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Lendzioszek M, Bryl A, Poppe E, Zorena K, Mrugacz M. Retinal Vein Occlusion-Background Knowledge and Foreground Knowledge Prospects-A Review. J Clin Med 2024; 13:3950. [PMID: 38999513 PMCID: PMC11242360 DOI: 10.3390/jcm13133950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Thrombosis of retinal veins is one of the most common retinal vascular diseases that may lead to vascular blindness. The latest epidemiological data leave no illusions that the burden on the healthcare system, as impacted by patients with this diagnosis, will increase worldwide. This obliges scientists to search for new therapeutic and diagnostic options. In the 21st century, there has been tremendous progress in retinal imaging techniques, which has facilitated a better understanding of the mechanisms related to the development of retinal vein occlusion (RVO) and its complications, and consequently has enabled the introduction of new treatment methods. Moreover, artificial intelligence (AI) is likely to assist in selecting the best treatment option for patients in the near future. The aim of this comprehensive review is to re-evaluate the old but still relevant data on the RVO and confront them with new studies. The paper will provide a detailed overview of diagnosis, current treatment, prevention, and future therapeutic possibilities regarding RVO, as well as clarifying the mechanism of macular edema in this disease entity.
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Affiliation(s)
- Maja Lendzioszek
- Department of Ophthalmology, Voivodship Hospital, 18-400 Lomza, Poland
| | - Anna Bryl
- Department of Ophthalmology and Eye Rehabilitation, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Ewa Poppe
- Department of Ophthalmology, Voivodship Hospital, 18-400 Lomza, Poland
| | - Katarzyna Zorena
- Department of Immunobiology and Environment Microbiology, Medical University of Gdansk, Dębinki 7, 80-211 Gdansk, Poland
| | - Malgorzata Mrugacz
- Department of Ophthalmology and Eye Rehabilitation, Medical University of Bialystok, 15-089 Bialystok, Poland
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Shaheen AR, Yannuzzi NA, Kennedy T, Yannuzzi LA. RETINAL VASCULAR DISEASE IN LIMB-GIRDLE MUSCULAR DYSTROPHY. Retin Cases Brief Rep 2024; 18:39-42. [PMID: 36007191 DOI: 10.1097/icb.0000000000001329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To report bilateral retinal vascular occlusive disease in limb-girdle muscular dystrophy (LGMD). METHODS Case report. RESULTS A 34-year-old Asian woman was referred for evaluation and management of central retinal vein occlusion. Ultra-wide-field fluorescein angiography showed resolving initial peripheral retinal vein occlusion in one eye and peripheral venular segmental staining in the fellow asymmetric eye. Genetic testing established the diagnosis of LGMD. CONCLUSION Similar to other forms of muscular dystrophy, LGMD is caused by genetic abnormalities in sarcolemma proteins, a key structural component that connects the intracellular cytoskeleton of a myofiber to the extracellular matrix. Like other muscular dystrophies, LGMD may be associated with retinal vascular abnormalities noted. In this case, retinal vascular smooth muscle dysfunction was seen in LGMD, analogous to reported vascular abnormalities in other muscular dystrophies such as facioscapulohumeral dystrophy and Duchenne muscular dystrophy.
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Fairbanks AM, Hoyek S, Patel NA. Ultra-Widefield Imaging of Presumed Vitreous Base-Associated Vasculopathy: Assessment of Peripheral Retinal Hemorrhages and Microaneurysms. JOURNAL OF VITREORETINAL DISEASES 2023; 7:322-328. [PMID: 37927322 PMCID: PMC10621711 DOI: 10.1177/24741264231164255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Purpose: To describe cases of asymptomatic peripheral retinal hemorrhage attributed to presumed vitreous base traction seen on ultra-widefield (UWF) imaging. Methods: This retrospective consecutive series comprised asymptomatic patients with peripheral retinal hemorrhages, microaneurysms, or both. Imaging included UWF fundus photography, fundus autofluorescence, fluorescein angiography (FA), optical coherence tomography (OCT), or a combination. Results: The series included 9 adult patients. The findings were observed on a routine eye examination or as an incidental finding in the contralateral eye of patients presenting with a retinal break or detachment. On UWF imaging, the distinguishing features of the peripheral retinal hemorrhages and microaneurysms presumably caused by vitreous base traction were their pinpoint shape and location at the vitreous base, in particular in the far temporal and superior retinal periphery. UWF FA showed punctate hyperfluorescent spots with no leakage. OCT showed signs of evolving posterior vitreous detachment. Management was limited to observation; with time, the microaneurysms were stable and the hemorrhages resolved. Conclusions: UWF imaging has led to the identification of presumed vitreous base vasculopathy. After a targeted workup is unrevealing, observation is appropriate.
