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Arora S, Zur D, Iovino C, Chhablani J. Peripapillary fluid: Obvious and not so obvious! Surv Ophthalmol 2024; 69:311-329. [PMID: 38016521 DOI: 10.1016/j.survophthal.2023.11.004] [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: 08/27/2022] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023]
Abstract
Intraretinal or subretinal fluid in the peripapillary area can be clinically visualized in conditions such as peripapillary choroidal neovascularization, optic disc pit maculopathy, and optic nerve head tumors and granulomas. Optical coherence tomography (OCT) helps to visualize peripapillary fluid in many other chorioretinal conditions such as peripapillary pachychoroid syndrome, posterior uveitis, central retinal vein occlusion, malignant hypertension, hypotonic maculopathy as well as neuro-ophthalmological conditions such as glaucoma, microcystic macular edema and disc edema due papilledema, non-arteritic anterior ischemic optic neuropathy, neuroretinitis, and diabetic papillopathy. Often, the differential diagnosis of peripapillary fluid is a bit tricky and may lead to misdiagnosis and improper management. We describe a diagnostic algorithm for peripapillary fluid on OCT and outline the salient features and management of these conditions.
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Affiliation(s)
- Supriya Arora
- Bahamas Vision Centre and Princess Margaret Hospital, Nassau NP, Bahamas
| | - Dinah Zur
- Division of Ophthalmology, 26738 Tel Aviv Sourasky Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Claudio Iovino
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, United States.
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2
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Ji YK, Hua RR, Liu S, Xie CJ, Zhang SC, Yang WH. Intelligent diagnosis of retinal vein occlusion based on color fundus photographs. Int J Ophthalmol 2024; 17:1-6. [PMID: 38239946 PMCID: PMC10754666 DOI: 10.18240/ijo.2024.01.01] [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: 08/29/2023] [Accepted: 10/17/2023] [Indexed: 01/22/2024] Open
Abstract
AIM To develop an artificial intelligence (AI) diagnosis model based on deep learning (DL) algorithm to diagnose different types of retinal vein occlusion (RVO) by recognizing color fundus photographs (CFPs). METHODS Totally 914 CFPs of healthy people and patients with RVO were collected as experimental data sets, and used to train, verify and test the diagnostic model of RVO. All the images were divided into four categories [normal, central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), and macular retinal vein occlusion (MRVO)] by three fundus disease experts. Swin Transformer was used to build the RVO diagnosis model, and different types of RVO diagnosis experiments were conducted. The model's performance was compared to that of the experts. RESULTS The accuracy of the model in the diagnosis of normal, CRVO, BRVO, and MRVO reached 1.000, 0.978, 0.957, and 0.978; the specificity reached 1.000, 0.986, 0.982, and 0.976; the sensitivity reached 1.000, 0.955, 0.917, and 1.000; the F1-Sore reached 1.000, 0.955 0.943, and 0.887 respectively. In addition, the area under curve of normal, CRVO, BRVO, and MRVO diagnosed by the diagnostic model were 1.000, 0.900, 0.959 and 0.970, respectively. The diagnostic results were highly consistent with those of fundus disease experts, and the diagnostic performance was superior. CONCLUSION The diagnostic model developed in this study can well diagnose different types of RVO, effectively relieve the work pressure of clinicians, and provide help for the follow-up clinical diagnosis and treatment of RVO patients.
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Affiliation(s)
- Yu-Ke Ji
- Eye Hospital, Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
| | - Rong-Rong Hua
- College of Electronic Information Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210000, Jiangsu Province, China
| | - Sha Liu
- Eye Hospital, Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
| | - Cui-Juan Xie
- Shenzhen Eye Institute, Shenzhen Eye Hospital, Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Shao-Chong Zhang
- Shenzhen Eye Institute, Shenzhen Eye Hospital, Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Wei-Hua Yang
- Shenzhen Eye Institute, Shenzhen Eye Hospital, Jinan University, Shenzhen 518000, Guangdong Province, China
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3
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Qu S, Zou Y, Yang L, Wu H. The progress of assessment methods and treatments of neovascular glaucoma secondary to central retinal vein occlusion. Front Med (Lausanne) 2024; 10:1280776. [PMID: 38259837 PMCID: PMC10800625 DOI: 10.3389/fmed.2023.1280776] [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: 08/21/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Neovascular glaucoma is a condition that results from central retinal vein occlusion and often leads to blindness. Accurate evaluation and appropriate treatment are crucial for patients. However, there is currently no uniform and clear standard to differentiate between ischemic and non-ischemic central retinal vein occlusion. Also, the assessment of neovascular glaucoma progression is uncertain. Meanwhile, although pan-retinal photocoagulation is a standard treatment to prevent the onset of neovascular glaucoma, its actual efficacy and the timing of intervention remain highly controversial. It is still challenging to balance the risks of side effects in the visual field against the uncertain effectiveness of the treatment. This paper delves into the pathogenesis of neovascular glaucoma to understand the development of therapeutic approaches. By taking into account various assessment criteria of central retinal vein occlusion and neovascular glaucoma over the years, combining functional tests and morphological tests provides the most accurate and rigorous solution. The age of patients, the extent, location, and duration of retinal ischemia are the primary factors that affect the severity and extent of ischemic central retinal vein occlusion and induce serious complications. From the perspective of prevention and treatment, the ischemic index is closely related to the development of neovascularization. The paper provides essential insights into the mechanism, efficacy, complications, and optimal timing of pan-retinal photocoagulation. Comparing the treatment effects of pan-retinal photocoagulation and intravitreal anti-VEGF injections, we suggest a combination of both treatments to explore effective treatment with fewer side effects in the long term. This article details the debate on the above issues and explores ideas for the clinical diagnosis and preventive treatment of neovascular glaucoma that results from ischemic central retinal vein occlusion.
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Affiliation(s)
| | | | | | - Hong Wu
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
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Cicinelli MV, La Franca L, Berni A, Bottazzi L, Rabiolo A, Lattanzio R, Udaondo P, Bandello F. Rate and associations of inner retinal thinning in eyes with retinal vein occlusion and regressed macular oedema. Eye (Lond) 2024; 38:138-144. [PMID: 37391514 PMCID: PMC10764826 DOI: 10.1038/s41433-023-02647-0] [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: 10/28/2022] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE To investigate the associations between visual acuity (VA) and structural optical coherence tomography (OCT) features in retinal vein occlusion (RVO) eyes after cystoid macular oedema (CMO) regression and to assess whether inner retinal thinning is progressive. METHODS Retrospective observational study of RVO eyes with regressed CMO for at least 6 months. OCT scans at CMO regression were analysed, and features were correlated with VA at that visit. The inner retinal thickness was longitudinally compared between RVO and unaffected fellow eyes (controls) with linear mixed models. The rate of inner retinal thinning was obtained as the interaction term between disease status and time. Associations between inner retinal thinning and clinical characteristics were explored. RESULTS Thirty-six RVO eyes were followed for 34.2 ± 21.1 months after CMO regression. The presence of ellipsoid zone disruption (regression estimate[standard error(SE)] = 0.16[0.04] LogMAR vs. intact, p < 0.001) and lower inner retinal thickness (regression estimate[SE] = -0.25[0.12] LogMAR for 100-μm increase, p = 0.01) were associated with worse VA. The inner retinal thickness decreased faster in RVO than controls (rate of retinal thinning -0.27 ± 0.09 μm/month vs. -0.08 ± 0.11 μm/month, p = 0.01). Macular ischaemia was associated with a faster rate of retinal thinning (interaction term macular ischaemia*follow-up time, p = 0.04). CONCLUSION Inner retinal and photoreceptors' layers integrity are associated with better visual acuity once CMO resolves. RVO eyes undergo progressive inner retinal thinning after CMO regression, faster in eyes with macular ischaemia.
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Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Lamberto La Franca
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Berni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Leonardo Bottazzi
- 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
| | - Patricia Udaondo
- Hospital Universitari i Politècnic La Fe, Avinguda Fernando Abril Martorell, No. 106, Valencia, Spain
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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5
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Au A, Ip M, Blodi BA, Scott IU, Oden NL, Van Veldhuisen PC, Sarraf D. OCT Grading System of Macular Infarction Predicts Vision in Participants With Central Retinal or Hemiretinal Vein Occlusion: A Secondary Analysis of SCORE2. Am J Ophthalmol 2023; 256:55-62. [PMID: 37544495 PMCID: PMC11040591 DOI: 10.1016/j.ajo.2023.07.028] [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: 04/09/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE To determine whether macular infarction measured as hyper-reflectivity of the middle and inner retinal layers predicts long-term visual acuity outcomes in participants with central retinal vein occlusion (CRVO) or hemi-retinal vein occlusion (HRVO). DESIGN Clinical cohort study using post hoc secondary analysis of phase 3 clinical trial data. METHODS This post hoc secondary analysis of the phase 3 Study of COmparative Treatments for REtinal Vein Occlusions 2 (SCORE2) clinical trial included 310 of the 362 participants with macular edema secondary to CRVO/HRVO who were randomized to injections of aflibercept or bevacizumab. Month 01 (M01) optical coherence tomography (OCT) images were analyzed using the following grading scheme: no infarction (grade 0), only middle retinal infarction (grade 1), diffuse middle and patchy inner retinal infarction (grade 2), and diffuse middle and inner retinal infarction (grade 3). Visual acuity letter score (VALS), central subfield thickness (CST), and number of anti-vascular endothelial growth factor (anti-VEGF) injections were correlated with the infarction severity grade at month 01. RESULTS More severe macular infarction, with both middle and inner retinal layer hyper-reflectivity (ie, grades 2 and 3), was associated with worse M00 VALS and was predictive of VALS at M01 to M60 (P < .001). More severe infarction was associated with greater CST at presentation; however, after the first anti-VEGF injection, CST decreased and was similar across all grades at all time points (P > .05) with similar number of injections. CONCLUSIONS Participants with more severe macular infarction at M01, as graded with OCT, exhibited worse visual outcomes despite significantly improved macular edema from month 6 to 5 years. This suggests that macular infarction may drive visual acuity after retinal fluid is treated with anti-VEGF.
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Affiliation(s)
- Adrian Au
- Stein Eye Institute (A.A., D.S.), University of California, Los Angeles, California, USA
| | - Michael Ip
- Doheny Image Reading Center (M.I.), Doheny Eye Institute, Los Angeles, California, USA
| | - Barbara A Blodi
- Department of Ophthalmology and Visual Sciences (B.A.B.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ingrid U Scott
- Departments of Ophthalmology and Public Health Sciences (I.U.S.), Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Neal L Oden
- The Emmes Company, LLC (N.L.O., P.C.V.V.), Rockville, Maryland, USA
| | | | - David Sarraf
- Stein Eye Institute (A.A., D.S.), University of California, Los Angeles, California, USA; VA Greater Los Angeles Healthcare System (D.S.), Los Angeles, California, USA.
