripheral regions with diameters of 1, 6 and 12 mm. Receiver operating characteristic curves (ROC), area under the curve (AUC), correlation analysis between OCTA metrics and best-corrected visual acuity (BCVA) were respectively evaluated. RESULTS BU patients showed significantly lower peripheral VD and FA in NFL (P = 0.019 and 0.002), lower central and parafoveal VD-SVP (P = 0.006 and <0.001), and lower VD-ICP, VD-DCP, FA-SVP, FA-ICP and FA-DCP in all regions (all P < 0.05) as compared to healthy controls. The ROC analysis indicated that the parafoveal, peripheral FA-DCP-1, and a combination of the two metrics were sensitive parameters for identifying retinal vessel changes in BU (AUC=0.90, 0.90, 0.91, respectively). The parafoveal and peripheral FA-DCP were negatively associated with logMAR BCVA (r=-0.764, P < 0.0001; r=-0.641, P < 0.0001). CONCLUSION The deep retinal layers were apt to be affected in BU patients. The parafoveal and peripheral FA values of DCP may be sensitive parameters for detecting retinal vasculature alterations in BU.
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Affiliation(s)
- Lingyu Dai
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Fanfan Huang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Qingyan Jiang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Suo Guo
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Shiyao Tan
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China.
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He Y, Qin MZ, Cao K, Zhang YP, Jiao X, Zhang Z, Wang GH, Liu Q, Liu Q, Ma JB, Jiang X, Guo CX. Assessment of the impact of low-density lipoprotein cholesterol on retinal vessels using optical coherence tomography angiography. Lipids Health Dis 2024; 23:301. [PMID: 39285295 PMCID: PMC11403859 DOI: 10.1186/s12944-024-02287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Accepted: 09/07/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND Low-density lipoprotein cholesterol (LDL-C) is acknowledged as an independent risk factor (IRF) for atherosclerotic cardiovascular disease. Nevertheless, studies on the impact of LDL-C on microvasculature are still scarce. The retina, abundant in microvasculature, can now be examined for microvascular alterations through the novel, non-invasive, and quantitative optical coherence tomography angiography (OCTA) technique. METHODS In this cross-sectional study, 243 patients from the geriatric department were recruited (between December 2022 and December 2023). Individuals were classified into four groups based on their LDL-C levels: Group 1 (≤ 1.8 mmol/L), Group 2 (> 1.8 mmol/L to ≤ 2.6 mmol/L), Group 3 (> 2.6 mmol/L to ≤ 3.4 mmol/L), and Group 4 (> 3.4 mmol/L). The OCTA results including retinal vessel density (VD), foveal avascular zone (FAZ) area, macula thickness, and retinal nerve fiber layer (RNFL) thickness were contrasted across these groups. T-tests, analysis of variance, Welch's tests, or rank-sum tests were employed for statistical comparisons. In cases where significant differences between groups were found, post-hoc multiple comparisons or rank-sum tests were performed for pairwise group comparisons. Spearman's correlation coefficient was employed to perform bivariate correlation analysis to evaluate the relationship between LDL-C levels and various OCTA measurements. Multivariable regression analysis was used to evaluate the association between LDL-C levels and various OCTA measurements. Linear regression analysis or mixed-effects linear models were applied. RESULTS It was discovered that individuals with LDL-C levels exceeding 2.6 mmol/L (Groups 3 and 4) exhibited reduced VD in the retina, encompassing both the optic disc and macular regions, compared to those with LDL-C levels at or below 2.6 mmol/L (Groups 1 and 2). A negative correlation among LDL-C levels and retinal VD was identified, with r values spanning from - 0.228 to -0.385. Further regression analysis presented β values between - 0.954 and - 2.378. Additionally, no notable disparities were detected among the groups regarding FAZ area, macular thickness, and RNFL thickness. CONCLUSIONS The outcomes of this study suggest that elevated LDL-C levels constitute an IRF for decreased VD across the entire retina. TRIAL REGISTRATION NCT05644548, December 1, 2022.
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Affiliation(s)
- Yu He
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ming-Zhao Qin
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yong-Peng Zhang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xuan Jiao
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zheng Zhang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Guo-Hong Wang
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Qi Liu
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Qian Liu
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jin-Bao Ma
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xue Jiang
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Cai-Xia Guo
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, People's Republic of China.
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Zhang T, Xie S, Sun X, Duan H, Li Y, Han M. Optical coherence tomography angiography for microaneurysms in anti-vascular endothelial growth factor treated diabetic macular edema. BMC Ophthalmol 2024; 24:400. [PMID: 39251933 PMCID: PMC11386363 DOI: 10.1186/s12886-024-03655-8] [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: 12/30/2023] [Accepted: 08/21/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND We aimed to evaluate microaneurysms (MAs) after treatment with anti-vascular endothelial growth factor (anti-VEGF) therapy to understand causes of chronic edema and anti-VEGF resistance. METHODS Patients with non-proliferative diabetic retinopathy, with or without macular edema were recruited. Optical coherence tomography angiography (OCTA) MAs-related parameters were observed, including the maximum diameter of overall dimensions, material presence, and flow signal within the lumen. OCTA parameters also included central macular thickness (CMT), foveal avascular zone, superficial and deep capillary plexuses, and non-flow area measurements on the superficial retinal slab. RESULTS Overall, 48 eyes from 43 patients were evaluated. CMT differed significantly between the diabetic macular edema (DME ) and non-DME (NDME) groups at 1st, 2nd, 3rd, and 6th months of follow-up (P < 0.001; <0.001; 0.003; <0.001, respectively). A total of 55 and 59 MAs were observed in the DME (mean = 99.40 ± 3.18 μm) and NDME (mean maximum diameter = 74.70 ± 2.86 μm) groups at baseline, respectively (significant between-group difference: P < 0.001). Blood flow signal was measurable for 46 (83.6%) and 34 (59.3%) eyes in the DME and NDME groups, respectively (significant between-group difference: P < 0.001). CONCLUSIONS Compared to the NDME group, the DME group had larger MAs and a higher blood-flow signal ratio. Following anti-VEGF therapy, changes in the diameter of MAs were observed before changes in CMT thickness.
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Affiliation(s)
- Tongmei Zhang
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, 4th Gansu Road, Heping District, Tianjin, 30020, PR China
| | - Shiyong Xie
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, 4th Gansu Road, Heping District, Tianjin, 30020, PR China
| | - Xiaoli Sun
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, 4th Gansu Road, Heping District, Tianjin, 30020, PR China
| | - Hongtao Duan
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, 4th Gansu Road, Heping District, Tianjin, 30020, PR China
| | - Ying Li
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, 4th Gansu Road, Heping District, Tianjin, 30020, PR China
| | - Mei Han
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, 4th Gansu Road, Heping District, Tianjin, 30020, PR China.
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Xu YL, Ma Y, Zhao Q. Correlation of glucose and lipid metabolism, renal function and retinopathy in diabetic retinopathy patients using OCTA detection. Am J Transl Res 2024; 16:3626-3636. [PMID: 39262747 PMCID: PMC11384353 DOI: 10.62347/wfuf5719] [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: 04/18/2024] [Accepted: 06/28/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVE To investigate the correlation between glucose and lipid metabolism, renal function, and retinopathy in patients with diabetic retinopathy (DR) based on optical coherence tomography angiography (OCTA). METHODS A total of 584 diabetic patients who underwent treatment at The Second Affiliated Hospital of Dalian Medical University from March 2022 to June 2023 were retrospectively selected as research participants. They were categorized into a NDR group (n=366) and a DR group (n=218) based on the presence or absence of DR. Relevant indexes of glucose and lipid metabolism, renal function, and OCTA findings were collected. Logistic regression analysis was applied to identify the influencing factors of diabetes mellitus complicated with DR. ROC curves were drawn to examine the diagnostic value of the screened influencing factors for diabetes mellitus complicated with DR. Finally, Spearman correlation coefficients were calculated to examine the relevance between influencing factors and the severity of DR Lesions. RESULTS Logistic regression showed that high levels of angiography 3 × 3 inner vascular density (IVD_33) and angiography 3 × 3 inner perfusion density (IPD_33) were protective factors for diabetes mellitus complicated with DR, and diabetic peridiabetic vascular disease (DPVD), elevated blood urea nitrogen (BUN), and urea levels were risk factors for diabetes mellitus complicated with DR (all P<0.05). ROC curve displayed that the areas under the curve (AUC) of IVD_33, DPVD, BUN, IPD_33, and Urea in predicting diabetes mellitus with DR were 0.779, 0.705, 0.621, 0.723, and 0.632, respectively. The AUC of combined prediction with OCTA index was higher than that of combined prediction without OCTA index (0.781 VS 0.84, P<0.05). Spearman correlation coefficient displayed that IVD_33 and IPD_33 were negatively correlated with the severity of DR, whereas DPVD and Urea showed a positive correlation (P<0.05). CONCLUSION Our findings provide valuable insights for the initial clinical assessment of diabetic patients with DR and aid in the early determination of DR severity. Corresponding intervention measures should be formulated as early as possible to remedy patients' outcomes.
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Affiliation(s)
- Yan-Li Xu
- Department of Ophalmology, The Second Affiliated Hospital of Dalian Medical University Dalian 116021, Liaoning, China
| | - Ying Ma
- Department of Ophalmology, The Second Affiliated Hospital of Dalian Medical University Dalian 116021, Liaoning, China
| | - Qi Zhao
- Department of Ophalmology, The Second Affiliated Hospital of Dalian Medical University Dalian 116021, Liaoning, China
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Sopeña-Pinilla M, Orduna-Hospital E, Diaz-Barreda MD, Boned-Murillo A, Fernandez-Espinosa G, Arias-Alvarez M, Acha-Perez J, Sanchez-Cano A, Pinilla I. Retinochoroidal Vascular Changes in Long-Term Type 1 Diabetic Patients Assessed by Optic Coherence Tomography Angiography. Biomedicines 2024; 12:1780. [PMID: 39200245 PMCID: PMC11351287 DOI: 10.3390/biomedicines12081780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/25/2024] [Accepted: 07/30/2024] [Indexed: 09/02/2024] Open
Abstract
To study retinal and choriocapillaris (CC) alterations using optical coherence tomography angiography (OCTA) in long-term type 1 diabetic (DM1) patients without diabetic retinopathy (DR). Seventy-eight eyes from 78 well-controlled DM1 patients diagnosed at least 15 years prior and 130 eyes of 130 healthy subjects were included in a cross-sectional descriptive study. Six eyes were excluded from the DM1 group. OCTA with Deep Range Imaging (DRI)-Triton swept source (SS)-OCT was performed. Statistically significant differences were found in all areas of the superficial capillary plexus (SCP), with lower values in DM1 patients. Differences were noted in all quadrants of the deep capillary plexus (DCP) except for the central area. Significant changes in CC blood flow were only found in the center. The foveal avascular zone (FAZ) area and diameters in the SCP were significantly different, while the DCP FAZ area was similar in both groups. Disease duration and microalbuminuria correlated negatively with some SCP areas and positively with FAZ values. Anatomical evaluation revealed microaneurysms in both plexuses, FAZ modifications, and areas lacking blood perfusion. Long-term type 1 diabetic patients without DR display microvascular abnormalities affecting retinal and CC blood perfusion, along with anatomical changes in retinal blood vessels.
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Affiliation(s)
- Maria Sopeña-Pinilla
- Department of Ophthalmology, Miguel Servet University Hospital, 50009 Zaragoza, Spain;
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; (E.O.-H.); (M.D.D.-B.); (A.B.-M.); (G.F.-E.); (M.A.-A.); (J.A.-P.); (A.S.-C.)
| | - Elvira Orduna-Hospital
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; (E.O.-H.); (M.D.D.-B.); (A.B.-M.); (G.F.-E.); (M.A.-A.); (J.A.-P.); (A.S.-C.)
- Department of Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain
| | - Maria D. Diaz-Barreda
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; (E.O.-H.); (M.D.D.-B.); (A.B.-M.); (G.F.-E.); (M.A.-A.); (J.A.-P.); (A.S.-C.)
- Department of Ophthalmology, Hospital Obispo Polanco, 44002 Teruel, Spain
| | - Ana Boned-Murillo
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; (E.O.-H.); (M.D.D.-B.); (A.B.-M.); (G.F.-E.); (M.A.-A.); (J.A.-P.); (A.S.-C.)
| | - Guisela Fernandez-Espinosa
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; (E.O.-H.); (M.D.D.-B.); (A.B.-M.); (G.F.-E.); (M.A.-A.); (J.A.-P.); (A.S.-C.)
| | - Marta Arias-Alvarez
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; (E.O.-H.); (M.D.D.-B.); (A.B.-M.); (G.F.-E.); (M.A.-A.); (J.A.-P.); (A.S.-C.)
- Department of Neurophysiology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
| | - Javier Acha-Perez
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; (E.O.-H.); (M.D.D.-B.); (A.B.-M.); (G.F.-E.); (M.A.-A.); (J.A.-P.); (A.S.-C.)
- Department of Endocrinology, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Ana Sanchez-Cano
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; (E.O.-H.); (M.D.D.-B.); (A.B.-M.); (G.F.-E.); (M.A.-A.); (J.A.-P.); (A.S.-C.)
- Department of Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain
| | - Isabel Pinilla
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; (E.O.-H.); (M.D.D.-B.); (A.B.-M.); (G.F.-E.); (M.A.-A.); (J.A.-P.); (A.S.-C.)