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Affiliation(s)
- Aaron M. Fairbanks
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Sandra Hoyek
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Nimesh A. Patel
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Jiang JW, Yi ZHZ, Wang XL, Liu JJ, Sun GP, Chen CZ. Quantitative analysis of retinal vasculature in normal eyes using ultra-widefield fluorescein angiography. Int J Ophthalmol 2021; 14:1915-1920. [PMID: 34926208 DOI: 10.18240/ijo.2021.12.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/26/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To quantify the area and density of retinal vascularity by ultra-widefield fluorescein angiography (UWFA). METHODS In a retrospective study, UWFA images were obtained using an ultra-widefield imaging device in 42 normal eyes of 42 patients. Central and peripheral steered images were used to define the edge of retinal vasculature by a certified grader. The length from the center of the optic disc to the edge of retinal vascularity (RVL) in each quadrant and the total retinal vascular perfusion area (RVPA) were determined by the grader using OptosAdvance software. The density of retinal vascularity (RVD) was quantified in different zones of central-steered images using Image J software. RESULTS Among 42 healthy eyes, the values for mean RVL in each quadrant were 19.007±0.781 mm (superior), 18.467±0.869 mm (inferior), 17.738±0.622 mm (nasal) and 24.241±1.336 mm (temporal). The mean RVPA was 1140.117±73.825 mm2. The mean RVD of the total retina was 4.850%±0.638%. RVD varied significantly between different retina zones (P<0.001), and significant differences existed in the RVD values for total retinal area in patients over 50 years old compared to those under 50 years old (P=0.033). No gender difference was found. CONCLUSION The UWFA device can be a promising tool for analyzing the overall retinal vasculature and may provide a better understanding of retinal vascular morphology in normal eyes. Aging may be related to lower RVD.
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Affiliation(s)
- Jing-Wen Jiang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Zuo-Hui-Zi Yi
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Xiao-Ling Wang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Jue-Jun Liu
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Gong-Peng Sun
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Chang-Zheng Chen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
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Abstract
Retinal vein occlusion (RVO) is a retinal vascular disease that severely impairs the visual function of patients. Observing the changes of retinal blood vessels before and after treatment is of great significance for the prognostic evaluation of RVO. The rapid development and widespread use of fundus imaging technique, especially ultra-wide-angle fundus fluorescein angiography (UWFFA) and optical coherence tomography angiography (OCTA) have made our observation of the retinal blood vessels of RVO more comprehensive and meticulous. In this paper, we reviewed the latest research progress of UWFFA and OCTA in RVO.
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Affiliation(s)
- Weiting An
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Jindong Han
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Poignet B, Bonnin P, Gaudric J, Chehaibou I, Vautier M, Tadayoni R, Gaudric A, Paques M, Bodaghi B, Saadoun D, Bonnin S. Correlation between Ultra-Wide-Field Retinal Imaging Findings and Vascular Supra-Aortic Changes in Takayasu Arteritis. J Clin Med 2021; 10:jcm10214916. [PMID: 34768435 PMCID: PMC8584942 DOI: 10.3390/jcm10214916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Takayasu arteritis (TA) is a chronic inflammatory large-vessel vasculitis. Ultra-wide-field imaging allows describing the retinal lesions in these patients and correlating them with vascular supra-aortic stenosis. (2) Methods: In total, 54 eyes of 27 patients diagnosed with TA were included, and a complete ophthalmological examination was performed, including UWF color fundus photography (UWF-CFP), fluorescein angiography (UWF-FA), and computed tomography angiography measuring supra-aortic stenosis. Eleven patients underwent Doppler ultrasound imaging assessing the blood flow velocity (BFV) in the central retinal artery (CRA). (3) Results: Microaneurysms were detected in 18.5% of eyes on fundus examination, in 24.4% of eyes on UWF-CFP, and in 94.4% of eyes on UWF-FA. The number of microaneurysms significantly correlated with the presence of an ipsilateral supra-aortic stenosis (p = 0.026), the presence of hypertension (p = 0.0011), and the duration of the disease (p = 0.007). The number of microaneurysms per eye negatively correlated with the BFV in the CRA (r = -0.61; p = 0.003). (4) Conclusions: UWF-FA improved the assessment of TA-associated retinal findings. The significant correlation between the number of microaneurysms and the BFV in the CRA gives new insight to our understanding of Takayasu retinopathy. The total number of microaneurysms could be used as an interesting prognostic factor for TA.