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6
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Lam MR, Yang CD, Colmenarez JA, Dong P, Gu L, Suh DW. The role of intrapartum fetal head compression in neonatal retinal hemorrhage. J AAPOS 2023; 27:267.e1-267.e7. [PMID: 37722620 DOI: 10.1016/j.jaapos.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE Neonatal retinal hemorrhage is a common finding in newborns, but the underlying mechanisms are not fully understood. A computational simulation was designed to study the events taking place in the eye and orbit when the head is compressed as the neonate passes through the birth canal. METHODS A finite element model of the eye, optic nerve sheath, and orbit was simulated and subjected to forces mimicking rises in intracranial pressure (ICP) associated with maternal contractions during normal vaginal delivery. Resulting changes in intraocular pressure (IOP), pressure in the optic nerve sheath, and stress within the sclera and retina were measured. RESULTS During contractions, increased ICP was transmitted to the orbit, globe, and optic nerve sheath. IOP rose by 2.71 kPa near the posterior pole. Pressure at the center of the optic nerve sheath rose by 7.31 kPa and up to 9.30 kPa at its interface with the sclera. Stress in the retina was highest near the optic disk and reached 10.93, 10.99, and 13.28 kPa in the preretinal, intraretinal, and subretinal layers, respectively. Stress in the sclera peaked at 12.76 kPa. CONCLUSIONS Increasing ICP associated with natural vaginal delivery increases intraorbital pressure, which applies stress to the retina. Associated retinal deformation may cause tearing of the retinal vasculature. Increased pressure within the optic nerve sheath may occlude the central retinal vein, resulting in outflow obstruction and subsequent rupture. Forces accumulated near the optic disk, likely accounting for the tendency of neonatal retinal hemorrhage to occur posteriorly.
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Affiliation(s)
- Matthew R Lam
- Creighton University School of Medicine, Phoenix, Arizona.
| | - Christopher D Yang
- Department of Ophthalmology and Visual Sciences, University of California, Irvine School of Medicine, Irvine, California; Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California
| | - Jose A Colmenarez
- Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, Florida
| | - Pengfei Dong
- Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, Florida
| | - Linxia Gu
- Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, Florida
| | - Donny W Suh
- Department of Ophthalmology and Visual Sciences, University of California, Irvine School of Medicine, Irvine, California; Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California
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7
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Tanaka S, Tanaka Y, Inoue T, Nagura K, Arasaki R, Okawa K, Kitahata S, Nakamura K, Kastube S, Yanagi Y, Maruyama-Inoue M, Kadonosono K. Retinal haemorrhages on ultra-widefield red channel images and perfusion status in central retinal vein occlusion. Eye (Lond) 2023; 37:2305-2309. [PMID: 36543943 PMCID: PMC10366201 DOI: 10.1038/s41433-022-02337-3] [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: 04/26/2022] [Revised: 10/10/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To evaluate the relationship between retinal haemorrhages detected on Ultra-widefield (UWF) red channel images and perfusion status in eyes with acute central retinal vein occlusion (CRVO). METHODS UWF fundus images were split into green and red channels using ImageJ software. The retinal haemorrhages were calculated quantitatively with both the green and red channel images, resulting in green channel haemorrhages (GCH) and red channel haemorrhages (RCH). The nonperfusion area (NPA) was also calculated from fluorescein angiography in each eye. The relationships between both the GCH and RCH with the NPA were investigated. RESULTS Thirty-two eyes of 32 patients with acute CRVO (18 men, 14 women) were included. The mean GCH and RCH values were 10.4% ± 8.2% and 1.7% ± 1.7%, respectively. The mean NPA was 39.2% ± 28.8%. Significant correlations were seen between the GCH and NPA (r = 0.38; P = 0.022) and RCH and NPA (r = 0.44; P = 0.010, linear regression analysis). Multivariate analysis suggested that only the RCHs were correlated significantly with the NPA. CONCLUSIONS Retinal haemorrhages detected by UWF red channel imaging were less compared to green channel imaging and associated closely with retinal NPAs in eyes with acute CRVO. UWF red channel imaging allowed us to identify ischaemia-related haemorrhage.
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Affiliation(s)
- Shin Tanaka
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Kanagawa, Japan.
| | - Yui Tanaka
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Koichi Nagura
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Rei Arasaki
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Kazuyoshi Okawa
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Shohei Kitahata
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Kentaro Nakamura
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Shiro Kastube
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Yasuo Yanagi
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Maiko Maruyama-Inoue
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Kanagawa, Japan
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Romano F, Lamanna F, Gabrielle PH, Teo KYC, Battaglia Parodi M, Iacono P, Fraser-Bell S, Cornish EE, Nassisi M, Viola F, Agarwal A, Samanta A, Chhablani J, Staurenghi G, Invernizzi A. Update on Retinal Vein Occlusion. Asia Pac J Ophthalmol (Phila) 2023; 12:196-210. [PMID: 36912792 DOI: 10.1097/apo.0000000000000598] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/11/2022] [Indexed: 03/14/2023] Open
Abstract
Retinal vein occlusion represents the second leading cause of retinal vascular disorders, with a uniform sex distribution worldwide. A thorough evaluation of cardiovascular risk factors is required to correct possible comorbidities. The diagnosis and management of retinal vein occlusion have changed tremendously in the last 30 years, but the assessment of retinal ischemia at baseline and during follow-up examinations remains crucial. New imaging techniques have shed light on the pathophysiology of the disease and laser treatment, once the only therapeutic option, is now only one of the possible approaches with antivascular endothelial growth factors and steroid injections being preferred in most cases. Nowadays long-term outcomes are better than those achievable 20 years ago and yet, many new therapeutic options are under development, including new intravitreal drugs and gene therapy. Despite this, some cases still develop sight-threatening complications deserving a more aggressive (sometimes surgical) approach. The purpose of this comprehensive review is to reappraise some old but still valid concepts and to integrate them with new research and clinical data. The work will provide an overview of the disease's pathophysiology, natural history, and clinical features along with a detailed discussion on the advantages of multimodal imaging and of the different treatment strategies with the aim of providing retina specialists with the most updated knowledge in the field.
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Affiliation(s)
- Francesco Romano
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Francesca Lamanna
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | - Kelvin Y C Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Maurizio Battaglia Parodi
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierluigi Iacono
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Samantha Fraser-Bell
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Elisa E Cornish
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Marco Nassisi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Viola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, US
- Department of Ophthalmology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anindya Samanta
- Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, US
| | - Jay Chhablani
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
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9
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Zhang W, Liu Y, Sang A. Efficacy and effectiveness of anti-VEGF or steroids monotherapy versus combination treatment for macular edema secondary to retinal vein occlusion: a systematic review and meta-analysis. BMC Ophthalmol 2022; 22:472. [PMID: 36474156 PMCID: PMC9727869 DOI: 10.1186/s12886-022-02682-7] [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: 06/06/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Retinal vein occlusion (RVO) is the main cause of retinal vascular blindness. Laser photocoagulation therapy is the regarded as the standard treatment for branch retinal vein occlusion (BRVO) in the guidelines, but it is not effective for macular edema (ME) secondary to central retinal vein occlusion (CRVO). As anti-VEGF (vascular endothelial growth factor) or steroids monotherapy has been used to treat RVO, but each has its advantages and disadvantages. Our purpose was to evaluate the efficacy and safety of intraocular injection of anti-VEGF combined with steroids versus anti-VEGF or steroids monotherapy for ME secondary to RVO. METHODS We systematically searched trials on Pubmed, Embase, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI) for RCTs (random clinical trials) or non-RCTs, comparing anti-VEGF or steroids monotherapy to their combination. The primary outcomes were changes in best-corrected visual acuity (BCVA), central macular thickness (CMT) and intraocular pressure (IOP). The pooled data was analyzed by random effects model. FINDINGS A total of 10 studies selected from 366 studies were included in this meta-analysis. Our results favored anti-VEGF with steroids combination therapy in comparison with anti-VEGF {pooled SMD (standardized mean difference), 95% CI, -0.16 [-0.28, -0.04], P = 0.01} or steroids (pooled SMD, 95% CI, -0.56 [-0.73, -0.40], P < 0.00001) alone on changes of BCVA. Compared with anti-VEGF monotherapy group, the combination therapy also had a better effect {pooled MD (mean difference), 95% CI, -9.62 [-17.31, -1.93], P = 0.01)} at improvements on CMT. On the changes of IOP, assessment favored that combination therapy was associated with a better relief of IOP compared to steroids monotherapy group (pooled MD, 95% CI, -5.93 [-7.87, -3.99],P < 0.00001). What's more, the incidence of ocular hypertension was lower in the combined treatment group compared with control group treated with steroids alone (Odds Ratio, 95% CI, 0.21 [0.06, 0.77], P = 0.02). Results also showed that the combination group can prolong the average time to first anti-VEGF reinjection (MD, 95% CI, 1.74 [0.57, 2.90], P = 0.003) compared to control group treated with anti-VEGF alone. CONCLUSION Anti-VEGF with steroids combination treatment can enable a better achievement of improving BCVA, CMT, reducing the risk of increased IOP and improving patient prognosis compared to anti-VEGF or steroids therapy alone, lengthening the average time to anti-VEGF reinjection with reducing the injections during follow-up.
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Affiliation(s)
- Wuyue Zhang
- grid.440642.00000 0004 0644 5481Eye Institute, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Yuan Liu
- grid.440642.00000 0004 0644 5481Eye Institute, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Aimin Sang
- grid.440642.00000 0004 0644 5481Eye Institute, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
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10
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Abstract
Purpose The aim of this experimental study was to investigate the pathogenesis of Terson syndrome (TS), which currently is controversial. Methods The central retinal artery (in 39 orbits), posterior ciliary arteries (in 8 orbits), and central retinal vein (CRV in 21 orbits) were occluded in rhesus monkeys by exposing them to lateral orbitotomy. Fundus examination and fluorescein fundus angiography were performed before and immediately after cutting the vessels and serially thereafter during the follow-up period. The rationale of the experimental study design is discussed. Results In eyes with central retinal artery occlusion, retinal hemorrhages were seen soon after the procedure in 7 eyes, and on follow-up in a total of 15 eyes. In posterior ciliary artery occlusion, retinal hemorrhages were seen soon after the procedure in one eye, and on follow-up in a total of three eyes. In eyes with CRV, all eyes had extensive scattered retinal hemorrhages. Conclusion The findings of this experimental study, and my basic, experimental, and comprehensive clinical studies on CRVO, suggest the following concept of the pathogenesis of TS: Compression of the CRV plays a crucial role in the development of TS. The CRV is compressed, as it lies in the subarachnoid space of the optic nerve sheath, by raised cerebrospinal fluid pressure and/or accumulated blood. . This results in retinal venous stasis and raised venous pressure in the retinal veins, leading to venous engorgement, rupture of the retinal capillaries. and retinal hemorrhages. The clinical importance of compression of the CRV and not occlusion of CRV in TS is that optic nerve sheath decompression by opening it and releasing the blood and raised cerebrospinal fluid (CSF) pressure, would result in immediate decompressing of the CRV in the subarachnoid space and restoration of normal circulation and prevent visual loss.