- Department of Ophthalmology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
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Yavuz S, Küçük MF, Ayan A. Comparison of the quantitative values of peripapillary, macular and choriocapillary microvascular structures according to the presence of lupus nephritis in patients with systemic lupus erythematosus. Photodiagnosis Photodyn Ther 2024; 48:104263. [PMID: 38955255 DOI: 10.1016/j.pdpdt.2024.104263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/26/2024] [Accepted: 06/28/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE To determine whether there are quantitative changes in macular, choriocapillary, and peripapillary microvascular structures using optical coherence tomography angiography (OCTA) due to the presence of lupus nephritis (LN) in patients with systemic lupus erythematosus (SLE) and to investigate the correlation between these quantitative values and disease duration. METHODS Fifty -five patients followed up in the rheumatology clinic with an SLE diagnosis were evaluated. As the control group, 61 eyes of 61 age- and gender-matched healthy individuals were included. The patients with SLE were further divided into two groups: those with LN (29 eyes) and those without LN (26 eyes). Macular, choriocapillary, and peripapillary microvascular structures were quantitatively analyzed with OCTA and compared between the three study groups. A correlation analysis of the measured quantitative values and disease duration was also performed. RESULTS In macular microvascular (MMV) analysis, the vessel densities (VDs) of the superficial capillary plexus (SCP) decreased in both SLE groups, while those of the deep capillary plexus (DCP) decreased only in the SLE group with LN. The foveal density significantly decreased in the SLE group with LN compared to the control group, there were no significant differences in terms of the radial peripapillary capillary VDs or the choriocapillaris flow area. Disease duration was not correlated with any of the quantitative parameters measured by OCTA in either SLE group. CONCLUSIONS Identifying differences in retinal microvascular circulation in SLE patients with kidney damage helps predict possible nephropathy and therefore may guide the treatment process of the patient.
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Affiliation(s)
- Sibel Yavuz
- Department of Ophthalmology, Antalya Training and Research Hospital, Health Sciences University, Turkey.
| | - Mehmet Fatih Küçük
- Department of Ophthalmology, Antalya Training and Research Hospital, Health Sciences University, Turkey
| | - Ayşe Ayan
- Department of Rheumatology, Antalya Training and Research Hospital, Health Sciences University, Turkey
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Xu S, Gao F, Luan R, Liu Y, Li X, Liu J. Normative data and correlation parameters for vessel density measured by 6 × 6-mm optical coherence tomography angiography in a large chinese urban healthy elderly population: date from the Beichen eye study. BMC Ophthalmol 2024; 24:298. [PMID: 39030533 PMCID: PMC11264911 DOI: 10.1186/s12886-024-03561-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/05/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND To establish a normative database for macular vessel density (VD) measured by optical coherence tomography angiography (OCTA) and explore the parameters related to the VD. METHODS An observational study in epidemiology. 5840 healthy elderly participants in Beichen district, Tianjin, China underwent detailed ophthalmic and systemic examinations. OCTA was performed in all subjects using a 6 × 6-mm line scan mode centered on the macula and the built-in software was used to quantify VD and stratify the retina. RESULTS One thousand four hundred sixty-one healthy elderly citizens (30.4% men) were included, with a median age of 60.0 years (8.0 years) and an age range of 50 to 87 years.VDs in the different plexuses: superficial capillary plexus (SCP) 43.9% (3.2%), deep capillary plexus (DCP) 44.3% (2.8%), outer capillary plexus (OCP) 21.9% (5.9%), choriocapillaris (CC) 52.1% (1.4%). 90% medical reference range of the VDs at different plexuses was reported. Age was correlated with the VDs of each capillary plexus. Sex was correlated with the VDs of DCP and OCP, and the VDs of DCP (p < 0.001) and OCP (p = 0.015) in women were higher than that in men. After age and sex adjustment, choroid average thickness was positively correlated with VDs of SCP (R = 0.067, p = 0.010) and DCP (R = 0.108, p < 0.001), ganglion cell layer (GCL) average thickness (R = 0.072, p = 0.006) was positively correlated with the VD of OCP, best-corrected visual acuity (BCVA) (R = 0.082, p = 0.002) was positively correlated with the VD of CC. CONCLUSIONS In this study, the normative VD database of the Chinese urban healthy elderly population measured by the OCTA was established, and parameters related to the VD of each capillary plexus were analyzed, providing new ideas for the future study of the relationship between macular VD and disease. TRIAL REGISTRATION The Beichen Eye Study had been registered on the Chinese Clinical Trial Registry website (registry number: ChiCTR2000032280) on April 25, 2020.
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Affiliation(s)
- Shuzhan Xu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Nankai District, 251 Fukang Rd, Tianjin, 300384, China
| | - Fei Gao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Nankai District, 251 Fukang Rd, Tianjin, 300384, China
| | - Rong Luan
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Nankai District, 251 Fukang Rd, Tianjin, 300384, China
| | - Yuqing Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Nankai District, 251 Fukang Rd, Tianjin, 300384, China
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Nankai District, 251 Fukang Rd, Tianjin, 300384, China.
| | - Juping Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Nankai District, 251 Fukang Rd, Tianjin, 300384, China.
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Massengill MT, Cubillos S, Sheth N, Sethi A, Lim JI. Response of Diabetic Macular Edema to Anti-VEGF Medications Correlates with Improvement in Macular Vessel Architecture Measured with OCT Angiography. OPHTHALMOLOGY SCIENCE 2024; 4:100478. [PMID: 38827030 PMCID: PMC11141254 DOI: 10.1016/j.xops.2024.100478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/20/2023] [Accepted: 01/19/2024] [Indexed: 06/04/2024]
Abstract
Purpose Improvements in best-corrected visual acuity (BCVA) and central subfield thickness (CST) have been well documented after intravitreal injection of anti-VEGF medications in diabetic macular edema (DME); however, their effect on the vasculature of the macula in diabetic retinopathy (DR) remains poorly understood. Our aim was to explore the effect of intravitreal injection of anti-VEGF on parameters of retinal vascular microstructure in DR with OCT angiography (OCTA). Design Retrospective study of adult patients with DME that were treated with anti-VEGF intravitreal injections at the University of Illinois at Chicago between 2017 and 2022. Participants Forty-one eyes from 30 patients with nonproliferative or proliferative DR with a mean age of 58.83 ± 11.71 years, mean number of intravitreal injections of 2.8 ± 1.4, and mean follow-up of 6.5 ± 1.7 months. Methods ImageJ was employed to measure parameters of retinal vascular microstructure in OCTA images, which included perfusion density, vessel-length density (VLD), vessel diameter, and foveal avascular zone (FAZ) characteristics (area, perimeter, and circularity). Student t tests and analysis of variance were used to determine statistical significance. Main Outcome Measures A primary analysis was performed comparing the mean of each parameter of all patients as a single group at the beginning and end of the study period. A subgroup analysis was then performed after stratifying patients based on visual improvement, change in CST, prior injection history, and number of injections. Results Eyes demonstrated statistical improvement in BCVA logarithm of the minimum angle of resolution score and CST after anti-VEGF treatment. Primary analysis showed a reduction in the vessel diameter of the superficial and deep retinal vasculature, as well as an increase in the circularity of the FAZ within the superficial retinal vasculature after anti-VEGF treatment. Subgroup analysis revealed that eyes with improvement in BCVA exhibited reduced vessel diameter in the superficial retinal vasculature and that eyes with the largest decrease in CST displayed increased perfusion density and VLD in the deep retinal vasculature. Conclusions Intravitreal injection of anti-VEGF agents to treat DME improved parameters of retinal vascular microstructure on OCTA over a period of 3 to 9 months, and this effect was most pronounced in eyes that experienced improvement in BCVA and CST. 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)
- Michael T. Massengill
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Samuel Cubillos
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Neil Sheth
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Abhishek Sethi
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Jennifer I. Lim
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
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11
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Kazantzis D, Holmes C, Wijesingha N, Sivaprasad S. Changes in foveal avascular zone parameters in individuals with prediabetes compared to normoglycemic controls: a systematic review and meta-analysis. Eye (Lond) 2024; 38:1855-1860. [PMID: 38589460 PMCID: PMC11226666 DOI: 10.1038/s41433-024-03058-5] [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: 11/02/2023] [Revised: 02/22/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024] Open
Abstract
To investigate changes in foveal avascular zone parameters in individuals with prediabetes compared to normoglycemic controls. PUBMED, Scopus and Cochrane Library were searched for published articles comparing the foveal avascular zone between prediabetic individuals and normoglycemic controls as assessed by optical coherence tomography angiography (OCTA). Standardised Mean Difference (SMD) with 95% confidence interval (CI) was computed for the comparison. A total of seven studies were included in our analysis, 6 provided data for the superficial capillary plexus from 345 eyes of individuals with prediabetes and 347 eyes of controls and 4 provided data on the deep capillary plexus from 285 eyes from individuals with prediabetes and 325 eyes of controls. Foveal avascular zone (FAZ) area in the superficial capillary plexus was enlarged in individuals with prediabetes compared to normoglycemic controls (SMD = 0.23, 95% CI = 0.03-0.44, p = 0.03, I2 = 27%, 6 studies). There was no statistically significant change in the deep capillary plexus FAZ area between the two groups (SMD = 1.14, 95% CI = -0.06-2.34, p = 0.06, I2 = 97%, 4 studies). FAZ area in the superficial capillary plexus was larger in individuals diagnosed with prediabetes compared to normoglycemic controls. This finding suggests that prediabetes could induce retinal microvascular changes before the onset of clinical diabetes. More original studies are needed to validate the results of the current meta-analysis.
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Affiliation(s)
- Dimitrios Kazantzis
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
| | - Christopher Holmes
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Naomi Wijesingha
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
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12
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Vujosevic S, Fantaguzzi F, Silva PS, Salongcay R, Brambilla M, Torti E, Nucci P, Peto T. Macula vs periphery in diabetic retinopathy: OCT-angiography and ultrawide field fluorescein angiography imaging of retinal non perfusion. Eye (Lond) 2024; 38:1668-1673. [PMID: 38402286 PMCID: PMC11156842 DOI: 10.1038/s41433-024-02989-3] [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: 06/23/2023] [Revised: 01/28/2024] [Accepted: 02/08/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVES To investigate the association between peripheral non-perfusion index (NPI) on ultrawide-field fluorescein angiography (UWF-FA) and quantitative OCT-Angiography (OCT-A) metrics in the macula. METHODS In total, 48 eyes with UWF-colour fundus photos (CFP), UWF-FA (California, Optos) and OCT-A (Spectralis, Heidelberg) were included. OCT-A (3 × 3 mm) was used to determine foveal avascular zone (FAZ) parameters and vessel density (VD), perfusion density (PD), fractal dimension (FD) on superficial capillary plexus (SCP). NPI's extent and distribution was determined on UWF-FA within fovea centred concentric rings corresponding to posterior pole (<10 mm), mid-periphery (10-15 mm), and far-periphery (>15 mm) and within the total retinal area, the central macular field (6×6 mm), ETDRS fields and within each extended ETDRS field (P3-P7). RESULTS Macular PD was correlated to NPI in total area of retina (Spearman ρ = 0.69, p < 0.05), posterior pole (ρ = 0.48, p < 0.05), mid-periphery (ρ = 0.65, p < 0.05), far-periphery (ρ = 0.59, p < 0.05), P3-P7 (ρ = 0,55 at least, p < 0.05 for each), central macula (ρ = 0.47, p < 0.05), total area in ETDRS (ρ = 0.55, p < 0.05). Macular VD and FD were correlated to NPI of total area of the retina (ρ = 0.60 and 0.61, p < 0.05), the mid-periphery (ρ = 0.56, p < 0.05) and far-periphery (ρ = 0.60 and ρ = 0.61, p < 0.05), and in P3-P7 (p < 0.05). FAZ perimeter was significantly corelated to NPI at posterior pole and central macular area (ρ = 0.37 and 0.36, p < 0.05), and FAZ area to NPI in central macular area (ρ = 0.36, p < 0.05). CONCLUSIONS Perfusion macular metrics on OCT-A correlated with UWF-FA's non-perfusion (NP), particularly in the retina's mid and far periphery, suggesting that OCT-A might be a useful non-invasive method to estimate peripheral retinal NP.
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Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
- Eye Clinic, IRCCS MultiMedica, Milan, Italy.
| | | | - Paolo S Silva
- Harvard Department of Ophthalmology, Joslin Diabetes Center, Beetham Eye Institute, Boston, MA, USA
| | | | - Marco Brambilla
- Department of Medical Physics, University Hospital Maggiore della Carità, Novara, Italy
| | - Emanuele Torti
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Paolo Nucci
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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13
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Hein M, Qambari H, An D, Balaratnasingam C. Current understanding of subclinical diabetic retinopathy informed by histology and high-resolution in vivo imaging. Clin Exp Ophthalmol 2024; 52:464-484. [PMID: 38363022 DOI: 10.1111/ceo.14363] [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: 10/30/2023] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 02/17/2024]
Abstract
The escalating incidence of diabetes mellitus has amplified the global impact of diabetic retinopathy. There are known structural and functional changes in the diabetic retina that precede the fundus photography abnormalities which currently are used to diagnose clinical diabetic retinopathy. Understanding these subclinical alterations is important for effective disease management. Histology and high-resolution clinical imaging reveal that the entire neurovascular unit, comprised of retinal vasculature, neurons and glial cells, is affected in subclinical disease. Early functional manifestations are seen in the form of blood flow and electroretinography disturbances. Structurally, there are alterations in the cellular components of vasculature, glia and the neuronal network. On clinical imaging, changes to vessel density and thickness of neuronal layers are observed. How these subclinical disturbances interact and ultimately manifest as clinical disease remains elusive. However, this knowledge reveals potential early therapeutic targets and the need for imaging modalities that can detect subclinical changes in a clinical setting.
