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Blot G, Karadayi R, Przegralek L, Sartoris TM, Charles-Messance H, Augustin S, Negrier P, Blond F, Muñiz-Ruvalcaba FP, Rivera-de la Parra D, Vignaud L, Couturier A, Sahel JA, Acar N, Jimenez-Corona A, Delarasse C, Garfias Y, Sennlaub F, Guillonneau X. Perilipin 2-positive mononuclear phagocytes accumulate in the diabetic retina and promote PPARγ-dependent vasodegeneration. J Clin Invest 2023; 133:e161348. [PMID: 37781924 PMCID: PMC10702478 DOI: 10.1172/jci161348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/01/2023] [Indexed: 10/03/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM), characterized by hyperglycemia and dyslipidemia, leads to nonproliferative diabetic retinopathy (NPDR). NPDR is associated with blood-retina barrier disruption, plasma exudates, microvascular degeneration, elevated inflammatory cytokine levels, and monocyte (Mo) infiltration. Whether and how the diabetes-associated changes in plasma lipid and carbohydrate levels modify Mo differentiation remains unknown. Here, we show that mononuclear phagocytes (MPs) in areas of vascular leakage in DR donor retinas expressed perilipin 2 (PLIN2), a marker of intracellular lipid load. Strong upregulation of PLIN2 was also observed when healthy donor Mos were treated with plasma from patients with T2DM or with palmitate concentrations typical of those found in T2DM plasma, but not under high-glucose conditions. PLIN2 expression correlated with the expression of other key genes involved in lipid metabolism (ACADVL, PDK4) and the DR biomarkers ANGPTL4 and CXCL8. Mechanistically, we show that lipid-exposed MPs induced capillary degeneration in ex vivo explants that was inhibited by pharmaceutical inhibition of PPARγ signaling. Our study reveals a mechanism linking dyslipidemia-induced MP polarization to the increased inflammatory cytokine levels and microvascular degeneration that characterize NPDR. This study provides comprehensive insights into the glycemia-independent activation of Mos in T2DM and identifies MP PPARγ as a target for inhibition of lipid-activated MPs in DR.
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Affiliation(s)
- Guillaume Blot
- Institute of Vision, Sorbonne University, INSERM, CNRS, Paris, France
- ED394 Physiology and Physiopathology Doctoral School, Sorbonne University, Paris, France
| | - Rémi Karadayi
- Institute of Vision, Sorbonne University, INSERM, CNRS, Paris, France
| | | | | | - Hugo Charles-Messance
- Institute of Vision, Sorbonne University, INSERM, CNRS, Paris, France
- ED394 Physiology and Physiopathology Doctoral School, Sorbonne University, Paris, France
| | | | - Pierre Negrier
- Institute of Vision, Sorbonne University, INSERM, CNRS, Paris, France
- A. de Rothschild Foundation Hospital, Paris, France
| | - Frédéric Blond
- Institute of Vision, Sorbonne University, INSERM, CNRS, Paris, France
| | | | - David Rivera-de la Parra
- Comprehensive Care Center for Diabetes Patients, Salvador Zubrian National Institute of Health Sciences and Nutrition, Mexico City, Mexico
- Institute of Ophthalmology “Fundación Conde de Valenciana” I.A.P., Mexico City, Mexico
| | - Lucile Vignaud
- Institute of Vision, Sorbonne University, INSERM, CNRS, Paris, France
| | - Aude Couturier
- Institute of Vision, Sorbonne University, INSERM, CNRS, Paris, France
- ED394 Physiology and Physiopathology Doctoral School, Sorbonne University, Paris, France
- Department of Ophthalmology, Hôpital Lariboisière, AP-HP, University of Paris, Paris, France
| | - José-Alain Sahel
- Institute of Vision, Sorbonne University, INSERM, CNRS, Paris, France
- A. de Rothschild Foundation Hospital, Paris, France
- Department of Ophthalmology, The University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- CHNO des Quinze-Vingts, Institut Hospitalo-Universitaire FOReSIGHT, INSERM-DGOS CIC 1423, Paris, France
| | - Niyazi Acar
- Eye and Nutrition Research Group, Center for Taste and Food Sciences, CNRS, INRAE, Institut Agro, Bourgogne Franche-Comté University, Dijon, France
| | - Aida Jimenez-Corona
- Department of Epidemiology and Visual Health, Instituto de Oftalmología Fundación Conde de Valenciana, Mexico City, Mexico
- General Directorate of Epidemiology, Secretariat of Health, Mexico City, Mexico
| | - Cécile Delarasse
- Institute of Vision, Sorbonne University, INSERM, CNRS, Paris, France
| | - Yonathan Garfias
- Department of Biochemistry, School of Medicine, National Autonomous University, Mexico City, Mexico
- Cell and Tissue Biology, Research Unit, Instituto de Oftalmología Fundación Conde de Valenciana”, Mexico City, Mexico
| | - Florian Sennlaub
- Institute of Vision, Sorbonne University, INSERM, CNRS, Paris, France
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Yamaguchi M, Nakao S, Wada I, Matoba T, Arima M, Kaizu Y, Shirane M, Ishikawa K, Nakama T, Murakami Y, Mizuochi M, Shiraishi W, Yamasaki R, Hisatomi T, Ishibashi T, Shibuya M, Stitt AW, Sonoda KH. Identifying Hyperreflective Foci in Diabetic Retinopathy via VEGF-Induced Local Self-Renewal of CX3CR1+ Vitreous Resident Macrophages. Diabetes 2022; 71:2685-2701. [PMID: 36203331 DOI: 10.2337/db21-0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/13/2022] [Indexed: 01/11/2023]