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Affiliation(s)
- Sohan S Hayreh
- Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, Iowa, USA,Correspondence to: Dr. Sohan S Hayreh, Department of Ophthalmology and Visual Sciences, University Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242-1091, USA. E-mail:
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11
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An W, Zhao Q, Yu R, Han J. The role of optical coherence tomography angiography in distinguishing ischemic versus non-ischemic central retinal vein occlusion. BMC Ophthalmol 2022; 22:413. [DOI: 10.1186/s12886-022-02637-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction:
To observe macular microvascular changes in patients with ischemic and non-ischemic central retinal vein occlusion (CRVO) by optical coherence tomography angiography (OCTA), and explore the value of OCTA in differentiating ischemic and non-ischemic CRVO.
Methods:
Cross sectional study. Fifty patients diagnosed as CRVO with macular edema were included. Macular edema in all patients were regressive after three consecutive anti-VEGF treatment. Patients were divided into ischemic and non-ischemic group according to ultra-wide-angle fundus fluorescein angiography (UWFFA). All patients underwent BCVA, IOP, color fundus photography, UWFFA and OCTA. The following parameters were measured: (1) Vessel density (VD): superficial and deep whole VD (SVD, DVD), superficial and deep central fovea VD (SFVD, DFVD), superficial and deep parafoveal VD (SPFVD, DPFVD); (2) Central foveal retinal thickness (CRT); (3) Area of foveal avascular zone (FAZ), perimeter of FAZ (PERIM), avascular index of FAZ (AI) and VD within a width of 300 microns around the FAZ region (FD-300). Comparison between ischemic and non-ischemic group was performed by two independent sample t-tests. Receiver operating characteristic (ROC) curve analysis was used to measure the area under the curve (AUC) of VD for predicting ischemic CRVO.
Results:
There were no significant differences in IOP, SFVD, DFVD and CRT between ischemic and non-ischemic group, and significant differences in age, BCVA, SVD, SPFVD, DVD, DPFVD, FAZ area, PERIM, AI and FD-300 between ischemic and non-ischemic group. ROC curve analysis showed AUC of DVD and DPFVD in predicting ischemic CRVO was highest (0.962). the threshold was 38.40%, and the sensitivity was 100%, but the specificity of DVD (92.3%) was significantly higher than that of DPFVD (84.6%). Therefore, DVD ≤ 38.40% can be used as the best threshold for determining ischemic CRVO.
Conclusion:
OCTA can quantitatively evaluate the macular microvascular structure of CRVO, which is helpful to distinguish ischemic from non-ischemic CRVO.
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Ferro Desideri L, Rutigliani C, Corazza P, Nastasi A, Roda M, Nicolo M, Traverso CE, Vagge A. The upcoming role of Artificial Intelligence (AI) for retinal and glaucomatous diseases. JOURNAL OF OPTOMETRY 2022; 15 Suppl 1:S50-S57. [PMID: 36216736 PMCID: PMC9732476 DOI: 10.1016/j.optom.2022.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 06/16/2023]
Abstract
In recent years, the role of artificial intelligence (AI) and deep learning (DL) models is attracting increasing global interest in the field of ophthalmology. DL models are considered the current state-of-art among the AI technologies. In fact, DL systems have the capability to recognize, quantify and describe pathological clinical features. Their role is currently being investigated for the early diagnosis and management of several retinal diseases and glaucoma. The application of DL models to fundus photographs, visual fields and optical coherence tomography (OCT) imaging has provided promising results in the early detection of diabetic retinopathy (DR), wet age-related macular degeneration (w-AMD), retinopathy of prematurity (ROP) and glaucoma. In this review we analyze the current evidence of AI applied to these ocular diseases, as well as discuss the possible future developments and potential clinical implications, without neglecting the present limitations and challenges in order to adopt AI and DL models as powerful tools in the everyday routine clinical practice.
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Affiliation(s)
- Lorenzo Ferro Desideri
- University Eye Clinic of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy.
| | | | - Paolo Corazza
- University Eye Clinic of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | | | - Matilde Roda
- Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna and S.Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - Massimo Nicolo
- University Eye Clinic of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | - Carlo Enrico Traverso
- University Eye Clinic of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | - Aldo Vagge
- University Eye Clinic of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
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13
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Karlsson RA, Hardarson SH. Artery vein classification in fundus images using serially connected U-Nets. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 216:106650. [PMID: 35139461 DOI: 10.1016/j.cmpb.2022.106650] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Retinal vessels provide valuable information when diagnosing or monitoring various diseases affecting the retina and disorders affecting the cardiovascular or central nervous systems. Automated retinal vessel segmentation can assist clinicians and researchers when interpreting retinal images. As there are differences in both the structure and function of retinal arteries and veins, separating these two vessel types is essential. As manual segmentation of retinal images is impractical, an accurate automated method is required. METHODS In this paper, we propose a convolutional neural network based on serially connected U-nets that simultaneously segment the retinal vessels and classify them as arteries or veins. Detailed ablation experiments are performed to understand how the major components contribute to the overall system's performance. The proposed method is trained and tested on the public DRIVE and HRF datasets and a proprietary dataset. RESULTS The proposed convolutional neural network achieves an F1 score of 0.829 for vessel segmentation on the DRIVE dataset and an F1 score of 0.814 on the HRF dataset, consistent with the state-of-the-art methods on the former and outperforming the state-of-the-art on the latter. On the task of classifying the vessels into arteries and veins, the method achieves an F1 score of 0.952 for the DRIVE dataset exceeding the state-of-the-art performance. On the HRF dataset, the method achieves an F1 score of 0.966, which is consistent with the state-of-the-art. CONCLUSIONS The proposed method demonstrates competitive performance on both vessel segmentation and artery vein classification compared with state-of-the-art methods. The method outperforms human experts on the DRIVE dataset when classifying retinal images into arteries, veins, and background simultaneously. The method segments the vasculature on the proprietary dataset and classifies the retinal vessels accurately, even on challenging pathological images. The ablation experiments which utilize repeated runs for each configuration provide statistical evidence for the appropriateness of the proposed solution. Connecting several simple U-nets significantly improved artery vein classification performance. The proposed way of serially connecting base networks is not limited to the proposed base network or segmenting the retinal vessels and could be applied to other tasks.
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Affiliation(s)
- Robert Arnar Karlsson
- Faculty of Medicine at the University of Iceland, Sæmundargata 2, Reykjavík, 102, Iceland; Faculty of Electrical and Computer Engineering at the University of Iceland, Sæmundargata 2, Reykjavík, 102, Iceland.
| | - Sveinn Hakon Hardarson
- Faculty of Medicine at the University of Iceland, Sæmundargata 2, Reykjavík, 102, Iceland.
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Karlsson RA, Olafsdottir OB, Helgadottir V, Belhadj S, Eliasdottir TS, Stefansson E, Hardarson SH. Automation improves repeatability of retinal oximetry measurements. PLoS One 2021; 16:e0260120. [PMID: 34914738 PMCID: PMC8675673 DOI: 10.1371/journal.pone.0260120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/02/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose Retinal oximetry is a technique based on spectrophotometry where images are analyzed with software capable of calculating vessel oxygen saturation and vessel diameter. In this study, the effect of automation of measurements of retinal vessel oxygen saturation and vessel diameter is explored. Methods Until now, operators have had to choose each vessel segment to be measured explicitly. A new, automatic version of the software automatically selects the vessels once the operator defines a measurement area. Five operators analyzed image pairs from the right eye of 23 healthy subjects with semiautomated retinal oximetry analysis software, Oxymap Analyzer (v2.5.1), and an automated version (v3.0). Inter- and intra-operator variability was investigated using the intraclass correlation coefficient (ICC) between oxygen saturation measurements of vessel segments in the same area of the retina. Results For semiautomated saturation measurements, the inter-rater ICC was 0.80 for arterioles and venules. For automated saturation measurements, the inter-rater ICC was 0.97 for arterioles and 0.96 for venules. For semiautomated diameter measurements, the inter-rater ICC was 0.71 for arterioles and venules. For automated diameter measurements the inter-rater ICC was 0.97 for arterioles and 0.95 for venules. The inter-rater ICCs were different (p < 0.01) between the semiautomated and automated version in all instances. Conclusion Automated measurements of retinal oximetry values are more repeatable compared to measurements where vessels are selected manually.
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Affiliation(s)
- Robert Arnar Karlsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Faculty of Electrical and Computer Engineering, University of Iceland, Reykjavik, Iceland
- * E-mail:
| | - Olof Birna Olafsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | - Thorunn Scheving Eliasdottir
- The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing, University of Iceland, Reykjavik, Iceland
| | - Einar Stefansson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- The National University Hospital of Iceland, Reykjavik, Iceland
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Hawy E, Sharma RA, Peragallo JH, Dattilo M, Newman NJ, Biousse V. Unilateral Isolated Paucisymptomatic Optic Disc Edema. J Neuroophthalmol 2021; 41:e523-e534. [PMID: 33394642 DOI: 10.1097/wno.0000000000001136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unilateral isolated optic disc edema (UIODE) represents a challenging clinical presentation that frequently precipitates an extensive diagnostic work-up. Patients without an apparent diagnosis despite appropriate investigations are often categorized as having "papillophlebitis," an entity that is poorly defined in the existing literature. Our aim was to describe the characteristics of a series of patients with paucisymptomatic UIODE, determine the optimal diagnostic approach to such cases, and clarify the clinical features of presumed papillophlebitis. METHODS We retrospectively identified 29 patients with UIODE who were seen by neuro-ophthalmologists at a single center between 2005 and 2019. Each patient presented with isolated, unilateral disc edema that was either entirely asymptomatic or associated with minimal visual symptoms. Patients underwent a comprehensive neuro-ophthalmic evaluation and several ophthalmic and systemic investigations. Data from the initial visit and all subsequent clinical visits were collected, including patient demographics, examination findings, and details of the diagnostic work-up. RESULTS Our 29 patients with UIODE were found to have a variety of underlying diagnoses including unilateral papilledema due to idiopathic intracranial hypertension (10 patients), optic nerve sheath meningioma (5), incipient nonarteritic anterior ischemic neuropathy (4), vitreopapillary traction (3), orbital masses (2), a peripapillary choroidal neovascular membrane (1), and presumed papillophlebitis (4). The duration of disc edema varied considerably based on the etiology, but most patients had favorable visual outcomes. CONCLUSIONS A systematic approach to the evaluation of UIODE, combined with long-term follow-up, led to a definite diagnosis in a majority of patients, with only 4 patients presumed to have papillophlebitis, a diagnosis the actual existence of which remains controversial.