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Affiliation(s)
- Martin Hein
- Physiology and Pharmacology Group, Lions Eye Institute, Perth, Western Australia, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
| | - Hassanain Qambari
- Physiology and Pharmacology Group, Lions Eye Institute, Perth, Western Australia, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
| | - Dong An
- Physiology and Pharmacology Group, Lions Eye Institute, Perth, Western Australia, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
| | - Chandrakumar Balaratnasingam
- Physiology and Pharmacology Group, Lions Eye Institute, Perth, Western Australia, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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14
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Tan TE, Jampol LM, Ferris FL, Tadayoni R, Sadda SR, Chong V, Domalpally A, Blodi BL, Duh EJ, Curcio CA, Antonetti DA, Dutta S, Levine SR, Sun JK, Gardner TW, Wong TY. Imaging Modalities for Assessing the Vascular Component of Diabetic Retinal Disease: Review and Consensus for an Updated Staging System. OPHTHALMOLOGY SCIENCE 2024; 4:100449. [PMID: 38313399 PMCID: PMC10837643 DOI: 10.1016/j.xops.2023.100449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 02/06/2024]
Abstract
Purpose To review the evidence for imaging modalities in assessing the vascular component of diabetic retinal disease (DRD), to inform updates to the DRD staging system. Design Standardized narrative review of the literature by an international expert workgroup, as part of the DRD Staging System Update Effort, a project of the Mary Tyler Moore Vision Initiative. Overall, there were 6 workgroups: Vascular Retina, Neural Retina, Systemic Health, Basic and Cellular Mechanisms, Visual Function, and Quality of Life. Participants The Vascular Retina workgroup, including 16 participants from 4 countries. Methods Literature review was conducted using standardized evidence grids for 5 modalities: standard color fundus photography (CFP), widefield color photography (WFCP), standard fluorescein angiography (FA), widefield FA (WFFA), and OCT angiography (OCTA). Summary levels of evidence were determined on a validated scale from I (highest) to V (lowest). Five virtual workshops were held for discussion and consensus. Main Outcome Measures Level of evidence for each modality. Results Levels of evidence for standard CFP, WFCP, standard FA, WFFA, and OCTA were I, II, I, I, and II respectively. Traditional vascular lesions on standard CFP should continue to be included in an updated staging system, but more studies are required before they can be used in posttreatment eyes. Widefield color photographs can be used for severity grading within the area covered by standard CFPs, although these gradings may not be directly interchangeable with each other. Evaluation of the peripheral retina on WFCP can be considered, but the method of grading needs to be clarified and validated. Standard FA and WFFA provide independent prognostic value, but the need for dye administration should be considered. OCT angiography has significant potential for inclusion in the DRD staging system, but various barriers need to be addressed first. Conclusions This study provides evidence-based recommendations on the utility of various imaging modalities for assessment of the vascular component of DRD, which can inform future updates to the DRD staging system. Although new imaging modalities offer a wealth of information, there are still major gaps and unmet research needs that need to be addressed before this potential can be realized. 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)
- Tien-En Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Programme (EYE ACP), Duke-National University of Singapore Medical School, Singapore
| | - Lee M. Jampol
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Ramin Tadayoni
- Ophthalmology Department, Lariboisière, AP-HP, Saint Louis and Fondation Adolphe de Rothschild Hospitals, Université Paris Cité, Paris, France
| | - Srinivas R. Sadda
- Doheny Eye Institute, Pasadena, California
- Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Victor Chong
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, Wisconsin Reading Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Barbara L. Blodi
- Department of Ophthalmology and Visual Sciences, Wisconsin Reading Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Elia J. Duh
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine A. Curcio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - David A. Antonetti
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - S. Robert Levine
- The Mary Tyler Moore & S. Robert Levine, MD Charitable Foundation, Greenwich, Connecticut
| | - Jennifer K. Sun
- Joslin Diabetes Center, Beetham Eye Institute, Harvard Medical School, Boston, Massachusetts
| | - Thomas W. Gardner
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Programme (EYE ACP), Duke-National University of Singapore Medical School, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
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15
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Channa R, Wolf RM, Simo R, Brigell M, Fort P, Curcio C, Lynch S, Verbraak F, Abramoff MD. A New Approach to Staging Diabetic Eye Disease: Staging of Diabetic Retinal Neurodegeneration and Diabetic Macular Edema. OPHTHALMOLOGY SCIENCE 2024; 4:100420. [PMID: 38284099 PMCID: PMC10818256 DOI: 10.1016/j.xops.2023.100420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/29/2023] [Accepted: 10/23/2023] [Indexed: 01/30/2024]
Abstract
Topic The goal of this review was to summarize the current level of evidence on biomarkers to quantify diabetic retinal neurodegeneration (DRN) and diabetic macular edema (DME). Clinical relevance With advances in retinal diagnostics, we have more data on patients with diabetes than ever before. However, the staging system for diabetic retinal disease is still based only on color fundus photographs and we do not have clear guidelines on how to incorporate data from the relatively newer modalities into clinical practice. Methods In this review, we use a Delphi process with experts to identify the most promising modalities to identify DRN and DME. These included microperimetry, full-field flash electroretinogram, spectral-domain OCT, adaptive optics, and OCT angiography. We then used a previously published method of determining the evidence level to complete detailed evidence grids for each modality. Results Our results showed that among the modalities evaluated, the level of evidence to quantify DRN and DME was highest for OCT (level 1) and lowest for adaptive optics (level 4). Conclusion For most of the modalities evaluated, prospective studies are needed to elucidate their role in the management and outcomes of diabetic retinal diseases. 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)
- Roomasa Channa
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin
| | - Risa M. Wolf
- Department of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rafael Simo
- Division of Endocrinology, Vall d’Hebron University Hospital, CIBERDEM, Barcelona, Spain
| | | | - Patrice Fort
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Christine Curcio
- Department of Ophthalmology, University of Alabama, Birmingham, Alabama
| | | | - Frank Verbraak
- Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Michael D. Abramoff
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
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16
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Campos AC, Lima EG, Jacobsen PK, Arnould L, Lottenberg S, Maia RM, Conci LS, Minelli T, Morato A, Dantas-Jr RN, Nomura CH, Rissoli P, Pimentel SG, Serrano Junior CV. Association between obstructive coronary disease and diabetic retinopathy: Cross-sectional study of coronary angiotomography and multimodal retinal imaging. J Diabetes Complications 2024; 38:108721. [PMID: 38471431 DOI: 10.1016/j.jdiacomp.2024.108721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/28/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024]
Abstract
AIMS To investigate the association between diabetic retinopathy (DR) and coronary artery disease (CAD) using coronary angiotomography (CCTA) and multimodal retinal imaging (MMRI) with ultra-widefield retinography and optical coherence tomography angiography and structural domain. METHODS Single-center, cross-sectional, single-blind. Patients with diabetes who had undergone CCTA underwent MMRI. Uni and multivariate analysis were used to assess the association between CAD and DR and to identify variables independently associated with DR. RESULTS We included 171 patients, 87 CAD and 84 non-CAD. Most CAD patients were males (74 % vs 38 %, P < 0.01), insulin users (52 % vs 38 %, p < 0.01) and revascularized (64 %). They had a higher prevalence of DR (48 % vs 22 %, p = 0.01), microaneurysms (25 % vs 13 %, p = 0.04), intraretinal cysts (22 % vs 8 %, p = 0.01) and areas of reduced capillary density (46 % vs 20 %, p < 0.01). CAD patients also had lower mean vascular density (MVD) (15.7 % vs 16.5,%, p = 0.049) and foveal avascular zone (FAZ) circularity (0.64 ± 0.1 vs 0.69 ± 0.1, p = 0.04). There were significant and negative correlations between Duke coronary score and MVD (r = -0.189; p = 0.03) and FAZ circularity (r = -0,206; p = 0.02). CAD, DM duration and insulin use independently associated with DR. CONCLUSIONS CAD patients had higher prevalence of DR and lower MVD. CAD, DM duration and insulin use were independently associated with DR.
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Affiliation(s)
- Andre Chateaubriand Campos
- Clinical Unit of Atherosclerosis, Instituto do Coracao do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Eduardo Gomes Lima
- Clinical Unit of Atherosclerosis, Instituto do Coracao do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Peter Karl Jacobsen
- Cardiology division - Rigshospitalet - University of Copenhagen, Blegdamsvej 9, 2100 Rigshospitalet, Copenhagen, Denmark
| | - Louis Arnould
- Ophthalmology Department, University Hospital, Dijon, France; Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), (EA 7460), Faculty of Health Sciences, Université de Bourgogne Franche-Comté, 21000 Dijon, France
| | - Simao Lottenberg
- Department of Endocrinology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Renata Martins Maia
- Department of Ophtalmology, Hospital das Clinicas HCMFUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Livia Silva Conci
- Department of Ophtalmology, Hospital das Clinicas HCMFUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Tomas Minelli
- Department of Ophtalmology, Hospital das Clinicas HCMFUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Andrea Morato
- Department of Ophtalmology, Hospital das Clinicas HCMFUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Roberto Nery Dantas-Jr
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Cesar Higa Nomura
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Pedro Rissoli
- Department of Ophtalmology, Hospital das Clinicas HCMFUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Sergio Gianotti Pimentel
- Department of Ophtalmology, Hospital das Clinicas HCMFUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Carlos Vicente Serrano Junior
- Clinical Unit of Atherosclerosis, Instituto do Coracao do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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17
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Soecknick F, Breher K, Nafar Z, Kubach S, Straub J, Wahl S, Ziemssen F. The clinical evaluation of a widefield lens to expand the field of view in optical coherence tomography (OCT-A). Sci Rep 2024; 14:6936. [PMID: 38521801 PMCID: PMC10960788 DOI: 10.1038/s41598-024-57405-3] [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: 11/21/2023] [Accepted: 03/18/2024] [Indexed: 03/25/2024] Open
Abstract
This study aimed to evaluate the clinical benefits of incorporating a widefield lens (WFL) in optical coherence tomography angiography (OCT-A) in patients with retinal vascular diseases in comparison to standard single-shot OCT-A scans. Sixty patients with retinal vascular diseases including diabetic retinopathy (DR) and retinal vein occlusion (RVO) were recruited. OCT-A imaging (PlexElite 9000) with and without WFL was performed in randomized order. The assessment included patient comfort, time, field of view (FoV), image quality and pathology detection. Statistical analysis included paired t-tests, Mann-Whitney U-tests and Bonferroni correction for multiple tests, with inter-grader agreement using the kappa coefficient. Using a WFL did not lead to statistically significant differences in DR and RVO group test times. Patient comfort remained high, with similar responses for WFL and non-WFL measurements. The WFL notably expanded the scan field (1.6× FoV increase), enhancing peripheral retinal visibility. However, image quality varied due to pathology and eye dominance, affecting the detection of peripheral issues in RVO and DR cases. The use of a WFL widens the scan field, aiding vascular retinal disease imaging with minor effects on comfort, time, and image quality. Further enhancements are needed for broader view angles, enabling improved quantification of non-perfused areas and more reliable peripheral proliferation detection.
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Affiliation(s)
- Fritz Soecknick
- Department of Ophthalmology, University of Tübingen, Tübingen, Germany.
- Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany.
| | | | | | | | | | - Siegfried Wahl
- Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
- Carl Zeiss Vision International GmbH, Aalen, Germany
| | - Focke Ziemssen
- Department of Ophthalmology, University of Tübingen, Tübingen, Germany
- Department of Ophthalmology, University of Leipzig, Leipzig, Germany
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18
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Qian B, Chen H, Wang X, Guan Z, Li T, Jin Y, Wu Y, Wen Y, Che H, Kwon G, Kim J, Choi S, Shin S, Krause F, Unterdechler M, Hou J, Feng R, Li Y, El Habib Daho M, Yang D, Wu Q, Zhang P, Yang X, Cai Y, Tan GSW, Cheung CY, Jia W, Li H, Tham YC, Wong TY, Sheng B. DRAC 2022: A public benchmark for diabetic retinopathy analysis on ultra-wide optical coherence tomography angiography images. PATTERNS (NEW YORK, N.Y.) 2024; 5:100929. [PMID: 38487802 PMCID: PMC10935505 DOI: 10.1016/j.patter.2024.100929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/09/2023] [Accepted: 01/15/2024] [Indexed: 03/17/2024]
Abstract
We described a challenge named "DRAC - Diabetic Retinopathy Analysis Challenge" in conjunction with the 25th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2022). Within this challenge, we provided the DRAC datset, an ultra-wide optical coherence tomography angiography (UW-OCTA) dataset (1,103 images), addressing three primary clinical tasks: diabetic retinopathy (DR) lesion segmentation, image quality assessment, and DR grading. The scientific community responded positively to the challenge, with 11, 12, and 13 teams submitting different solutions for these three tasks, respectively. This paper presents a concise summary and analysis of the top-performing solutions and results across all challenge tasks. These solutions could provide practical guidance for developing accurate classification and segmentation models for image quality assessment and DR diagnosis using UW-OCTA images, potentially improving the diagnostic capabilities of healthcare professionals. The dataset has been released to support the development of computer-aided diagnostic systems for DR evaluation.
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Affiliation(s)
- Bo Qian
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Hao Chen
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong 999077, China
- Department of Chemical and Biological Engineering, The Hong Kong University of Science and Technology, Hong Kong 999077, China
| | - Xiangning Wang
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Zhouyu Guan
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
| | - Tingyao Li
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yixiao Jin
- Tsinghua Medicine, Tsinghua University, Beijing 100084, China
| | - Yilan Wu
- Tsinghua Medicine, Tsinghua University, Beijing 100084, China
| | - Yang Wen
- School of Electronic and Information Engineering, Shenzhen University, Shenzhen 518060, China
| | - Haoxuan Che
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong 999077, China
| | | | | | - Sungjin Choi
- AI/DX Convergence Business Group, KT, Seongnam 13606, Korea
| | - Seoyoung Shin
- AI/DX Convergence Business Group, KT, Seongnam 13606, Korea
| | - Felix Krause
- Johannes Kepler University Linz, Linz 4040, Austria
| | | | - Junlin Hou
- School of Computer Science, Shanghai Key Laboratory of Intelligent Information Processing, Fudan University, Shanghai 200433, China
| | - Rui Feng
- School of Computer Science, Shanghai Key Laboratory of Intelligent Information Processing, Fudan University, Shanghai 200433, China
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
| | - Yihao Li
- LaTIM UMR 1101, INSERM, 29609 Brest, France
- University of Western Brittany, 29238 Brest, France
| | - Mostafa El Habib Daho
- LaTIM UMR 1101, INSERM, 29609 Brest, France
- University of Western Brittany, 29238 Brest, France
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Qiang Wu
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Ping Zhang
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH 43210, USA
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH 43210, USA
- Translational Data Analytics Institute, The Ohio State University, Columbus, OH 43210, USA
| | - Xiaokang Yang
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yiyu Cai
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Carol Y. Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Weiping Jia
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
| | - Huating Li
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Centre for Innovation and Precision Eye Health; and Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Tien Yin Wong
- Tsinghua Medicine, Tsinghua University, Beijing 100084, China
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Bin Sheng
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
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19
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Manfredini M, Ragusa E, Gibertini M, Bigi L, Ferrari B, Lasagni C, Magnoni C, Lazzerini A, Farnetani F, Verdina T. Retinal Microvascular Alterations in Hidradenitis Suppurativa Patients: A Pilot Study Using Optical Coherence Tomography Angiography. J Clin Med 2024; 13:1464. [PMID: 38592296 PMCID: PMC10932047 DOI: 10.3390/jcm13051464] [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: 01/15/2024] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Hidradenitis suppurativa (HS) is a relapsing-remitting inflammatory disease characterized by the progression of asymptomatic nodules to deep-seated lesions and fistula formation that leads to suppuration and scarring. Optical coherence tomography angiography (OCTA) is a new non-invasive imaging technique that carefully analyzes retinal microvasculature networks with high-resolution imaging. Recent studies have demonstrated that retinal vessel density and retinal perfusion reflect systemic inflammatory responses. This study's aim was to analyze OCTA-derived retinal microvasculature parameters to understand if patients affected by HS and without any relevant ocular or systemic comorbidities showed impaired retinal vascular function and morphology. Method: We performed a case-control study of HS patients and age- and sex-matched control cohort. A total of 20 eyes from 10 HS patients and 30 eyes from 15 healthy controls were analyzed, and OCTA-derived microvasculature parameters were compared between groups. Results: OCTA images showed that HS patients, compared to healthy controls, were typically characterized by higher values of the foveal avascular zone (FAZ) both in the superficial capillary plexus (SCP) and in the deep capillary plexus (DCP), and by lower values of vessel density (VD)-SCP, VD-DCP, and vessel length density (VLD)-SCP in the foveal region. These findings partially reflect changes that have been demonstrated in diabetic patients that could be induced by a protracted metabolic or systemic inflammatory dysregulation. Conclusions: In conclusion, OCTA enables large-scale, non-invasive visual screening and follow-up of the retinal vasculature features, providing a new strategy for the prevention and monitoring of visual changes in HS patients.