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Affiliation(s)
- Barthelemy Poignet
- Ophthalmology Department, Hopital Pitié Salpêtrière, Sorbonne University, 75013 Paris, France; (B.B.); (S.B.)
- Correspondence:
| | - Philippe Bonnin
- Clinical Physiology and Fonctionnal Explorations, Hôpital Lariboisière, University of Paris, 75010 Paris, France;
| | - Julien Gaudric
- Vascular Surgery Department, Hôpital Pitié Salpêtrière, Sorbonne University, 75013 Paris, France;
| | - Ismael Chehaibou
- Ophthalmology Department, Hôpital Lariboisière, University of Paris, 75010 Paris, France; (I.C.); (R.T.); (A.G.)
| | - Mathieu Vautier
- Immunopathology, Immunotherapies of Autoimmunes and Inflammatory Diseases, Hôpital Pitié-Salpêtrière, Sorbonne University, 75013 Paris, France;
- Department of Internal Medicine and Clinical Immunology, Hopital Pitié-Salpêtrière, Sorbonne University, 75013 Paris, France;
| | - Ramin Tadayoni
- Ophthalmology Department, Hôpital Lariboisière, University of Paris, 75010 Paris, France; (I.C.); (R.T.); (A.G.)
- Ophthalmology Department Fondation Adolphe de Rothschild, 75019 Paris, France
| | - Alain Gaudric
- Ophthalmology Department, Hôpital Lariboisière, University of Paris, 75010 Paris, France; (I.C.); (R.T.); (A.G.)
| | - Michel Paques
- Clinical Investigation Center CIC 1423, Quinze-Vingts Hospital, Sorbonne University, 75012 Paris, France;
| | - Bahram Bodaghi
- Ophthalmology Department, Hopital Pitié Salpêtrière, Sorbonne University, 75013 Paris, France; (B.B.); (S.B.)
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Hopital Pitié-Salpêtrière, Sorbonne University, 75013 Paris, France;
| | - Sophie Bonnin
- Ophthalmology Department, Hopital Pitié Salpêtrière, Sorbonne University, 75013 Paris, France; (B.B.); (S.B.)
- Ophthalmology Department, Hôpital Lariboisière, University of Paris, 75010 Paris, France; (I.C.); (R.T.); (A.G.)
- Ophthalmology Department Fondation Adolphe de Rothschild, 75019 Paris, France
- Clinical Investigation Center CIC 1423, Quinze-Vingts Hospital, Sorbonne University, 75012 Paris, France;
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Deák GG, Pulido JS, Jampol LM. SEGMENTAL DIFFUSE VASCULAR LEAKAGE: A FLUORESCEIN ANGIOGRAPHIC FINDING IN PATIENTS WITH VON HIPPEL-LINDAU DISEASE. Retin Cases Brief Rep 2021; 15:628-631. [PMID: 30932993 DOI: 10.1097/icb.0000000000000868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe a novel fluorescein angiographic finding in patients with von Hippel-Lindau disease. METHODS Retrospective case series of patients diagnosed with retinal capillary hemangioblastoma (RCH) in the setting of von Hippel-Lindau. RESULTS We identified six eyes of three patients with von Hippel-Lindau and leaky retinal vessels. All eyes showed segmental diffuse vascular leakage (SDVL) that was seen in the late phase of the angiogram and that originated from third order and more peripheral retinal veins and adjacent capillaries. These vessels did not drain from the RCHs. Segmental diffuse vascular leakage was mainly seen in the mid and far periphery. In some cases, it was located near the RCHs, while in other cases, it was remote. Segmental diffuse vascular leakage was also seen in one eye without RCHs. On follow-up, the extent and intensity of segmental diffuse vascular leakage did not change after the RCHs were treated with laser or cryotherapy. CONCLUSION Diffuse vascular leakage from retinal venules around and away from RCHs in patients with von Hippel-Lindau disease is seen, but the clinical and prognostic importance of this finding is uncertain.