Abstract
Intraretinal hyperreflective foci (HRF) are significant biomarkers for diabetic macular edema. However, HRF at the vitreoretinal interface (VRI) have not been examined in diabetic retinopathy (DR). A prospective observational clinical study with 162 consecutive eyes using OCT imaging showed significantly increased HRF at the VRI during DR progression (P < 0.01), which was reversed by anti-vascular endothelial growth factor (VEGF) therapy. F4/80+ macrophages increased significantly at the VRI in Kimba (vegfa+/+) or Akimba (Akita × Kimba) mice (both P < 0.01), but not in diabetic Akita (Ins2+/-) mice, indicating macrophage activation was modulated by elevated VEGF rather than the diabetic milieu. Macrophage depletion significantly reduced HRF at the VRI (P < 0.01). Furthermore, BrdU administration in Ccr2rfp/+Cx3cr1gfp/+vegfa+/- mice identified a significant contribution of M2-like tissue-resident macrophages (TRMs) at the VRI. Ki-67+ and CD11b+ cells were observed in preretinal tissues of DR patients, while exposure of vitreal macrophages to vitreous derived from PDR patients induced a significant proliferation response in vitro (P < 0.01). Taken together, the evidence suggests that VEGF drives a local proliferation of vitreous resident macrophages (VRMs) at the VRI during DR. This phenomenon helps to explain the derivation and disease-relevance of the HRF lesions observed through OCT imaging in patients.
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Affiliation(s)
- Muneo Yamaguchi
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shintaro Nakao
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Ophthalmology, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
- Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Iori Wada
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuya Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mitsuru Arima
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Kaizu
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mariko Shirane
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keijiro Ishikawa
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takahito Nakama
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yusuke Murakami
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Wataru Shiraishi
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryo Yamasaki
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshio Hisatomi
- Department of Ophthalmology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Tatsuro Ishibashi
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masabumi Shibuya
- Institute of Physiology and Medicine, Jobu University, Gunma, Japan
| | - Alan W Stitt
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University, Belfast, Northern Ireland
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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3
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Feng J, Yang X, Xu M, Wang Y, Shi X, Zhang Y, Huang P. Association of Microvasculature and Macular Sensitivity in Idiopathic Macular Epiretinal Membrane: Using OCT Angiography and Microperimetry. Front Med (Lausanne) 2021; 8:655013. [PMID: 34869402 PMCID: PMC8635104 DOI: 10.3389/fmed.2021.655013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 10/14/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose: To investigate the correlation between retinal capillary structure and macular function in patients with idiopathic epiretinal membrane (iERM) by using optical coherence tomography angiography (OCTA) and microperimetry. Methods: This retrospective and observational study included 30 idiopathic ERM eyes of 30 consecutive patients. OCTA was performed to evaluate macular microvasculature including the superficial capillary plexus, deep capillary plexus, and foveal avascular zone. Best corrected visual acuity (BCVA) and microperimetry were measured at baseline and 3 months after surgery. Associations between macular microvasculature and visual function were assessed. Results: Visual function including BCVA and macular sensitivity improved significantly at 3 months post-operatively (p < 0.001). At baseline, BCVA was positively correlated with foveal or parafoveal sensitivities and negatively correlated with central foveal thickness (p < 0.05). Pre-operative foveal sensitivity was significantly correlated with the vessel density of foveal or parafoveal superficial capillary plexus (p < 0.05). A multiple regression model revealed that pre-operative vessel density of foveal deep capillary plexus was an independent positive prognostic factor for post-operative BCVA (B = −0.020 ± 0.006, p = 0.006) and macular sensitivity (B = 0.200 ± 0.081, p = 0.027). Conclusion: Integrated evaluation of iERM by using OCTA and microperimetry shows an association between microvasculature and macular sensitivity. Pre-operative vessel density of foveal deep capillary plexus assessed by OCTA may be a potentially valuable prognostic factor for iERM surgery.
