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Yang W, Ren R, Xie Y, Wang J, Guan H, Ji M. Diabetic uveopathy. Surv Ophthalmol 2024:S0039-6257(24)00116-4. [PMID: 39265739 DOI: 10.1016/j.survophthal.2024.09.001] [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: 07/14/2023] [Revised: 08/30/2024] [Accepted: 09/09/2024] [Indexed: 09/14/2024]
Abstract
Diabetes can involve several ocular structures -- including the cornea, lens, and retina -- and cause vascular and neural changes in these tissues. Although retinopathy is the most common ocular complication of diabetes, uveopathy can also be observed. This includes vascular, neural, muscular, and basement membrane changes. The main clinical manifestations of diabetic uveopathy are anterior uveitis and abnormal pupillary dynamics. Fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography are ideal for the imaging of vascular changes of the iris and choroid, while dynamic pupillometry is a simple screening tool to detect neuropathy. Additionally, ultrasound biomicroscopy can provide clear images of the ciliary body. Iris abnormalities, primarily angiopathy and neuropathy, can appear as alterations in vascular diameter, neovascularization, and abnormal pupillary dynamics. Choroidal abnormalities primarily affect blood vessels, including alterations in vascular diameter, microaneurysm formation, and neovascularization. The abnormal manifestations in the ciliary body include a decrease in vessel count, alterations in their diameter, isolated angiomatous dilatation, and diffuse thickening of the basal membrane of the pigment epithelium.
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Affiliation(s)
- Wenyu Yang
- Eye Institute, Affiliated Hospital of Nantong University, China; Medical School of Nantong University, China
| | - Ruoxin Ren
- Eye Institute, Affiliated Hospital of Nantong University, China; Dalian Medical University, China
| | - Yi Xie
- Eye Institute, Affiliated Hospital of Nantong University, China; Medical School of Nantong University, China
| | - Junhui Wang
- Eye Institute, Affiliated Hospital of Nantong University, China; Dalian Medical University, China
| | - Huaijin Guan
- Eye Institute, Affiliated Hospital of Nantong University, China
| | - Min Ji
- Eye Institute, Affiliated Hospital of Nantong University, China.
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Toprak A, Koc H, Alpay A, Ugurbas SH. The effect of intravitreal anti-VEGF injections on choroidal vascular index in patients with diabetic macular edema. Cutan Ocul Toxicol 2024; 43:204-210. [PMID: 39028139 DOI: 10.1080/15569527.2024.2380325] [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: 11/27/2023] [Revised: 06/10/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE This study aims to examine and compare the effects of intravitreal bevacizumab injection (IVB) at subfoveal 1500 micron (μm) and submacular 6000 μm in patients with diabetic macular edema (DME). METHODS Fifty eyes of 45 patients with DME who completed six doses of IVB were included in the study group, and 50 eyes of 42 patients who had diabetic retinopathy (DR) but did not receive any treatment were included in the control group. Central macular thickness (CMT), central choroidal thickness (CCT), subfoveal and total choroidal area (TCA), and choroidal vascular index (CVI) were calculated and their changes at zero, three and six months were evaluated. RESULTS At baseline, CVI was significantly lower in both the subfoveal and total macular areas in the study group (p = 0.004, p = 0.003). In the study group, a significant decrease was observed in CVI between zero and six months in the subfoveal area (p = 0.001). In the submacular area, the decrease in CVI in the study group was significant between zero to three months and zero to six months. There was moderate correlation between measurements of CVI in the subfoveal and total macular areas (r = 0.66, p < 0.001). CONCLUSION These findings indicate that intravitreal bevacizumab injection reduces the CVI and the effects of intravitreal anti-VEGF on CVI emerge earlier and more prominently in the submacular 6000 µm area.
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Affiliation(s)
- Aydin Toprak
- Kırıkhan State Hospital, Kırıkhan, Hatay, Turkey
| | - Hakan Koc
- Faculty of Medicine, Department of Ophthalmology, Giresun University, Giresun, Turkey
| | - Atilla Alpay
- Faculty of Medicine, Department of Ophthalmology, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Suat Hayri Ugurbas
- Faculty of Medicine, Department of Ophthalmology, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
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Bilici S, Erol TG, Bilici ME, Ugurbas SC, Ugurbas SH. Evaluation of Choroidal Structures in Children with Newly Diagnosed Type-1 Diabetes Mellitus. BEYOGLU EYE JOURNAL 2024; 9:144-148. [PMID: 39239630 PMCID: PMC11372406 DOI: 10.14744/bej.2024.36036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/17/2024] [Accepted: 07/20/2024] [Indexed: 09/07/2024]
Abstract
Objectives The objective of this study was to evaluate the subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) in children with newly diagnosed type 1 diabetes mellitus (T1DM). Methods A total of 80 children (40 with T1DM and 40 healthy controls) were included in this cross-sectional study. Enhanced depth imaging optical coherence tomography (EDI-OCT) images of all participants were analyzed. The SFCT, total choroidal area (TCA), luminal area (LA), stromal area (SA), and CVI measurements were obtained from EDI-OCT images and compared between groups. The effects of HbA1c, fasting plasma glucose, and axial length measurements on choroidal measurements were investigated. Results There was no significant difference between the groups according to TCA (0.84 [0.57-1.26] vs. 0.88 [0.65-1.16] mm2, p=0.745), LA (0.55 [0.41-0.79] vs. 0.59 [0.43-0.74] mm2, p=0.745), SA (0.27 [0.15-0.47] vs. 0.28 [0.15-0.47] mm2, p=0.935), and CVI (68.03 [66.5-70.5] vs. 67.75 [66.2-69.5] %, p=0.794), respectively. However, T1DM patients had thinner SFCT compared to control subjects (309.0 [327-489] and 398.5 [219-491], p<0.044). No correlation was found between HbA1c, fasting plasma glucose, axial length measurements, and SFCT, TCA, LA, SA, or CVI. Conclusion Children with newly diagnosed T1DM have thinner SCFT in comparison to healthy children, however, no significant difference in CVI was observed between the groups. Long-term follow-up should be used to confirm the impact of the DM duration on CVI.
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Affiliation(s)
- Serdar Bilici
- Department of Ophthalmology, Zonguldak Bulent Ecevit University, Faculty of Medicine, Zonguldak, Türkiye
| | - Tuba Gultekin Erol
- Department of Ophthalmology, Zonguldak Bulent Ecevit University, Faculty of Medicine, Zonguldak, Türkiye
| | - Meliha Esra Bilici
- Department of Pediatric Endocrinology, Zonguldak Bulent Ecevit University, Faculty of Medicine, Zonguldak, Türkiye
| | - Silay Canturk Ugurbas
- Department of Ophthalmology, Zonguldak Bulent Ecevit University, Faculty of Medicine, Zonguldak, Türkiye
| | - Suat Hayri Ugurbas
- Department of Ophthalmology, Zonguldak Bulent Ecevit University, Faculty of Medicine, Zonguldak, Türkiye
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Li Z, Yang F, Deng X, Zhao Y, Gong H, Zhou Q, Gama Z, Lan Y. Association between choroidal thickness and diabetic macular edema: a meta-analysis. Acta Diabetol 2024; 61:951-961. [PMID: 38853179 DOI: 10.1007/s00592-024-02306-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/10/2024] [Indexed: 06/11/2024]
Abstract
AIMS To evaluate the association between subfoveal choroidal thickness (SFCT) and diabetic macular edema (DME). DESIGN A systematic review and meta-analysis. METHODS A retrospective or prospective study comparing SFCT in diabetic retinopathy (DR) patients with and without DME was included. The data were collected from published studies retrieved from PubMed, Web of Science, Embase, Ovid Medline, and Cochrane Library. The final search was conducted on July 2, 2023. Heterogeneity was assessed using I2 statistics, and a random-effects model was used for the meta analysis. This study calculated the weighted mean difference (WMD) and 95% confidence interval (CI) for SFCT. RESULTS A total of 26 relevant studies were identified, involving a combined sample size of 3201 eyes (1302 DR-DME eyes and 1899 DR-no DME eyes). The results showed no significance between DR-DME and DR-no DME (WMD = - 3.57 μm; 95% CI -26.54 to 19.41 μm; P = 0.76). Sub-analysis based on nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) subgroups showed that the SFCT of NPDR-DME was significantly thinner than that of NPDR-no DME eyes (WMD = - 19.80 μm; 95% CI - 34.55 to - 5.04 μm; P = 0.009), while there was no significance in SFCT between PDR-DME and PDR-no DME (WMD = - 26.45 μm; 95% CI - 104.00 to 51.11 μm; P = 0.50). CONCLUSION The SFCT was thinner in NPDR-DME eyes compared to NPDR-no DME eyes. Thinning SFCT might cause retinal hypoxia, and play an important role in DME occurrence. Additionally, this study highlights the importance of considering DR grades and treatment history when evaluating SFCT between DME and no DME.
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Affiliation(s)
- Zhenping Li
- Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road, Guangzhou, 510120, China
| | - Fan Yang
- Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road, Guangzhou, 510120, China
| | - Xiaowen Deng
- Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road, Guangzhou, 510120, China
| | - Yunjiao Zhao
- Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road, Guangzhou, 510120, China
| | - Haijun Gong
- Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road, Guangzhou, 510120, China
| | - Qihang Zhou
- Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road, Guangzhou, 510120, China
| | - Zhujue Gama
- Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road, Guangzhou, 510120, China
| | - Yuqing Lan
- Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road, Guangzhou, 510120, China.
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Dursun E, Derhem B, Çobanoğlu S, Oğurel T. Investigation of choroidal structure changes after intravitreal anti-VEGF therapy for retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06562-2. [PMID: 39037469 DOI: 10.1007/s00417-024-06562-2] [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: 03/13/2024] [Revised: 06/05/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND We aimed to investigate the effect of retinal vein occlusion (RVO) on the posterior segment structures of the eye and its changes with intravitreal anti-Vascular Endothelial Growth Factor (VEGF) treatment. METHODS This prospective longitudinal study included 29 eyes of 29 patients with RVO (17 males and 12 females) followed for 6 months. The best corrected visual acuity (BCVA), macula, choroid ticknesses and choroidal vascularity index (CVI) obtained by spectral-domain optical coherence tomography were recorded at baseline and the first, third, and sixth months after the first injection. Results were compared with fellow eyes (non-affected eyes) and age- and sex-matched controls. RESULTS BCVA increased significantly in the 6th month, more in the first month of injection (p < 0.05 for each). Central macular tickness, subfoveal choroid tickness, stromal and total area of choroid decreased significantly after injection (p < 0.05 for each). CVI values increased significantly, especially in the 1st month after injection (p < 0.05 for each). In eyes with Branch RVO, there was a significant decrease in the macular thickness of the occlusive areas with treatment, while there was no statistically significant change in the non-occlusive macular thickness. CONCLUSION Observation of changes in choroidal structure may be useful to assess the activity of RVO and predict the efficacy of anti-VEGF therapy.
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Affiliation(s)
- Erdem Dursun
- Faculty of Medicine, Ophthalmology Department, Kırıkkale University, Seyrantepe Mh. Asude Kent Sitesi C Blok no:22 Yahsihan, Kırıkkale, Turkey.
| | - Baki Derhem
- Faculty of Medicine, Family Medicine Department, Kırıkkale University, Kırıkkale, Turkey
| | - Seval Çobanoğlu
- Faculty of Medicine, Ophthalmology Department, Kırıkkale University, Seyrantepe Mh. Asude Kent Sitesi C Blok no:22 Yahsihan, Kırıkkale, Turkey
| | - Tevfik Oğurel
- Faculty of Medicine, Ophthalmology Department, Kırıkkale University, Seyrantepe Mh. Asude Kent Sitesi C Blok no:22 Yahsihan, Kırıkkale, Turkey
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Zhang X, Wang H, Zhang K, Ma J, He H, Song S, Shao E, Chen B, Yang J, Zhao X, Sui W, Wang M, Liu S, Guo X, Zhu H, Yao Y, Zhong Y, Xing B. Blood Glucose Levels Moderate the Associations Between IGF-1 Levels and Choroidal Metrics in Patients With Diabetes With Acromegaly Without Diabetic Retinopathy. Transl Vis Sci Technol 2024; 13:20. [PMID: 39078643 PMCID: PMC11290567 DOI: 10.1167/tvst.13.7.20] [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: 12/29/2023] [Accepted: 06/21/2024] [Indexed: 07/31/2024] Open
Abstract
Purpose To examine the effects of serum growth hormone (GH) and insulin-like growth factor-1 (IGF-1) on choroidal structures with different blood glucose levels in patients with diabetes mellitus (DM) with acromegaly without diabetic retinopathy. Methods Eighty-eight eyes of 44 patients with acromegaly were divided into a nondiabetic group (23 patients, 46 eyes) and a diabetic group (21 patients, 42 eyes). Forty-four age- and sex-matched healthy controls and 21 patients with type 2 DM without diabetic retinopathy were also included. Linear regression models with a simple slope analysis were used to identify the correlation and interaction between endocrine parameters and choroidal thickness (ChT), total choroidal area (TCA), luminal area (LA), stromal area (SA), and choroidal vascular index (CVI). Results Our study revealed significant increases in the ChT, LA, SA, and TCA in patients with acromegaly compared with healthy controls, with no difference in the CVI. Comparatively, patients with DM with acromegaly had greater ChT than matched patients with type 2 DM, with no significant differences in other choroidal parameters. The enhancement of SA, LA and TCA caused by an acromegalic status disappeared in patients with diabetic status, whereas ChT and CVI were not affected by the interaction. In the diabetic acromegaly, higher IGF-1 (P = 0.006) and GH levels (P = 0.049), longer DM duration (P = 0.007), lower blood glucose (P = 0.001), and the interaction between GH and blood glucose were associated independently with thicker ChT. Higher GH levels (P = 0.016, 0.004 and 0.007), longer DM duration (P = 0.022, 0.013 and 0.013), lower blood glucose (P = 0.034, 0.011 and 0.01), and the interaction of IGF-1 and blood glucose were associated independently with larger SA, LA, and TCA. As blood glucose levels increased, the positive correlation between serum GH level and ChT diminished, and became insignificant when blood glucose was more than 7.35 mM/L. The associations between serum IGF-1 levels and LA, SA, and TCA became increasingly negative, with LA, becoming significantly and negatively associated to the GH levels only when blood glucose levels were more than 8.59 mM/L. Conclusions Acromegaly-related choroidal enhancements diminish in the presence of DM. In diabetic acromegaly, blood glucose levels are linked negatively with changes in choroidal metrics and their association with GH and IGF-1. Translational Relevance We revealed the potential beneficial impacts of IGF-1 and GH on structural measures of the choroid in patients with DM at relatively well-controlled blood glucose level, which could provide a potential treatment target for diabetic retinopathy.