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Affiliation(s)
- Marco Manfredini
- Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy (C.L.)
| | - Emanuele Ragusa
- Institute of Ophthalmology, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Matteo Gibertini
- Institute of Ophthalmology, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Laura Bigi
- Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy (C.L.)
| | - Barbara Ferrari
- Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy (C.L.)
| | - Claudia Lasagni
- Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy (C.L.)
| | - Cristina Magnoni
- Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy (C.L.)
| | - Andrea Lazzerini
- Institute of Ophthalmology, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Francesca Farnetani
- Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy (C.L.)
| | - Tommaso Verdina
- Institute of Ophthalmology, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
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20
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El Habib Daho M, Li Y, Zeghlache R, Boité HL, Deman P, Borderie L, Ren H, Mannivanan N, Lepicard C, Cochener B, Couturier A, Tadayoni R, Conze PH, Lamard M, Quellec G. DISCOVER: 2-D multiview summarization of Optical Coherence Tomography Angiography for automatic diabetic retinopathy diagnosis. Artif Intell Med 2024; 149:102803. [PMID: 38462293 DOI: 10.1016/j.artmed.2024.102803] [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: 08/24/2023] [Revised: 12/19/2023] [Accepted: 02/03/2024] [Indexed: 03/12/2024]
Abstract
Diabetic Retinopathy (DR), an ocular complication of diabetes, is a leading cause of blindness worldwide. Traditionally, DR is monitored using Color Fundus Photography (CFP), a widespread 2-D imaging modality. However, DR classifications based on CFP have poor predictive power, resulting in suboptimal DR management. Optical Coherence Tomography Angiography (OCTA) is a recent 3-D imaging modality offering enhanced structural and functional information (blood flow) with a wider field of view. This paper investigates automatic DR severity assessment using 3-D OCTA. A straightforward solution to this task is a 3-D neural network classifier. However, 3-D architectures have numerous parameters and typically require many training samples. A lighter solution consists in using 2-D neural network classifiers processing 2-D en-face (or frontal) projections and/or 2-D cross-sectional slices. Such an approach mimics the way ophthalmologists analyze OCTA acquisitions: (1) en-face flow maps are often used to detect avascular zones and neovascularization, and (2) cross-sectional slices are commonly analyzed to detect macular edemas, for instance. However, arbitrary data reduction or selection might result in information loss. Two complementary strategies are thus proposed to optimally summarize OCTA volumes with 2-D images: (1) a parametric en-face projection optimized through deep learning and (2) a cross-sectional slice selection process controlled through gradient-based attribution. The full summarization and DR classification pipeline is trained from end to end. The automatic 2-D summary can be displayed in a viewer or printed in a report to support the decision. We show that the proposed 2-D summarization and classification pipeline outperforms direct 3-D classification with the advantage of improved interpretability.
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Affiliation(s)
- Mostafa El Habib Daho
- Univ Bretagne Occidentale, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France
| | - Yihao Li
- Univ Bretagne Occidentale, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France
| | - Rachid Zeghlache
- Univ Bretagne Occidentale, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France
| | - Hugo Le Boité
- Sorbonne University, Paris, F-75006, France; Service d'Ophtalmologie, Hôpital Lariboisière, APHP, Paris, F-75475, France
| | - Pierre Deman
- ADCIS, Saint-Contest, F-14280, France; Evolucare Technologies, Le Pecq, F-78230, France
| | | | - Hugang Ren
- Carl Zeiss Meditec, Dublin, CA 94568, USA
| | | | - Capucine Lepicard
- Service d'Ophtalmologie, Hôpital Lariboisière, APHP, Paris, F-75475, France
| | - Béatrice Cochener
- Univ Bretagne Occidentale, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France; Service d'Ophtalmologie, CHRU Brest, Brest, F-29200, France
| | - Aude Couturier
- Service d'Ophtalmologie, Hôpital Lariboisière, APHP, Paris, F-75475, France
| | - Ramin Tadayoni
- Service d'Ophtalmologie, Hôpital Lariboisière, APHP, Paris, F-75475, France; Paris Cité University, Paris, F-75006, France
| | - Pierre-Henri Conze
- Inserm, UMR 1101, Brest, F-29200, France; IMT Atlantique, Brest, F-29200, France
| | - Mathieu Lamard
- Univ Bretagne Occidentale, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France
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21
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Lv Y, Zhai C, Sun G, He Y. Chitosan as a promising materials for the construction of nanocarriers for diabetic retinopathy: an updated review. J Biol Eng 2024; 18:18. [PMID: 38388386 PMCID: PMC10885467 DOI: 10.1186/s13036-024-00414-7] [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: 12/17/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Diabetic retinopathy (DR) is a condition that causes swelling of the blood vessels of the retina and leaks blood and fluids. It is the most severe form of diabetic eye disease. It causes vision loss in its advanced stage. Diabetic retinopathy is responsible for causing 26% of blindness. Very insufficient therapies are accessible for the treatment of DR. As compared to the conventional therapies, there should be enhanced research on the controlled release, shorter duration, and cost-effective therapy of diabetic retinopathy. The expansion of advanced nanocarriers-based drug delivery systems has been now employed to exploit as well as regulate the transport of many therapeutic agents to target sites via the increase in penetration or the extension of the duration of contact employing production by enclosing as well as distributing tiny molecules in nanostructured formulation. Various polymers have been utilized for the manufacturing of these nanostructured formulations. Chitosan possesses incredible biological and chemical properties, that have led to its extensive use in pharmaceutical and biomedical applications. Chitosan has been used in many studies because of its enhanced mucoadhesiveness and non-toxicity. Multiple studies have used chitosan as the best candidate for manufacturing nanocarriers and treating diabetic retinopathy. Numerous nanocarriers have been formulated by using chitosan such as nanostructured lipid carriers, solid lipid nanoparticles, liposomes, and dendrimers for treating diabetic retinopathy. This current review elaborates on the recent advancements of chitosan as a promising approach for the manufacturing of nanocarriers that can be used for treating diabetic retinopathy.
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Affiliation(s)
- Yan Lv
- Department of Ophthalmology, Jilin Province FAW General Hospital, Changchun, 130011, China
| | - Chenglei Zhai
- Department of Orthopaedics, Jilin Province FAW General Hospital, Changchun, 130011, China
| | - Gang Sun
- Department of General Surgery, Jilin Province FAW General Hospital, Changchun, 130011, China.
| | - Yangfang He
- Department of Endocrinology, the Second Hospital of Jilin University, Changchun, 130000, China
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22
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Chen L, Feng Y, Zhang SS, Liu YF, Lin P. Quantifying peripapillary vessel density and retinal nerve fibre layer in type 1 diabetic children without clinically detectable retinopathy using OCTA. Int J Ophthalmol 2024; 17:278-281. [PMID: 38371265 PMCID: PMC10827608 DOI: 10.18240/ijo.2024.02.08] [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: 03/02/2023] [Accepted: 12/12/2023] [Indexed: 02/20/2024] Open
Abstract
AIM To quantify changes in radial peripapillary capillary vessel density (ppVD) and the peripapillary retinal nerve fiber layer (pRNFL) in children with type 1 diabetes without clinical diabetic retinopathy by optical coherence tomography angiography (OCTA), providing a basis for early retinopathy in children with type 1 diabetes. METHODS This was a retrospective study. A total of 30 patients (3-14y) with type 1 diabetes without clinical diabetic retinopathy (NDR group) were included. A total of 30 age-matched healthy subjects were included as the normal control group (CON group). The HbA1c level in the last 3mo was measured once in the NDR group. The pRNFL thickness and ppVD were automatically measured, and the mean pRNFL and ppVD were calculated in the nasal, inferior, temporal, and superior quadrants. The changes in ppVD and pRNFL in the two groups were analyzed. RESULTS Compared with CON group, the nasal and superior ppVDs decreased in the NDR group (all P<0.01). The thickness of the nasal pRNFL decreased significantly (P<0.01), while the inferior, temporal and superior pRNFLs slightly decreased but not significant in the NDR group (all P>0.05). Person and Spearman correlation analysis of ppVD and pRNFL thickness in each quadrant of the NDR group showed a positive correlation between nasal and superior (all P<0.01), while inferior and temporal had no significant correlation (all P>0.05). There was no significant correlation between the HbA1c level and ppVD and pRNFL in any quadrant (all P>0.05). There was no significant correlation between the course of diabetes mellitus and ppVD and pRNFL in any quadrant (all P>0.05). CONCLUSION ppVD and pRNFL decrease in eyes of children with type 1 diabetes before clinically detectable retinopathy and OCTA is helpful for early monitoring..
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Affiliation(s)
- Ling Chen
- Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710002, Shaanxi Province, China
| | - Yun Feng
- Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710002, Shaanxi Province, China
| | - Sha-Sha Zhang
- Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710002, Shaanxi Province, China
| | - Yan-Fang Liu
- Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710002, Shaanxi Province, China
| | - Ping Lin
- Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710002, Shaanxi Province, China
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23
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Wijesingha N, Tsai WS, Keskin AM, Holmes C, Kazantzis D, Chandak S, Kubravi H, Sivaprasad S. Optical Coherence Tomography Angiography as a Diagnostic Tool for Diabetic Retinopathy. Diagnostics (Basel) 2024; 14:326. [PMID: 38337841 PMCID: PMC10855126 DOI: 10.3390/diagnostics14030326] [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: 01/05/2024] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus, leading to visual impairment if left untreated. This review discusses the use of optical coherence tomography angiography (OCTA) as a diagnostic tool for the early detection and management of DR. OCTA is a fast, non-invasive, non-contact test that enables the detailed visualisation of the macular microvasculature in different plexuses. OCTA offers several advantages over fundus fluorescein angiography (FFA), notably offering quantitative data. OCTA is not without limitations, including the requirement for careful interpretation of artefacts and the limited region of interest that can be captured currently. We explore how OCTA has been instrumental in detecting early microvascular changes that precede clinical signs of DR. We also discuss the application of OCTA in the diagnosis and management of various stages of DR, including non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), diabetic macular oedema (DMO), diabetic macular ischaemia (DMI), and pre-diabetes. Finally, we discuss the future role of OCTA and how it may be used to enhance the clinical outcomes of DR.
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Affiliation(s)
- Naomi Wijesingha
- UCL Institute of Ophthalmology, London EC1V 9EL, UK;
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Wei-Shan Tsai
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Ayse Merve Keskin
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Christopher Holmes
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Dimitrios Kazantzis
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Swati Chandak
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Heena Kubravi
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Sobha Sivaprasad
- UCL Institute of Ophthalmology, London EC1V 9EL, UK;
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
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24
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Maloca PM, Pfau M, Janeschitz-Kriegl L, Reich M, Goerdt L, Holz FG, Müller PL, Valmaggia P, Fasler K, Keane PA, Zarranz-Ventura J, Zweifel S, Wiesendanger J, Kaiser P, Enz TJ, Rothenbuehler SP, Hasler PW, Juedes M, Freichel C, Egan C, Tufail A, Scholl HPN, Denk N. Human selection bias drives the linear nature of the more ground truth effect in explainable deep learning optical coherence tomography image segmentation. JOURNAL OF BIOPHOTONICS 2024; 17:e202300274. [PMID: 37795556 DOI: 10.1002/jbio.202300274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/11/2023] [Accepted: 10/04/2023] [Indexed: 10/06/2023]
Abstract
Supervised deep learning (DL) algorithms are highly dependent on training data for which human graders are assigned, for example, for optical coherence tomography (OCT) image annotation. Despite the tremendous success of DL, due to human judgment, these ground truth labels can be inaccurate and/or ambiguous and cause a human selection bias. We therefore investigated the impact of the size of the ground truth and variable numbers of graders on the predictive performance of the same DL architecture and repeated each experiment three times. The largest training dataset delivered a prediction performance close to that of human experts. All DL systems utilized were highly consistent. Nevertheless, the DL under-performers could not achieve any further autonomous improvement even after repeated training. Furthermore, a quantifiable linear relationship between ground truth ambiguity and the beneficial effect of having a larger amount of ground truth data was detected and marked as the more-ground-truth effect.