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Affiliation(s)
- Eman Hawy
- Departments of Ophthalmology (EH, RAS, JHP, MD, NJN, VB), Pediatrics (JHP), Neurology (NJN, VB), and Neurological Surgery (NJN), Emory University School of Medicine, Atlanta, Georgia
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16
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Antaki F, Milad D, Sahyoun JY, Coussa RG. Paracentral acute middle maculopathy in non-ischaemic central retinal vein occlusion: the role of en face optical coherence tomography. BMJ Case Rep 2021; 14:e246842. [PMID: 34764101 PMCID: PMC8587704 DOI: 10.1136/bcr-2021-246842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Fares Antaki
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Daniel Milad
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Jean-Yves Sahyoun
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Razek Georges Coussa
- Department of Ophthalmology and Visual Sciences, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Kim YN, Shin JW, Park YJ, Lee JY, Kim JG, Yoon YH, Kim YJ. Glaucoma as a prognostic factor of central retinal vein occlusion: visual and anatomical outcomes and occurrence of ischaemic central retinal vein occlusion. Acta Ophthalmol 2021; 99:e523-e530. [PMID: 33113286 DOI: 10.1111/aos.14608] [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: 03/21/2020] [Accepted: 08/09/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the functional and anatomical outcomes of central retinal vein occlusion (CRVO) according to the presence of glaucoma before the onset of CRVO, and to assess whether pre-existing glaucoma affects the prognosis of CRVO in terms of development and conversion to ischaemic CRVO. METHODS In this retrospective cohort study, patients with treatment-naïve CRVO were enrolled between December 2009 and February 2019. The patients were classified into two groups according to the presence of pre-existing primary open-angle glaucoma at CRVO diagnosis. We reviewed medical records regarding basic demographics, ocular characteristics and treatments. The effects of pre-existing glaucoma on the occurrence of ischaemic CRVO were also investigated using Cox proportional hazard models. RESULTS Of 166 eyes from 166 patients, 26 (15.7%) had pre-existing glaucoma. The pre-existing glaucoma group revealed significantly older (69.4 ± 13.3 versus 56.5 ± 15.9) and lower BCVA at baseline (1.06 ± 0.75 versus 0.64 ± 0.58, logMAR) and final visits (1.56 ± 1.35 versus 0.64 ± 0.48, logMAR) (all p < 0.05) than non-glaucomatous group. In terms of perfusion status of CRVO, the glaucoma group showed higher incidence of ischaemic CRVO (30.8% versus 5.3%, p = 0.052) at initial and last visits as well as more disorganization of retinal inner layers (DRIL) at 3 months (76.0% versus 49.6%, p = 0.015). Pre-existing glaucoma (hazard ratio (HR) = 2.141, p = 0.014), lower vision at baseline (HR = 2.071, p = 0.001) and DRIL at 3 months (HR = 2.905, p = 0.011) were significant risk factors for the occurrence of ischaemic CRVO. CONCLUSION In patients with CRVO, pre-existing glaucoma was associated with poorer visual and anatomical outcomes, and played as a significant risk factor for the development and conversion to ischaemic CRVO with lower vision and presence of DRIL at early phase of CRVO.
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Affiliation(s)
- You Na Kim
- Department of Ophthalmology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Joong Won Shin
- Department of Ophthalmology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Yu Jeong Park
- Department of Ophthalmology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Joo Yong Lee
- Department of Ophthalmology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - June Gone Kim
- Department of Ophthalmology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Young Hee Yoon
- Department of Ophthalmology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Yoon Jeon Kim
- Department of Ophthalmology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
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Kang EYC, Yeung L, Lee YL, Wu CH, Peng SY, Chen YP, Gao QZ, Lin C, Kuo CF, Lai CC. A Multimodal Imaging-Based Deep Learning Model for Detecting Treatment-Requiring Retinal Vascular Diseases: Model Development and Validation Study. JMIR Med Inform 2021; 9:e28868. [PMID: 34057419 PMCID: PMC8204240 DOI: 10.2196/28868] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/18/2021] [Accepted: 05/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Retinal vascular diseases, including diabetic macular edema (DME), neovascular age-related macular degeneration (nAMD), myopic choroidal neovascularization (mCNV), and branch and central retinal vein occlusion (BRVO/CRVO), are considered vision-threatening eye diseases. However, accurate diagnosis depends on multimodal imaging and the expertise of retinal ophthalmologists. OBJECTIVE The aim of this study was to develop a deep learning model to detect treatment-requiring retinal vascular diseases using multimodal imaging. METHODS This retrospective study enrolled participants with multimodal ophthalmic imaging data from 3 hospitals in Taiwan from 2013 to 2019. Eye-related images were used, including those obtained through retinal fundus photography, optical coherence tomography (OCT), and fluorescein angiography with or without indocyanine green angiography (FA/ICGA). A deep learning model was constructed for detecting DME, nAMD, mCNV, BRVO, and CRVO and identifying treatment-requiring diseases. Model performance was evaluated and is presented as the area under the curve (AUC) for each receiver operating characteristic curve. RESULTS A total of 2992 eyes of 2185 patients were studied, with 239, 1209, 1008, 211, 189, and 136 eyes in the control, DME, nAMD, mCNV, BRVO, and CRVO groups, respectively. Among them, 1898 eyes required treatment. The eyes were divided into training, validation, and testing groups in a 5:1:1 ratio. In total, 5117 retinal fundus photos, 9316 OCT images, and 20,922 FA/ICGA images were used. The AUCs for detecting mCNV, DME, nAMD, BRVO, and CRVO were 0.996, 0.995, 0.990, 0.959, and 0.988, respectively. The AUC for detecting treatment-requiring diseases was 0.969. From the heat maps, we observed that the model could identify retinal vascular diseases. CONCLUSIONS Our study developed a deep learning model to detect retinal diseases using multimodal ophthalmic imaging. Furthermore, the model demonstrated good performance in detecting treatment-requiring retinal diseases.
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Affiliation(s)
- Eugene Yu-Chuan Kang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ling Yeung
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yi-Lun Lee
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Cheng-Hsiu Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shu-Yen Peng
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yueh-Peng Chen
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Quan-Ze Gao
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chihung Lin
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
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Wang Q, Yang J, Jonas JB, Shi X, Wu S, Chen S, Yan Y, Zhou W, Dong L, Wei W, Wang YX. Prevalence of Retinal Vein Occlusions and Estimated Cerebrospinal Fluid Pressure: The Kailuan Eye Study. Eye Brain 2021; 13:147-156. [PMID: 34045911 PMCID: PMC8149277 DOI: 10.2147/eb.s290107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/23/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the prevalence of retinal vein occlusions (RVOs) and associated factors in a Chinese population. Patients and Methods The cross-sectional community-based Kailuan Eye Study included individuals who participated in the Kailuan Study. RVOs were diagnosed on the fundus photographs. Estimated cerebrospinal fluid pressure (eCSFP) was calculated as “eCSFP=0.44*Body Mass Index+0.16*Diastolic Blood Pressure-0.18*Age”. Results The study included 12,499 participants with a mean age of 52.9±13.1 years. The overall prevalence of RVO was 120/12,499 or 0.96%, with branch RVOs observed in 116/12,499 individuals and central RVOs in 4/12,499 individuals. RVOs started at the optic disc in 19 participants (15.8% of all RVOs), and in 101 (84.2%) individuals arterio-venous crossings outside the optic disc. In multivariable analysis, a higher RVO prevalence was associated with older age (P<0.001), higher eCSFP (P<0.001), and higher fasting serum glucose concentration (P<0.001). Differentiating between RVOs at arterio-venous crossings and RVOs at the optic disc revealed that the prevalence of both RVO types was associated with higher eCSFP (P<0.001 and P=0.004, respectively) after adjusting for age and fasting serum glucose concentration. Conclusion In this adult Chinese population recruited on a community basis, the prevalence of any RVO (mean: 0.96) was associated with older age, higher eCSFP and higher fasting serum glucose concentration. Higher eCSFP may play an etiologic role in RVOs.
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Affiliation(s)
- Qian Wang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jingyan Yang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University, Mannheim, Germany
| | - Xuehui Shi
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shouling Wu
- Cardiology Department, Kailuan General Hospital, Tangshan, People's Republic of China
| | - Shuohua Chen
- Health Care Center, Kailuan Group, Tangshan, People's Republic of China
| | - Yanni Yan
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wenjia Zhou
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Li Dong
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wenbin Wei
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology and Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
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Blood-retinal barrier as a converging pivot in understanding the initiation and development of retinal diseases. Chin Med J (Engl) 2021; 133:2586-2594. [PMID: 32852382 PMCID: PMC7722606 DOI: 10.1097/cm9.0000000000001015] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Clinical ophthalmologists consider each retinal disease as a completely unique entity. However, various retinal diseases, such as uveitis, age-related macular degeneration, diabetic retinopathy, and primary open-angle glaucoma, share a number of common pathogenetic pathways. Whether a retinal disease initiates from direct injury to the blood-retinal barrier (BRB) or a defect/injury to retinal neurons or glia that impairs the BRB secondarily, the BRB is a pivotal point in determining the prognosis as self-limiting and recovering, or developing and progressing to a clinical phenotype. The present review summarizes our current knowledge on the physiology and cellular and molecular pathology of the BRB, which underlies its pivotal role in the initiation and development of common retinal diseases.
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Donaldson L, Margolin E. Approach to patient with unilateral optic disc edema and normal visual function. J Neurol Sci 2021; 424:117414. [PMID: 33799215 DOI: 10.1016/j.jns.2021.117414] [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: 01/27/2021] [Revised: 02/28/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
In patients with swollen optic nerve head and normal visual function, optic disc drusen (ODD) is the most common diagnosis. The best tests for detecting ODD are funds autofluorescence and enhanced-depth imaging ocular coherence tomography (EDIOCT). After ODD has been ruled out, asymmetric papilledema should be assumed to be the cause and MRI of the brain and orbits with contrast and venography should be performed in all patients. It allows one to look for indirect signs of increased inctracranial pressure (ICP), optic perineuritis, and other inflammatory or compressive processes affecting optic nerve or its sheath such as optic nerve sheath meningioma. If imaging signs of raised ICP are present, lumbar puncture should be performed with measurement of opening pressure and analysis of cerebrospinal fluid (CSF) contents in all patients with fever, meningismus or neurologic deficits as well as patients who are not in the typical demographic group for idiopathic intracranial hypertension (IIH). Optic nerve sheath enhancement on MRI should prompt work-up for causes of optic perineuritis. When the appropriate neuroimaging is normal, the differential diagnosis is limited and ophthalmological consultation is necessary to determine whether other subtle ocular abnormalities are present on biomicroscopic and dilated fundus examination.
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Affiliation(s)
- Laura Donaldson
- University of Toronto, Faculty of Medicine, Department of Ophthalmology and Vision Sciences, Toronto, Ontario, Canada
| | - Edward Margolin
- University of Toronto, Faculty of Medicine, Department of Ophthalmology and Vision Sciences, Toronto, Ontario, Canada; University of Toronto, Faculty of Medicine, Department of Medicine, Division of Neurology, Toronto, Ontario, Canada.