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Affiliation(s)
- Xia Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Neurosurgery, Pituitary Tumour Center of Excellence, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Heng Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Zhang
- Chongqing Chang'an Industrial Group Co., Ltd, Chongqing, China
| | - Jin Ma
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Neurosurgery, Pituitary Tumour Center of Excellence, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huijing He
- Department of Epidemiology and Statistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuang Song
- Center for Statistical Science, Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Enhua Shao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Chen
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science of Technology, Wuhan, China
| | - Jingyuan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinyu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenda Sui
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sihua Liu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaopeng Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huijuan Zhu
- Department of Neurosurgery, Pituitary Tumour Center of Excellence, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Yao
- Department of Neurosurgery, Pituitary Tumour Center of Excellence, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Zhong
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Neurosurgery, Pituitary Tumour Center of Excellence, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bing Xing
- Department of Neurosurgery, Pituitary Tumour Center of Excellence, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Üçer MB, Cevher S. Analysis of the Choroidal Structure in the Early Stage of Type 2 Diabetic Retinopathy. Ophthalmic Surg Lasers Imaging Retina 2024; 55:392-399. [PMID: 38648425 DOI: 10.3928/23258160-20240408-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND OBJECTIVE Our aim was to evaluate the choroidal structure in the early stage of Type 2 diabetic retinopathy (DR). MATERIALS AND METHODS The study included patients with nonproliferative diabetic retinopathy (NPDR) without edema (n = 30, NPDR group), patients with diabetes without retinopathy (n = 30, No DR group), and healthy subjects (n = 33, control group). Choroidal thickness (CT), total choroidal area (TCA), luminal area (LA), stromal area (SA), and choroidal vascularity index (CVI) were evaluated. RESULTS The hypertension (HT) rate was highest in patients with NPDR (63.3%), and lowest in the control group (27.3%). Subfoveal, nasal, temporal CT, TCA, and LA were thinner in patients with diabetes compared to the control group for both patients with and without HT, although not significantly. CTs, TCA, LA, and SA were lower in hypertensive patients than patients without HT in all groups. CVI and LA/SA were significantly lower in NPDR group compared to the controls for both patients with and without HT. CONCLUSION In patients with diabetes and before clinical retinopathy develops, the thinning of the CT and CVI begins. A decrease in CVI continues as the retinopathy progresses. HT appears to be a factor that can reduce CT, TCA, LA, and SA. [Ophthalmic Surg Lasers Imaging Retina 2024;55:392-399.].
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Lee B, Josic K, Nittala MG, Velaga SB, Karamat A, Srinivas S, Corvi F, Singh G, Sadda S, Sun JK, Ip M. Long-Term Effects of Intravitreal Ranibizumab Compared With Panretinal Photocoagulation on Optical Coherence Tomography Measured Choroidal Thickness and Vascularity. Transl Vis Sci Technol 2024; 13:19. [PMID: 39058503 PMCID: PMC11282891 DOI: 10.1167/tvst.13.7.19] [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: 02/23/2024] [Accepted: 05/19/2024] [Indexed: 07/28/2024] Open
Abstract
Purpose Compare choroidal changes in ranibizumab versus panretinal photocoagulation (PRP)-treated eyes with proliferative diabetic retinopathy (PDR). Methods DRCR Retina Network Protocol S post hoc analysis evaluated optical coherence tomography change in choroidal thickness (subfoveal and 3mm superior and inferior to the fovea) through five years; choroidal vascularity index (CVI) was assessed at baseline and one year. Mixed linear models for choroidal change included adjustments for the baseline choroidal value and age. Results This study included 328 eyes (158 ranibizumab and 170 PRP) from 256 participants (88 ranibizumab and 95 PRP eyes at five years). Mean change in choroidal thickness from baseline to five years at the fovea was -12 µm in ranibizumab versus -8 µm in PRP (difference [95% confidence interval]: -4 [-18 to 10], P = 0.57), superior was -14 µm versus -19 µm (difference: 5 [-8 to 17], P = 0.45) and inferior was -26 µm versus -32 µm [difference: 5 (-9 to 20), P = 0.45]; change at all three points within the ranibizumab group, and the superior and inferior points for PRP, were statistically significant (P < .05). Mean change in CVI at one year was -0.02% in ranibizumab versus -0.95% in PRP (difference: 0.93 [-0.35 to 2.21], P = 0.14). Conclusions In patients with PDR, treatment with ranibizumab versus PRP did not result in statistically significant differences in five-year choroidal thickness or one-year CVI change. Both groups had significant decreases in choroidal thickness at five years. Translational Relevance Ranibizumab treatment for PDR did not statistically significantly affect choroidal thickness or vascularity differently than PRP.
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Affiliation(s)
- Brian Lee
- Doheny Eye Institute, University of California, Los Angeles, CA, USA
| | - Kristin Josic
- Jaeb Center for Health Research, Tampa, FL, USA
- DRCR Retina Network, Tampa, FL, USA
| | | | - Swetha B. Velaga
- Doheny Eye Institute, University of California, Los Angeles, CA, USA
| | - Ayesha Karamat
- Doheny Eye Institute, University of California, Los Angeles, CA, USA
| | - Sowmya Srinivas
- Doheny Eye Institute, University of California, Los Angeles, CA, USA
| | - Federico Corvi
- Doheny Eye Institute, University of California, Los Angeles, CA, USA
| | - Gagan Singh
- Doheny Eye Institute, University of California, Los Angeles, CA, USA
| | - Srinivas Sadda
- Doheny Eye Institute, University of California, Los Angeles, CA, USA
| | - Jennifer K. Sun
- DRCR Retina Network, Tampa, FL, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA
| | - Michael Ip
- Doheny Eye Institute, University of California, Los Angeles, CA, USA
- DRCR Retina Network, Tampa, FL, USA
| | - for the DRCR Retina Network
- Doheny Eye Institute, University of California, Los Angeles, CA, USA
- Jaeb Center for Health Research, Tampa, FL, USA
- DRCR Retina Network, Tampa, FL, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA
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Kang M, Oh J, Kim M, Byeon SH, Kim SS, Shin JY. Extracellular fluid excess linked to reduced choroidal vascularity index in patients with chronic kidney disease. Sci Rep 2024; 14:12769. [PMID: 38834727 DOI: 10.1038/s41598-024-63444-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 05/29/2024] [Indexed: 06/06/2024] Open
Abstract
Extracellular fluid (ECF) excess is common in patients with chronic kidney disease (CKD). This study (involving 284 patients with CKD) explored the association between choroidal vascularity index (CVI) and ECF excess. We categorised patients into three groups based on extracellular water/total body water: normal, mildly overhydrated, and severely overhydrated. The more severe ECF status was associated with a lower CVI after adjustment (B = - 0.902, p = 0.001). In non-diabetic patients, both vascular luminal (LA, p < 0.001) and stromal areas (SA, p = 0.003) were significantly reduced in patients with severe ECF excess compared to others, whereas diabetic patients showed no significant differences in LA (p = 0.96) and SA (p = 0.86) based on ECF excess status. These findings suggest that ECF status may influence CVI in patients with CKD, underscoring the need for further research to clarify its direct impact on choroidal changes.
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Affiliation(s)
- Minjae Kang
- Department of Ophthalmology, Institute of Vision Research, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Jongrok Oh
- Department of Ophthalmology, Institute of Vision Research, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joo Youn Shin
- Department of Ophthalmology, Institute of Vision Research, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea.
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Keskin Ç, Dilekçi ENA, Üçgül AY, Üçgül RK, Toprak G, Cengiz D. Choroidal vascularity index as a predictor for the development of retinopathy in diabetic patients. J Endocrinol Invest 2024; 47:1175-1180. [PMID: 37993663 DOI: 10.1007/s40618-023-02236-8] [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: 08/30/2023] [Accepted: 10/28/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Today, limited and controversial data are available on predictive markers for diabetic retinopathy. Choroidal thickness (CT) is an unstable parameter affected by many factors. Also, previous studies had conflicting findings on choroidal thickness. In this study, we aimed to investigate the role of choroidal vascularity index (CVI), a relatively new marker, in evaluating choroidal vascular status and its relationship with diabetic retinopathy (DR). MATERIALS AND METHODS A total of 124 subjects, 84 patients with type 2 diabetes mellitus (DM) and 40 healthy controls, were included in the study. The patients were divided into two groups as follows: those without DR and those with non-proliferative DR (NPDRP). All subjects underwent enhanced-depth imaging optical coherence tomography (EDI-OCT), and CT values were noted. To measure CVI, luminal (LA) and stromal areas of the choroidal images were binarized using Image J program. CVI was defined as the proportion of LA to total choroid area (TCA). Demographic and laboratory data of the patients were collected retrospectively. RESULTS CVI were found to be lower in diabetic patients compared to non-diabetic patients. CVI values in 3 groups were as follows: 67.9% ± 1.8 (healthy controls), 66.1% ± 2.4 (no DR), and 63.2% ± 2.6 (NPDRP) (p < 0.001). All groups were similar in terms of CT values (p = 0.296). The cut-off value for CVI in predicting retinopathy was 64.7%. Hypertension and current smoking were found to be more frequent in diabetic patients with CVI < 64.7% compared to those with CVI > 64.7%. CONCLUSIONS CVI tends to be lower in diabetic patients with or without DR compared to healthy controls. Moreover, patients with DR have a lower CVI than those without DR. CVI can be considered an early and sensitive biomarker for the onset of DR.
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Affiliation(s)
- Ç Keskin
- Department of Endocrinology and Metabolic Diseases, Izzet Baysal Training and Research Hospital, Abant Izzet Baysal University, Bolu, Turkey.
| | - E N A Dilekçi
- Department of Endocrinology and Metabolic Diseases, Izzet Baysal Training and Research Hospital, Abant Izzet Baysal University, Bolu, Turkey
| | - A Y Üçgül
- Department of Ophthalmology, Izzet Baysal Training and Research Hospital, Abant Izzet Baysal University, Bolu, Turkey
| | - R K Üçgül
- Department of Ophthalmology, Izzet Baysal Training and Research Hospital, Abant Izzet Baysal University, Bolu, Turkey
| | - G Toprak
- Department of Ophthalmology, Izzet Baysal Training and Research Hospital, Abant Izzet Baysal University, Bolu, Turkey
| | - D Cengiz
- Department of Internal Medicine, Izzet Baysal Training and Research Hospital, Abant Izzet Baysal University, Bolu, Turkey
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Bayraktar MF, Toprak G, Alkan Y. The relationship between Choroidal Vascular Index and non-invasive ultrasonographic atherosclerosis predictors. Photodiagnosis Photodyn Ther 2024; 46:104046. [PMID: 38467337 DOI: 10.1016/j.pdpdt.2024.104046] [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: 01/12/2024] [Revised: 02/24/2024] [Accepted: 03/08/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND This study explores the intricate connections between choroidal vascular index (CVI) and non-invasive ultrasonographic atherosclerosis predictors, shedding light on the potential links between ocular vascular dynamics and systemic cardiovascular health. METHODS We conducted a cross-sectional analysis of 81 participants, assessing CVI, intima-media thickness (IMT), extra-media thickness (EMT), and the PATIMA index. The presence of coronary artery disease (CAD) was also evaluated. Statistical methods included descriptive statistics, t-tests for group comparisons, Spearman correlation analysis, and receiver operating characteristic (ROC) curve analysis. RESULTS Our findings revealed that patients with CAD had lower CVI values compared to those without CAD, underscoring a potential association between CVI and CAD. Significant negative correlations were observed between CVI and IMT, EMT, PATIMA, and CAD. ROC curve analysis identified optimal CVI cutoff values for hypertension and CAD detection, showcasing its potential as a diagnostic marker. DISCUSSION Our results align with existing literature on ocular vascular changes, supporting the notion that CVI may be a promising indicator of systemic vascular conditions. The study contributes to the broader understanding of the relationships between ocular and cardiovascular health, providing a foundation for future research and clinical applications. CONCLUSION The study suggests that CVI holds clinical relevance as a non-invasive marker for identifying systemic conditions, offering insights into the fields of neurology, physical therapy, and rehabilitation. Addressing its limitations, this research encourages further investigation into the multifaceted connections between CVI and atherosclerosis predictors.