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Affiliation(s)
- Peter M Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Maximilian Pfau
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Lucas Janeschitz-Kriegl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Michael Reich
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lukas Goerdt
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Philipp L Müller
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- Makula Center, Suedblick Eye Centers, Augsburg, Germany
| | - Philippe Valmaggia
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Katrin Fasler
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Tim J Enz
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | | | - Pascal W Hasler
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Marlene Juedes
- Pharma Research and Early Development (pRED), Pharmaceutical Sciences (PS), Roche, Innovation Center Basel, Basel, Switzerland
| | - Christian Freichel
- Pharma Research and Early Development (pRED), Pharmaceutical Sciences (PS), Roche, Innovation Center Basel, Basel, Switzerland
| | - Catherine Egan
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Nora Denk
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
- Pharma Research and Early Development (pRED), Pharmaceutical Sciences (PS), Roche, Innovation Center Basel, Basel, Switzerland
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Dan AO, Mocanu CL, Bălășoiu AT, Tănasie CA, Puiu I, Târtea AE, Sfredel V. Correlations between Retinal Microvascular Parameters and Clinical Parameters in Young Patients with Type 1 Diabetes Mellitus: An Optical Coherence Tomography Angiography Study. Diagnostics (Basel) 2024; 14:317. [PMID: 38337833 PMCID: PMC10855750 DOI: 10.3390/diagnostics14030317] [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: 12/27/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES In the current study, we investigated the correlations between retinal microvascular parameters using optical coherence tomography angiography (OCTA) and clinical parameters for a group of 69 young patients with type 1 diabetes mellitus (T1DM). MATERIALS AND METHODS This retrospective, exploratory study enrolled 69 patients between 5 years old and 30 years old who met the inclusion criteria. All the study participants underwent a comprehensive ophthalmic examination and OCTA scans for the evaluation of the retinal microcirculation. The retinal OCTA parameters were correlated with the following clinical parameters: the patient's age at the onset of the disease, the duration of T1DM, the BMI at the time of enrollment in the study, the HbA1C values at onset, the mean values of HbA1C over the period of monitoring the disease and the degree of DKA at onset. RESULTS For the study group, the foveal avascular zone (FAZ) area and perimeter correlated positively with the mean value of HbA1C (Pearson correlation, Sig.2-Tailed Area: 0.044; perimeter: 0.049). The total vessel density in the superficial capillary plexus (SCP) correlated negatively with the duration of T1DM, based on the superior and inferior analyzed areas (Spearman correlation, Sig.2-Tailed SCP in total region: 0.002; SCP in the superior region: 0.024; SCP in the inferior region: 0.050). The foveal thickness also correlated negatively with the levels of diabetic ketoacidosis (DKA) at onset (Spearman correlation, Sig.2-Tailed: 0.034) and the levels of HbA1C at onset (Spearman correlation, Sig.2-Tailed: 0.047). Further on, the study patients were distributed into two groups according to the duration of the disease: group 1 included 32 patients with a duration of T1DM of less than 5 years, and group 2 included 37 patients with a duration of T1DM of more than 5 years. Independent t-tests were used to compare the OCTA retinal parameters for the two subgroups. While the FAZ-related parameters did not show significant statistical differences between the two groups, the vessel densities in both the SCP and DCP were significantly lower in group 2. CONCLUSIONS Our data suggest that specific alterations in OCTA imaging biomarkers correlate with various clinical parameters: the FAZ area and perimeter increase with higher mean values of HbA1C, leading to poor metabolic control. Moreover, the SCP total vessel density decreases as the duration of T1DM increases. Regarding the vessel densities in the SCP and the DCP, they decrease with a duration of the disease of more than 5 years.
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Affiliation(s)
- Alexandra Oltea Dan
- Department of Physiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.O.D.)
| | - Carmen Luminița Mocanu
- Department of Ophthalmology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Andrei Teodor Bălășoiu
- Department of Ophthalmology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Cornelia Andreea Tănasie
- Department of Physiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.O.D.)
| | - Ileana Puiu
- Department of Pediatrics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Anca Elena Târtea
- Department of Neurology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Veronica Sfredel
- Department of Physiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.O.D.)
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Li M, Huang K, Zeng C, Chen Q, Zhang W. Visualization and quantization of 3D retinal vessels in OCTA images. OPTICS EXPRESS 2024; 32:471-481. [PMID: 38175076 DOI: 10.1364/oe.504877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024]
Abstract
Optical coherence tomography angiography (OCTA) has been increasingly used in the analysis of ophthalmic diseases in recent years. Automatic vessel segmentation in 2D OCTA projection images is commonly used in clinical practice. However, OCTA provides a 3D volume of the retinal blood vessels with rich spatial distribution information, and it is incomplete to segment retinal vessels only in 2D projection images. Here, considering that it is difficult to manually label 3D vessels, we introduce a 3D vessel segmentation and reconstruction method for OCTA images with only 2D vessel labels. We implemented 3D vessel segmentation in the OCTA volume using a specially trained 2D vessel segmentation model. The 3D vessel segmentation results are further used to calculate 3D vessel parameters and perform 3D reconstruction. The experimental results on the public dataset OCTA-500 demonstrate that 3D vessel parameters have higher sensitivity to vascular alteration than 2D vessel parameters, which makes it meaningful for clinical analysis. The 3D vessel reconstruction provides vascular visualization in different retinal layers that can be used to monitor the development of retinal diseases. Finally, we also illustrate the use of 3D reconstruction results to determine the relationship between the location of arteries and veins.
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27
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Zhou J, Cai Y, Li T, Zhou H, Dong H, Wu X, Li Z, Wang W, Yuan D, Li Y, Shi J. Aflibercept Loaded Eye-Drop Hydrogel Mediated with Cell-Penetrating Peptide for Corneal Neovascularization Treatment. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2302765. [PMID: 37679056 DOI: 10.1002/smll.202302765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/30/2023] [Indexed: 09/09/2023]
Abstract
Corneal neovascularization (CoNV) is a major cause of visual impairment worldwide. Currently, available treatment options have limited efficacy and are associated with adverse effects due to biological barriers and clearance mechanisms. To address this challenge, a novel topical delivery system is developed-Gel 2_1&Eylea-an aflibercept-loaded eye-drop hydrogel mediated with cell-penetrating peptide 1. Gel 2_1&Eylea demonstrates superior membrane permeability, increased stability, and prolonged drug retention time on the ocular surface, and thus may improve drug efficacy. In a rabbit CoNV model, Gel 2_1&Eylea significantly reduces the density of neovascularization with no adverse effects on normal corneoscleral limbal vessels, demonstrating high efficacy and biocompatibility. This work identifies a promising treatment for CoNV which has the potential to benefit other ocular neovascular diseases.
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Affiliation(s)
- Jianan Zhou
- Hunan Provincial Key Laboratory of Animal Models and Molecular Medicine, State Key Laboratory of Chemo/Bio-Sensing and Chemometrics, School of Biomedical Sciences, Hunan University, Changsha, Hunan, 410082, China
| | - Yuting Cai
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Tingting Li
- Hunan Provincial Key Laboratory of Animal Models and Molecular Medicine, State Key Laboratory of Chemo/Bio-Sensing and Chemometrics, School of Biomedical Sciences, Hunan University, Changsha, Hunan, 410082, China
| | - Haixiang Zhou
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Huilei Dong
- Hunan Provincial Key Laboratory of Animal Models and Molecular Medicine, State Key Laboratory of Chemo/Bio-Sensing and Chemometrics, School of Biomedical Sciences, Hunan University, Changsha, Hunan, 410082, China
| | - Xia Wu
- Hunan Provincial Key Laboratory of Animal Models and Molecular Medicine, State Key Laboratory of Chemo/Bio-Sensing and Chemometrics, School of Biomedical Sciences, Hunan University, Changsha, Hunan, 410082, China
- Shenzhen International Institute for Biomedical Research, Longhua District, Shenzhen, Guangdong, 518116, China
| | - Zenghui Li
- Hunan Provincial Key Laboratory of Animal Models and Molecular Medicine, State Key Laboratory of Chemo/Bio-Sensing and Chemometrics, School of Biomedical Sciences, Hunan University, Changsha, Hunan, 410082, China
| | - Wenjie Wang
- Hunan Provincial Key Laboratory of Animal Models and Molecular Medicine, State Key Laboratory of Chemo/Bio-Sensing and Chemometrics, School of Biomedical Sciences, Hunan University, Changsha, Hunan, 410082, China
| | - Dan Yuan
- Hunan Provincial Key Laboratory of Animal Models and Molecular Medicine, State Key Laboratory of Chemo/Bio-Sensing and Chemometrics, School of Biomedical Sciences, Hunan University, Changsha, Hunan, 410082, China
| | - Yun Li
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Junfeng Shi
- Hunan Provincial Key Laboratory of Animal Models and Molecular Medicine, State Key Laboratory of Chemo/Bio-Sensing and Chemometrics, School of Biomedical Sciences, Hunan University, Changsha, Hunan, 410082, China
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28
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Huang H, Wang XY, Wei H, Kang M, Zou J, Ling Q, Xu SH, Huang H, Chen X, Wang YX, Shao Y, Yu Y. Retinal microvascular and microstructural alterations in the diagnosis of meibomian gland dysfunction in severely obese population: a new approach. Int J Ophthalmol 2023; 16:1977-1985. [PMID: 38111945 PMCID: PMC10700072 DOI: 10.18240/ijo.2023.12.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 11/01/2023] [Indexed: 12/20/2023] Open
Abstract
AIM To study retinal microvascular and microstructural alterations in meibomian gland dysfunction (MGD) in severely obese population using optical coherence tomography angiography (OCTA). METHODS Twelve MGD patients with severely obese population (PAT group; 24 eyes) and 12 healthy controls (HC group; 24 eyes) were recruited. OCTA images were segmented into five [superior (S), nasal (N), inferior (I), temporal (T), and central foveal (C)] or nine [inner superior (IS), outer superior (OS), inner nasal (IN), outer nasal (ON), inner inferior (II), outer inferior (OI), inner temporal (IT), outer temporal (OT), and C] subregions. The superficial vessel density (SVD), retinal thickness (RT), foveal avascular zone (FAZ) parameters, and retinal volume were measured. RESULTS Visual acuity was significantly different between two groups (0.8±0.17 in PAT group vs 0.2±0.06 in HC group). SVD was significantly lower in PATs in N, T, OS, IN, OT, and ON. The area under the receiver operating characteristic curve (AUC) for T was 0.961 [95% confidence interval (CI): 0.908 to 1.000], for OS was 0.962 (95%CI: 0.915 to 1.000). RT was significantly lower in PATs in IS, OS, OI, OT, ON, IT, IN, and II. AUC for OT was 0.935 (95%CI: 0.870 to 0.999), for IS was 0.915 (95% CI: 0.838 to 0.992). Angiography results showed significantly lower area and perimeter of FAZ, SVD of the inner retina and both retinal volume and the average volume thickness in the PAT group. CONCLUSION Vision may be affected in patients with MGD due to changes in retinal microvessels and microstructures. These changes detected by OCTA may be a potential marker for diagnosing MGD in severe obesity.
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Affiliation(s)
- Hai Huang
- Nanchang Aier Eye Hospital, Nanchang 330006, Jiangxi Province, China
| | - Xiao-Yu Wang
- Department of Endocrinology and Metabolism, the First Affiliated Hospital of Nanchang University, Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang 330006, Jiangxi Province, China
- The First Clinical Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Hong Wei
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200433, China
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang 330006, Jiangxi Province, China
| | - Min Kang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200433, China
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang 330006, Jiangxi Province, China
| | - Jie Zou
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200433, China
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang 330006, Jiangxi Province, China
| | - Qian Ling
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200433, China
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang 330006, Jiangxi Province, China
| | - San-Hua Xu
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200433, China
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang 330006, Jiangxi Province, China
| | - Hui Huang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200433, China
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang 330006, Jiangxi Province, China
| | - Xu Chen
- Department of Ophthalmology and Visual Sciences, Maastricht University, Maastricht 6200MA, Limburg Province, Netherlands
| | - Yi-Xin Wang
- School of Optometry and Vision Sciences, Cardiff University, Cardiff CF244HQ, United Kingdom
| | - Yi Shao
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200433, China
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang 330006, Jiangxi Province, China
| | - Yao Yu
- Department of Endocrinology and Metabolism, the First Affiliated Hospital of Nanchang University, Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang 330006, Jiangxi Province, China
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Gokmen O, Ozgur G. Effects of COVID-19 infection on retinal vascular density and choroidal thickness measured by optical coherence tomography angiography. Photodiagnosis Photodyn Ther 2023; 44:103859. [PMID: 37871811 DOI: 10.1016/j.pdpdt.2023.103859] [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: 07/18/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 10/25/2023]
Abstract
AIM The present study evaluates the possible effects of COVID-19 on choroid thickness, the Foveal Avascular Zone (FAZ) and retinal vascular indices in the same individuals who had Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA) data prior to the COVID-19 pandemic. METHODS The OCT and OCTA images of the same individuals with no known ophthalmic pathology who developed a COVID-19 infection were obtained were retrieved retrospectively from the database and compared with the repeated images of OCT and OCTA images 1-2 months after COVID-19 infection. RESULTS Eighty eyes of 40 patients (26 female [65%], 14 male [35%]) who had developed a prior Covid-19 infection were included in the study. When comparing the measurements of the same participants before and after Covid-19 infection, no significant difference was detected in the mean average choroidal thicknesses (p=0.998), average superficial (p=0.425) and deep (p=0.333) retinal vascular densities, and superficial (p=0.991) and deep (p=0.075) FAZ measurements. CONCLUSIONS No significant effect of COVID-19 on choroid thickness, FAZ or retinal vascular densities was noted in the present study, although there are some studies in literature with equivocal results.
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Affiliation(s)
- Onur Gokmen
- Department of Ophthalmology Van, Yuzuncu Yil University Dursun Odabasi Tip Merkezi - Van, Bardakcı Mah. Kampus, Turkey.
| | - Gokhan Ozgur
- Department of Ophthalmology Samsun, Health Sciences University Samsun Training and Research Hospital, Turkey
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30
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Al-Hinnawi AR, Al-Latayfeh M, Tavakoli M. Innovative Macula Capillaries Plexuses Visualization with OCTA B-Scan Graph Representation: Transforming OCTA B-Scan into OCTA Graph Representation. J Multidiscip Healthc 2023; 16:3477-3491. [PMID: 38024137 PMCID: PMC10662934 DOI: 10.2147/jmdh.s433405] [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: 08/01/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The aim of this study is to transform optical coherence tomography angiography (OCTA) scans into innovative OCTA graphs, serving as novel biomarkers representing the macular vasculature. Patients and Methods The study included 90 healthy subjects and 39 subjects with various abnormalities (29 with diabetic retinopathy, 5 with age-related macular degeneration, and 5 with choroid neovascularization). OCTA 5µm macular coronal views (MCVs) were generated for each subject, followed by blood vessel segmentation and skeleton processing. Subsequently, the blood vessel density index, blood vessel skeleton index, and blood vessel tortuosity index were computed. The graphs of each metric were plotted against the axial axes of the OCTA B-scan, representing the integrity of vasculature at successive 5µm macular depths. Results The results revealed two significant findings. First, the B-scans from OCTA can be transformed into OCTA graphs, yielding three specific OCTA graphs in this study. These graphs provide new biomarkers for assessing the integrity of deep vascular complex (DVC) and superficial vascular complex (SVC) within the macula. Second, a statistically significant difference was observed between normal (n=90) and abnormal (n=39) subjects, with a t-test p-value significantly lower than 0.001. The Mann-Whitney u-test also yielded significant difference but only between the 90 normal and 29 DR subjects. Conclusion The novel OCTA graphs offer a unique representation of the macula's SVC and DVC, suggesting their potential in aiding physicians in the diagnosis of eye health within OCTA clinics. Further research is warranted to finalize the shape of these newly derived OCTA graphs and establish their clinical relevance and utility.