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22
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Hayreh SS. Photocoagulation for retinal vein occlusion. Prog Retin Eye Res 2021; 85:100964. [PMID: 33713810 DOI: 10.1016/j.preteyeres.2021.100964] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
The role of photocoagulation in retinal vein occlusion (RVO) has been studied since 1974. The most serious complications of central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) are: (i) visual deterioration, most commonly due to macular edema, and (ii) the development of ocular neovascularization (NV), particularly neovascular glaucoma (NVG), with hazardous consequences for vision and even the eye itself. Before discussing the role of photocoagulation in the management of NV and macular edema in RVO, it is crucial to gain a basic scientific understanding of the following relevant issues: classification of RVO, ocular NV in RVO, and the natural history of macular edema and visual outcome of RVO. These topics are discussed. In CRVO, ocular NV is a complication of ischemic CRVO but not of nonischemic CRVO. Photocoagulation has been advocated to prevent and/or treat the development of ocular NV and NVG. Since NVG is the most dreaded, intractable and blinding complication of ischemic CRVO, the role of photocoagulation and its management are discussed. Findings of three randomized, prospective clinical trials dealing with photocoagulation in ischemic CRVO are discussed. The role of photocoagulation in the management of ocular NV and macular edema in BRVO, and three randomized, prospective clinical trials dealing with those are discussed. Recent advent of intravitreal anti-VEGF and corticosteroid therapies has drastically changed the role of photocoagulation in the management of macular edema and NV in CRVO and BRVO. This is discussed in detail.
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Affiliation(s)
- Sohan Singh Hayreh
- Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, IA, USA.
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23
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SCORE2 Report 13: Intraretinal Hemorrhage Changes in Eyes With Central or Hemiretinal Vein Occlusion Managed With Aflibercept, Bevacizumab or Observation. Secondary Analysis of the SCORE and SCORE2 Clinical Trials. Am J Ophthalmol 2021; 222:185-193. [PMID: 32828880 DOI: 10.1016/j.ajo.2020.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To investigate the relationship between intraretinal macular hemorrhage and visual acuity outcomes in eyes with central retinal vein occlusion or hemiretinal vein occlusion managed with aflibercept, bevacizumab, or observation. DESIGN Retrospective analysis of data from 2 randomized clinical trials. METHODS A total of 362 participants were randomized in the Study of Comparative Treatments for Retinal Vein Occlusion 2, and 88 participants randomized to observation in the Standard Care vs Corticosteroid in Retinal Vein Occlusion Study. Participants received monthly intravitreal aflibercept or bevacizumab through month 6 or observation through month 8. The main outcome was visual acuity letter score (VALS). RESULTS Reduced area of hemorrhage by month 6 was observed in 70.7% (116 of 164) of aflibercept-treated eyes, 63.8% (104 of 163) of bevacizumab-treated eyes, and 42.2% (27 of 64) of observation eyes by month 8 (P < .01). Relative to eyes with hemorrhage during follow-up, aflibercept-treated eyes without hemorrhage at month 6 had a mean VALS improvement of 8.0 (99% confidence interval [CI]: 1.9, 14.2); bevacizumab-treated eyes without hemorrhage at month 6 had a mean VALS improvement of 3.2 (99% CI: -4.6, 11.0); and observation eyes without hemorrhage at month 8 had a mean VALS improvement of 13.5 (99% CI: 0.4, 26.5). At month 6, the presence of hemorrhage and the change in central subfield thickness (CST) were significantly associated with the change in VALS; however, CST was a more important predictor. CONCLUSION Improvement in hemorrhage during follow-up was associated with visual acuity improvements and predicted visual acuity changes beyond what was explained by CST. These findings suggest that intraretinal macular hemorrhage is an important indicator of disease severity in retinal vein occlusion.
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24
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Michl M, Fabianska M, Seeböck P, Sadeghipour A, Haj Najeeb B, Bogunovic H, Schmidt-Erfurth UM, Gerendas BS. Automated quantification of macular fluid in retinal diseases and their response to anti-VEGF therapy. Br J Ophthalmol 2020; 106:113-120. [PMID: 33087314 DOI: 10.1136/bjophthalmol-2020-317416] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 12/15/2022]
Abstract
AIM To objectively assess disease activity and treatment response in patients with retinal vein occlusion (RVO), neovascular age-related macular degeneration (nAMD) and centre-involved diabetic macular oedema (DME), using artificial intelligence-based fluid quantification. METHODS Posthoc analysis of 2311 patients (11 151 spectral-domain optical coherence tomography volumes) from five clinical, multicentre trials, who received a flexible antivascular endothelial growth factor (anti-VEGF) therapy over a 12-month period. Fluid volumes were measured with a deep learning algorithm at baseline/months 1, 2, 3 and 12, for three concentric circles with diameters of 1, 3 and 6 mm (fovea, paracentral ring and pericentral ring), as well as four sectors surrounding the fovea (superior, nasal, inferior and temporal). RESULTS In each disease, at every timepoint, most intraretinal fluid (IRF) per square millimetre was present at the fovea, followed by the paracentral ring and pericentral ring (p<0.0001). While this was also the case for subretinal fluid (SRF) in RVO/DME (p<0.0001), patients with nAMD showed more SRF in the paracentral ring than at the fovea up to month 3 (p<0.0001). Between sectors, patients with RVO/DME showed the highest IRF volumes temporally (p<0.001/p<0.0001). In each disease, more SRF was consistently found inferiorly than superiorly (p<0.02). At month 1/12, we measured the following median reductions of initial fluid volumes. For IRF: RVO, 95.9%/97.7%; nAMD, 91.3%/92.8%; DME, 37.3%/69.9%. For SRF: RVO, 94.7%/97.5%; nAMD, 98.4%/99.8%; DME, 86.3%/97.5%. CONCLUSION Fully automated localisation and quantification of IRF/SRF over time shed light on the fluid dynamics in each disease. There is a specific anatomical response of IRF/SRF to anti-VEGF therapy in all diseases studied.
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Affiliation(s)
- Martin Michl
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Maria Fabianska
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Philipp Seeböck
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Amir Sadeghipour
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Bilal Haj Najeeb
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Hrvoje Bogunovic
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | | | - Bianca S Gerendas
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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25
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Cote-Olijnyk M, Fowlkes S, Assouline S. Chronic myelogenous leukemia presenting as central retinal vein occlusion. Leuk Lymphoma 2020; 61:2515-2518. [DOI: 10.1080/10428194.2020.1775203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Sabrina Fowlkes
- Department of Medicine, Division of Hematology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Sarit Assouline
- Department of Medicine, Division of Hematology, Jewish General Hospital, McGill University, Montreal, Canada
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26
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Wang J, Li Y, Fang SF, Wang H. Efficacy of intravitreal Lucentis injection on major and macular branch retinal vein occlusion. BMC Ophthalmol 2020; 20:274. [PMID: 32646391 PMCID: PMC7350754 DOI: 10.1186/s12886-020-01544-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 07/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background The objective of our study was to assess the efficacy of intravitreal Lucentis injection on major and macular branch retinal vein occlusion (BRVO). Methods In this retrospective analysis, 43 patients (major BRVO n = 24; macular BRVO, n = 19) were treated with intravitreal injection of Lucentis with a 1 + PRN regimen, which is diagnosed by fluorescein fundus angiography (FFA). “1 + PRN”, namely, one intravitreal injection of Lucentis at the baseline, and then continue or stop according to the condition of the patient. The following observation indexes were measured at baseline and follow-up (1–6 months): best corrected visual acuity (BCVA), foveal thickness (CFT), total retinal volume with macular diameter of 6 mm. During the follow-up, repeated injections were given according to patients’ demand, and the number of injections was recorded. Result The observation indexes of patients with BRVO were significantly improved after 6 months of Lucentis treatment in both major and macular groups, including BCVA, CFT and the retinal volume of the 6 mm-diameter macula. Interestingly, there were significant differences in the therapeutic effect between the two groups, and the macular group had better therapeutic effect than the major group with the less number of repeated injections. Conclusions To sum up, intravitreal injection of Lucentis was effective for both major and macular BRVO, and the efficacy in macular subtype group was better than that in major subtype group with the more obviously improvement and the less number of injections.
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Affiliation(s)
- Jing Wang
- Department of Ophthalmology, Shandong Provincial Western Hospital, Shandong Provincial ENT Hospital, Jinan, 250023, P.R. China
| | - Ying Li
- Department of Geriatric Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, P.R. China.,Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital, Cheeloo College of Medicine,Shandong University, Jinan, 250012, P.R. China
| | - Shu-Fen Fang
- Department of Ophthalmology, Laizhou People's Hospital of Yantai, Yantai, 261400, P.R. China
| | - Hong Wang
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No.107, west wenhua road, Jinan, Shandong, 250012, P.R. China.
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27
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Sever O, Cakir A, Horozoglu F. A comparison of the effect of intravitreal dexamethasone implant on macular and branch retinal vein occlusion. A real life experience. Eur J Ophthalmol 2020; 30:1106-1111. [PMID: 32530706 DOI: 10.1177/1120672120934982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aimed to compare the effects of intravitreal dexamethasone (IVDx) implants on branch retinal vein occlusions (BRVOs) and macular vein occlusions (MVOs). METHODS Seventeen consecutive patients with MVO and 18 patients with BRVO, whose foveal thicknesses were greater than 300 µm, were recruited for this study. BRVO and MVO patients were diagnosed by means of fundus fluorescein angiography. Patients were treatment-naive. Initially, each patient in both the BRVO and MVO groups received an IVDx implant, and then a pro re nata IVDx regimen was initiated. Primary outcomes included VA gain, intraocular pressure (IOP) changes, macular ischemia, central macular thickness, retinal neovascularization, and number of IVDx injections. Follow-up time was 12 months. RESULTS The MVO group initially had significantly lower central macular thickness and a lower percentage of macular ischemia and systemic hypertension than those in the BRVO group (p = 0.001, 0.045, and 0.010, respectively). There was a statistically significant VA gain in both groups (p < 0.001), but the VA gain of the MVO group was greater than that of the BRVO group (p < 0.001). The mean total number of IVDx injections administered throughout the study period was significantly lower in the MVO group than in the BRVO group (1.3 ± 0.4 vs 2.0 ± 0.0; p = 0.001). DISCUSSION MVO and BRVO have different disease characteristics, and IVDx implants were more effective on the visual gain in patients with MVO than that of patients with BRVO who had higher numbers of IVDx injections.