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Affiliation(s)
- Muhammet Fatih Bayraktar
- Specialist, Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, 14030, Turkey
| | - Güvenç Toprak
- Specialist, Department of Ophthalmology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, 14030, Turkey.
| | - Yunus Alkan
- Specialist, Department of Ophthalmology, Mardin Derik State Hospital, Mardin, 47800, Turkey
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12
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Cui Y, Feng D, Wu C, Wang P, Cui R, Wang X, Chang W, Shang W, Zhao B, Liu J, Qin X. Quantitative assessment of OCT and OCTA parameters in diabetic retinopathy with and without macular edema: single-center cross-sectional analysis. Front Endocrinol (Lausanne) 2024; 14:1275200. [PMID: 38523868 PMCID: PMC10960358 DOI: 10.3389/fendo.2023.1275200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/08/2023] [Indexed: 03/26/2024] Open
Abstract
Aim The retinal and choroidal parameters were analyzed to understand the impairment of microcirculation of both retina and choroid in patients with diabetic retinopathy (DR). Methods Fifty-five treatment-naive non-proliferative diabetic retinopathy (NPDR) patients (75 eyes) with type 2 diabetes mellitus (T2DM), including 28 patients (36 eyes) with diabetic macular edema (DME) and 27 patients (39 eyes) without DME, and 25 healthy subjects (47 eyes) were enrolled in this study. The following parameters of DR patients with and without DME were evaluated: the foveal avascular zone area (FAZ-a), FAZ perimeter (FAZ-p), FAZ circularity index (FAZ-CI), total subfoveal choroidal area (TCA), luminal area (LA), stromal area (SA), choroidal vascularity index (CVI), choriocapillaris flow area percentage, superficial capillary plexus (SCP), and deep capillary plexus (DCP). Results SCP, DCP, and the percentage of choriocapillaris flow area were significantly different between DR patients with and without DME. The DR patients presented lower LA, CVI, and FAZ-CI compared to those of healthy controls (all p < 0.05). The percentage of choriocapillaris flow area in DR patients with and without DME was significantly lower than that in healthy controls (p < 0.05). SCP and DCP were significantly correlated with FAZ-a and FAZ-p but presented insignificant associations with FAZ-CI. Conclusions Optical coherence tomography (OCT) and OCT angiography (OCTA) parameters, such as LA, CVI, FAZ-CI, and the percentage of choriocapillaris flow area, were reduced compared to those in controls, indicating that the microcirculations of the retina and choroid in the macular area were impaired in DR patients with DME and without DME.
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Affiliation(s)
- Yanyan Cui
- Department of Ophthalmology, The Second Hospital of Shandong University, Jinan, China
| | | | | | - Ping Wang
- Ophthalmological Center, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Ruoxi Cui
- Nanchang University Queen Mary School, Nanchang, China
| | - Xiaokun Wang
- Civil Aviation Medical Center of CAAC Northeast Regional Administration, Shenyang, China
| | - Weiwei Chang
- Department of Ophthalmology, Affiliated Hospital of Jining Medical University, Jining, China
| | | | - Bojun Zhao
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jing Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xuejiao Qin
- Department of Ophthalmology, The Second Hospital of Shandong University, Jinan, China
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Peng SY, Chen TC, Hsieh YT, Ho TC, Yang CM, Yang CH. Choroidal Changes in Patients with Diabetic Retinopathy: A Retrospective Study. Diagnostics (Basel) 2024; 14:537. [PMID: 38473008 DOI: 10.3390/diagnostics14050537] [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: 02/08/2024] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
This study aimed to investigate the characteristic choroidal changes in patients with diabetic retinopathy and identify factors affecting choroidal thickness (CTh), choroidal vascular index (CVI), and choriocapillaris flow. We retrospectively analyzed 79 eyes of 48 patients with diabetes between August 2021 and February 2022. We collected laboratory data, including HbA1c, serum creatinine, blood urea nitrogen, triglyceride, total cholesterol, high-density lipoprotein, and low-density lipoprotein (LDL) levels. Optical coherence tomography images of the foveal avascular zone, retinal vascular density, choroidal flow, retinal thickness, CTh, and CVI were analyzed. Possible determining factors affecting CTh, CVI, and choriocapillaris flow were analyzed using nonparametric multivariate analysis. LDL (p < 0.001) positively correlated with CTh, whereas CVI (p = 0.007) was negatively correlated with CTh in diabetic patients with diabetes. We also identified a negative correlation between choriocapillaris flow and deep parafoveal retinal vessel density in patients with low-grade diabetic retinopathy (DR), which diminished in those with more advanced DR. Our study provides further information on the changes in choroidal structure and blood flow in patients with diabetes.
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Affiliation(s)
- Shu-Yu Peng
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10029, Taiwan
| | - Ta-Ching Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10029, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 10051, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10029, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 10051, Taiwan
| | - Tzyy-Chang Ho
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10029, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 10051, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10029, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 10051, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10029, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 10051, Taiwan
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14
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Jing R, Sun X, Cheng J, Li X, Wang Z. Vascular changes of the choroid and their correlations with visual acuity in diabetic retinopathy. Front Endocrinol (Lausanne) 2024; 15:1327325. [PMID: 38464970 PMCID: PMC10920230 DOI: 10.3389/fendo.2024.1327325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
Objective To investigate changes in the choroidal vasculature and their correlations with visual acuity in diabetic retinopathy (DR). Methods The cohort was composed of 225 eyes from 225 subjects, including 60 eyes from 60 subjects with healthy control, 55 eyes from 55 subjects without DR, 46 eyes from 46 subjects with nonproliferative diabetic retinopathy (NPDR), 21 eyes from 21 subjects with proliferative diabetic retinopathy (PDR), and 43 eyes from 43 subjects with clinically significant macular edema (CSME). Swept-source optical coherence tomography (SS-OCT) was used to image the eyes with a 12-mm radial line scan protocol. The parameters for 6-mm diameters of region centered on the macular fovea were analyzed. Initially, a custom deep learning algorithm based on a modified residual U-Net architecture was utilized for choroidal boundary segmentation. Subsequently, the SS-OCT image was binarized and the Niblack-based automatic local threshold algorithm was employed to calibrate subfoveal choroidal thickness (SFCT), luminal area (LA), and stromal area (SA) by determining the distance between the two boundaries. Finally, the ratio of LA and total choroidal area (SA + LA) was defined as the choroidal vascularity index (CVI). The choroidal parameters in five groups were compared, and correlations of the choroidal parameters with age, gender, duration of diabetes mellitus (DM), glycated hemoglobin (HbA1c), fasting blood sugar, SFCT and best-corrected visual acuity (BCVA) were analyzed. Results The CVI, SFCT, LA, and SA values of patients with DR were found to be significantly lower compared to both healthy patients and patients without DR (P < 0.05). The SFCT was significantly higher in NPDR group compared to the No DR group (P < 0.001). Additionally, the SFCT was lower in the PDR group compared to the NPDR group (P = 0.014). Furthermore, there was a gradual decrease in CVI with progression of diabetic retinopathy, reaching its lowest value in the PDR group. However, the CVI of the CSME group exhibited a marginally closer proximity to that of the NPDR group. The multivariate regression analysis revealed a positive correlation between CVI and the duration of DM as well as LA (P < 0.05). The results of both univariate and multivariate regression analyses demonstrated a significant positive correlation between CVI and BCVA (P = 0.003). Conclusion Choroidal vascular alterations, especially decreased CVI, occurred in patients with DR. The CVI decreased with duration of DM and was correlated with visual impairment, indicating that the CVI might be a reliable imaging biomarker to monitor the progression of DR.
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Affiliation(s)
- Ruixia Jing
- Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Xiubin Sun
- Department of Biostatistics, School of Public Health, Cheeloo Collage of Medicine, Shandong University, Jinan, China
| | - Jimin Cheng
- Department of Ophthalmology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xue Li
- Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Zhen Wang
- Department of Ophthalmology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
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15
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Ablordeppey RK, Lin CR, Song B, Benavente-Perez A. Choroidal Morphology and Photoreceptor Activity Are Related and Affected by Myopia Development. Invest Ophthalmol Vis Sci 2024; 65:3. [PMID: 38300557 PMCID: PMC10846344 DOI: 10.1167/iovs.65.2.3] [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: 07/18/2023] [Accepted: 01/14/2024] [Indexed: 02/02/2024] Open
Abstract
Purpose The choroid is critical for the regulation of eye growth and is involved in the pathogenesis of myopia-associated ocular complications. This study explores the relationship among choroidal biometry, photoreceptor activity, and myopic growth in marmosets (Callithrix jacchus) with lens-induced myopia. Methods A total of 34 common marmosets aged 92 to 273 days old were included in this study. Axial myopia was induced in 17 marmosets using negative soft contact lenses and 17 marmosets served as untreated controls. Cycloplegic refraction (RE) and vitreous chamber depth (VCD) were measured using autorefraction and A-scan ultrasonography, respectively. Choroidal scans were obtained using spectral-domain optical coherence tomography and binarized to calculate subfoveal choroidal thickness (ChT), total choroidal area (TCA), luminal area (LA), stromal area (SA), choroidal vascularity index (CVI), and LA/SA. To assess photoreceptor activity, the a-wave of the full-field electroretinogram was measured. Regression models were used to investigate the relationship between outcome measures. Results Eyes induced with axial myopia (RE = -7.14 ± 4.03 diopters [D], VCD = 6.86 ± 0.39 mm) showed significant reductions (4.92-21.24%) in all choroidal parameters (ChT, TCA, LA, SA, CVI, and LA/SA) compared to controls (RE = -1.25 ± 0.60 D, VCD = 6.58 ± 0.26 mm, all P < 0.05), which changed as a function of refraction and vitreous elongation, and were associated with a decrease in the a-wave amplitude. Further, multiple regression showed that a combination of ChT and CVI could well predict RE and VCD. Conclusions This study reports the existence of significant alterations in choroidal morphology in non-human primate eyes induced with myopia. The changes in choroidal anatomy were associated with reduced light-adapted a-wave amplitude. These findings may represent early markers for reduced visual performance and chorioretinal complications known to occur in eyes with large degrees of myopia.
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Affiliation(s)
- Reynolds Kwame Ablordeppey
- Department of Biological and Vision Sciences, State University of New York College of Optometry, New York, New York, United States
| | - Carol Ren Lin
- Department of Biological and Vision Sciences, State University of New York College of Optometry, New York, New York, United States
| | - Brian Song
- Department of Biological and Vision Sciences, State University of New York College of Optometry, New York, New York, United States
| | - Alexandra Benavente-Perez
- Department of Biological and Vision Sciences, State University of New York College of Optometry, New York, New York, United States
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16
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Xia H, Yang J, Hou Q, Wu X, Wang C, Li X. Insights into the pattern of choroidal vascularity index changes in idiopathic macular hole. Sci Rep 2024; 14:1132. [PMID: 38212475 PMCID: PMC10784455 DOI: 10.1038/s41598-024-51739-8] [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: 07/23/2023] [Accepted: 01/09/2024] [Indexed: 01/13/2024] Open
Abstract
This retrospective study aimed to investigate the changes in choroidal vascularity index (CVI) before and after surgery for idiopathic macular hole (MH). Enhanced depth imaging optical coherence tomography (EDI-OCT) images were analyzed at baseline and at 1-week, 1-month, and 3-month postoperative visits. A total of 97 patients (97 eyes) were included in the study. At baseline, overall CVI and macular CVI showed negative correlation with axial length (AL) and positive correlation with central corneal thickness (CCT). There were no significant differences in macular CVI or overall CVI between affected and healthy eyes, as well as in subgroup analysis of different stages of macular CVI. Following surgery, there was a significant decrease in CVI at 1 week postoperatively, followed by a gradual recovery to baseline levels over time. The observed changes in CVI may be attributed to factors such as air tamponade, pressure changes, and photoreceptor metabolism. This study provides insights into the pattern of CVI changes associated with MH surgery. The findings suggest that stage 4 MH is associated with decreased macular CVI in affected eyes. These results contribute to a better understanding of the effects of surgery on choroidal blood flow in MH patients.
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Affiliation(s)
- Huaqin Xia
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Jiarui Yang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Qingyi Hou
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Xinchun Wu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Changguan Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China.
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China.
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17
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Szeto SK, Lai TY, Vujosevic S, Sun JK, Sadda SR, Tan G, Sivaprasad S, Wong TY, Cheung CY. Optical coherence tomography in the management of diabetic macular oedema. Prog Retin Eye Res 2024; 98:101220. [PMID: 37944588 DOI: 10.1016/j.preteyeres.2023.101220] [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: 06/28/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
Diabetic macular oedema (DMO) is the major cause of visual impairment in people with diabetes. Optical coherence tomography (OCT) is now the most widely used modality to assess presence and severity of DMO. DMO is currently broadly classified based on the involvement to the central 1 mm of the macula into non-centre or centre involved DMO (CI-DMO) and DMO can occur with or without visual acuity (VA) loss. This classification forms the basis of management strategies of DMO. Despite years of research on quantitative and qualitative DMO related features assessed by OCT, these do not fully inform physicians of the prognosis and severity of DMO relative to visual function. Having said that, recent research on novel OCT biomarkers development and re-defined classification of DMO show better correlation with visual function and treatment response. This review summarises the current evidence of the association of OCT biomarkers in DMO management and its potential clinical importance in predicting VA and anatomical treatment response. The review also discusses some future directions in this field, such as the use of artificial intelligence to quantify and monitor OCT biomarkers and retinal fluid and identify phenotypes of DMO, and the need for standardisation and classification of OCT biomarkers to use in future clinical trials and clinical practice settings as prognostic markers and secondary treatment outcome measures in the management of DMO.