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Affiliation(s)
- Abdel-Razzak Al-Hinnawi
- Department of Medical Imaging, Faculty of Allied Medical Sciences, Isra University, Amman, Jordan
| | - Motasem Al-Latayfeh
- Department of Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Mitra Tavakoli
- Exeter Centre of Excellence for Diabetes Research, National Institute for Health and Care Research (NIHR) Exeter Clinical Research Facility, and Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, Exeter, UK
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31
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Ma F, Wang S, Dai C, Qi F, Meng J. A new retinal OCT-angiography diabetic retinopathy dataset for segmentation and DR grading. JOURNAL OF BIOPHOTONICS 2023; 16:e202300052. [PMID: 37421596 DOI: 10.1002/jbio.202300052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Diabetic retinopathy (DR) is one of the most common diseases caused by diabetes and can lead to vision loss or even blindness. The wide-field optical coherence tomography (OCT) angiography is non-invasive imaging technology and convenient to diagnose DR. METHODS A newly constructed Retinal OCT-Angiography Diabetic retinopathy (ROAD) dataset is utilized for segmentation and grading tasks. It contains 1200 normal images, 1440 DR images, and 1440 ground truths for DR image segmentation. To handle the problem of grading DR, we propose a novel and effective framework, named projective map attention-based convolutional neural network (PACNet). RESULTS The experimental results demonstrate the effectiveness of our PACNet. The accuracy of the proposed framework for grading DR is 87.5% on the ROAD dataset. CONCLUSIONS The information on ROAD can be viewed at URL https://mip2019.github.io/ROAD. The ROAD dataset will be helpful for the development of the early detection of DR field and future research. TRANSLATIONAL RELEVANCE The novel framework for grading DR is a valuable research and clinical diagnosis method.
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Affiliation(s)
- Fei Ma
- Qufu Normal University, Rizhao, Shandong, China
| | | | - Cuixia Dai
- College Science, Shanghai Institute of Technology, Shanghai, China
| | - Fumin Qi
- National Supercomputing Center in Shenzhen, Shenzhen, Guangdong, China
| | - Jing Meng
- Qufu Normal University, Rizhao, Shandong, China
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32
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Fasoula NA, Xie Y, Katsouli N, Reidl M, Kallmayer MA, Eckstein HH, Ntziachristos V, Hadjileontiadis L, Avgerinos DV, Briasoulis A, Siasos G, Hosseini K, Doulamis I, Kampaktsis PN, Karlas A. Clinical and Translational Imaging and Sensing of Diabetic Microangiopathy: A Narrative Review. J Cardiovasc Dev Dis 2023; 10:383. [PMID: 37754812 PMCID: PMC10531807 DOI: 10.3390/jcdd10090383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Microvascular changes in diabetes affect the function of several critical organs, such as the kidneys, heart, brain, eye, and skin, among others. The possibility of detecting such changes early enough in order to take appropriate actions renders the development of appropriate tools and techniques an imperative need. To this end, several sensing and imaging techniques have been developed or employed in the assessment of microangiopathy in patients with diabetes. Herein, we present such techniques; we provide insights into their principles of operation while discussing the characteristics that make them appropriate for such use. Finally, apart from already established techniques, we present novel ones with great translational potential, such as optoacoustic technologies, which are expected to enter clinical practice in the foreseeable future.
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Affiliation(s)
- Nikolina-Alexia Fasoula
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Yi Xie
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Nikoletta Katsouli
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Mario Reidl
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Michael A. Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (M.A.K.); (H.-H.E.)
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (M.A.K.); (H.-H.E.)
| | - Vasilis Ntziachristos
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany
| | - Leontios Hadjileontiadis
- Department of Biomedical Engineering, Healthcare Engineering Innovation Center (HEIC), Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates;
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | | | - Alexandros Briasoulis
- Aleksandra Hospital, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece;
| | - Gerasimos Siasos
- Sotiria Hospital, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece;
| | - Kaveh Hosseini
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran 1411713138, Iran;
| | - Ilias Doulamis
- Department of Surgery, The Johns Hopkins Hospital, School of Medicine, Baltimore, MD 21287, USA;
| | | | - Angelos Karlas
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (M.A.K.); (H.-H.E.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany
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Yang DW, Tang ZQ, Tang FY, Szeto SK, Chan J, Yip F, Wong CY, Ran AR, Lai TY, Cheung CY. Clinically relevant factors associated with a binary outcome of diabetic macular ischaemia: an OCTA study. Br J Ophthalmol 2023; 107:1311-1318. [PMID: 35450939 DOI: 10.1136/bjophthalmol-2021-320779] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/09/2022] [Indexed: 01/25/2023]
Abstract
AIMS We investigated the demographic, ocular, diabetes-related and systemic factors associated with a binary outcome of diabetic macular ischaemia (DMI) as assessed by optical coherence tomography angiography (OCTA) evaluation of non-perfusion at the level of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in a cohort of patients with diabetes mellitus (DM). MATERIALS AND METHODS 617 patients with DM were recruited from July 2015 to December 2020 at the Chinese University of Hong Kong Eye Centre. Image quality assessment (gradable or ungradable for assessing DMI) and DMI evaluation (presence or absence of DMI) were assessed at the level of the SCP and DCP by OCTA. RESULTS 1107 eyes from 593 subjects were included in the final analysis. 560 (50.59%) eyes had DMI at the level of SCP, and 647 (58.45%) eyes had DMI at the level of DCP. Among eyes without diabetic retinopathy (DR), DMI was observed in 19.40% and 24.13% of eyes at SCP and DCP, respectively. In the multivariable logistic regression models, older age, poorer visual acuity, thinner ganglion cell-inner plexiform layer thickness, worsened DR severity, higher haemoglobin A1c level, lower estimated glomerular filtration rate and higher low-density lipoprotein cholesterol level were associated with SCP-DMI. In addition to the aforementioned factors, presence of diabetic macular oedema and shorter axial length were associated with DCP-DMI. CONCLUSION We reported a series of associated factors of SCP-DMI and DCP-DMI. The binary outcome of DMI might promote a simplified OCTA-based DMI evaluation before subsequent quantitative analysis for assessing DMI extent and fulfil the urge for an updating diabetic retinal disease staging to be implemented with OCTA.
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Affiliation(s)
- Da Wei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Zi Qi Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Fang Yao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Simon Kh Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Jason Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Fanny Yip
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Cherie Yk Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - An Ran Ran
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Timothy Yy Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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Gobeka HH, Balcı A, Doğan M, Ay İE, Yörükoğlu Kayabaş S, Büyükokudan U. Optical coherence tomography angiography characteristics of retinochoroidal and optic nerve head microcirculation in cryptogenic organizing pneumonia. Photodiagnosis Photodyn Ther 2023; 43:103720. [PMID: 37487811 DOI: 10.1016/j.pdpdt.2023.103720] [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: 06/21/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND To assess retinochoroidal and optic nerve head microcirculation alterations in cryptogenic organizing pneumonia. METHODS Thirty cryptogenic organizing pneumonia patients in the resolution phase (group 1, 30 right eyes) and 33 healthy subjects (group 2, 33 right eyes) were compared. Patients had 40 mg/day corticosteroids for 8-10 days, and a pulmonary function test, which revealed only minimally restrictive ventilation features. After gathering demographic data, a comprehensive ophthalmological exam and optical coherence tomography angiography were performed three months following maximum disease resolution with corticosteroid therapy RESULTS: Groups 1 and 2 had mean ages of 54.37±14.87 and 49.61±12.36 years, respectively (P = 0.171). Despite the lack of statistical significance, superficial and deep capillary plexus vessel densities in all macular regions were lower in group 1, as were foveal avascular zone parameters (P>0.05). However, the outer retinal and choriocapillaris flows increased significantly in group 1, especially in select areas (P<0.001, for both). There were no significant differences in whole image (P = 0.346), inside disk (P = 0.438), or peripapillary (P = 0.185) optic nerve head vessel densities between the two groups; however, nasal (P<0.001) and inferior quadrant (P = 0.006) vessel densities differed significantly. Global retinal nerve fiber layer thickness did not differ significantly between groups 1 and 2 (112.83±14.71 versus 111.45±12.74 µm, respectively; P = 0.692). Group 1, however, had significantly higher superior, nasal, and inferior quadrant, and significantly lower temporal quadrant retinal nerve fiber layer thickness (P<0.001, for all). CONCLUSIONS Concerning the impact of probable cryptogenic organizing pneumonia-induced hypoxia on ocular tissues, optical coherence tomography angiography assessments of retinochoroidal and optic nerve head microcirculation could be employed as a biomarker for cerebral microcirculation.
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Affiliation(s)
- Hamidu Hamisi Gobeka
- Department of Ophthalmology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye.
| | - Aydın Balcı
- Department of Chest Diseases, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Mustafa Doğan
- Department of Ophthalmology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - İbrahim Ethem Ay
- Department of Ophthalmology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Seray Yörükoğlu Kayabaş
- Department of Ophthalmology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Uğur Büyükokudan
- Department of Public health, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
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Kalva P, Akram R, Mekala P, Patel M, Suresh S, Kooner KS. Quantification of vascular morphology in optical coherence tomography angiography in primary open angle glaucoma. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2023; 3:119-125. [PMID: 37846359 PMCID: PMC10577834 DOI: 10.1016/j.aopr.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/07/2023] [Accepted: 05/12/2023] [Indexed: 10/18/2023]
Abstract
Purpose To quantitatively measure and compare the vascular morphology in healthy eyes and eyes with primary open-angle glaucoma (POAG) using optical coherence tomography angiography (OCTA) scans. Methods This is a retrospective and cross-sectional study which include healthy individuals and individuals with POAG that underwent OCTA imaging at an academic center's glaucoma clinic. We analyzed OCTA scans of the macula and optic nerve head (ONH) of one eye from each subject to quantitatively measure vessel density (VD), vessel length density (VLD), and branchpoint density (BPD). We compared these 3 parameters between the healthy and POAG groups and used logistic regression classification models to determine their diagnostic value in differentiating healthy and glaucomatous eyes. Results We included 49 healthy subjects and 49 subjects with POAG. After age-adjusted analysis, the parameters of VD, VLD, and BPD were significantly reduced in eyes with POAG (P < 0.001) in all scan layers and most significantly around the ONH. The parameter with the best performances were radial peripapillary capillary (RPC) VD [AUC (areas under the curve): 0.939 (0.891, 0.987)] which had statistically higher performances (P < 0.05) than parameters in the superficial or deep layers. All 3 parameters in the RPC layer had statistically similar performances. Conclusions We found that VD, VLD, and BPD were reduced in glaucomatous eyes. The morphologic parameters of VLD and BPD had similar performances to the traditional parameter of VD in RPC layers. Our results suggest that vascular morphology parameters may provide additional value in the diagnosis and evaluation of glaucoma.
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Affiliation(s)
- Praneeth Kalva
- Department of Ophthalmology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Rubeel Akram
- Department of Ophthalmology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Priya Mekala
- Department of Ophthalmology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Monica Patel
- Department of Ophthalmology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Sruthi Suresh
- Department of Ophthalmology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Karanjit S. Kooner
- Department of Ophthalmology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
- Department of Ophthalmology, Veteran Affairs North Texas Health Care Medical Center, Dallas, TX, USA
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Javed A, Khanna A, Palmer E, Wilde C, Zaman A, Orr G, Kumudhan D, Lakshmanan A, Panos GD. Optical coherence tomography angiography: a review of the current literature. J Int Med Res 2023; 51:3000605231187933. [PMID: 37498178 PMCID: PMC10387790 DOI: 10.1177/03000605231187933] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
This narrative review presents a comprehensive examination of optical coherence tomography angiography (OCTA), a non-invasive retinal vascular imaging technology, as reported in the existing literature. Building on the coherence tomography principles of standard OCT, OCTA further delineates the retinal vascular system, thus offering an advanced alternative to conventional dye-based imaging. OCTA provides high-resolution visualisation of both the superficial and deep capillary networks, an achievement previously unattainable. However, image quality may be compromised by factors such as motion artefacts or media opacities, potentially limiting the utility of OCTA in certain patient cohorts. Despite these limitations, OCTA has various potential clinical applications in managing retinal and choroidal vascular diseases. Still, given its considerable cost implications relative to current modalities, further research is warranted to justify its broader application in clinical practice.
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Affiliation(s)
- Ahmed Javed
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Aishwarya Khanna
- Department of Ophthalmology, Royal Derby Hospital, Derby, United Kingdom
| | - Eleanor Palmer
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Craig Wilde
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Anwar Zaman
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Gavin Orr
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Dharmalingam Kumudhan
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Arun Lakshmanan
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Georgios D Panos
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
- Division of Ophthalmology and Visual Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Jin K, Shen W, Liang Y, He M. Epidemiology, Translation and Clinical Research of Ophthalmology. J Clin Med 2023; 12:3819. [PMID: 37298014 PMCID: PMC10253839 DOI: 10.3390/jcm12113819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
The human eye is a complex and vital organ that plays a significant role in maintaining a high quality of human life [...].