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Affiliation(s)
- Jingyang Feng
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China.,Shanghai Key Laboratory of Fundus Disease, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xiaotong Yang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Mengqiao Xu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuwei Wang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang Shi
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong, China
| | - Yumeng Zhang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peirong Huang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China.,Shanghai Key Laboratory of Fundus Disease, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
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Abstract
PURPOSE To report a 67-year-old woman with polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome, showing bilateral serous retinal detachment. The retinal lesion was evaluated by multimodal imaging using spectral domain optical coherence tomography and an adaptive optics (AO) camera. METHODS A case report. RESULTS Optical coherence tomography showed hyperreflective foci mainly in the inner retina in both eyes. The AO images showed many low-reflective dots in the right eye. Three months after hematological treatment, both hyperreflective foci in the optical coherence tomography images and the low-reflective dots in the AO images disappeared. CONCLUSION Low-reflective dots were detected in AO images of eyes with serous retinal detachment secondary to POEMS syndrome. AO cameras can detect retinal microstructures in living eyes.
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Shi JR, Zhang Q, Zhang T, Zhuang H, Sun ZC, Qin YW. Effects of intravitreal conbercept before panretinal photocoagulation on lipid exudates in diabetic macular documented by optical coherence tomography. Int J Ophthalmol 2020; 13:606-613. [PMID: 32399412 DOI: 10.18240/ijo.2020.04.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/14/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the effects of intravitreal conbercept (IVC) as adjunctive treatments before panretinal photocoagulation (PRP) to decrease hyperreflective dots (HRDs) in Chinese proliferative diabetic retinopathy (PDR) patients. METHODS Fifty-nine enrolled patients were categorized into 2 groups: single dose IVC (0.5 mg/0.05 mL) 1wk before PRP (Plus group) or PRP only (PRP group). Six months later, we measured the best corrected visual acuity (BCVA), central macula thickness (CMT) by optical coherence tomography and counted the number of HRDs in different retina layers. RESULTS The average CMT significantly decreased in Plus group but increased in PRP group. The average BCVA in the Plus group was also significantly better than that in the PRP group. Total HRDs decreased in the Plus group but increased in PRP group significantly. IVC pre-treatment has beneficial effects on reducing HRDs forming in the inner retina layer while the PRP alone increased the HRDs in the outer retina layer. CONCLUSION IVC is a promising adjunctive treatment to PRP in the treatment of PDR. Single dose IVC one week before PRP is suggested to improve retina blood-retina barrier, decrease lipid exudate and inhibit HRDs development in PDR.
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Affiliation(s)
- Jing-Rong Shi
- EENT Hospital, Fudan University, Shanghai 200031, China
| | - Quan Zhang
- EENT Hospital, Fudan University, Shanghai 200031, China.,Hainan (Boao) International Eye Hospital, Qionghai 571400, Hainan Province, China
| | - Ting Zhang
- EENT Hospital, Fudan University, Shanghai 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Hong Zhuang
- EENT Hospital, Fudan University, Shanghai 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Zhong-Cui Sun
- EENT Hospital, Fudan University, Shanghai 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Yao-Wu Qin
- EENT Hospital, Fudan University, Shanghai 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
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Murakami Y, Ishikawa K, Nakao S, Sonoda KH. Innate immune response in retinal homeostasis and inflammatory disorders. Prog Retin Eye Res 2019; 74:100778. [PMID: 31505218 DOI: 10.1016/j.preteyeres.2019.100778] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 08/12/2019] [Accepted: 09/02/2019] [Indexed: 01/03/2023]
Abstract
Innate immune cells such as neutrophils, monocyte-macrophages and microglial cells are pivotal for the health and disease of the retina. For the maintenance of retinal homeostasis, these cells and immunosuppressive molecules in the eye actively regulate the induction and the expression of inflammation in order to prevent excessive activation and subsequent tissue damage. In the disease context, these regulatory mechanisms are modulated genetically and/or by environmental stimuli such as damage-associated molecular patterns (DAMPs), and a chronic innate immune response regulates or contributes to the formation of diverse retinal disorders such as uveitis, retinitis pigmentosa, retinal vascular diseases and retinal fibrosis. Here we summarize the recent knowledge regarding the innate immune response in both ocular immune regulation and inflammatory retinal diseases, and we describe the potential of the innate immune response as a biomarker and therapeutic target.