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Affiliation(s)
- Simon Kh Szeto
- 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
| | - Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | - Jennifer K Sun
- Beetham Eye Institute, Harvard Medical School, Boston, USA
| | - SriniVas R Sadda
- Doheny Eye Institute, University of California Los Angeles, Los Angeles, USA
| | - Gavin Tan
- Singapore Eye Research Institute, SingHealth Duke-National University of Singapore, Singapore
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Tien Y Wong
- Tsinghua Medicine, Tsinghua University, Beijing, China; Singapore Eye Research Institute, Singapore
| | - 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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Bolac R, Bas S, Ozkan EMA, Balci S, Alpogan O. Evaluation of the effect of sodium-glucose cotransporter-2 inhibitor treatment on choroidal vascular parameters in patients with type 2 diabetes mellitus. Photodiagnosis Photodyn Ther 2023; 44:103804. [PMID: 37714281 DOI: 10.1016/j.pdpdt.2023.103804] [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: 06/19/2023] [Revised: 08/29/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND To evaluate the effect of sodium-glucose cotransporter-2 inhibitor treatment on choroidal vascular parameters in patients with type 2 diabetes mellitus (T2DM). METHODS Twenty eyes of 20 patients with T2DM without diabetic retinopathy and 20 eyes of 20 age- and sex-matched patients as the control group were included in the study. The patients were evaluated using enhanced depth imaging optic coherence tomography before treatment and at the third month of treatment. The choroidal images were binarized into luminal areas (LAs) and stromal areas (SAs). The choroidal vascularity index (CVI) was defined as the ratio of the LA to the total circumscribed choroid area (TCA). RESULTS The mean age of the patients was 56.65±8.41 years. The patients' mean disease duration was 6.65±5.72 years, the mean HbA1c level was 8.89±1.62%, and the mean body mass index was 33.13±4.84 kg/m2. The subfoveal TCA, subfoveal LA, subfoveal SA, total TCA, total LA, and total SA values of the patient group were found to be significantly lower than those of the control group (p = 0.006, p = 0.003, p = 0.028, p = 0.001, p = 0.001, and p = 0.006, respectively). There was a significant increase in the subfoveal TCA, subfoveal LA, subfoveal SA, subfoveal CVI, total TCA, total LA, and total SA values after empagliflozin treatment compared to before empagliflozin treatment (p = 0.005, p = 0.003, p = 0.021, p = 0.032, p < 0.001, p < 0.001, and p = 0.001 respectively). CONCLUSIONS Empagliflozin provides an improvement in diabetic choroidal changes through its effect on choroidal vascularity parameters.
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Affiliation(s)
- Ruveyde Bolac
- University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey.
| | - Suleyman Bas
- Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Internal Medicine, Istanbul, Turkey.
| | - Esma Merve Arda Ozkan
- University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Department of Internal Medicine, Istanbul, Turkey
| | - Sevcan Balci
- University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Oksan Alpogan
- University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
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Szydełko-Paśko U, Przeździecka-Dołyk J, Dołyk A, Małyszczak A, Misiuk-Hojło M. Evaluation of Choroidal and Retinal Features in Patients with Primary Vasculitis-An Original Optical Coherence Tomography and Optical Coherence Tomography Angiography Study. J Clin Med 2023; 12:6827. [PMID: 37959292 PMCID: PMC10648798 DOI: 10.3390/jcm12216827] [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: 09/15/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Ocular manifestations have been described in the course of various types of vasculitis. However, there seems to be no routine ophthalmological examinations for patients suffering from those diseases. To ensure holistic care we aimed to investigate any retinal and choroidal abnormalities in patients suffering from primary vasculitis. The objective was to use non-invasive methods, which would not be time- and cost-consuming, yet would be helpful in routine tests. We conducted a prospective and observational study in 41 patients (78 eyes) with 5 types of primary vasculitis, including: Takayasu's arteritis; giant cell arteritis; Buerger's disease; granulomatosis with polyangiitis; and polyarteritis nodosa. A total of 44 healthy individuals were enrolled in the control group for comparison (88 eyes). With the use of optical coherence tomography, optical coherence tomography angiography, and MATLAB, the following parameters were assessed: choroidal thickness; vascularity index; area and perimeter of foveal avascular zone; and circularity index. The following parameters were lower in the study group compared to the control group: mean nasal and temporal CTs; mean central, temporal, and nasal CVI; and mean CI. In contrast, the results of mean central CT as well as the area and perimeter of FAZ were higher in the study group. The differences were statistically significant in the case of all parameters except for CI. Conducting routine ophthalmological examinations in patients diagnosed with vasculitis by assessment of the retina and choroid by measuring parameters like CT, CVI, area and perimeter of FAZ, and CI could be beneficial, as it may detect pathological changes before any ocular symptoms alarm the patients. CVI seems to be especially promising for choroidal evaluation, as it appears to be less influenced by various factors compared to CT.
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Affiliation(s)
| | - Joanna Przeździecka-Dołyk
- Department of Optics and Photonics, Wrocław Univeristy of Science and Technology, 50-370 Wrocław, Poland
| | - Andrzej Dołyk
- Clinic of Angiology, Systemic Hypertension and Diabetology, Wrocław Teaching Hospital, 50-556 Wrocław, Poland
| | - Artur Małyszczak
- Department of Ophthalmology, Wrocław Medical University, 50-556 Wrocław, Poland
| | - Marta Misiuk-Hojło
- Department of Ophthalmology, Wrocław Medical University, 50-556 Wrocław, Poland
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20
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Noureldine AM, Abdelmaksoud AMS, Mostafa HAAF, Macky T, ElBohy AE. Orbital blood vessels changes on color duplex imaging in diabetics with and without diabetic retinopathy. Sci Rep 2023; 13:17115. [PMID: 37816787 PMCID: PMC10564715 DOI: 10.1038/s41598-023-43838-9] [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: 02/01/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023] Open
Abstract
To compare changes in ophthalmic artery (OA) and its branches in diabetics with and without diabetic retinopathy (DR) using color duplex imaging (CDI), and to correlate these changes with the disease variables. 60 eyes of 60 diabetic patients were enrolled, divided into 3 groups: without DR (Group A), with Non-Proliferative DR (Group B) and with Proliferative DR (PDR) (Group C). Laboratory testing including HbA1c was done. Patients underwent CDI, by which OA, Central Retinal Artery (CRA) and Ciliary Arteries were identified; for each of them we measured Peak systolic velocity (PSV), End Diastolic velocity (EDV) and Resistivity Index (RI). Results were compared to clinical, laboratory and fundus examination. OA EDV was significantly lower and OA RI was found to be significantly higher in Group C (p = 0.027 and 0.025 respectively). CRA PSV and EDV were significantly lower in Group C (p = 0.017 and 0.001 respectively). PCA RI was significantly higher in Group C (p = 0.008). HbA1c was negatively correlated with CRA PSV (p = 0.041), also it was negatively correlated with CRA EDV (p = 0.0001), as well as with PCA EDV (p = 0.002). There was direct significant correlation between HbA1c and PCA RI (p = 0.012). Duration since diagnosis was negatively correlated with CRA EDV (p = 0.004). Multivariate linear regression showed that DR is an independent predictor for low OA EDV, high OA RI, low CRA EDV and high PCA RI. DR is an independent risk factor for orbital and ocular vessels flow alteration, thus can be used as a prognostic tool in diabetic patients. CDI can be reliably used in diabetics to predict early changes or progression of DR.
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Affiliation(s)
- Alia M Noureldine
- Ophthalmology Department, Kasr Alainy School of Medicine, Cairo University, Cairo, 11956, Egypt.
| | | | | | - Tamer Macky
- Ophthalmology Department, Kasr Alainy School of Medicine, Cairo University, Cairo, 11956, Egypt
| | - Abo Elmagd ElBohy
- Diagnostic and Interventional Radiology, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
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21
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Bilici S, Serbest E, Ugurbas SH. Short-term Effects of Intravitreal Dexamethasone Implant on Choroidal Structure in Eyes with Refractory Diabetic Macular Edema. BEYOGLU EYE JOURNAL 2023; 8:193-197. [PMID: 37766765 PMCID: PMC10521124 DOI: 10.14744/bej.2023.73644] [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: 11/29/2022] [Revised: 05/20/2023] [Accepted: 07/05/2023] [Indexed: 09/29/2023]
Abstract
Objectives The objective of the study was to evaluate choroidal structural changes after intravitreal dexamethasone implant (IDI) in eyes with diabetic macular edema (DME) refractory to antivascular endothelial growth factor (VEGF) therapy. Methods Twenty-three eyes of 14 patients with DME refractory to anti-VEGF therapy were included in this retrospective study. Detailed ophthalmological examinations were recorded, and optical coherence tomography images were obtained before and 3 months after IDI. Choroidal images were binarized into the luminal area and total choroidal area. Subfoveal choroidal thickness and choroidal vascularity index (CVI) were calculated. Results The mean best-corrected visual acuity (BCVA) and central macular thickness (CMT) were improved significantly (from 0.94 to 0.81 LogMAR, p=0.02, and from 464 to 371 μ, p=0.01, respectively) after IDI. There were no significant changes in both SCFT and CVI at the end of the follow-up period (from 446.3 to 428.8 μ, p=0.51 and from 63.1 to 63.7 p=0.35, respectively). Conclusion IDI in eyes with DME refractory to anti-VEGF therapy improves BCVA and CMT but has no significant effect on SCFT and CVI in the short term.
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Affiliation(s)
- Serdar Bilici
- Department of Ophthalmology, Zonguldak Bulent Ecevit University Faculty of Medicine, Zonguldak, Türkiye
| | - Enes Serbest
- Department of Ophthalmology, Zonguldak Bulent Ecevit University Faculty of Medicine, Zonguldak, Türkiye
| | - Suat Hayri Ugurbas
- Department of Ophthalmology, Zonguldak Bulent Ecevit University Faculty of Medicine, Zonguldak, Türkiye
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22
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Battista M, Cascavilla ML, Borrelli E, Barresi C, Lari G, Caporali L, Viganò C, Berni A, Carelli V, Bandello F, Barboni P. Choroidal vascularity index in hereditary optic neuropathies. Eye (Lond) 2023; 37:2679-2684. [PMID: 36747110 PMCID: PMC10482917 DOI: 10.1038/s41433-023-02383-5] [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: 05/05/2022] [Revised: 12/04/2022] [Accepted: 01/10/2023] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To assess the choroidal vascularity index (CVI) in patients affected by Leber hereditary optic neuropathy (LHON) compared to patients affected by dominant optic atrophy (DOA) and healthy subjects. METHODS In this retrospective study, we considered three cohorts: LHON eyes (48), DOA eyes (48) and healthy subjects' eyes (48). All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) acquisition. OCT parameters as subfoveal choroidal thickness (Sub-F ChT), mean choroidal thickness (ChT), total choroidal area (TCA), luminal choroidal area (LCA) were calculated. CVI was obtained as the ratio of LCA and TCA. RESULTS Subfoveal ChT in LHON patients did not show statistically significant differences compared to controls, while in DOA a reduction in choroidal thickness was observed (p = 0.344 and p = 0.045, respectively). Mean ChT was reduced in both LHON and DOA subjects, although this difference reached statistical significance only in DOA (p = 0.365 and p = 0.044, respectively). TCA showed no significant differences among the 3 cohorts (p = 0.832). No changes were detected in LCA among the cohorts (p = 0.389), as well as in the stromal choroidal area (SCA, p = 0.279). The CVI showed no differences among groups (p = 0.898): LHON group was characterized by a similar CVI in comparison to controls (p = 0.911) and DOA group (p = 0.818); the DOA group was characterized by a similar CVI in comparison to controls (p = 1.0). CONCLUSION CVI is preserved in DOA and LHON patients, suggesting that even in the chronic phase of the neuropathy the choroidal structure is not irreversibly compromised.
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Affiliation(s)
- Marco Battista
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Lucia Cascavilla
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Borrelli
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Costanza Barresi
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Lari
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Leonardo Caporali
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Chiara Viganò
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Berni
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valerio Carelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Unit of Neurology, Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Francesco Bandello
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Piero Barboni
- Vita-Salute San Raffaele University Milan, Milan, Italy.
- IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Studio Oculistico d'Azeglio, Bologna, Italy.
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23
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Han R, Chang W, Ding X, Jiang R, Chang Q, Xu G, Yu Z, Wei Q. The choroid vascular index and its association with visual acuity in children and young adults with high myopia. Eye (Lond) 2023; 37:2542-2547. [PMID: 36539600 PMCID: PMC10397268 DOI: 10.1038/s41433-022-02369-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 11/25/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To explore the relationship between the choroid vascular index (CVI) and best corrected visual acuity (BCVA) in a young population with high myopia (HM). SUBJECTS/METHODS Three hundred twenty-six patients with HM were recruited. All subjects underwent a comprehensive ophthalmic examination and enhanced depth imaging optical coherence tomography (EDI-OCT). The horizontal and vertical subfoveal choroidal areas within a 3-mm diameter centred over the fovea were selected. Choroid thickness (ChT), horizontal and vertical total choroidal area (TCAH and TCAV), luminal area (LAH and LAV) and stromal area (SAH and SAV) within the 3-mm diameter were assessed. CVI values (CVIH and CVIV), defined as the ratio of LA to TCA, were also calculated. The correlations among choroid parameters and ocular characteristics were analysed. RESULTS The median age, spherical equivalent (SE) and BCVA were 22.4 years, -10.1 dioptres and 0.099 logMAR, respectively. The ChT was thickest on the temporal and superior sides of the macula and thinnest in the nasal region, with a significant difference. The value of CVIH was significantly greater than that of CVIV because SCAH was smaller than SCAV. Both CVIH and CVIV were closely correlated with BCVA in all patients. CONCLUSIONS The CVI is significantly related to BCVA but is not affected by age, axial length or SE, suggesting that the CVI could be used as an adjunct tool for assessing the visual acuity status in patients with HM.
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Affiliation(s)
- Ruyi Han
- Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Weiteng Chang
- Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Xinyi Ding
- Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Rui Jiang
- Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Qing Chang
- Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Zhiqiang Yu
- Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.
| | - Qiaoling Wei
- Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.
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Zhong JB, Yao YF, Zeng GQ, Zhang Y, Ye BK, Dou XY, Cai L. A closer association between blood urea nitrogen and the probability of diabetic retinopathy in patients with shorter type 2 diabetes duration. Sci Rep 2023; 13:9881. [PMID: 37336896 DOI: 10.1038/s41598-023-35653-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/22/2023] [Indexed: 06/21/2023] Open
Abstract
Blood urea nitrogen (BUN) is an indicator of renal function and catabolic status in human body. Diabetic retinopathy (DR) is a major microvascular complication of diabetes mellitus (DM) and a serious threat to the vision of diabetic patients. We included 426 type 2 diabetic patients who visited the endocrinology department of Guangdong Provincial People's Hospital and received an ophthalmology consultation from December 2017 to November 2018. The outcome was the probability of DR in participants. Multivariable logistics analysis was used to confirm the relationship between BUN and the probability of DR. And interaction tests were conducted to find the effects of DM duration on their association. A total of 167 of 426 patients with type 2 diabetes had DR, with a probability of 39.20%. After adjusting for potential confounders, a positive association between BUN and the probability of DR (OR = 1.12; 95% CI 1.03-1.21; P = 0.0107). And a test for interaction between DM duration and BUN on the probability of DR was significant (P = 0.0295). We suggested that in patients with type 2 diabetes, BUN was positively associated with the probability of DR and the association was influenced by DM duration.