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Affiliation(s)
- Gábor Gy Deák
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria ; and
| | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Lee M Jampol
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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She HC, Zhang XF, Zhang YP, Jiao X, Zhou HY. Peripheral arterial filling time and peripheral retina fluorescence features in ultra-widefield angiography. Int J Ophthalmol 2021; 14:1034-1040. [PMID: 34282388 PMCID: PMC8243182 DOI: 10.18240/ijo.2021.07.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/22/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the peripheral arterial filling time (PAFT) and venous filling time (VFT) in eyes without known diseases that may influence filling process using ultra-widefield (UWF) fluorescein angiography (FA), and to review the peripheral retina fluorescence features. METHODS A total of 30 eyes of 30 patients were retrospectively reviewed in this observational study. UWF-FA was performed using Optos 200Tx. PAFT and VFT was recorded. The interval between the arterial or venous filling completion and the previous photo was documented. The appearance of the far peripheral retina was described as either granular background fluorescence or mottled fluorescent band or vascular leakage. Terminal vascular patterns was described as loop pattern or branching pattern. Microvascular abnormalities such as arteriovenous shunting, vessels crossing the horizontal raphe, right angle vessels, terminal networks, capillary nonperfusion, drusen or microaneurysms were evaluated. RESULTS The normal limits of PAFT was 3.397-8.984s and 4.399-11.753s for VFT. The appearance of the far peripheral retina, defined as granular background (63%), mottled fluorescence (20%), or vascular leakage (17%), was symmetrical between both eyes. Capillary nonperfusion (23%) and microaneurysms (40%) were more frequently found in eyes with loop pattern than in eyes with branching pattern. Other peripheral signs such as right-angle vessels (73%), and terminal networks (80%) were commonly seen on UWF-FA in the normal peripheral retina. CONCLUSION The main courses of retinal artery and vein filling time are overlapping with each other on UWF-FA. Notably, the arterial filling process is completed in the arteriovenous phase rather than the traditionally named arterial phase. There are various manifestations in the peripheral retina of normal eyes.
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Affiliation(s)
- Hai-Cheng She
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Xi-Fang Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Yong-Peng Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Xuan Jiao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Hai-Ying Zhou
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
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Kumar V, Surve A, Kumawat D, Takkar B, Azad S, Chawla R, Shroff D, Arora A, Singh R, Venkatesh P. Ultra-wide field retinal imaging: A wider clinical perspective. Indian J Ophthalmol 2021; 69:824-835. [PMID: 33727441 PMCID: PMC8012972 DOI: 10.4103/ijo.ijo_1403_20] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/18/2020] [Accepted: 09/04/2020] [Indexed: 01/09/2023] Open
Abstract
The peripheral retina is affected in a variety of retinal disorders. Traditional fundus cameras capture only a part of the fundus even when montaging techniques are used. Ultra-wide field imaging enables us to delve into the retinal periphery in greater detail. It not only facilitates assessing color images of the fundus, but also fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and red and green free images. In this review, a literature search using the keywords "ultra-widefield imaging", "widefield imaging", and "peripheral retinal imaging" in English and non-English languages was done and the relevant articles were included. Ultra-wide field imaging has made new observations in the normal population as well as in eyes with retinal disorders including vascular diseases, degenerative diseases, uveitis, age-related macular degeneration, retinal and choroidal tumors and hereditary retinal dystrophies. This review aims to describe the utility of ultra-wide field imaging in various retinal disorders.