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Affiliation(s)
- Yusuke Murakami
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka, 812-8582, Japan
| | - Keijiro Ishikawa
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka, 812-8582, Japan
| | - Shintaro Nakao
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka, 812-8582, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka, 812-8582, Japan.
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7
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High-resolution imaging of diabetic retinopathy lesions using an adaptive optics retinal camera. Rom J Ophthalmol 2019; 63:29-34. [PMID: 31198895 PMCID: PMC6531764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose. Adaptive optics (AO) imaging is a promising high-resolution investigation technique in ophthalmology that can bring new information about the pathophysiology of diabetic retinopathy. Material and methods. Seven patients previously diagnosed with diabetic retinopathy were investigated with optical coherence tomography (OCT) scanning, OCT angiography, fundus photo, and AO retinal camera (rtx1TM, Imagine Eyes, Orsay, France). Results. The red lesions on fundus photos appeared on AO imaging as hyporeflective lesions. OCT angiography helped us to differentiate between microaneurysms and hemorrhages. Hard exudates had a heterogeneous granular appearance. Retinal oedema was proved to have a blurring effect on the AO images. In addition to this, cystic spaces were identified to have a hyporeflective demarcation line. Conclusions. AO imaging is offering a fine documentation of retinal lesions and might become an important instrument for early diagnosis of diabetic retinopathy and for explaining its pathophysiological mechanisms. Abbreviations: AO = adaptive optics, AOO = adaptive optics ophthalmoscopy, SS = swept source, OCT =optical coherence tomography, SLO = scanning laser ophthalmoscope.
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Loganadane P, Delbosc B, Saleh M. Short-Term Progression of Diabetic Hard Exudates Monitored with High-Resolution Camera. Ophthalmic Res 2018; 61:3-9. [PMID: 30466082 DOI: 10.1159/000493858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/17/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the progression of diabetic hard exudates over an 8-week period, using a high-resolution adaptive optics camera. DESIGN Prospective observational study. METHODS Five eyes of three patients presenting diabetic maculopathy with hard exudates were studied. An area of clinically visible exudates was imaged sequentially using SD-OCT and high-resolution flood illumination adaptive optics for 2 months, on a weekly basis. A time-lapse video was obtained for each eye studied. Changes in terms of surface, number of free elements (foci), and central macular thickness were recorded. RESULTS Short-term modifications in terms of disposition, size, and number of exudates were observed. Two patterns of progression were identified: two eyes showed exudate dislocation concomitant with the regression of the underlying macular edema, with hard exudates being progressively replaced by a multitude of smaller foci. These exudates were labeled resorption exudates. In three other eyes with persistent diabetic macular edema, foci aggregated into larger exudates. CONCLUSION Diabetic hard exudate changes occurred over a short period of time but were not assessable clinically. Adaptive optics was able to document these subtle changes precisely. Further studies using this imaging modality may improve our understanding of the natural history of exudates and eventually help assess the efficacy of the various treatments available such as lipid-lowering drugs and anti-VEGFs injections.