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Affiliation(s)
- Kai Jin
- Eye Center, The Second Affiliated Hospital School of Medicine Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou 310009, China;
| | - Wenyue Shen
- Eye Center, The Second Affiliated Hospital School of Medicine Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou 310009, China;
| | - Yuanbo Liang
- National Clinical Research Center for Ocular Diseases, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, China;
| | - Mingguang He
- Centre for Eye Research Australia, Royal Victorian, Eye and Ear Hospital, University of Melbourne, Melbourne 3002, Australia
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Crincoli E, Colantuono D, Miere A, Zhao Z, Ferrara S, Souied EH. Perivenular Capillary Rarefaction in Diabetic Retinopathy: Interdevice Characterization and Association to Clinical Staging. OPHTHALMOLOGY SCIENCE 2023; 3:100269. [PMID: 36875334 PMCID: PMC9978849 DOI: 10.1016/j.xops.2023.100269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/29/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
Purpose Geometric perfusion deficit (GPD) is a newly described OCT angiography (OCTA) parameter identifying the total area of presumed retinal ischemia. The aim of our study is to characterize differences in GPD and other common quantitative OCTA parameters between macular full field, perivenular zones, and periarteriolar zones for each clinical stage of nonproliferative diabetic retinopathy (DR) and to assess the influence of ultrahigh-speed acquisition and averaging on the described differences. Design Prospective observational study. Participants Forty-nine patients, including 11 (22.4%) with no sign of DR, 12 (24.5%) with mild DR, 13 (26.5%) with moderate DR, and 13 (26.5%) with severe DR. Patients with diabetic macular edema, proliferative DR, media opacity, head tremor, and overlapping retinal diseases or systemic diseases influencing OCTA were excluded. Methods OCT angiography was performed 3 times for each patient: 1 using Solix Fullrange single volume (V1) mode, 1 using Solix Fullrange 4 volumes mode with automatically averaged scan (V4), and 1 using AngioVue. Main Outcome Measures Full macular, periarteriolar, and perivenular perfusion density (PD), vessel length density (VLD), vessel density index, and GPD for both the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Results In patients showing no sign of DR, PD and VLD were significantly lower in the perivenular area in both the DCP and SCP using V1 and V4, whereas GPD was significantly higher in the perivenular zone in the DCP and SCP with all 3 devices. In patients with mild DR, all 3 measurements (PD, VLD, and GPD) were significantly different in the perivenular zone with all 3 devices. In patients with moderate DR, PD and VLD were lower in the DCP and SCP when measured with V1 and V4. Moreover, GPD was higher in the perivenular zone in the DCP with all 3 devices, whereas only V4 detected a difference in the SCP. In severe DR, only V4 detected a lower PD and VLD and a higher GPD in the DCP of the perivenular zone. V4 also detected a higher GPD in the SCP. Conclusions Geometric perfusion deficit highlights prevalent perivenular location of macular capillary ischemia in all stages of DR. In severe DR patients, only averaging technology allows detection of the same finding. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Key Words
- Capillary ischemia
- DCP, deep capillary plexus
- DR, diabetic retinopathy
- Diabetic retinopathy
- GPD, geometric perfusion deficit
- Geometric perfusion density
- OCT angiography
- OCTA, OCT angiography
- PD, perfusion density
- ROIs, regions of interest
- SCP, superficial capillary plexus
- V1, single volume
- V4, 4 volumes mode with automatically averaged scan
- VDI, vessel density index
- VLD, vessel length density
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Affiliation(s)
- Emanuele Crincoli
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Créteil, France
- Catholic University of “Sacro Cuore”, Rome, Italy
| | - Donato Colantuono
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Créteil, France
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Créteil, France
| | - Zhanlin Zhao
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Créteil, France
| | | | - Eric H. Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Créteil, France
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Lv M, Li T, Li Y. Clinical application of optical coherence tomography angiography in diabetic macular edema. Afr Health Sci 2023; 23:484-489. [PMID: 38223604 PMCID: PMC10782371 DOI: 10.4314/ahs.v23i2.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Diabetic macular edema (DME) is characterized by a retinal thickening or hard exudation deposition in the fundus microvasculature, capillary leakage, increased vascular permeability, extracellular fluid accumulation in the fovea of a foveal disc. Optical coherence tomography angiography (OCTA) is a new item of fundus structure examination. OCTA is to reconstruct the retinal choroidal vascular structure from the continuous same cross-sectional views and blood flow signals obtained by optical scanning, thereby obtaining an image. It is very significant to evaluate, diagnose, treat and manage the disease.
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Affiliation(s)
- Meng Lv
- Department of Ophthalmology, the Central Hospital of Enshi Autonomous Prefecture, Hubei University of Medicine, Shiyan 442000, Hubei Province, P.R.C
| | - Tuo Li
- Department of Ophthalmology, the Central Hospital of Enshi Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi 445000, Hubei Province, P.R.C
| | - Yin Li
- Department of Ophthalmology, the Central Hospital of Enshi Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi 445000, Hubei Province, P.R.C
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Qi Z, Si Y, Feng F, Zhu J, Yang X, Wang W, Zhang Y, Cui Y. Analysis of retinal and choroidal characteristics in patients with early diabetic retinopathy using WSS-OCTA. Front Endocrinol (Lausanne) 2023; 14:1184717. [PMID: 37293481 PMCID: PMC10244727 DOI: 10.3389/fendo.2023.1184717] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/11/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction Diabetic retinopathy (DR) is one of the most common and destructive microvascular complications of DM, and has become a major cause of irreversible visual impairment. The purpose of this study was to evaluate the changes in fundus microcirculation in non-diabetic retinopathy (NDR) and mild non-proliferative diabetic retinopathy (NPDR) in patients with type 2 diabetic mellitus (T2DM) using widefield swept-source optical coherence tomography angiography (WSSOCTA), and to investigate the correlation with laboratory indices of T2DM. Methods Eighty nine, 58 and 28 eyes were included in the NDR, NPDR and Control groups, respectively, were enrolled in this study. The 12mm×12mm fundus images obtained by WSS-OCTA were divided into 9 regions (supratemporal, ST; temporal, T; inferotemporal, IT; superior, S; central macular area, C; inferior, I; supranasal, SN; nasal, N; inferonasal, IN) to evaluate changes in vessel density (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris, and mid-large choroidal vessel (MLCV), as well as changes in inner retinal thickness (IRT), outer retinal thickness (ORT), and choroidal thickness (CT). Results: Compared with control group, MLCV VD (I, N, IN) was significantly decreased in NDR group, SCP VD (IT, C, I) and DCP VD (T, IT, I) were significantly decreased in NPDR group. In NPDR group, DCP VD (IT) was significantly decreased compared with that in NDR group. Compared with control group, CT (ST, T, IT, S, SN, IN) was significantly declined in NDR group, and IRT (ST, IT) and ORT (ST, N) were significantly increased in NPDR group. In NPDR group, IRT (ST) and ORT (T, S) were significantly increased compared with NDR group. Correlation analysis showed that age, body mass index, fasting blood glucose, fasting insulin, fasting C-peptide, and estimated glomerular filtration rate in T2DM patients were statistically correlated with retinal and choroidal thickness/VD. Discussion Structural and blood flow changes in the choroid occur before the onset of DR and precede changes in the retinal microcirculation, and MLCV thickness/VD is a more sensitive imaging biomarker for the clinical detection of DR. WSS-OCTA enables large-scale non-invasive visual screening and follow-up of the retinal and choroidal vasculature in DR patients, providing a new strategy for the prevention and monitoring of DR in patients with T2DM.
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Affiliation(s)
- Zhihao Qi
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuanyuan Si
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Feng Feng
- Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, China
| | - Jing Zhu
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
| | - Xuepeng Yang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenjuan Wang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
| | - Yuting Zhang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
| | - Yan Cui
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
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Fernández-Espinosa G, Ruiz-Tabuenca C, Orduna-Hospital E, Pinilla I, Salgado-Remacha FJ. A Reliable Criterion for the Correct Delimitation of the Foveal Avascular Zone in Diabetic Patients. J Pers Med 2023; 13:jpm13050822. [PMID: 37240992 DOI: 10.3390/jpm13050822] [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: 04/09/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Manual segmentation of the Foveal Avascular Zone (FAZ) has a high level of variability. Research into retinas needs coherent segmentation sets with low variability. METHODS Retinal optical coherence tomography angiography (OCTA) images from type-1 diabetes mellitus (DM1), type-2 diabetes mellitus (DM2) and healthy patients were included. Superficial (SCP) and deep (DCP) capillary plexus FAZs were manually segmented by different observers. After comparing the results, a new criterion was established to reduce variability in the segmentations. The FAZ area and acircularity were also studied. RESULTS The new segmentation criterion produces smaller areas (closer to the real FAZ) with lower variability than the different criteria of the explorers in both plexuses for the three groups. This was particularly noticeable for the DM2 group with damaged retinas. The acircularity values were also slightly reduced with the final criterion in all groups. The FAZ areas with lower values showed slightly higher acircularity values. We also have a consistent and coherent set of segmentations with which to continue our research. CONCLUSIONS Manual segmentations of FAZ are generally carried out with little attention to the consistency of the measurements. A novel criterion for segmenting the FAZ allows segmentations made by different observers to be more similar.
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Affiliation(s)
| | | | - Elvira Orduna-Hospital
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain
- Departamento de Física Aplicada, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Isabel Pinilla
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain
- Department of Ophthalmology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Departamento de Cirugía, Universidad de Zaragoza, 50009 Zaragoza, Spain
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Ong CJT, Wong MYZ, Cheong KX, Zhao J, Teo KYC, Tan TE. Optical Coherence Tomography Angiography in Retinal Vascular Disorders. Diagnostics (Basel) 2023; 13:diagnostics13091620. [PMID: 37175011 PMCID: PMC10178415 DOI: 10.3390/diagnostics13091620] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023] Open
Abstract
Traditionally, abnormalities of the retinal vasculature and perfusion in retinal vascular disorders, such as diabetic retinopathy and retinal vascular occlusions, have been visualized with dye-based fluorescein angiography (FA). Optical coherence tomography angiography (OCTA) is a newer, alternative modality for imaging the retinal vasculature, which has some advantages over FA, such as its dye-free, non-invasive nature, and depth resolution. The depth resolution of OCTA allows for characterization of the retinal microvasculature in distinct anatomic layers, and commercial OCTA platforms also provide automated quantitative vascular and perfusion metrics. Quantitative and qualitative OCTA analysis in various retinal vascular disorders has facilitated the detection of pre-clinical vascular changes, greater understanding of known clinical signs, and the development of imaging biomarkers to prognosticate and guide treatment. With further technological improvements, such as a greater field of view and better image quality processing algorithms, it is likely that OCTA will play an integral role in the study and management of retinal vascular disorders. Artificial intelligence methods-in particular, deep learning-show promise in refining the insights to be gained from the use of OCTA in retinal vascular disorders. This review aims to summarize the current literature on this imaging modality in relation to common retinal vascular disorders.
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Affiliation(s)
- Charles Jit Teng Ong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Mark Yu Zheng Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Kai Xiong Cheong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Jinzhi Zhao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Kelvin Yi Chong Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (EYE ACP), Duke-NUS Medical School, Singapore 169857, Singapore
| | - Tien-En Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (EYE ACP), Duke-NUS Medical School, Singapore 169857, Singapore
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Arrigo A, Teussink M, Antropoli A, Bianco L, Aragona E, Gambarotta S, Bandello F, Battaglia Parodi M. Confocal MultiColor Signal Depends on Perfusion Characteristics of Retinal Microaneurysms in Diabetic Retinopathy as Detected by OCTA. Transl Vis Sci Technol 2023; 12:6. [PMID: 37133839 PMCID: PMC10166113 DOI: 10.1167/tvst.12.5.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Purpose To propose a noninvasive way of classifying multimodal imaging of retinal microaneurysms (MA) secondary to diabetic retinopathy (DR). Methods The research was designed as a cross-sectional, observational study of patients affected by DR. Multimodal imaging included confocal MultiColor imaging, optical coherence tomography (OCT) and OCT angiography (OCTA). MA green- and infrared-reflectance components were assessed by confocal MultiColor imaging, reflectivity properties by OCT, and MA perfusion features by OCTA. In addition, we included high-resolution (HR) and high-speed (HS) OCTA scans to assess HR-HS agreement in detecting retinal MA and to highlight different perfusion features detected by both OCTA acquisitions. Results We analyzed 216 retinal MAs, divided into green (46; 21%), red (58; 27%) and mixed types (112; 52%). Green MAs were mainly hyper-reflective on OCT, with no or poor filling on OCTA. Red MAs were characterized by an isoreflective signal on OCT and full filling on OCTA. Mixed MAs showed a hyper-reflective border and a hyporeflective core on OCT and partial filling on OCTA. No differences in red MA HR/HS size discrepancy and reflectivity were found, whereas these progressively increased as the MA MultiColor signal changed from infrared to green. MA types significantly correlated with visual acuity, DR duration, and DR severity. Conclusions Retinal MA can be classified reliably by means of a fully noninvasive multimodal imaging-based assessment. MA types are matched with visual acuity, DR duration and DR severity. Both HR and HS OCTA are highly effective in detecting MA, although HR OCTA is to be preferred in the presence of fibrotic evolution. Translational Relevance This study outlines a proposed novel MA classification based on noninvasive multimodal imaging. The findings presented in this paper endorse the clinical relevance of this approach, highlighting how this classification is associated with both DR duration and severity.
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Affiliation(s)
- Alessandro Arrigo
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Alessio Antropoli
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Bianco
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuela Aragona
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sofia Gambarotta
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Cai Y, Wu Z, Yuan R, Wang P, Xu H, Xu Y, Yao X, Wang H, Zou J. Alterations in Macular Microvasculature in Pterygium Patients Measured by OCT Angiography. Diagnostics (Basel) 2023; 13:diagnostics13091603. [PMID: 37174994 PMCID: PMC10177751 DOI: 10.3390/diagnostics13091603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Previous studies have reported an association between pterygia and maculopathy, yet the underlying mechanisms and alterations to the macular microvasculature in pterygium patients have yet to be fully elucidated. Our study conducted an analysis of macular superficial vessel length density (VLD) and vessel perfusion density (VPD) to establish associations between the conjunctival and macular microvasculature in patients with unilateral and bilateral pterygia. We revealed a loss of macular microvasculature in the outer nasal (ON) region in both unilateral and bilateral pterygium patients. VLD was significantly decreased in both pterygium groups in the ON region, and VPD was notably lower in bilateral pterygium patients in the same area. Furthermore, in unilateral pterygium patients, the vessel percent pixel coverage (PPC) of the pterygium and the area of the pterygium exhibited a negative correlation with VLD in the ON region. Multiple stepwise linear regression models indicated that the PPC could best predict VLP in the ON region. Taken together, our findings suggest that patients with pterygia may be more susceptible to macular diseases, and this may be due to a compensatory increase in blood perfusion via the anterior ciliary artery. These results underscore the importance of managing maculopathy in patients with pterygia.