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Affiliation(s)
- Ozkan Sever
- Department of Ophthalmology, Namık Kemal University School of Medicine, Tekirdağ, Marmara, Turkey
| | - Akin Cakir
- Department of Ophthalmology, Okmeydanı Education and Research Hospital, Istanbul, Turkey
| | - Fatih Horozoglu
- Department of Ophthalmology, Namik Kemal University School of Medicine, Namık Kemal University, Tekirdağ, Turkey
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28
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Park DG, Ryu G, Kim D, Sagong M. Correlations between Macular Microvascular Alterations and Peripheral Ischemia in Patients with Branch Retinal Vein Occlusion. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.5.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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29
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Au A, Hilely A, Scharf J, Gunnemann F, Wang D, Chehaibou I, Iovino C, Grondin C, Farecki ML, Falavarjani KG, Phasukkijwatana N, Battista M, Borrelli E, Sacconi R, Powell B, Hom G, Greenlee TE, Conti TF, Ledesma-Gil G, Teke MY, Choudhry N, Fung AT, Krivosic V, Baek J, Lee MY, Sugiura Y, Querques G, Peiretti E, Rosen R, Lee WK, Yannuzzi LA, Zur D, Loewenstein A, Pauleikhoff D, Singh R, Modi Y, Hubschman JP, Ip M, Sadda S, Freund KB, Sarraf D. Relationship Between Nerve Fiber Layer Hemorrhages and Outcomes in Central Retinal Vein Occlusion. Invest Ophthalmol Vis Sci 2020; 61:54. [PMID: 32460316 PMCID: PMC7405700 DOI: 10.1167/iovs.61.5.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/09/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the depth and pattern of retinal hemorrhage in acute central retinal vein occlusion (CRVO) and to correlate these with visual and anatomic outcomes. Methods Retinal hemorrhages were evaluated with color fundus photography and fluorescein angiography at baseline and follow-up. Snellen visual acuity (VA), central foveal thickness (CFT), extent of retinal ischemia, and development of neovascularization were analyzed. Results 108 eyes from 108 patients were evaluated. Mean age was 63.6 ± 16.1 years with a predilection for the right eye (73.1%). Average follow-up was 17.2 ± 19.2 months. Mean VA at baseline was 20/126 and 20/80 at final follow-up. Baseline (P = 0.005) and final VA (P = 0.02) in eyes with perivascular nerve fiber layer (NFL) hemorrhages were significantly worse than in eyes with deep hemorrhages alone. Baseline CFT was greater in the group with perivascular hemorrhages (826 ± 394 µm) compared to the group with deep hemorrhages alone (455 ± 273 µm, P < 0.001). The 10 disc areas of retinal ischemia was more common in patients with perivascular (80.0%) and peripapillary (31.3%) versus deep hemorrhages alone (16.1%, P < 0.001). Neovascularization of the iris was more common, although this differrence was not significant, in the groups with peripapillary (14.3%) and perivascular (2.0%) NFL versus deep hemorrhages alone (0.0%). Conclusions NFL retinal hemorrhages at baseline correlate with more severe forms of CRVO, with greater macular edema, poorer visual outcomes, and greater risk of ischemia and neovascularization. This may be related to the organization of the retinal capillary plexus. The depth and pattern of distribution of retinal hemorrhages in CRVO may provide an easily identifiable early biomarker of CRVO prognosis.
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Affiliation(s)
- Adrian Au
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Assaf Hilely
- Stein Eye Institute, University of California, Los Angeles, California, United States
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jackson Scharf
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Frederic Gunnemann
- Stein Eye Institute, University of California, Los Angeles, California, United States
- Department of Ophthalmology, St. Franziskus-Hospital, Münster, Germany
| | - Derrick Wang
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Ismael Chehaibou
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Claudio Iovino
- Department of Surgical Science, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Christelle Grondin
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | | | - Khalil Ghasemi Falavarjani
- Eye Research Center and Eye Department, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nopasak Phasukkijwatana
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marco Battista
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute University Vita-Salute San Raffaele, Milan, Italy
| | - Enrico Borrelli
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute University Vita-Salute San Raffaele, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute University Vita-Salute San Raffaele, Milan, Italy
| | - Brittany Powell
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Grant Hom
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Tyler E. Greenlee
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Thais F. Conti
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | | | - Mehmet Yasin Teke
- Ophthalmology Department, Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Netan Choudhry
- Vitreous Retina Macula Specialists of Toronto, Toronto, Ontario, Canada
| | - Adrian T. Fung
- Discipline of Ophthalmology, Westmead and Central Clinical Schools, University of Sydney; Department of Ophthalmology, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Valerie Krivosic
- Hôpital Lariboisière, AP-HP, Université Paris-Diderot, Sorbonne Paris Cité. France
| | - Jiwon Baek
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Mee Yon Lee
- Department of Ophthalmology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Yoshimi Sugiura
- Vitreous Retina Macula Consultants of New York, New York, United States
| | - Giuseppe Querques
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute University Vita-Salute San Raffaele, Milan, Italy
| | - Enrico Peiretti
- Department of Surgical Science, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Richard Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Won Ki Lee
- Retina Center, Nune Eye Hospital, Gangnam-gu, Seoul, Republic of Korea
| | | | - Dinah Zur
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Loewenstein
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Rishi Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Yasha Modi
- Department of Ophthalmology, New York University School of Medicine, New York, New York, United States
| | - Jean Pierre Hubschman
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Michael Ip
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, United States
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, United States
| | - K. Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, United States
| | - David Sarraf
- Stein Eye Institute, University of California, Los Angeles, California, United States
- VA Greater Los Angeles Healthcare System, Los Angeles, California, United States
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Koh YY, Lai CC, Wu WC, Hwang YS, Chen KJ, Wang NK, Chen TL, Huang JCC, Liu L, Yeung L. Baseline clinical features predict visual outcome in young patients with central retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2020; 258:1367-1377. [PMID: 32281001 DOI: 10.1007/s00417-020-04679-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/14/2020] [Accepted: 04/01/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate prognostic factors in young patients with central retinal vein occlusion (CRVO). METHODS Retrospective case series. CRVO patients aged ≤ 50 and follow-up ≥ 6 months were enrolled. The best corrected visual acuity (BCVA) and central retinal thickness (CRT) at baseline, 3 months, 6 months, and last visit were documented. Severity of retinopathy was graded by comparing to standard photos. Prognostic factors associated with visual outcome at 6 months were evaluated by multiple linear regression models. RESULTS A total of 73 eyes from 69 patients with mean age 37.6 ± 8.5 were enrolled. Forty-seven (68%) patients were male. The mean follow-up duration was 25.9 ± 23.0 months. LogMAR BCVA improved from 0.979 ± 0.785 at baseline to 0.594 ± 0.748 at the 6 months (p < 0.001) and CRT improved from 475 ± 222 μm to 299 ± 104 μm (p < 0.001). Forty-eight (66%) eyes required anti-vascular endothelial growth factor (anti-VEGF) treatment. The mean number of injections was 2.25 ± 1.41 in the first 6 months and 75% of eyes received ≦ 3 injections during the clinical course. The baseline BCVA (coefficient 0.518, p < 0.001), grade of retinal hemorrhage (coefficient 0.230, p = 0.006), grade of retinal venous engorgement (coefficient 0.238, p = 0.011), grade of optic disc edema (coefficient - 0.226, p = 0.005), and diabetes mellitus (coefficient 0.264, p = 0.047) were the independent factors associated with visual outcome at 6 months. CONCLUSIONS Baseline clinical features are useful for the prediction of visual outcome at 6 months in young CRVO patients.
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Affiliation(s)
- Yeo-Yang Koh
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, No. 222, Maijin Road, Keelung City, 204, Taiwan
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Chi Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yih-Shiou Hwang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuan-Jen Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Nan-Kai Wang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY, USA
| | - Tun-Lu Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jerry Chien-Chieh Huang
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, No. 222, Maijin Road, Keelung City, 204, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Laura Liu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ling Yeung
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, No. 222, Maijin Road, Keelung City, 204, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Tripathy K. Ischemic central retinal venous occlusion as a possible differential diagnosis of Purtscher-like retinopathy. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2019; 94:518. [PMID: 31387758 DOI: 10.1016/j.oftal.2019.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 06/10/2023]
Affiliation(s)
- K Tripathy
- Department of Vitreoretina and Uvea, ASG Eye Hospital, Kolkata, West Bengal, India.
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32
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Diagnostic and Therapeutic Challenges. Retina 2019; 39:1819-1823. [DOI: 10.1097/iae.0000000000002219] [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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33
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Li W, Ma M, Hu B, Dong L, Li X. Spontaneous resolution of bilateral central retinal vein occlusion with cystoid macular oedema during pregnancy. Acta Ophthalmol 2019; 97:e482-e483. [PMID: 27879054 DOI: 10.1111/aos.13213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Wenbo Li
- Tianjin Medical University Eye Hospital Tianjin China
| | - Minwang Ma
- Affiliated Hospital of Medical College of Chinese People's Armed Police Force (CapF) Tianjin China
| | - Bojie Hu
- Tianjin Medical University Eye Hospital Tianjin China
| | - Lijie Dong
- Tianjin Medical University Eye Hospital Tianjin China
| | - Xiaorong Li
- Tianjin Medical University Eye Hospital Tianjin China
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34
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Choi EY, Kang HG, Lee SC, Kim M. Intravitreal dexamethasone implant for central retinal vein occlusion without macular edema. BMC Ophthalmol 2019; 19:92. [PMID: 30999889 PMCID: PMC6471867 DOI: 10.1186/s12886-019-1097-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the efficacy of an intravitreal dexamethasone (IVD) implant (Ozurdex®) for the treatment of central retinal vein occlusion (CRVO) without macular edema (ME). Methods A retrospective cohort study was designed, and 20 eyes of 20 patients diagnosed with non-ischemic CRVO without ME were included. A total of 10 CRVO eyes were observed without treatment, and another 10 CRVO eyes received a single IVD injection at baseline. Mean changes in pathomorphologic parameters of fundus and optical coherence tomography parameters were measured at baseline and at 1, 3, 6, and 12 months. Results The decreases in venous tortuosity (p = 0.014 for superior; 0.036 for inferior arcades) and width (p = 0.024 for superior; 0.003 for inferior arcades) from baseline to 12 months after injection were significantly greater in the treated group than the observed group. The improvements in RNFL swelling (p = 0.010) and retinal hemorrhage (p = 0.006) were also significantly greater in the treated group. Visual symptom improvement was significantly faster in the treated group (p = 0.001). In two cases, IVD injection resulted in complete resolution of cilioretinal artery occlusion associated with the CRVO, leading to complete visual recovery in 1 week. None of the treated eyes showed signs of ME development, ischemia progression, or neovascularization. Conclusions IVD implant was significantly effective in improving venous engorgement, retinal hemorrhage, RNFL swelling, and visual symptoms by presumed alleviation of disc swelling and venous outflow. This treatment may be a considerable treatment option in CRVO patients with no ME.
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Affiliation(s)
- Eun Young Choi
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, South Korea
| | - Hyun Goo Kang
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, South Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Min Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, South Korea.
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Tao Y, Huang C, Liu M, Sun L, Li L, Wei Y, Yu X, Wang H. Short-term effect of intravitreal conbercept injection on major and macular branch retinal vein occlusion. J Int Med Res 2019; 47:1202-1209. [PMID: 30678515 PMCID: PMC6421366 DOI: 10.1177/0300060518819613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of intravitreal conbercept injection on major and macular branch retinal vein occlusion (BRVO). METHODS This retrospective analysis involved 43 patients with BRVO (major BRVO n = 24; macular BRVO, n = 19) who were diagnosed by fluorescein fundus angiography (FFA) and injected with intravitreal conbercept. The following outcomes were measured at baseline and follow-up (1-6 months): best-corrected visual acuity (BCVA), central foveal thickness (CFT), total retinal volume in a 6-mm diameter section of the macula, choroidal thickness under the central fovea of the macula, relative area of retinal hemorrhage, complications, and times when repeated injection was performed. RESULTS There were significant differences between the two groups in terms of BCVA, CFT, and total retinal volume in a 6-mm diameter section of the macula at 6 months after treatment. Choroidal thickness under the central fovea of the macula and relative area of retinal hemorrhage showed no significant differences between the two groups at 6 months after treatment; however, they significantly differed from baseline measurements. CONCLUSION In general, intravitreal injection of conbercept may have a better short-term effect in patients with macular BRVO than in patients with major BRVO.