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Affiliation(s)
- Prisca Loganadane
- Department of Ophthalmology, Besançon University Hospital, Besançon, France
| | - Bernard Delbosc
- Department of Ophthalmology, Besançon University Hospital, Besançon, France
| | - Maher Saleh
- Department of Ophthalmology, Besançon University Hospital, Besançon, France,
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9
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Decorrelation Signal of Diabetic Hyperreflective Foci on Optical Coherence Tomography Angiography. Sci Rep 2018; 8:8798. [PMID: 29892079 PMCID: PMC5995832 DOI: 10.1038/s41598-018-27192-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/25/2018] [Indexed: 11/29/2022] Open
Abstract
Diabetic hyperreflective foci in the outer retinal layers are a clinically relevant finding on optical coherence tomography (OCT) images, although their characteristics remain to be elucidated. Here we investigated the decorrelation signal around hyperreflective foci on OCT angiography (OCTA) images in diabetic retinopathy (DR). We retrospectively reviewed sufficient quality OCTA images from 102 eyes of 66 patients that were obtained using split-spectrum amplitude-decorrelation angiography algorithm. Most confluent hyperreflective foci were randomly deposited or appeared in a radiating array on the en-face structural OCT images in the inner nuclear layer (INL) or Henle’s fiber layer (HFL), respectively. Within the INL, hyperreflective foci were not accompanied by decorrelation signals and attached to capillaries on OCTA images. Decorrelation signals were sometimes delineated in hyperreflective foci in the HFL and other times appeared to be pseudopod-like or wrapping around hyperreflective foci, referred to as reflectance-decorrelated foci. The decorrelation signal intensity of hyperreflective foci in the HFL was associated with logMAR VA (R = 0.553, P < 0.001) and central subfield thickness (R = 0.408, P < 0.001) but not with DR severity. These data suggest that reflectance-decorrelated foci on OCTA images are clinically relevant as well as shed lights on the properties in diabetic hyperreflective foci.
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Marupally AG, Vupparaboina KK, Peguda HK, Richhariya A, Jana S, Chhablani J. Semi-automated quantification of hard exudates in colour fundus photographs diagnosed with diabetic retinopathy. BMC Ophthalmol 2017; 17:172. [PMID: 28931389 PMCID: PMC5607622 DOI: 10.1186/s12886-017-0563-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/05/2017] [Indexed: 01/18/2023] Open
Abstract
Background Hard exudates (HEs) are the classical sign of diabetic retinopathy (DR) which is one of the leading causes of blindness, especially in developing countries. Accordingly, disease screening involves examining HEs qualitatively using fundus camera. However, for monitoring the treatment response, quantification of HEs becomes crucial and hence clinicians now seek to measure the area of HEs in the digital colour fundus (CF) photographs. Against this backdrop, we proposed an algorithm to quantify HEs using CF images and compare with previously reported technique using ImageJ. Methods CF photographs of 30 eyes (20 patients) with diabetic macular edema were obtained. A robust semi-automated algorithm was developed to quantify area covered by HEs. In particular, the proposed algorithm, a two pronged methodology, involved performing top-hat filtering, second order statistical filtering, and thresholding of the colour fundus images. Subsequently, two masked observers performed HEs measurements using previously reported ImageJ-based protocol and compared with those obtained through proposed method. Intra and inter-observer grading was performed for determining percentage area of HEs identified by the individual algorithm. Results Of the 30 subjects, 21 were males and 9 were females with a mean age of the 50.25 ± 7.80 years (range 33–66 years). The correlation between the two measurements of semi-automated and ImageJ were 0.99 and 0.99 respectively. Previously reported method detected only 0–30% of the HEs area in 9 images, 30–60% in 12 images and 60–90% in remaining images, and more than 90% in none. In contrast, proposed method, detected 60–90% of the HEs area in 13 images and 90–100% in remaining 17 images. Conclusion Proposed method semi-automated algorithm achieved acceptable accuracy, qualitatively and quantitatively, on a heterogeneous dataset. Further, quantitative analysis performed based on intra- and inter-observer grading showed that proposed methodology detects HEs more accurately than previously reported ImageJ-based technique. In particular, we proposed algorithm detect faint HEs also as opposed to the earlier method.
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Affiliation(s)
- Abhilash Goud Marupally
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V.Prasad Eye Institute, Hyderabad, 500034, India
| | - Kiran Kumar Vupparaboina
- Engineering Group, Srujana Center for Innovation, L.V.Prasad Eye Institute, Hyderabad, 500034, India.,Deptartment of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, 502285, India
| | - Hari Kumar Peguda
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V.Prasad Eye Institute, Hyderabad, 500034, India
| | - Ashutosh Richhariya
- Engineering Group, Srujana Center for Innovation, L.V.Prasad Eye Institute, Hyderabad, 500034, India
| | - Soumya Jana
- Deptartment of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, 502285, India
| | - Jay Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V.Prasad Eye Institute, Hyderabad, 500034, India.