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Affiliation(s)
- Yingjun Cai
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Zhenkai Wu
- The First People's Hospital of Changde, Changde 415000, China
| | - Ruolan Yuan
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Pingbao Wang
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Huizhuo Xu
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yi Xu
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xueyan Yao
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Hua Wang
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jing Zou
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
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Kocer AM, Bilgin G, Atesoglu Hİ, Turkay M, Kosekahya P. Evaluation of Ocular Microvascular Characteristics in Smokers and Patients with Chronic Obstructive Pulmonary Disease Using an Optical Coherence Tomography Angiography. Photodiagnosis Photodyn Ther 2023; 42:103578. [PMID: 37088332 DOI: 10.1016/j.pdpdt.2023.103578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE To investigate retinal microvascular changes in patients with chronic obstructive pulmonary disease (COPD) using optical coherence tomography angiography (OCTA) and to compare these values with those of smokers and healthy non-smokers. METHODS This study was performed on 38 eyes of 38 patients with COPD, 30 eyes of 30 smokers, and 31 eyes of 31 healthy non-smokers. Foveal avascular zone (FAZ) area, superficial (SCP) and deep (DCP) capillary plexus (whole image, fovea, parafovea, and perifovea) and radial peripapillary capillary (RPC) vessel densities (whole image, peripapillary, and inside disc) were evaluated via OCTA device (Optovue, Fremont, CA, USA). The forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) ratio and FEV1 values of patients with COPD were recorded. RESULTS There were statistically similar values in smoking pack-years between the smoker and COPD groups (p = 0.059). Entire SCP and DCP vessel densities were significantly different among the all groups (p < 0.05); for these parameters, the control group had the highest and the COPD group had the lowest vessel density values. Significantly decreased RPC vessel densities in all regions were detected in the COPD group compared with the other groups. Multiple regression analysis showed significant positive correlations between the FEV1 and the SCP, DCP, and RPC vessel densities (for all, p < 0.05). CONCLUSIONS This study detected lower vessel densities in patients with COPD than in smokers and healthy controls and reported decreased vessel density measurements with increasing COPD severity. COPD patients with or without a history of smoking may benefit from higher prioritization in terms of ophthalmic screening to prevent ocular complications.
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Affiliation(s)
- Ali Mert Kocer
- M.D. Ophthalmology Department, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Gulden Bilgin
- M.D. Associate Professor, Chest Diseases Department, Ankara Training and Research Hospital, Ankara, Turkey
| | | | - Mine Turkay
- M.D. Ophthalmology Department, Etlik Integrated Health Campus, Ankara, Turkey
| | - Pınar Kosekahya
- M.D. Associate Professor, Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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Arnould L, Meriaudeau F, Guenancia C, Germanese C, Delcourt C, Kawasaki R, Cheung CY, Creuzot-Garcher C, Grzybowski A. Using Artificial Intelligence to Analyse the Retinal Vascular Network: The Future of Cardiovascular Risk Assessment Based on Oculomics? A Narrative Review. Ophthalmol Ther 2023; 12:657-674. [PMID: 36562928 PMCID: PMC10011267 DOI: 10.1007/s40123-022-00641-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
The healthcare burden of cardiovascular diseases remains a major issue worldwide. Understanding the underlying mechanisms and improving identification of people with a higher risk profile of systemic vascular disease through noninvasive examinations is crucial. In ophthalmology, retinal vascular network imaging is simple and noninvasive and can provide in vivo information of the microstructure and vascular health. For more than 10 years, different research teams have been working on developing software to enable automatic analysis of the retinal vascular network from different imaging techniques (retinal fundus photographs, OCT angiography, adaptive optics, etc.) and to provide a description of the geometric characteristics of its arterial and venous components. Thus, the structure of retinal vessels could be considered a witness of the systemic vascular status. A new approach called "oculomics" using retinal image datasets and artificial intelligence algorithms recently increased the interest in retinal microvascular biomarkers. Despite the large volume of associated research, the role of retinal biomarkers in the screening, monitoring, or prediction of systemic vascular disease remains uncertain. A PubMed search was conducted until August 2022 and yielded relevant peer-reviewed articles based on a set of inclusion criteria. This literature review is intended to summarize the state of the art in oculomics and cardiovascular disease research.
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Affiliation(s)
- Louis Arnould
- Ophthalmology Department, Dijon University Hospital, 14 Rue Paul Gaffarel, 21079, Dijon CEDEX, France. .,University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR U1219, 33000, Bordeaux, France.
| | - Fabrice Meriaudeau
- Laboratory ImViA, IFTIM, Université Bourgogne Franche-Comté, 21078, Dijon, France
| | - Charles Guenancia
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases, (EA 7460), Faculty of Health Sciences, Université de Bourgogne Franche-Comté, Dijon, France.,Cardiology Department, Dijon University Hospital, Dijon, France
| | - Clément Germanese
- Ophthalmology Department, Dijon University Hospital, 14 Rue Paul Gaffarel, 21079, Dijon CEDEX, France
| | - Cécile Delcourt
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR U1219, 33000, Bordeaux, France
| | - Ryo Kawasaki
- Artificial Intelligence Center for Medical Research and Application, Osaka University Hospital, Osaka, Japan
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Catherine Creuzot-Garcher
- Ophthalmology Department, Dijon University Hospital, 14 Rue Paul Gaffarel, 21079, Dijon CEDEX, France.,Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Poznan, Poland
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Bajka A, Bacci T, Wiest MRJ, Brinkmann M, Hamann T, Toro M, Zweifel SA. Feasibility and Clinical Utility of Wide-Field Optical Coherence Tomography Angiography Compared to Ultrawide-Field Fluorescein Angiography in Patients with Diabetic Retinopathy. Klin Monbl Augenheilkd 2023; 240:490-495. [PMID: 37164407 DOI: 10.1055/a-2031-2657] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE To test the diagnostic performance of a novel wide-field swept-source optical coherence tomography angiography (WF-OCTA) device in detecting retinal non-perfusion (NP) and neovascularization (NV) in eyes with diabetic retinopathy (DR) and to compare this with the standard-of-care imaging method, ultrawide-field fluorescein angiography (UWFFA). METHODS Prospective, observational, cross-sectional single-center study evaluating patients with DR imaged with WF-OCTA (Xephilio OCT-S1; Canon Inc., Tokyo, Japan) and UWFFA (Optos California; Optos plc, Dunfermline, United Kingdom). WF-OCTA images of the superficial capillary plexus (SCP) consisted of single capture 23 × 20 mm scans centered on the fovea. In UWFFA and WF-OCTA, qualitative and quantitative measurements were assessed to analyze retinal NP and NV. Vessel density (VD) in WF-OCTA and ischemic index (ISI) in UWFFA were calculated. Qualitatively, the presence of NV and NP was assessed in both WF-OCTA (posterior pole/midperipheral retina) and UWFFA (posterior pole/midperipheral retina/far peripheral retina). RESULTS Ten consecutive patients with variable DR severity stages (17 eyes) were evaluated. Two eyes had to be excluded due to low quality of the WF-OCTA images. Therefore, 15 eyes were included for final analysis. Mean age was 57 years (± SD: 15.2) and the male : female ratio was 4 : 6. UWFFA identified retinal NP in 11 eyes (73%). Posterior pole NP was present in eight eyes, midperiphery NP was present in eight eyes, and far periphery NP was present in seven eyes. Retinal NV was detected in four eyes using UWFFA (two eyes with only midperiphery NV). WF-OCTA detected retinal NP in 11 eyes (9 cases with both posterior pole and midperiphery NP). NV was detected in three eyes (two with posterior pole and midperipheral NV, four with only midperipheral NV). Mean VD evaluated using WF-OCTA of the SCP was 0.40 (± SD: 0.1), and mean ISI in UWFFA was 0.09 (± SD: 1.3). Spearman's test did not show a significant correlation between the ISI in UWFFA and VD in WF-OCTA (p = 0.803). CONCLUSIONS Noninvasive WF-OCTA has great potential for the management of patients with DR. This new imaging modality might be useful in daily clinical routine in order to lower the number of invasive examinations. However, in a small percentage of patients, OCTA images cannot be reliably graded for the presence of NP and NV. In these cases, conventional FA needs to be performed.
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Affiliation(s)
- Anahita Bajka
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Tommaso Bacci
- Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Max Brinkmann
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Timothy Hamann
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Mario Toro
- Ophthalmology, University of Naples Federico II, Napoli, Italy
| | - Sandrine Anne Zweifel
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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Mohite AA, Perais JA, McCullough P, Lois N. Retinal Ischaemia in Diabetic Retinopathy: Understanding and Overcoming a Therapeutic Challenge. J Clin Med 2023; 12:jcm12062406. [PMID: 36983406 PMCID: PMC10056455 DOI: 10.3390/jcm12062406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Retinal ischaemia is present to a greater or lesser extent in all eyes with diabetic retinopathy (DR). Nonetheless, our understanding of its pathogenic mechanisms, risk factors, as well as other characteristics of retinal ischaemia in DR is very limited. To date, there is no treatment to revascularise ischaemic retina. METHODS Review of the literature highlighting the current knowledge on the topic of retinal ischaemia in DR, important observations made, and underlying gaps for which research is needed. RESULTS A very scarce number of clinical studies, mostly cross-sectional, have evaluated specifically retinal ischaemia in DR. Interindividual variability on its natural course and consequences, including the development of its major complications, namely diabetic macular ischaemia and proliferative diabetic retinopathy, have not been investigated. The in situ, surrounding, and distance effect of retinal ischaemia on retinal function and structure and its change over time remains also to be elucidated. Treatments to prevent the development of retinal ischaemia and, importantly, to achieve retinal reperfusion once capillary drop out has ensued, are very much needed and remain to be developed. CONCLUSION Research into retinal ischaemia in diabetes should be a priority to save sight.
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Affiliation(s)
- Ajay A Mohite
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast BT12 6BA, UK
| | - Jennifer A Perais
- Welcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Philip McCullough
- Welcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Noemi Lois
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast BT12 6BA, UK
- Welcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast BT9 7BL, UK
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Yao H, Li Z. Is preclinical diabetic retinopathy in diabetic nephropathy individuals more severe? Front Endocrinol (Lausanne) 2023; 14:1144257. [PMID: 37008921 PMCID: PMC10064084 DOI: 10.3389/fendo.2023.1144257] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/24/2023] [Indexed: 03/19/2023] Open
Abstract
Purpose To analyse the retinal vessel density and thickness characteristics of diabetic nephropathy (DN) individuals with preclinical diabetic retinopathy (DR) using optical coherence tomography angiography (OCTA). Methods This retrospective case-control study included 88 eyes of 88 type 2 DM patients with preclinical DR [44 non-DN (NDN) and 44 DN]. OCTA images and data were acquired using AngioVue 2.0 of the spectral domain OCT device. The foveal avascular zone (FAZ) area, superficial capillary plexus (SCP) and deep capillary plexus vessel densities, ganglion cell complex (GCC) and full retinal thicknesses, peripapillary capillary density and nerve fibre layer (RNFL) thickness were compared between the NDN and DN groups. The relationship between each renal function parameter and each OCTA parameter was analysed. Results SCP vessel density, GCC thickness and full retinal thickness were significantly reduced in DN individuals compared to NDN individuals [(NDN versus DN) SCP vessel density: 46.65 ± 3.84% versus 44.35 ± 5.25%, p=0.030; GCC thickness: 100.79 ± 5.92 μm versus 93.28 ± 8.66 μm, p<0.001; full retinal thickness: whole area: 287.04 ± 13.62 μm versus 277.71 ± 15.10 μm, p=0.005). Within the peripapillary area, capillary density was also significantly reduced in the whole area (50.19 ± 3.10% versus 47.46 ± 5.93%, p=0.016) and some sectors in the DN group, though RNFL thickness was only decreased in some sectors. For all individuals, estimated glomerular filtration rate (eGFR) correlated significantly with most OCTA parameters and then showed a significantly negative correlation with FAZ area (β=-16.43, p=0.039) in multivariate linear regression analysis. In the NDN group, eGFR showed a significantly negative correlation with FAZ area (β=-18.746, p=0.048) and a significantly positive correlation with SCP vessel density (β=0.580, p=0.036). Conclusion Preclinical DR may be more severe in DN individuals than in NDN individuals with regard to microvascular and microstructural impairment. Moreover, eGFR may be a good indicator for retinal microvascular impairment.
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Affiliation(s)
- Hongyan Yao
- Ningbo Eye Hospital, Ningbo University, Ningbo, China
| | - Zijing Li
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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Wei X, Sui R. A Review of Machine Learning Algorithms for Retinal Cyst Segmentation on Optical Coherence Tomography. SENSORS (BASEL, SWITZERLAND) 2023; 23:3144. [PMID: 36991857 PMCID: PMC10054815 DOI: 10.3390/s23063144] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 06/19/2023]
Abstract
Optical coherence tomography (OCT) is an emerging imaging technique for diagnosing ophthalmic diseases and the visual analysis of retinal structure changes, such as exudates, cysts, and fluid. In recent years, researchers have increasingly focused on applying machine learning algorithms, including classical machine learning and deep learning methods, to automate retinal cysts/fluid segmentation. These automated techniques can provide ophthalmologists with valuable tools for improved interpretation and quantification of retinal features, leading to more accurate diagnosis and informed treatment decisions for retinal diseases. This review summarized the state-of-the-art algorithms for the three essential steps of cyst/fluid segmentation: image denoising, layer segmentation, and cyst/fluid segmentation, while emphasizing the significance of machine learning techniques. Additionally, we provided a summary of the publicly available OCT datasets for cyst/fluid segmentation. Furthermore, the challenges, opportunities, and future directions of artificial intelligence (AI) in OCT cyst segmentation are discussed. This review is intended to summarize the key parameters for the development of a cyst/fluid segmentation system and the design of novel segmentation algorithms and has the potential to serve as a valuable resource for imaging researchers in the development of assessment systems related to ocular diseases exhibiting cyst/fluid in OCT imaging.
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