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Affiliation(s)
- Jian-Bo Zhong
- Department of Ophthalmology, Shenzhen University General Hospital, Shenzhen, Guangdong Province, China
- Shenzhen University Medical College, No. 3688 Nanhai Ave, Shenzhen, 518061, Guangdong Province, China
| | - Yu-Feng Yao
- Department of Ophthalmology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
- Shantou University Medical College, No. 22 Xinling Road, Shantou, 515031, Guangdong Province, China
| | - Guo-Qiang Zeng
- Department of Ophthalmology, Shenzhen University General Hospital, Shenzhen, Guangdong Province, China
- Shenzhen University Medical College, No. 3688 Nanhai Ave, Shenzhen, 518061, Guangdong Province, China
| | - Yi Zhang
- Department of Ophthalmology, Shenzhen University General Hospital, Shenzhen, Guangdong Province, China
| | - Bai-Kang Ye
- Department of Ophthalmology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
- Shantou University Medical College, No. 22 Xinling Road, Shantou, 515031, Guangdong Province, China
| | - Xiao-Yan Dou
- Department of Ophthalmology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China.
| | - Li Cai
- Department of Ophthalmology, Shenzhen University General Hospital, Shenzhen, Guangdong Province, China.
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25
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Liu Y, Zhang JY, Ding X, He FL, Lu LN, Fu Y. Choroidal structural changes following vitrectomy performed with phacoemulsification in unilateral idiopathic epiretinal membrane. BMC Ophthalmol 2023; 23:52. [PMID: 36747177 PMCID: PMC9901130 DOI: 10.1186/s12886-023-02803-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study aims to determine the influence of vitrectomy combined with macular epiretinal membrane dissection and internal limiting membrane (ILM) peeling and phacoemulsification on choroidal vasculature in patients with unilateral idiopathic epiretinal membrane (IERM) and concurrent cataract using optical coherence tomography (OCT). METHODS This retrospective study included 26 eyes of 26 patients (8 males and 18 females) with unilateral IERM without vitreomacular traction (VMT) (group 1) and the patients' fellow eyes (n = 26, group 2). Three-port 25-G pars plana vitrectomy (PPV) combined with macular epiretinal membrane dissection and ILM peeling and phacoemulsification was performed on all patients. The comprehensive ophthalmologic examinations of all patients involved OCT measurements at every visit before and after surgery, and the choroidal thickness (CT), central macular thickness (CMT) and choroidal vascularity index (CVI) were calculated. RESULTS The mean age of the IERM patients was 66.58 ± 7.06 years. Postoperatively, best corrected visual acuity (BCVA) was significantly greater than baseline (P = 0.023). The CVI of the IERM eyes was significantly lower (P < 0.01) than that of the fellow eyes at baseline. The subfoveal CT in the IERM eyes was lower than that in the fellow eyes (P = 0.023), but there was, no significant difference in the average CT between the two groups at baseline (P = 0.071). In eyes with IERM, the CVI significantly increased at 1 week, 1 month (P < 0.001), and 3 months (P = 0.049) postoperatively, the subfoveal CT was markedly thickened 1 month after surgery (P = 0.001), the temporal 3 mm and nasal CT significantly increased at 1 week and 1 month postoperatively (P = 0.041, P = 0.022 for temporal 3 mm; P < 0.001, P = 0.047 for nasal 1.5 mm; P = 0.01, P = 0.001 for nasal 3 mm), and only the temporal 3 mm CT increased significantly at 3 months postoperatively (P = 0.017). The baseline CMT of the IERM eyes was significantly thicker than that of the fellow eyes (P < 0.001). CMT significantly decreased at 3 months postoperatively in IERM eyes(P = 0.033). CONCLUSIONS The increase in the CVI in the IERM eyes without VMT after combined PPV with ILM peeling and phacoemulsification persists for at least 3 months.
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Affiliation(s)
- Yan Liu
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Jia Ying Zhang
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Xia Ding
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Fang Lin He
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Lin Na Lu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China. .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Yao Fu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China. .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, 639 Zhizaoju Road, Shanghai, 200011, China.
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İlgüy S, Işık MU. Prognostic value of choroidal vascular index in determining response to intravitreal dexamethasone implant treatment used in refractory diabetic macular edema. Lasers Med Sci 2023; 38:47. [PMID: 36680633 DOI: 10.1007/s10103-023-03711-7] [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: 08/09/2022] [Accepted: 01/11/2023] [Indexed: 01/22/2023]
Abstract
To investigate the effect of intravitreal dexamethasone (IVD) implant injection, which was used in the treatment of DME, on CVI and to investigate whether CVI can be used as a prognostic marker in the treatment of anti-VEGF resistant DME. A retrospective observational and comparative study. Twenty-five eyes of 25 patients with refractory diabetic macular edema who underwent intravitreal dexamethasone (IVD) implant and 50 eyes of 50 healthy patients were included in the study. Central macular thickness (CMT), subfoveal choroidal thickness (SFCT), luminal choroidal area (LCA), total choroidal area (TCA), stromal choroidal area (SCA), and choroidal vascularity index (CVI) were measured on optical coherence tomography. There was no significant difference between the groups in terms of age and gender. When the pre-treatment values in the IVD group were compared with the healthy group, LCA and SCA values were higher, and CVI ratios were lower in the IVD group compared to the control group. When baseline, 1st, and 3rd months after injection were compared, it was determined that there was a significant decrease in CMT and LCA. There was no statistically significant difference in SFCT, TCA, and CVI. There was a significant negative correlation between baseline CVI and 3rd month CMT after IVD (rho: - 0.643, p: 0.001). It was observed that the baseline and 1st month LCA values were significantly higher than the 3rd month. The choroidal vascular structure may be affected by IVD treatment. CVI may also have value as a prognostic marker in monitoring the response to treatment.
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Affiliation(s)
- Serdar İlgüy
- Retina Department, Department of Ophthalmology, Kastamonu Training and Research Hospital, Kastamonu, Turkey.
| | - Mehmed Uğur Işık
- Retina Department, Department of Ophthalmology, Faculty of Medicine, Kastamonu University, Kastamonu, Turkey
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27
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Lin Z, Yu H, Shi C, Chen H, Lin G, Shen M, Wang C. Acute hyperglycemia compromises the responses of choroidal vessels using swept-source optical coherence tomography during dark and light adaptations. Front Endocrinol (Lausanne) 2023; 14:1049326. [PMID: 36843596 PMCID: PMC9947340 DOI: 10.3389/fendo.2023.1049326] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
PURPOSE To clarify the effects of acute hyperglycemia on the responses of choroidal structural components and vascularity index during light modulation in healthy participants using techniques including image binarization and artificial intelligence (AI) segmentation based on swept-source optical coherence tomography (SS-OCT). METHODS Twenty-four eyes of 24 healthy participants were imaged at different stages after ambient light, 40 min of dark adaptation, and 5 min of light adaptation in two imaging sessions: control and after receiving 75 g of oral glucose solution. The choroidal structural parameters, including luminal volume (LV), stromal volume (SV), total choroidal volume (TCV), and choroidal vascularity index (CVI) within a 6 mm area were determined using a custom algorithm based on image binarization and AI segmentation of SS-OCT. These measurements were compared among the conditions after adjusting for axial length, age to identify the differences. RESULTS In the dark, CVI decreased (-0.36 ± 0.09%) significantly in acute hyperglycemia compared to the control condition. During the transition to ambient light, there was an increasing trend in the choroidal parameters compared with the control experiment. However, only TCV (0.38 ± 0.17 mm3) and LV (0.27 ± 0.10 mm3) showed a significant increase at the time point of 5 min after ambient light. CONCLUSION Analysis of choroidal structural parameters and CVI based on SS-OCT images is a potentially powerful method to objectively reflect subtle changes in neurovascular coupling between the choroid and photoreceptor during dark adaptation.
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Affiliation(s)
- Zhiyang Lin
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Huankai Yu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ce Shi
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Hongling Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Guangqing Lin
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Meixiao Shen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- *Correspondence: Meixiao Shen, ; Chenxiao Wang,
| | - Chenxiao Wang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- *Correspondence: Meixiao Shen, ; Chenxiao Wang,
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CHOROIDAL VASCULAR DENSITY IN DIABETIC RETINOPATHY ASSESSED WITH SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY. Retina 2023; 43:34-41. [PMID: 36223764 DOI: 10.1097/iae.0000000000003644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE We aimed to assess choroidal vascularity by diabetic retinopathy (DR) stage using the choroidal vascular density (CVD) obtained from swept-source optical coherence tomography en-face images. METHODS This prospective, cross-sectional, multicenter study included patients from Niigata City General Hospital and Saiseikai Niigata Hospital between October 2016 and October 2017. Choroidal vascular density was obtained by binarizing swept-source optical coherence tomography en-face images of patients with diabetes and those with DR, patients without DR, and healthy age-matched volunteers. RESULTS Patients were allocated to the healthy control (n = 28), no DR (n = 23), nonproliferative DR (NPDR) without diabetic macular edema (DME) (n = 50), NPDR + DME (n = 38), and proliferative DR (PDR) or any previous treatment with panretinal photocoagulation (n = 26) groups. Investigation of the choriocapillaris slab level indicated that the no DR group had significantly high CVD values ( P < 0.05), and the PDR groups had significantly low CVD values ( P < 0.01). Investigation of the large choroidal vessel level indicated that the NPDR + DME and PDR groups had significantly lower CVD values than the control group ( P < 0.05 and P < 0.01, respectively). CONCLUSION We found that at the choriocapillaris slab level, the no DR group had a higher CVD and the NPDR with DME and PDR groups had a lower CVD than the control group. At the level of the large choroidal vessels, the NPDR with DME and PDR groups had a lower CVD than the control group. There were significant differences in choroidal vasculature found using CVD obtained from swept-source optical coherence tomography en-face images of patients with diabetes and DR.
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Khalatyan AS, Yusef YN. [Choroidal changes in patients with diabetes mellitus]. Vestn Oftalmol 2023; 139:158-165. [PMID: 38235643 DOI: 10.17116/oftalma2023139061158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus (DM) and considered one of the leading causes of vision loss worldwide. The choroid supplies blood to the retina, photoreceptors and the retinal pigment epithelium, it is essential for metabolic exchange in the retina. Many experimental studies have reported that choroidal pathology in diabetic patients may play a role in the development of DR. Choroidal thickness (CT) can be used to assess the vascularization of the choroid. Choroidal vascularity index (CVI) is also used as a marker in assessment of choroidal vascularization. Many studies have been conducted to evaluate choroidal changes in various eye diseases. However, the data on CT in DM patients, especially in those with DR, are conflicting. Thus, the choroidal status in diabetic patients with or without DR remains controversial. In this systematic review we analyze a number of articles dedicated to the relationship between structural changes in the choroid in patients with diabetes mellitus and diabetic retinopathy of different stages, paying particular attention to choroidal thickness and certain other parameters that allow assessment of choroidal changes.
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Affiliation(s)
- A S Khalatyan
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - Yu N Yusef
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Assessment of Choroidal Vascularity in Inactive Thyroid Associated Orbitopathy. BEYOGLU EYE JOURNAL 2023; 8:38-44. [PMID: 36911212 PMCID: PMC9993418 DOI: 10.14744/bej.2022.04900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/15/2022] [Accepted: 10/09/2022] [Indexed: 12/24/2022]
Abstract
Objectives The objectives of the study were to evaluate the vascular and stromal structure of the choroid in patients with inactive thyroid associated orbitopathy (TAO) by measuring choroidal vascularity index (CVI) and choroidal thickness (CT) using enhanced depth imaging (EDI) optical coherence tomography (OCT). Methods The choroidal image was taken with EDI mode spectral domain (SD)-OCT. All scans were taken between 9.30 am and 11.30 am to avoid the diurnal variation of CT and CVI. To calculate CVI, macular SD-OCT scans were binarized using the publicly available software ImageJ and luminal area and total choroidal area (TCA) were measured. CVI was calculated as the proportion of LA to TCA. Furthermore, the relation between CVI and axial length, gender, and age was evaluated. Results This study included 78 individuals with a mean age of 51.4±7.3 years. Group 1 consisted of 44 patients with inactive stage TAO, and Group 2 consisted of 34 healthy controls. Subfoveal CT was 338.92±73.93 µm in Group 1 and 303.97±40.35 µm in Group 2 (p=0.174). The CVI significantly differed between the two groups, which was higher in group 1 (p=0.000). Conclusion Although CT was not different between groups, CVI which is the indicator of the vascular status of the choroid, was higher in patients with TAO in the inactive stage compared with healthy control subjects.
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Gujar R, Cagini C, Fruttini D, Corbucci R, Rasheed MA, Vupparaboina KK, Mariotti C, Chhablani J, Lupidi M. Choroidal vascularity profile in diabetic eyes using wide field optical coherence tomography. Eur J Ophthalmol 2022; 33:11206721221143161. [PMID: 36457221 DOI: 10.1177/11206721221143161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE To report the wide-field choroidal vascularity up to the mid-equator area in diabetic retinopathy (DR) subjects using wide-field optical coherence tomography (WF-OCT). DESIGN Prospective, Cross-sectional study. PARTICIPANTS Forty-seven eyes of 25 DR subjects. METHODS WF-OCT images (55 degrees) were obtained using Spectralis HRA + OCT (Heidelberg Engineering, Germany) in extremes of gazes in all quadrants and manual montages were created to obtain wide field images up to mid equator. A previously reported semi-automated algorithm was used to calculate choroidal vascularity profile (CVI). Regression analysis was performed to identify the factors influencing CVI. RESULTS Forty-seven eyes from 25 patients were enrolled in the study. The mean age was 68.4 ± 10.6 years. The refractive error (spherical equivalent) ranged from -2.25 to +3.75 diopters. Most common DR grade among study subjects was moderate NPDR (29.41%) and 74.5% eyes had diabetic macular edema (DME). The mean CVI in the macular area (58.29 ± 3.63) was significantly lower than in any of the other fundus areas (all p ˂ 0.01). The maximum CVI was seen in the nasal region (66.60 ± 5.61), followed by temporal (65.69 ± 3.81), superior (65.01 ± 4.87), and inferior (63.80 ± 5.42). The vertical macular area had the least coefficient of variation (CV) of CVI (0.06) while the inferior quadrant had the highest CV (0.08). CONCLUSION The current study describes the CVI profile on WF-OCT in DR eyes up to mid-equator. The significant increase of the CVI compared to healthy subjects and its significant regional variations introduce this novel quantitative parameter as a reliable biomarker of the diabetes-induced choroidal microangiopathy.