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Kaizu Y, Nakao S, Wada I, Yamaguchi M, Fujiwara K, Yoshida S, Hisatomi T, Ikeda Y, Hayami T, Ishibashi T, Sonoda KH. Imaging of Retinal Vascular Layers: Adaptive Optics Scanning Laser Ophthalmoscopy Versus Optical Coherence Tomography Angiography. Transl Vis Sci Technol 2017; 6:2. [PMID: 28875064 PMCID: PMC5580501 DOI: 10.1167/tvst.6.5.2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/03/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Retinal vascular networks are observed as a layered structure residing in a nerve fiber layer and an inner nuclear layer of the retina. This study aimed to evaluate reflectance confocal adaptive optics scanning laser ophthalmoscopy (AO-SLO) for imaging of the layered retinal vascular networks. METHODS This study included 16 eyes of 16 healthy cases. On the fovea, 2.8- and 3.0 mm2-areas were imaged using a prototype AO-SLO and optical coherence tomography angiography (OCTA), respectively. AO-SLO images focused on the nerve fiber and photoreceptor layers were recorded in the area. Two different vessel images (capillary networks in the superficial layer and in all layers) were generated to examine if the deep capillary network could be distinguished. We compared AO-SLO with OCTA in imaging of the layered retinal vascular networks. RESULTS Sufficient images of capillary networks for analysis could be generated when the motion contrast was enhanced with AO-SLO movies in seven cases (43.8%). The deep capillary network could be distinguished in the merged image. Vascular depiction performance in AO-SLO was significantly better than in OCTA at both 0.5- and 1.0-mm areas from the fovea (P < 0.05). CONCLUSIONS Retinal vascular imaging using AO-SLO might be a useful adjunct to OCTA as a supportive method to evaluate the retina in healthy patients and patients with disease. TRANSLATIONAL RELEVANCE In cases requiring accurate and detailed retinal vasculature observation, AO-SLO might be useful for evaluating retinal vascular lesions as a supportive imaging method of OCTA.
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Affiliation(s)
- Yoshihiro Kaizu
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shintaro Nakao
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Iori Wada
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Muneo Yamaguchi
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kohta Fujiwara
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigeo Yoshida
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshio Hisatomi
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Ikeda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takehito Hayami
- Department of Intelligent Mechanical Systems, Graduate School of Natural Science and Technology, Okayama University, Okayama, Japan
| | - Tatsuro Ishibashi
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Sawides L, Sapoznik KA, de Castro A, Walker BR, Gast TJ, Elsner AE, Burns SA. Alterations to the Foveal Cone Mosaic of Diabetic Patients. Invest Ophthalmol Vis Sci 2017; 58:3395-3403. [PMID: 28687853 PMCID: PMC5501497 DOI: 10.1167/iovs.17-21793] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose We measured localized changes occurring in the foveal cone photoreceptors and related defects in the cone mosaic to alterations in the nearby retinal vasculature. Methods The central 4° of the retina of 54 diabetic (53.7 ± 12.5 years) and 85 control (35.8 ± 15.2 years) participants were imaged with the Indiana adaptive optics scanning laser ophthalmoscope. Foveal cones and overlying retinal capillaries were imaged and infrared scanning laser ophthalmoscopy (IR SLO) images and optical coherence tomography (OCT) B-scans were obtained. Follow-up imaging sessions were performed with intervals from 4 to 50 months for 22 of the 54 diabetic participants. Results The foveal cone mosaics of 49 of 54 diabetic participants were of sufficient quality to assess the absence or presence of small localized defects in the cone mosaic. In 13 of these 49 diabetic participants we found localized defects, visualized as sharp-edged areas of cones with diminished reflectivity. These small, localized areas ranged in size from 10 × 10 μm to 75 × 30 μm. Of these 13 participants with cone defects, 11 were imaged over periods from 4 to 50 months and the defects remained relatively stable. These dark regions were not shadows of overlying retinal vessels, but all participants with these localized defects had alterations in the juxtafoveal capillary network. Conclusions The foveal cone mosaic can show localized areas of dark cones that persist over time, that apparently correspond to either missing or nonreflecting cones, and may be related to local retinal ischemia.
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Affiliation(s)
- Lucie Sawides
- School of Optometry, Indiana University, Bloomington, Indiana, United States
| | - Kaitlyn A Sapoznik
- School of Optometry, Indiana University, Bloomington, Indiana, United States
| | - Alberto de Castro
- School of Optometry, Indiana University, Bloomington, Indiana, United States
| | - Brittany R Walker
- School of Optometry, Indiana University, Bloomington, Indiana, United States
| | - Thomas J Gast
- School of Optometry, Indiana University, Bloomington, Indiana, United States
| | - Ann E Elsner
- School of Optometry, Indiana University, Bloomington, Indiana, United States
| | - Stephen A Burns
- School of Optometry, Indiana University, Bloomington, Indiana, United States
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