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Affiliation(s)
- Yuan Tao
- 1 Department of Ophthalmology, Jinan Second People's Hospital, Jinan, Shandong, P.R. China
| | - Chao Huang
- 2 Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Min Liu
- 3 Department of Ophthalmology, Jinan Eighth People's Hospital, Jinan, Shandong, P.R. China
| | - Liyuan Sun
- 2 Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Linlin Li
- 4 Department of Ophthalmology, People's Hospital of Qihe County, Qihe, Shandong, P.R. China
| | - Yuhua Wei
- 2 Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Xiaoting Yu
- 2 Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Hong Wang
- 2 Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
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Deep Neural Network-Based Method for Detecting Central Retinal Vein Occlusion Using Ultrawide-Field Fundus Ophthalmoscopy. J Ophthalmol 2018; 2018:1875431. [PMID: 30515316 PMCID: PMC6236766 DOI: 10.1155/2018/1875431] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/17/2018] [Indexed: 11/17/2022] Open
Abstract
The aim of this study is to assess the performance of two machine-learning technologies, namely, deep learning (DL) and support vector machine (SVM) algorithms, for detecting central retinal vein occlusion (CRVO) in ultrawide-field fundus images. Images from 125 CRVO patients (n=125 images) and 202 non-CRVO normal subjects (n=238 images) were included in this study. Training to construct the DL model using deep convolutional neural network algorithms was provided using ultrawide-field fundus images. The SVM uses scikit-learn library with a radial basis function kernel. The diagnostic abilities of DL and the SVM were compared by assessing their sensitivity, specificity, and area under the curve (AUC) of the receiver operating characteristic curve for CRVO. For diagnosing CRVO, the DL model had a sensitivity of 98.4% (95% confidence interval (CI), 94.3–99.8%) and a specificity of 97.9% (95% CI, 94.6–99.1%) with an AUC of 0.989 (95% CI, 0.980–0.999). In contrast, the SVM model had a sensitivity of 84.0% (95% CI, 76.3–89.3%) and a specificity of 87.5% (95% CI, 82.7–91.1%) with an AUC of 0.895 (95% CI, 0.859–0.931). Thus, the DL model outperformed the SVM model in all indices assessed (P < 0.001 for all). Our data suggest that a DL model derived using ultrawide-field fundus images could distinguish between normal and CRVO images with a high level of accuracy and that automatic CRVO detection in ultrawide-field fundus ophthalmoscopy is possible. This proposed DL-based model can also be used in ultrawide-field fundus ophthalmoscopy to accurately diagnose CRVO and improve medical care in remote locations where it is difficult for patients to attend an ophthalmic medical center.
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Khayat M, Williams M, Lois N. Ischemic retinal vein occlusion: characterizing the more severe spectrum of retinal vein occlusion. Surv Ophthalmol 2018; 63:816-850. [DOI: 10.1016/j.survophthal.2018.04.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 04/14/2018] [Accepted: 04/20/2018] [Indexed: 12/15/2022]
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PARACENTRAL ACUTE MIDDLE MACULOPATHY IN A PERIVENULAR FERN-LIKE DISTRIBUTION WITH EN FACE OPTICAL COHERENCE TOMOGRAPHY. Retin Cases Brief Rep 2018; 12 Suppl 1:S25-S28. [PMID: 29176528 DOI: 10.1097/icb.0000000000000657] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a case of central retinal vein occlusion resulting in a perivenular pattern of paracentral acute middle maculopathy lesions best identified with en face optical coherence tomography (OCT). METHODS Retrospective case report. Optos ultra-widefield fluorescein angiography, spectral domain OCT, en face OCT, and OCT angiography were performed. RESULTS A 41-year-old man presented with decreased vision in the right eye for 2 weeks. Funduscopic examination of the affected right eye was notable for subtle retinal whitening in the macula, mild retinal venous dilation and tortuosity, and few scattered retinal dot and blot hemorrhages consistent with an acute central retinal vein occlusion. Widefield fluorescein angiography demonstrated delayed arterial and venous filling but no evidence of significant peripheral retinal vascular ischemia. En face OCT segmented at the inner nuclear layer illustrated a remarkable and precise perivenular distribution of fern-like paracentral acute middle maculopathy with periarterial sparing, whereas en face OCT segmented at the outer nuclear layer demonstrated florid cystoid macular edema. At 6-week follow-up, OCT demonstrated patchy areas of atrophic inner nuclear layer and spontaneous resolution of the cystoid macular edema. Optical coherence tomography angiography at the level of the deep capillary plexus illustrated remarkable flow reduction of the deep capillary plexus in mainly a perivenular distribution. CONCLUSION The authors report a case of a central retinal vein occlusion with mild retinal findings associated with a remarkable perivenular pattern of paracentral acute middle maculopathy with en face OCT. Follow-up OCT angiography demonstrated significant flow reduction of the deep capillary plexus in a perivenular pattern. The perivenular pattern of paracentral acute middle maculopathy lesions with en face OCT can be an important finding suggestive of a central retinal vein occlusion.
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Madanagopalan VG, Kumari B. Predictive Value of Baseline Biochemical Parameters for Clinical Response of Macular Edema to Bevacizumab in Eyes With Central Retinal Vein Occlusion: A Retrospective Analysis. Asia Pac J Ophthalmol (Phila) 2018; 7:321-330. [PMID: 29082677 DOI: 10.22608/apo.2017205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the influence of baseline biochemical parameters on the improvement in best corrected visual acuity (BCVA) and reduction in central foveal thickness (CFT) in patients treated with intravitreal bevacizumab (IVB; Avastin, Genentech, Inc) for macular edema (ME) secondary to central retinal vein occlusion (CRVO). DESIGN A retrospective study. METHODS Seventy eyes of 70 participants with CRVO who underwent IVB for ME and had at least 1 month of follow-up after the last injection were studied. Demographic variables, systolic and diastolic blood pressure (SBP and DBP), BCVA, CFT measured by optical coherence tomography (OCT), and biochemical investigations [hemoglobin, fasting and postprandial blood sugar (FBS and PPBS), lipid profile, blood urea (BU), serum creatinine (SC), glycosylated hemoglobin (HbA1c)] at baseline were noted. IVB need at every visit was based on clinical and OCT parameters. Changes in BCVA (ΔBCVA) and CFT (ΔCFT) from baseline to last injection were estimated. RESULTS After IVB, there was a statistically significant reduction in mean CFT (P < 0.01). The group of patients with normal BU and SC had more than 2 lines of improvement compared with those with elevated values (P = 0.043 and 0.009, respectively). Other parameters like FBS, PPBS, hemoglobin, HbA1c, and serum lipids were not associated with improvement of BCVA and reduction of CFT. CONCLUSIONS Normal baseline renal parameters (BU and SC) predict better visual outcome after treatment for ME in CRVO and offer additional benefit over and above that obtained with ME reduction.
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Affiliation(s)
- V G Madanagopalan
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India
| | - Bibha Kumari
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India
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OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN RETINAL VEIN OCCLUSION: Correlations Between Macular Vascular Density, Visual Acuity, and Peripheral Nonperfusion Area on Fluorescein Angiography. Retina 2018; 38:1562-1570. [PMID: 28574924 PMCID: PMC6086221 DOI: 10.1097/iae.0000000000001737] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Optical coherence tomography angiography is a noninvasive examination, which allowed automated measurements of vascular density at the level of the superficial and deep capillary plexus. Correlations were found in patients with retinal vein occlusion between the automatically quantified macular vascular densities obtained using optical coherence tomography angiography and the data obtained from conventional examination, particularly visual acuity and peripheral retinal nonperfusion assessed using fluorescein angiography. Purpose: To study correlations in patients with retinal vein occlusion between the automatically quantified macular vascular densities in the superficial and deep capillary plexus (DCP) obtained using optical coherence tomography angiography (OCTA) and the data from conventional examination, particularly visual acuity and peripheral retinal nonperfusion assessed using fluorescein angiography (FA). Methods: Retrospective, observational study of patients with retinal vein occlusion who underwent a comprehensive ophthalmic examination including FA and OCTA using the AngioVue OCTA system version 2015.100.0.35 (OptovueRTVue XR 100; AVANTI, Inc, Fremont, CA). Vascular densities in the superficial capillary plexus and DCP, as well as the area of the foveal avascular zone, were measured using the AngioAnalytics software. Results: Our study of 65 eyes of 61 patients (33 men, mean age: 67 years) showed a significant correlation between peripheral nonperfusion on FA and (1) automatically quantified global vascular density in both plexus (P = 0.021 for the DCP) and (2) foveal avascular zone area (P = 0.037). We also found significant correlations between capillary dropouts in both plexus and peripheral nonperfusion (P < 0.001 for both) and between visual acuity and vascular densities (P = 0.002 for the global density in the DCP). Global density less than 46% in the DCP was associated to the presence of peripheral nonperfusion area on FA (P = 0.003) and to enlargement of the superficial foveal avascular zone (P = 0.002). Conclusion: Our study demonstrated a significant correlation between automatically quantified macular vascular density on OCTA and peripheral nonperfusion on FA; OCTA could help identify high-risk retinal vein occlusion patients who may benefit from further evaluation using FA.
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QUALITATIVE AND QUANTITATIVE FOLLOW-UP USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF RETINAL VEIN OCCLUSION TREATED WITH ANTI-VEGF: Optical Coherence Tomography Angiography Follow-up of Retinal Vein Occlusion. Retina 2018; 37:1176-1184. [PMID: 27685676 DOI: 10.1097/iae.0000000000001334] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate changes of vascular flow of patients treated with intravitreal injections of anti-vascular endothelial growth factor for macular edema secondary to retinal vein occlusion (RVO) with optical coherence tomography angiography (OCTA). METHODS Patients with RVO with macular edema and treated with intravitreal injections of anti-vascular endothelial growth factors were retrospectively evaluated. The following examinations were performed before and after treatment: best-corrected visual acuity, spectral domain optical coherence tomography, fluorescein angiography, and OCTA (Optovue, Inc). Automatic measurement of vascular density of the superficial and deep capillary plexus was also performed and compared with age- and sex-matched healthy subjects. RESULTS Twenty-eight eyes of 28 patients (mean age 66.2 years; males 19%) were evaluated, including 13 central RVO, 11 branch RVO, and 4 hemicentral RVO. After treatment, mean central macular thickness significantly decreased from 644 μm to 326 μm and best-corrected visual acuity increased from 20/125 to 20/63 (P < 0.01 for both results). On OCTA, perifoveal capillary disruption (P = 0.029) and the number of cysts in the superficial capillary plexus and deep capillary plexus (P < 0.002) significantly decreased after treatment. The mean vascular density in the superficial capillary plexus slightly decreased during follow-up from 46.44% to 45.01% (not significantly). These densities were significantly less than those observed in healthy controls (P < 0.001). CONCLUSION Optical coherence tomography angiography showed regression of macular edema, reduced capillary disruption and cysts, and slight decrease in mean macular vascular density with time and despite treatment. Thus, OCTA enables qualitative and quantitative evaluation during follow-up of patients treated for RVO.