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PERIPHERAL RETINAL ANGIOGRAPHIC FINDINGS IN MACULAR TELANGIECTASIS TYPE 2. Retina 2021; 41:480-486. [PMID: 32969983 DOI: 10.1097/iae.0000000000002981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the retinal periphery in patients with idiopathic juxtafoveal telangiectasis or macular telangiectasis Type 2 (MacTel2), using widefield fluorescein angiography. METHODS Single-center, retrospective, observational case series of 50 eyes of 50 patients with MacTel2 and 50 eyes of 50 age-matched controls. RESULTS Thirty-seven eyes in the MacTel2 group (74%) showed peripheral capillary nonperfusion or dropout, compared with 37 eyes in the control group (74%, P = 1.0). Morphologically, the MacTel2 group trended toward having a higher proportion of pruning-type capillary dropout (44%) compared with controls (28%), but this was not statistically significant (P = 0.12). Patients with MacTel2 had a higher incidence of microaneurysms compared with controls (MacTel2 56%; controls 42%; P = 0.048), independent of age or systemic risk factors. There was no difference in the incidence of venous-venous shunts (MacTel2 10%; controls 10%; P = 1.0), arteriovenous shunts (MacTel2 14%; controls 18%; P = 0.60), venous tortuosity (MacTel2 60%; controls 66%; P = 0.58), or arterial tortuosity (MacTel2 54%; controls 68%; P = 0.20), which was mild in most cases. CONCLUSION We note a high incidence of peripheral vascular and retinal findings in both patients with MacTel2 and age-matched controls, using widefield fluorescein angiography. Patients with MacTel2 had significantly more microaneurysms, independent of age or other systemic risk factors.
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Park EA, Huckfeldt RM, Comander JI, Sobrin L. Peripheral Leakage on Ultra-Widefield Fluorescein Angiography in Patients With Inherited Retinal Degeneration. JOURNAL OF VITREORETINAL DISEASES 2021; 5:147-156. [PMID: 37009079 PMCID: PMC9979058 DOI: 10.1177/2474126420951988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: This report illustrates that peripheral vascular leakage on ultra-widefield fluorescein angiography (FA) can occur in patients with inherited retinal degeneration (IRD) without evidence of a separate cause of leakage. Methods: We searched the electronic medical records of the Massachusetts Eye and Ear Infirmary from 2010 to 2019 for patients with an IRD diagnosis and examination with an ultra-widefield FA. Images from FAs were evaluated in masked fashion by 2 retina specialists. Documentation of an evaluation for alternative causes of vascular leakage was recorded, as well as results from electroretinography, Goldmann perimetry, and genetic testing. Results: A total of 305 patients with an IRD diagnosis and FA procedure code were identified. Of these, 26 patients had both a clinical diagnosis of IRD and ultra-widefield FA on detailed medical-record review. Three patients had FA to evaluate a Coats-like response and were excluded. Of the remaining 23, 4 patients (17%) had significant peripheral leakage on FA. Of these, 1 had pericentral retinitis pigmentosa (for which the genetic cause of disease was undefined), 1 had Refsum disease with confirmed biallelic PHYH mutations, 1 had a CRB1-associated macular dystrophy, and 1 had CERKL-associated macular dystrophy. There was no evidence of ocular inflammation from history, examination, or laboratory testing to account for the FA findings. Of the 19 patients without significant leakage, 4 had minimal leakage and 15 had no peripheral leakage. Conclusions: Peripheral retinal vascular leakage can be seen on ultra-widefield FA in patients with IRD that is likely due to the IRD disease process itself rather than to an additional, distinct eye condition.