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Affiliation(s)
- Ramkailash Gujar
- Department of Medicine and Surgery, Section of Ophthalmology, 60250University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Carlo Cagini
- Department of Medicine and Surgery, Section of Ophthalmology, 60250University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Daniela Fruttini
- Department of Internal Medicine, 60250University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Roberta Corbucci
- Department of Medicine and Surgery, Section of Ophthalmology, 60250University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | | | - Cesare Mariotti
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Jay Chhablani
- Department of Ophthalmology, 6595UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA
| | - Marco Lupidi
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
- Fondazione per la Macula Onlus, Di.N.O.G.Mi., UniversityEye Clinic, Genova, Italy
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Peripapillary Choroidal Vasculature in Pediatric Eyes with Type 1 Diabetes Mellitus. BEYOGLU EYE JOURNAL 2022; 7:291-297. [PMID: 36628087 PMCID: PMC9794507 DOI: 10.14744/bej.2022.24471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/14/2022] [Accepted: 09/13/2022] [Indexed: 01/13/2023]
Abstract
Objectives Choroidal vasculature change in children with diabetes mellitus is not investigated enough although it could reflect clinical outcome. Methods Pediatric Type 1 diabetes mellitus (T1DM) patients and healthy controls were retrospectively evaluated. Peripapillary retinal nerve fiber layer optical coherence tomography (OCT) images of the right eyes were analyzed. Choroidal parameters including total choroidal area, luminal area, stromal area, and choroidal vascularity index were measured through image binarization. Results Twenty eyes of 20 patients were compared with 46 eyes of 46 healthy controls. Mean total choroidal area, luminal area, and stromal area were 1.59±0.35, 1.10±0.24, and 0.50±0.13 mm2 in patients' eyes and 1.52±0.49, 1.05±0.34, and 0.47±0.17 mm2 in healthy eyes. No difference was found in choroidal vascularity indices between patients and healthy eyes (68.8±3.9% vs. 69.4±4.4%, p=0.521). Temporal choroidal vascularity index was significantly higher than its nasal counterpart in healthy eyes (71.8±5.0% vs. 68.6±4.9%, p<0.001) which was not significant in patients' eyes (70.7±4.0% vs. 68.9±5.1%, p=0.067). Temporal quadrant had the highest choroidal vascularity index score among all quadrants in healthy controls (all p<0.05), whereas no choroidal vascularity index difference between quadrants was detected in patients (p=0.75). Conclusion Peripapillary choroidal vasculature has shown subtle sectoral changes which did not reflect the overall peripapillary OCT section in pediatric T1DM patients when compared with healthy controls.
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Wang Y, Chen S, Lin J, Chen W, Huang H, Fan X, Cao X, Shen M, Ye J, Zhu S, Xue A, Lu F, Shao Y. Vascular Changes of the Choroid and Their Correlations With Visual Acuity in Pathological Myopia. Invest Ophthalmol Vis Sci 2022; 63:20. [DOI: 10.1167/iovs.63.12.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yiyi Wang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Sisi Chen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, China
| | - Jue Lin
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Wen Chen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Huimin Huang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Xin Fan
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Xinyuan Cao
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Jie Ye
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Shuangqian Zhu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Anquan Xue
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Fan Lu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, China
| | - Yilei Shao
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
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Jiang J, Liu J, Yang J, Jiang B. Optical coherence tomography evaluation of choroidal structure changes in diabetic retinopathy patients: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:986209. [DOI: 10.3389/fmed.2022.986209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionDiabetic retinopathy (DR) is one of the major causes of blindness among working-aged adults worldwide. This study aimed to evaluate the differences in the subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) using optical coherence tomography (OCT) of patients with diabetic eyes with no retinopathy (NDR) and with diabetic retinopathy (DR).MethodsWe performed a comprehensive literature search of the PubMed, Embase, and Cochrane Library databases up to October 2021. The weighted mean difference (WMD) with the 95% confidence interval (CI) was pooled for continuous outcomes.ResultsTwenty-three cross-sectional studies comprising 2,534 eyes including 1,070 NDR eyes, 1,464 DR eyes were included in the systematic review and meta-analysis. The pooled results showed SFCT was significantly thicker in DR than in NDR patients after adjusting for axial length (WMD = 27.90 μm; 95% CI: 11.51 to 44.28; P = 0.001), and the CVI was significantly lower in DR patients (WMD = −1.59; 95% CI: −2.67 to −0.52; P = 0.004).ConclusionWe described changes in the SFCT and CVI in DR. Resultantly, the CVI and SFCT may be valuable parameters for monitoring the onset of DR and helpful for a better understanding of the role of the choroid in the pathological process of DR.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/#myprospero, CRD42021228738.
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Singh RB, Perepelkina T, Testi I, Young BK, Mirza T, Invernizzi A, Biswas J, Agarwal A. Imaging-based Assessment of Choriocapillaris: A Comprehensive Review. Semin Ophthalmol 2022:1-22. [PMID: 35982638 DOI: 10.1080/08820538.2022.2109939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
PURPOSE Over the past two decades, advancements in imaging modalities have significantly evolved the diagnosis and management of retinal diseases. Through these novel platforms, we have developed a deeper understanding of the anatomy of the choroidal vasculature and the choriocapillaris. The recently developed tools such as optical coherence tomography (OCT) and OCT angiography (OCTA) have helped elucidate the pathological mechanisms of several posterior segment diseases. In this review, we have explained the anatomy of the choriocapillaris and its close relationship to the outer retina and retinal pigment epithelium. METHODS A comprehensive search of medical literature was performed through the Medline/PubMed database using search terms: choriocapillaris, choroid, quantification, biomarkers, diabetic retinopathy, age-related macular degeneration, choroidal blood flow, mean blur rate, flow deficit, optical coherence tomography, optical coherence tomography angiography, fluorescein angiography, indocyanine green angiography, OCTA, Doppler imaging, uveitis, choroiditis, white dot syndrome, tubercular serpiginous-like choroiditis, choroidal granuloma, pachychoroid, toxoplasmosis, central serous chorioretinopathy, multifocal choroiditis, choroidal neovascularization, choroidal thickness, choroidal vascularity index, choroidal vascular density, and choroidal blood supply. The search terms were used either independently or combined with choriocapillaris/choroid. RESULTS The imaging techniques which are used to qualitatively and quantitatively analyze choriocapillaris are described. The pathological alterations in the choriocapillaris in an array of conditions such as diabetes mellitus, age-related macular degeneration, pachychoroid spectrum of diseases, and inflammatory disorders have been comprehensively reviewed. The future directions in the study of choriocapillaris have also been discussed. CONCLUSION The development of imaging tools such as OCT and OCTA has dramatically improved the assessment of choriocapillaris in health and disease. The choriocapillaris can be delineated from the stromal choroid using the OCT and quantified by manual or automated methods. However, these techniques have inherent limitations due to the lack of an anatomical distinction between the choriocapillaris and the stromal choroid, which can be overcome with the use of predefined segmentation slabs on OCT and OCTA. These segmentation slabs help in standardizing the choriocapillaris imaging and obtain repeatable measurements in various conditions such as diabetic retinopathy, age-related macular degeneration, pachychoroid spectrum, and ocular inflammations. Additionally, Doppler imaging has also been effectively used to evaluate the choroidal blood flow and quantifying the choriocapillaris and establishing its role in the pathogenesis of various retinochoroidal diseases. As tremendous technological advancements such as wide-field and ultra-wide field imaging take place, there will be a significant improvement in the ease and accuracy of quantifying the choriocapillaris.
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Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.,Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Tatiana Perepelkina
- Department of Ophthalmology, Louisiana State University Health Sciences, Shreveport, LA, USA
| | - Ilaria Testi
- Department of Ophthalmology, Moorfields Eye Hospital, London, UK
| | - Benjamin K Young
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Tuba Mirza
- Department of Ophthalmology, Ascension Macomb Oakland Eye Institute, Warren, MI, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Nethralaya, Chennai, India
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.,Department of Ophthalmology, Maastricht University Medical Center, Maastricht, The Netherlands
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Bianco L, Arrigo A, Aragona E, Antropoli A, Berni A, Saladino A, Battaglia Parodi M, Bandello F. Neuroinflammation and neurodegeneration in diabetic retinopathy. Front Aging Neurosci 2022; 14:937999. [PMID: 36051309 PMCID: PMC9424735 DOI: 10.3389/fnagi.2022.937999] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022] Open
Abstract
Diabetic retinopathy (DR) is the most common complication of diabetes and has been historically regarded as a microangiopathic disease. Now, the paradigm is shifting toward a more comprehensive view of diabetic retinal disease (DRD) as a tissue-specific neurovascular complication, in which persistently high glycemia causes not only microvascular damage and ischemia but also intraretinal inflammation and neuronal degeneration. Despite the increasing knowledge on the pathogenic pathways involved in DR, currently approved treatments are focused only on its late-stage vasculopathic complications, and a single molecular target, vascular endothelial growth factor (VEGF), has been extensively studied, leading to drug development and approval. In this review, we discuss the state of the art of research on neuroinflammation and neurodegeneration in diabetes, with a focus on pathophysiological studies on human subjects, in vivo imaging biomarkers, and clinical trials on novel therapeutic options.
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Affiliation(s)
| | - Alessandro Arrigo
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Loiudice P, Covello G, Figus M, Posarelli C, Sartini MS, Casini G. Choroidal Vascularity Index in Central and Branch Retinal Vein Occlusion. J Clin Med 2022; 11:jcm11164756. [PMID: 36012996 PMCID: PMC9410370 DOI: 10.3390/jcm11164756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/13/2022] [Accepted: 08/14/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Background: we aimed to evaluate choroidal vascularity change in eyes with central and branch retinal vein occlusion (RVO). (2) Methods: in this retrospective cross-sectional study, we reviewed the records of 47 patients with recent-onset, naïve, unilateral retinal vein occlusion. Enhanced-depth imaging optical coherence tomography scans were binarized using the ImageJ software; luminal area (LA) and total choroidal area (TCA) were measured. The choroidal vascularity index (CVI) was calculated as the proportion of LA to TCA. Depending on the pattern of macular oedema, eyes were classified as having no macular oedema (nME), cystoid macular oedema (CME), cystoid macular oedema with serous retinal detachment (mixed). (3) Results: CVI, TCA and LA were greater in eyes with RVO than in fellow, unaffected eyes. No difference was found between central and branch RVO except for central macular thickness (CMT). When compared with controls, eyes with CME presented a significant increase in subfoveal choroidal thickness, CMT, TCA, LA and CVI; eyes with mixed macular oedema had greater CMT and CVI than contralateral eyes; no significant differences in any of the considered parameters were observed in eyes with nME. (4) Conclusions: The results suggest that RVO alters the vascularity of the choroid that varies according to the type of macular oedema.
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Affiliation(s)
- Pasquale Loiudice
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
- Complex Operative Ophthalmology Unit, “F. Lotti” Hospital, 56025 Pontedera, Italy
- Correspondence:
| | - Giuseppe Covello
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Michele Figus
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Chiara Posarelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Maria Sole Sartini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Giamberto Casini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
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Obadă O, Pantalon AD, Rusu-Zota G, Hăisan A, Lupuşoru SI, Chiseliţă D. Choroidal Assessment in Patients with Type 2 Diabetes Mellitus and Non-Proliferative Diabetic Retinopathy by Swept-Source Ocular Coherence Tomography and Image Binarization. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070918. [PMID: 35888637 PMCID: PMC9319764 DOI: 10.3390/medicina58070918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The aim of this study was to evaluate choroidal structure and vascularity indices in patients with non-proliferative diabetic retinopathy (NPDR). Materials and Methods: Sixty-three eyes from sixty-three patients were evaluated: 21 from healthy subjects, 20 with diabetes mellitus (DM) and no diabetic retinopathy (DR), and 22 with DM and non-proliferative diabetic retinopathy without diabetic macular edema (DME). Each patient underwent ocular examination, macular swept-source ocular coherence tomography (SS-OCT) imaging, glycemic control, and systemic high blood pressure (HBP) evaluation. Subfoveal choroidal thickness (SF-CT) was manually assessed on a line scan. Line scan OCT images were exported to ImageJ program. The areas under a 1.5, 3 and 6 mm horizontal line centered on the fovea were assessed by converting the OCT images to binary images, and total choroidal area (TCA), luminal area (LA), stromal area (SA), LA:SA ratio, and choroidal vascularity index (CVI) were evaluated. SF-CT and choroidal parameters were compared between groups, and correlations with ocular and systemic factors were analyzed. Results: SF-CT, TCA, LA, and SA were similar between groups. CVIs were significantly different between groups for all three studied areas (CVI-1.5: 66.21% vs. 66.06% vs. 63.74%, p = 0.003; CVI-3: 65.88% vs. 66.46% vs. 63.79%, p = 0.008; CVI-6: 64.79% vs. 65.40% vs. 63.61%, p = 0.032). NPDR patients had significantly lower CVIs compared to DM patients (p < 0.05). No association of choroidal parameters with glycemic control, DM duration and HBP was found significant (p < 0.05). Conclusions: Choroidal assessment by SS-OCT and image binarization in healthy subjects, subjects with DM without DR, and subjects with DM and NPDR indicated that CVI changes were identifiable and significant in early DR. The lack of association with ocular and systemic factors suggest that CVIs are reliable assessment parameters of choroidal vascular structure.