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Exudative retinal detachment. Surv Ophthalmol 2017; 62:723-769. [DOI: 10.1016/j.survophthal.2017.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/01/2017] [Accepted: 05/05/2017] [Indexed: 12/11/2022]
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ASSOCIATION BETWEEN RETINAL HEMORRHAGIC PATTERNS AND PERFUSION STATUS IN EYES WITH ACUTE CENTRAL RETINAL VEIN OCCLUSION. Retina 2017; 37:500-508. [PMID: 27611056 DOI: 10.1097/iae.0000000000001196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate peripheral retinal hemorrhagic patterns in eyes with acute central retinal vein occlusion, and to explore their clinical relevance in differentiating for the retinal perfusion status, through a prospective, and cross-sectional study. METHODS Fifty eyes with acute central retinal vein occlusion were included. Retinal hemorrhagic patterns at the equator and retinal perfusion status were evaluated by ultra-wide field fundus photography and fluorescein angiography. RESULTS Retinal perfusion was categorized as nonischemic in 29 eyes, ischemic in 18 eyes, and undeterminable in 3 eyes. None of the examined eyes had flame-shaped retinal hemorrhages in the periphery. All hemorrhages were rounded-dot or blot and were variable in size. Particle analysis was performed to quantify hemorrhage size, and showed higher values in eyes having larger blot hemorrhages, and lower values in eyes having dot or smaller blot hemorrhages. Mean size of maximum peripheral dot or blot hemorrhage was larger in eyes classified as ischemic (10,763.0 ± 5,946.3 pixels) than as nonischemic (2,839.9 ± 1,153.6 pixels, P < 0.001). The authors calculated area under the curve to investigate the ability of continuous variables to discriminate retinal perfusion status, which was 0.963 (P < 0.001) for mean size of maximum peripheral blot hemorrhages. CONCLUSION The authors objectively evaluated retinal hemorrhagic patterns at the equator in eyes with acute central retinal vein occlusion using particle analysis. The resulting hemorrhage size measurement was considered to be often useful in determining retinal perfusion status. Because they can be noninvasively evaluated with readily available equipment, peripheral hemorrhagic patterns might be good clinical markers of retinal perfusion.
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New Developments in the Classification, Pathogenesis, Risk Factors, Natural History, and Treatment of Branch Retinal Vein Occlusion. J Ophthalmol 2017; 2017:4936924. [PMID: 28386476 PMCID: PMC5366235 DOI: 10.1155/2017/4936924] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/07/2017] [Indexed: 12/15/2022] Open
Abstract
For years, branch retinal vein occlusion is still a controversial disease in many aspects. An increasing amount of data is available regarding classification, pathogenesis, risk factors, natural history, and therapy of branch retinal vein occlusion. Some of the conclusions may even change our impression of branch retinal vein occlusion. It will be beneficial for our doctors to get a deeper understanding of this disease and improve the treatment skills. The aims of this review is to collect the information above and report new ideas especially from the past a few years.
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Kim JY, Choi KS. Intravitreal Bevacizumab Injections for Macular Edema Secondary to Major and Macular Branch Retinal Vein Occlusion. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.10.1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Joo Yoen Kim
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Kyoung Sub Choi
- Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Optical coherence tomography angiography in retinal vein occlusion treated with dexamethasone implant: a new test for follow-up evaluation. Eur J Ophthalmol 2016; 26:460-8. [PMID: 27405288 DOI: 10.5301/ejo.5000829] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To quantitatively and qualitatively analyze patients with macular edema secondary to retinal vein occlusion (RVO) and treated with the intravitreal dexamethasone implant using optical coherence tomography angiography (OCTA). METHODS The files of patients treated with intravitreal injection of dexamethasone implant for macular edema secondary to RVO were retrospectively analyzed. Before and after injection, the following data were recorded: best-corrected visual acuity (BCVA), central macular thickness (CMT) measured using spectral-domain optical coherence tomography, fluorescein angiography, and OCTA (Optovue, Inc., Fremont, CA, USA). Results of automatic measurement of vascular density of the superficial capillary plexus (SCP) and deep capillary plexus were obtained before and after treatment and compared to those of healthy subjects matched for age and sex. RESULTS Seven eyes of 7 patients (mean age, 76 years; 57% male) were analyzed, including 3 cases of central RVO and 4 cases of branch RVO. All patients received 1 intravitreal injection of dexamethasone implant. After a mean follow-up of 2 months, CMT significantly decreased from 657 µm to 324 µm on average and BCVA increased from 20/100 to 20/50 (p = 0.017 and p<0.001, respectively). At the SCP, the mean whole en face vascular density slightly decreased during follow-up from 43.21% to 42.76% (not statistically significant). Vascular densities were largely inferior to those observed in control subjects (p≤0.01 in all quadrants). CONCLUSIONS This study confirms the potential contribution of OCTA as a novel noninvasive imaging technology that enables a quantitative and qualitative evaluation of the follow-up of macular edema in RVO. Optical coherence tomography angiography may complement advantageously multimodal imaging to monitor patients with RVO.
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Han JC, Eo DR, Lee TK, Shin JH, Kee C. Does Glaucoma Share Common Pathogenesis with Branch Retinal Vein Occlusion? PLoS One 2016; 11:e0156966. [PMID: 27304065 PMCID: PMC4909192 DOI: 10.1371/journal.pone.0156966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/23/2016] [Indexed: 11/18/2022] Open
Abstract
Background To evaluate the observed prevalence and the optic nerve head (ONH) characteristics of normal tension glaucoma (NTG)-suspect eyes in branch retinal vein occulusion (BRVO) eyes in Korean population. Methods This was a retrospective observational study. We investigated 445 BRVO eyes that were diagnosed in the retina clinic of Samsung Medical Center between March 2005 and December 2011. The observed prevalence of NTG-suspect in BRVO eyes was evaluated compared to the previous population based study. In addition, NTG-suspect cases in BRVO were divided into three groups based on the characteristics of optic disc morphology. Results In 445 BRVO eyes, 30 eyes were excluded from the present study. In 415 BRVO eyes, 4.3% (18 eyes) (95% confident interval [CI], 2.4–6.3%) were diagnosed with suspect glaucoma and this is not significantly different from the result in the general Korean population (P = 0.09). We classified the NTG-suspect eyes into three groups such as disc rim notching and thinning type (Group 1; 55.6%), optic cup-sited hemorrhage type (Group 2; 16.7%) and disc rim thinning and pallor type (Group 3; 27.8%). NTG-suspect in the fellow eye were only found in group 1 (80%) and group 2 (67%), but not in group 3 (P = 0.01). Conclusions BRVO and glaucoma seem to have no common vascular pathogenesis in consideration of the prevalence of NTG-suspect in BRVO eyes compared to general Korean population.
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Affiliation(s)
- Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doo Ri Eo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taek Kwan Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Hoon Shin
- Department of Ophthalmology, Busan National University Hospital, Busan National University School of Medicine, Busan, Republic of Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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Central Retinal Vein Occlusion Resolving After Orbital Decompression in Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2016; 33:S188-S190. [PMID: 26808177 DOI: 10.1097/iop.0000000000000635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 49-year-old male presented with proptosis and was found to have optic nerve edema with peripapillary hemorrhages. Diagnostic testing showed a suppressed thyroid-stimulating hormone. CT orbits showed homogenous tendon-sparing enlargement of the medial and inferior rectus muscles, characteristic of thyroid eye disease. Intravenous methylprednisolone was administered given the concern for compressive optic neuropathy. He initially had improvement of his symptoms, so orbital decompression was deferred. Subsequently he presented with worsening diplopia and right proptosis, a new afferent pupillary defect, and a cecocentral visual field defect. Dilated examination revealed significant optic nerve head edema and diffuse retinal hemorrhages in all 4 quadrants consistent with a central retinal vein occlusion. The patient underwent an urgent 3-wall orbital decompression on the right. Close follow up postoperatively showed resolution of the central retinal vein occlusion and the associated optic disc edema, peripapillary hemorrhages, and macular edema. Orbital decompression is known to improve many manifestations of thyroid eye disease, but this is the first report of orbital decompression resulting in resolution of a central retinal vein occlusion.
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Coscas F, Glacet-Bernard A, Miere A, Caillaux V, Uzzan J, Lupidi M, Coscas G, Souied EH. Optical Coherence Tomography Angiography in Retinal Vein Occlusion: Evaluation of Superficial and Deep Capillary Plexa. Am J Ophthalmol 2016; 161:160-71.e1-2. [PMID: 26476211 DOI: 10.1016/j.ajo.2015.10.008] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/04/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the optical coherence tomography angiography (OCT angiography) appearance of the superficial and deep capillary plexa in eyes with retinal vein occlusion (RVO) and to compare these findings with those of fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD OCT). DESIGN Retrospective observational case series. METHODS Patients presenting with RVO to Creteil University Eye Clinic were retrospectively evaluated. All patients had undergone a comprehensive ophthalmic examination including FA, SD OCT, and OCT angiography. RESULTS There were 54 (31 male, 57%) RVO patients with a mean age of 70 years. The perifoveal capillary arcade was visible in 52 of 54 eyes (96%) on OCT angiography and in 45 eyes (83%) on FA; this arcade was disrupted in 48 eyes (92%) and 39 eyes (72%) on OCT angiography and FA, respectively (P = .002). Perifoveal capillary arcade disruption was correlated with peripheral retinal ischemia (P = .025). Intraretinal cystoid spaces were observed in 34 eyes (68%) using FA, in 40 eyes (76%) using SD OCT, and in 49 eyes (90%) using OCT angiography (P = .008 for OCT angiography vs SD OCT and P = .001 for OCT angiography vs FA). Retinal capillary network abnormalities were observed in all patients in both superficial capillary plexus and deep capillary plexus on OCT angiography. Nonperfusion grayish areas were more frequent in the deep capillary plexus (43 eyes, 84%) than in the superficial capillary plexus (30 eyes, 59%, P < .001). CONCLUSION OCT angiography can simultaneously evaluate both macular perfusion and edema. For the first time, an imaging technique enables the evaluation of the deep capillary plexus, which appears to be more severely affected than the superficial capillary plexus in RVO.
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Lajoie J, Renouvin A, Mahieu L, Tolou C, Suarez C, Ouardani S, Hamid S, Cassagne M, Pagot-Mathis V, Matonti F, Soler V. Blanc périveinulaire isolé : quand un œdème blanc du pôle postérieur d’origine vasculaire ne rime pas avec oblitération artérielle rétinienne. J Fr Ophtalmol 2016; 39:31-9. [DOI: 10.1016/j.jfo.2015.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 08/09/2015] [Accepted: 09/07/2015] [Indexed: 11/24/2022]
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