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Affiliation(s)
- Otilia Obadă
- Department of Ophthalmology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universităţii Street, 700115 Iaşi, Romania;
- Department of Ophthalmology, “Saint Spiridon” Clinical Emergency Hospital, 1 Independenţei Street, 700111 Iaşi, Romania
- Correspondence: (O.O.); (A.D.P.)
| | - Anca Delia Pantalon
- Department of Ophthalmology, “Saint Spiridon” Clinical Emergency Hospital, 1 Independenţei Street, 700111 Iaşi, Romania
- Correspondence: (O.O.); (A.D.P.)
| | - Gabriela Rusu-Zota
- Department of Pharmacology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universităţii Street, 700115 Iaşi, Romania;
| | - Anca Hăisan
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy,16 Universităţii Street, 700115 Iaşi, Romania;
| | - Smaranda Ioana Lupuşoru
- Department of Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universităţii Street, 700115 Iaşi, Romania;
| | - Dorin Chiseliţă
- Department of Ophthalmology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universităţii Street, 700115 Iaşi, Romania;
- Oftaprof Ophthalmology Clinic, 54 Stejar Street, 700327 Iaşi, Romania
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Correlation between Choroidal Vascularity Index and Outer Retina in Patients with Diabetic Retinopathy. J Clin Med 2022; 11:jcm11133882. [PMID: 35807164 PMCID: PMC9267134 DOI: 10.3390/jcm11133882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/26/2022] [Accepted: 07/01/2022] [Indexed: 02/04/2023] Open
Abstract
The choroid supplies blood to the outer retina. We quantified outer retinal and choroidal parameters to understand better the pathogenesis of diabetic retinopathy (DR) and diabetic macular edema (DME). The retrospective cross-sectional single-center study included 210 eyes from 139 diabetic patients and 76 eyes from 52 healthy controls. Spectral-domain optical coherence tomography (OCT) was carried out with a Spectralis HRA + OCT imaging device. The outer retinal layer (ORL), outer nuclear layer (ONL), and choroidal thicknesses were assessed along with the choroidal vascularity index (CVI). The presence of DR, whether with DME or without, was associated with choroidal thinning (p < 0.001). Compared with the controls, patients with DR without DME presented with lower ORL and ONL thickness (p < 0.001), whereas those with DR and DME had higher values of both parameters (p < 0.001). Significant correlations between outer retinal and choroidal parameters were found only in patients with DR without DME (ORL with choroidal thickness: p = 0.003, rho = 0.34; ORL with CVI: p < 0.001, rho = 0.49, ONL with CVI: p < 0.027, rho = 0.25). No correlations between choroidal and outer retinal parameters were observed in the controls and patients with DR and concomitant DME. Aside from diabetic choroidopathy, other pathogenic mechanisms seem to predominate in the latter group.
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Hui VWK, Szeto SKH, Tang F, Yang D, Chen H, Lai TYY, Rong A, Zhang S, Zhao P, Ruamviboonsuk P, Lai CC, Chang A, Das T, Ohji M, Huang SS, Sivaprasad S, Wong TY, Lam DSC, Cheung CY. Optical Coherence Tomography Classification Systems for Diabetic Macular Edema and Their Associations With Visual Outcome and Treatment Responses - An Updated Review. Asia Pac J Ophthalmol (Phila) 2022; 11:247-257. [PMID: 34923521 DOI: 10.1097/apo.0000000000000468] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Optical coherence tomography (OCT) is an invaluable imaging tool in detecting and assessing diabetic macular edema (DME). Over the past decade, there have been different proposed OCT-based classification systems for DME. In this review, we present an update of spectral-domain OCT (SDOCT)-based DME classifications over the past 5 years. In addition, we attempt to summarize the proposed OCT qualitative and quantitative parameters from different classification systems in relation to disease severity, risk of progression, and treatment outcome. Although some OCT-based measurements were found to have prognostic value on visual outcome, there has been a lack of consensus or guidelines on which parameters can be reliably used to predict treatment outcomes. We also summarize recent literatures on the prognostic value of these parameters including quantitative measures such as macular thickness or volume, central subfield thickness or foveal thickness, and qualitative features such as the morphology of the vitreoretinal interface, disorganization of retinal inner layers, ellipsoid zone disruption integrity, and hyperreflec-tive foci. In addition, we discuss that a framework to assess the validity of biomarkers for treatment outcome is essentially important in assessing the prognosis before deciding on treatment in DME. Finally, we echo with other experts on the demand for updating the current diabetic retinal disease classification.
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Affiliation(s)
- Vivian W K Hui
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, china
- Hong Kong Eye Hospital, Hong Kong, China
| | - Simon K H Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, china
- Hong Kong Eye Hospital, Hong Kong, China
| | - Fangyao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, china
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, china
| | - Haoyu Chen
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, china
- 2010 Retina & Macula Center, Kowloon, Hong Kong
| | - Ao Rong
- Department of Ophthalmology, Tongji Hospital Affiliated to Tongji University, Shanghai, China
- Shanghai Xin Shi Jie Eye Hospital, Shanghai, China
| | | | - Peiquan Zhao
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Paisan Ruamviboonsuk
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Andrew Chang
- Sydney Retina Clinic, Sydney Eye Hospital, University of Sydney, Sydney, NSw, Australia
| | - Taraprasad Das
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Suber S Huang
- Retina Center of Ohio, Cleveland, OH, US
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, US
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Dennis S C Lam
- C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, china
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Kung EW, Chan VT, Tang Z, Yang D, Sun Z, Wang YM, Chan C, Kwan MC, Shi J, Cheung CY. Alterations in the Choroidal Sublayers in Relationship to Severity and Progression of Diabetic Retinopathy: A Swept-Source OCT Study. OPHTHALMOLOGY SCIENCE 2022; 2:100130. [PMID: 36249687 PMCID: PMC9560641 DOI: 10.1016/j.xops.2022.100130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 12/03/2022]
Abstract
Purpose To examine the association of baseline choroidal sublayers metrics with the risk of diabetic retinopathy (DR) progression over 2 years, with adjustment for confounding factors that affect choroidal measurements. Design Prospective, observational cohort study. Participants One hundred three eyes from 62 patients with diabetes mellitus (DM). Methods Patients were followed up at 6-month intervals for at least 2 years. Choroidal metrics including choroidal area, choroidal thickness (CT), and choroidal vascularity index were measured for both (1) the choriocapillaris plus Sattler's layer and (2) the Haller's layer within the subfoveal and parafoveal region. Cox proportional models were constructed to estimate the relationship between baseline choroidal metrics and DR progression, adjusted for intereye correlation, established risk factors (i.e., duration of DM, glycated hemoglobin [HbA1c] level, body mass index [BMI], use of insulin, and mean arterial blood pressure [MABP]) and confounding factors of choroidal measurements (i.e., age and axial length). Additional predictive value of choroidal metrics was assessed using the C-statistic. Main Outcome Measures Hazard ratios (HRs) calculated by Cox proportional hazards model to demonstrate the associations between baseline choroidal metrics and DR progression. Results After adjusting for age, axial length, and intereye correlation, choroidal metrics in Haller's layer at baseline that were associated with a higher risk of DR progression included increases in subfoveal choroidal area (HR, 2.033; 95% confidence interval [CI], 1.179-3.505; P = 0.011), subfoveal plus parafoveal choroidal area (HR, 1.909; 95% CI, 1.096-3.326; P = 0.022), subfoveal CT (HR, 2.032; 95% CI, 1.181-3.498; P = 0.010), and subfoveal plus parafoveal CT (HR, 1.908; 95% CI, 1.097-3.319; P = 0.022). These associations remained statistically significant after additionally adjusting for duration of DM, HbA1c level, BMI, use of insulin, and MABP. Addition of these choroidal metrics significantly improved the discrimination for DR progression when compared with established risk factors alone (e.g., duration of DM and HbA1c; increase in C-statistic ranged from 8.08% to 9.67% [P < 0.05]). Conclusions Eyes with a larger choroidal area and CT in Haller's layer at baseline were associated with a higher risk of DR progression over 2 years.
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Key Words
- BMI, body mass index
- CI, confidence interval
- CSI, choroid–sclera interface
- CT, choroidal thickness
- CVI, choroidal vascularity index
- Choroid
- DM, diabetes mellitus
- DME, diabetic macular edema
- DR progression
- DR, diabetic retinopathy
- Diabetic choroidopathy
- Diabetic retinopathy
- HR, hazard ratio
- HbA1c, glycated hemoglobin
- MABP, mean arterial blood pressure
- NPDR, nonproliferative diabetic retinopathy
- PDR, proliferative diabetic retinopathy
- SS, swept-source
- Swept-source OCT
- VA, visual acuity
- VEGF, vascular endothelial growth factor
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Affiliation(s)
- Erica W.T. Kung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Victor T.T. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ziqi Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Zihan Sun
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yu Meng Wang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - C.H. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Michael C.H. Kwan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jian Shi
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 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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42
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Impact of Penetration and Image Analysis in Optical Coherence Tomography on the Measurement of Choroidal Vascularity Parameters. Retina 2022; 42:1965-1974. [DOI: 10.1097/iae.0000000000003547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Temel E, Özcan G, Yanık Ö, Demirel S, Batıoğlu F, Kar İ, Özmert E. Choroidal structural alterations in diabetic patients in association with disease duration, HbA1c level, and presence of retinopathy. Int Ophthalmol 2022; 42:3661-3672. [PMID: 35604622 DOI: 10.1007/s10792-022-02363-w] [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: 04/09/2021] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess choroidal structural changes in diabetic patients in association with disease duration, HbA1c level, and presence of retinopathy. METHODS This retrospective cross-sectional study included treatment-naive patients with non-proliferative DR (NPDR) (group 1), diabetic patients without DR (group 2), and healthy subjects (group 3). Patients were also grouped according to the duration of diabetes: long-term group (> 15 years, n = 32) and short-term group (˂ 15 years, n = 28). The choroidal thickness was measured at three points; subfoveal, 1500 μm nasal, and 1500 μm temporal to the fovea. The choroidal area, stromal area, luminal area (LA), and choroidal vascularity index (CVI) were quantified using ImageJ. Partial correlation analysis and one-way analysis of covariance test were performed for statistical analysis. RESULTS The study included 30 eyes of 30 treatment-naive patients with NPDR (group 1), 30 eyes of 30 diabetic patients without DR (group 2), and 30 eyes of 30 healthy persons (group 3). The mean subfoveal, nasal, and temporal choroidal thicknesses were decreased in group 1 in comparison with controls (p < 0.001, p = 0.035, and p = 0.005, respectively). The mean LA in group 1 and group 2 were both significantly lower compared to group 3 (group 1 vs. group 3, p = 0.004; group 2 vs. group 3, p = 0.020). CVI was significantly lower in group 1 and group 2 than in controls (group 1 vs. group 3, p = 0.019; group 2 vs. group 3, p = 0.025). CVI was significantly lower in the long-duration group than in the short-duration group (p < 0.001). A moderate negative correlation was found between the duration of diabetes and CVI (r = - 0.467, p < 0.001). A moderate negative correlation was found between HbA1c level and luminal area and CVI (r = - 0.466, p < 0.001, and r = - 0.425, p < 0.001, respectively). CONCLUSION Choroidal structure and CVI are altered even in the absence of clinically confirmed retinopathy and these alterations are related to the duration of diabetes.
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Affiliation(s)
- Emine Temel
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey.
| | - Gökçen Özcan
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Özge Yanık
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sibel Demirel
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Figen Batıoğlu
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - İrem Kar
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Emin Özmert
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Fursova AZ, Vasilyeva MA, Tarasov MS, Zubkova MY, Derbeneva AS, Nikulich IF, Gamza YA. [Features of structural and microvascular changes of the choroid in angioretinopathy of various etiologies]. Vestn Oftalmol 2022; 138:47-56. [PMID: 35488562 DOI: 10.17116/oftalma202213802147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To study structural and microvascular changes in the choroid in patients with chronic kidney disease (CKD), diabetic retinopathy (DR) and arterial hypertension (AH), and their relationship with the level of renal function, carbohydrate metabolism and blood pressure. MATERIAL AND METHODS The study involved 172 patients (325 eyes): 56 patients with CKD (109 eyes); 66 patients with DR (121 eyes); 50 patients with AH (95 eyes). All patients underwent comprehensive ophthalmological examination including visometry, biomicroscopy, ophthalmoscopy, optical coherence tomography (OCT) and OCT angiography. RESULTS In patients with DR and CKD, a decrease in the thickness of the ganglion cell complex and the inner plexiform layer (GCL+IPL) was noted: in proliferative DR (PDR) - 62.45±4.25 µm, in stage 4-5 CKD - 75.23±6.43 µm; a decrease in choroidal thickness (CT) of minimal values in stage 4-5 CKD (179.9±37.72 µm) and PDR (211.0±40.7 µm). The decrease in choroidal vascularity index (CVI) depended on the stage of CKD and PDR (in PDR - 63.47±1.37, in stage 4-5 CKD - 65.93±2.01). Maximum decrease in perfusion density and vascular density was found in patients with DR (37.22±9.00% and 15.11±3.39 mm, respectively). An increase in the area, perimeter of the foveolar avascular zone (FAZ), and a decrease in the circularity index were noted in all groups, with most pronounced changes in PDR and stage 4-5 CKD. Patients with CKD were found to have strong correlations of CT and CVI with creatinine, urea, proteinuria and glomerular filtration rate (GFR). Patients with diabetes mellitus and PDR were revealed to have strong relations of CT, CVI, GCL+IPL, the area and perimeter of FAZ with creatinine levels and the duration of diabetes mellitus. CONCLUSION Choroidal thickness and choroidal vascularity index are important diagnostic markers of disorders of chorioretinal microcirculation that allow stratifying individual assessment of risk factors for progression of both chronic kidney disease and diabetic retinopathy.
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Affiliation(s)
- A Zh Fursova
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - M A Vasilyeva
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia
| | - M S Tarasov
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - M Y Zubkova
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - A S Derbeneva
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - I F Nikulich
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - Yu A Gamza
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
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Zhou H, Lu J, Chen K, Shi Y, Gregori G, Rosenfeld PJ, Wang RK. Mitigating the effects of choroidal hyper- and hypo-transmission defects on choroidal vascularity index assessments using optical coherence tomography. Quant Imaging Med Surg 2022; 12:2932-2946. [PMID: 35502369 PMCID: PMC9014140 DOI: 10.21037/qims-21-1093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/11/2022] [Indexed: 01/12/2023]
Abstract
Background Changes in choroidal vascularity index (CVI) are associated with multiple choroid-related ocular diseases. CVI is calculated as the area/volume ratio of vessels in the choroid, which could be affected by alterations in regional signal intensities due to hypo-transmission defects (hypoTDs) caused by drusen and retinal pigment epithelium (RPE) detachments, and hyper-transmission defects (hyperTDs) caused by the absence of RPE. To develop a simulation model to verify the CVI assessments in eyes with hyper/hypoTDs and demonstrate that accurate CVIs can be achieved after attenuation correction on swept-source optical coherence tomography (SS-OCT). Methods A simulation model was developed on 6×6 mm macular scans from normal subjects. Signal intensity in a cylindrical region below RPE was altered to mimic hyper/hypoTDs. CVIs were compared inside and outside the simulated regions before and after attenuation correction. CVI assessments of OCT scans from patients with hyperTDs due to geographic atrophy (GA) and from patients with hypoTDs due to drusen that subsequently resolved with the disappearance of the hypoTDs were compared with and without attenuation correction. Results Ten normal eyes were recruited to generate the hyper/hypoTD simulation model. In eyes with hypoTDs, CVIs were overestimated, and in eyes with hyperTDs, the CVIs were underestimated (P<0.001). After attenuation correction, the uneven distribution of signal intensity was eliminated and the resulting CVI showed no significant difference compared with the 'ground truth', which is measured from the original scans. Attenuation correction successfully eliminated the influence of hyperTDs caused by GA on CVI measurements (n=38). Quantitatively, no significant difference was found in the CVIs of eyes before and after drusen collapse with attenuation correction (n=8). Conclusions The simulation model could reveal the impact of hypo/hyperTDs on CVI quantification in eyes with choroid-involved ocular diseases. The importance of attenuation correction to ensure accuracy in choroidal vessel segmentation was demonstrated by analyzing eyes with GA or drusen.
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Affiliation(s)
- Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Jie Lu
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Kelly Chen
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Yingying Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Philip J. Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
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46
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Madhpuriya G, Gokhale S, Agrawal A, Nigam P, Wan YL. Evaluation of Hemodynamic Changes in Retrobulbar Blood Vessels Using Color Doppler Imaging in Diabetic Patients. Life (Basel) 2022; 12:life12050629. [PMID: 35629297 PMCID: PMC9145998 DOI: 10.3390/life12050629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background—Diabetic retinopathy is a common complication of long-standing hyperglycemia. Microangiopathy-induced retinal changes are well-visualized on ophthalmoscopic examination. However, certain hemodynamic alterations have also been documented in the diabetic population, which have not been completely understood. Aim—To study the hemodynamic changes in retrobulbar circulation in diabetic patients with and without retinopathy, and to compare these changes with non-diabetic controls. Materials and Methods—This hospital-based prospective study included 50 diabetic and 50 non-diabetic patients. The diabetic groups consisted of 25 patients without retinopathy and 25 patients with retinopathy, and were labeled as Groups I and II, respectively. All subjects underwent orbital color Doppler ultrasonography using a linear high-frequency probe. The color Doppler parameters (peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI)) were measured and recorded using the spectral waveform of the ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary arteries (SPCA). Comparison of obtained values was carried out using appropriate tests of significance. Results—The resistive indices of the ophthalmic, central retinal, and short posterior ciliary arteries were significantly higher in diabetic patients compared to controls (p < 0.001). The difference was also significant between Group I and Group II. Comparison of PSV and EDV of CRA and SPCAs among three groups using one-way ANOVA revealed a significant difference, with the highest blood flow velocities in the control group and the lowest in diabetics with retinopathy. The ophthalmic artery showed no significant change in blood flow velocity. Analysis using the Pearson correlation coefficient provided a positive correlation between the RI values of OA, CRA, and SPCA and the presence of diabetic retinopathy (OA = r 0.417, p < 0.001; CRA = r 0.466, p < 0.001; SPCA = r 0.438; p < 0.001). Conclusions—The resistive index of OA, CRA, and SPCA is a reliable indicator to assess diabetic-associated hemodynamic changes. The use of orbital color Doppler ultrasonography in diabetic patients can help in the identification of patients who are at risk of developing retinopathy.
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Affiliation(s)
- Gulshan Madhpuriya
- Department of Radiodiagnosis, M.G.M. Medical College and M.Y. Hospital, Indore 452001, India; (G.M.); (A.A.); (P.N.)
| | | | - Alka Agrawal
- Department of Radiodiagnosis, M.G.M. Medical College and M.Y. Hospital, Indore 452001, India; (G.M.); (A.A.); (P.N.)
| | - Prakhar Nigam
- Department of Radiodiagnosis, M.G.M. Medical College and M.Y. Hospital, Indore 452001, India; (G.M.); (A.A.); (P.N.)
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
- Correspondence: ; Tel.: +886-3-3281-200 (ext. 2575)
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47
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Wang W, Li L, Wang J, Chen Y, Kun X, Gong X, Wei D, Wang D, Liang X, Liu H, Huang W. Macular Choroidal Thickness and the Risk of Referable Diabetic Retinopathy in Type 2 Diabetes: A 2-Year Longitudinal Study. Invest Ophthalmol Vis Sci 2022; 63:9. [PMID: 35420642 PMCID: PMC9034727 DOI: 10.1167/iovs.63.4.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/19/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the associations between choroidal thickness (CT) and the 2-year incidence of referable diabetic retinopathy (RDR). Methods This was a prospective cohort study. Patients with type 2 diabetes in Guangzhou, China, aged 30 to 80 years underwent comprehensive examinations, including standard 7-field fundus photography. Macular CT was measured using a commercial swept-source optical coherence tomography (SS-OCT) device (DRI OCT Triton; Topcon, Tokyo, Japan). The relative risk (RR) with 95% confidence intervals (CIs) was used to quantify the association between CT and new-onset RDR. The prognostic value of CT was assessed using the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results A total of 1345 patients with diabetes were included in the study, and 120 (8.92%) of them had newly developed RDR at the 2-year follow-up. After adjusting for other factors, the increased RDR risk was associated with greater HbA1c (RR = 1.35, 95% CI = 1.17-1.55, P < 0.001), higher systolic blood pressure (SBP; RR = 1.02, 95% CI = 1.01-1.03, P = 0.005), lower triglyceride (TG) level (RR = 0.81, 95% CI = 0.69-0.96, P = 0.015), presence of diabetic retinopathy (DR; RR = 8.16, 95% CI = 4.47-14.89, P < 0.001), and thinner average CT (RR = 0.903, 95% CI = 0.871-0.935, P < 0.001). The addition of average CT improved NRI (0.464 ± 0.096, P < 0.001) and IDI (0.0321 ± 0.0068, P < 0.001) for risk of RDR, and it also improved the AUC from 0.708 (95% CI = 0.659-0.757) to 0.761 (95% CI = 0.719-0.804). Conclusions CT thinning measured by SS-OCT is an early imaging biomarker for the development of RDR, suggesting that alterations in CT play an essential role in DR occurrence.
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Affiliation(s)
- Wei Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Longyue Li
- School of Medicine, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jun Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yifan Chen
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Xiong Kun
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xia Gong
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Daheng Wei
- Institute of Eyes, Jinzhou Medical University, Jinzhou, Liaoning, People's Republic of China
| | - Dongning Wang
- Institute of Eyes, Jinzhou Medical University, Jinzhou, Liaoning, People's Republic of China
| | - Xiaolin Liang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Hua Liu
- Institute of Eyes, Jinzhou Medical University, Jinzhou, Liaoning, People's Republic of China
| | - Wenyong Huang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
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Three-dimensional modelling of the choroidal angioarchitecture in a multi-ethnic Asian population. Sci Rep 2022; 12:3831. [PMID: 35264578 PMCID: PMC8907174 DOI: 10.1038/s41598-022-07510-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 02/07/2022] [Indexed: 11/08/2022] Open
Abstract
This study aimed to describe the topographic variation of the macula's choroidal angioarchitecture using three-dimensional (3D) choroidal vascularity index (CVI) of healthy eyes from an Asian population and to investigate the associations of CVI. 50 participants were recruited via stratified randomisation based on subfoveal choroidal thickness from the Singapore Epidemiology of Eye Diseases Study. Macular volume scans were acquired using spectral-domain optical coherence tomography with enhanced depth imaging. CVI was assessed based on B-scan binarisation and choroid segmentation. The 3D CVI of the whole, superior, central, and inferior macula were 62.92 ± 1.57%, 62.75 ± 1.93%, 63.35 ± 1.72%, and 62.66 ± 1.70%, respectively, pairwise comparisons P all > 0.05). 3D CVI (Whole Macula) and 2D CVI (Subfoveal) were associated only with each other and not with other ocular and systemic factors. 2D CVI (Subfoveal) had a moderate agreement with 3D CVI (Central Macula) [intraclass corelation coefficient (ICC) = 0.719], and had poorer agreement with 3D CVI of the whole macula, superior, and inferior macula (ICC = 0.591, 0.483, and 0.394, respectively). Scanning volume did not influence 3D CVI measurements. In conclusion, 3D CVI demonstrated no significant topographic variation. CVI was not correlated with demographic or ocular structural features. 2D CVI of the fovea is partially representative of 3D CVI of the macula.
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49
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Nicolini N, Tombolini B, Barresi C, Pignatelli F, Lattanzio R, Bandello F, Cicinelli MV. Assessment of Diabetic Choroidopathy Using Ultra-Widefield Optical Coherence Tomography. Transl Vis Sci Technol 2022; 11:35. [PMID: 35353150 PMCID: PMC8976931 DOI: 10.1167/tvst.11.3.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose The purpose of this study was to investigate a confocal scanning laser ophthalmoscopy (cSLO) ultra-widefield (UWF) swept-source optical coherence tomography (S-SOCT) in assessment of diabetic choroidopathy and to evaluate the agreement of measurements with a spectral-domain OCT (SD-OCT) instrument. Methods We conducted a cross-sectional study of patients with diabetes evaluating the choroidal vascularity index (CVI) in the nasal, temporal, and central macula segments of a UWF SS-OCT scan centered to the fovea. UWF pseudocolored fundus images were used for diabetic retinopathy (DR) severity staging. The CVI values were compared between different degrees of severity of DR and different posterior-pole sectors with linear mixed models. Central macula CVI measurements were repeated on SD-OCT scans; the interobserver intraclass coefficient (ICC) was calculated between SS-OCT and SD-OCT. Results A total of 151 eyes of 85 patients were included. The CVI values decreased from nonproliferative DR to proliferative DR, with high-risk proliferative DR having significantly lower CVI values than moderate to severe nonproliferative DR (P = 0.03). The central macula region was the most evidently affected; the nasal sector was the least affected. The agreement between SS-OCT and SD-OCT was moderate (ICC = 0.50). Conclusions Diabetic choroidopathy progresses with worsening of DR toward proliferative disease; choroidal depletion is more prominent in the macula. Caution is recommended in comparing CVI values between different devices. Translational Relevance Choroidal vascularity informs about the severity of DR and its complications, such as macular edema. The agreement between readers and between instruments may be suboptimal in certain cases.
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Affiliation(s)
- Nicolò Nicolini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Beatrice Tombolini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Costanza Barresi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Rosangela Lattanzio
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Choroidal Vascularity Index Assessment: A Potential Noninvasive Technique for Diagnosing Diabetic Nephropathy. J Ophthalmol 2022; 2022:3124746. [PMID: 35251707 PMCID: PMC8894076 DOI: 10.1155/2022/3124746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/04/2022] [Accepted: 01/22/2022] [Indexed: 11/22/2022] Open
Abstract
Aims This study aimed to compare the accuracy of the choroidal vascularity index (CVI) and diabetic retinopathy (DR) in the diagnosis of diabetic nephropathy (DN). Methods We performed a cross-sectional study of 117 patients with proteinuria and diabetes mellitus (DM) in which 45 patients were diagnosed with DN by renal pathology. Demographic information, clinical features, and laboratory data were collected. A total of 234 eyes underwent evaluation of DR and the CVI using enhanced depth imaging-optical coherence tomography scans. We analyzed the association between the CVI and DN and compared the CVI and DR for diagnosing DN using area under receiver operating characteristic curves (AUROCs). Results The severe nonproliferative DR and proliferative DR groups showed a lower CVI than the no DR and mild/moderate nonproliferative DR groups (P < 0.01 or P < 0.001). There was a significantly lower CVI in patients with DN stage III (63.01% ± 1.47%) compared with those in DN stages IIa (62.1% ± 1.41%, P < 0.001) and IIb (59.85% ± 1.98%, P < 0.01). The sensitivity and specificity of the CVI for diagnosing DN were 84% (71%–94%) and 95% (88%–99%), respectively, which were preferable to those of DR. The AUROCs for the CVI and DR for diagnosing DN were 0.932 and 0.831, respectively. The CVI outperformed DR for diagnosing DN (P < 0.05). The cutoff value of the CVI was 63.13%. Conclusion The CVI might be a reliable noninvasive technique for predicting the pathological stage of DN and is superior to DR in diagnosing DN.
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