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Affiliation(s)
- Elli A. Park
- Boston University School of Medicine, Boston, MA, USA
| | - Rachel M. Huckfeldt
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Jason I. Comander
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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12
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Ultra-widefield fundus fluorescein angiography findings in patients with ankylosing spondylitis experiencing uveitis. Int Ophthalmol 2020; 40:2627-2634. [DOI: 10.1007/s10792-020-01443-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/23/2020] [Indexed: 11/25/2022]
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13
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Zhang T, Wang Z, Sun L, Li S, Huang L, Liu C, Chen C, Luo X, Yu B, Ding X. Ultra-wide-field scanning laser ophthalmoscopy and optical coherence tomography in FEVR: findings and its diagnostic ability. Br J Ophthalmol 2020; 105:995-1001. [PMID: 32788330 DOI: 10.1136/bjophthalmol-2020-316226] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/12/2020] [Accepted: 07/11/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To describe some novel vitreoretinal microstructural findings in patients with mild familial exudative vitreoretinopathy (FEVR) on ultra-wide-field scanning laser ophthalmoscopy (UWF-SLO) and UWF optical coherence tomography (UWF-OCT) and to evaluate their clinical significance. METHODS A total of 32 patients and 32 healthy controls were studied. An additional independent 40 FEVR patients, 44 patients with non-FEVR retinopathies and 40 healthy controls participated in a diagnostic test to validate the abilities of novel findings in FEVR screening. RESULTS A novel anatomic change, named Temporal Mid-Peripheral Vitreoretinal Interface Abnormality (TEMPVIA), was found on UWF-SLO in 88.3% of FEVR patients and in none of the healthy controls. The clinical significance of TEMPVIA was further validated by a diagnostic test in new independent cases, with satisfying sensitivity (91.5%) and specificity (98.8%) and Youden Index 0.90. In addition to foveal hypoplasia, some previously unrecognised, novel clinical changes in FEVR, for instance, retinoschisis, focal retinal thickening, sudden thinning of the retina and retinal ridge, were identified using UWF-OCT. CONCLUSION The results of this study have led to an update of the clinical spectrum of FEVR and have improved our understanding of its pathogenesis. TEMPVIA is therefore suggested to be a useful biomarker in the screening strategy for mild FEVR.
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Affiliation(s)
- Ting Zhang
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Zhongshan Ophthalmic Center, Guangzhou, China
| | - Zhirong Wang
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Zhongshan Ophthalmic Center, Guangzhou, China
| | - Limei Sun
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Zhongshan Ophthalmic Center, Guangzhou, China
| | - Songshan Li
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Zhongshan Ophthalmic Center, Guangzhou, China
| | - Li Huang
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Zhongshan Ophthalmic Center, Guangzhou, China
| | - Chengxi Liu
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Zhongshan Ophthalmic Center, Guangzhou, China
| | - Chonglin Chen
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Zhongshan Ophthalmic Center, Guangzhou, China
| | - Xiaoling Luo
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Zhongshan Ophthalmic Center, Guangzhou, China
| | - Bilin Yu
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Zhongshan Ophthalmic Center, Guangzhou, China
| | - Xiaoyan Ding
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Zhongshan Ophthalmic Center, Guangzhou, China
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Preliminary study of ultra-widefield peripheral retinal angiographic patterns in children and its association to the perinatal condition. Sci Rep 2020; 10:13602. [PMID: 32788722 PMCID: PMC7423607 DOI: 10.1038/s41598-020-70677-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/28/2020] [Indexed: 11/20/2022] Open
Abstract
This preliminary study analyzed the peripheral retinal vascular pattern in children, using ultra-widefield fluorescein angiography, and its association with perinatal conditions. Retrospective review was conducted examining the fluorescein angiographic findings of children with amblyopia (January 2017 to December 2018). We categorized the peripheral vascular patterns into two groups: loop and branching patterns. We investigated differences in these patterns, according to the perinatal condition. Thirty children (9.27 ± 3.41 years old; 47.67% male) were included. An equal number of children had the loop or branching pattern (15:15). The gestational age (GA) in the loop group was significantly shorter than the branching group (32.92 ± 5.62 vs. 36.67 ± 5.63 weeks, p = 0.04). The birth weight of the loop group was significantly lower than the branching group (2.00 ± 1.03 vs. 2.72 ± 0.93 kg, p = 0.03). Gender, age, delivery-type, and visual acuity, were not different between the groups. Lower birth weight and shorter GA were observed in children with the loop pattern. The difference in peripheral retinal vascular patterns, according to birth weight and GA, might be due to the development of immature retinal vessels at birth.
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Kumar P, Ravani R, Agarwal S, Dhanda S, Kumar V. Insights into retinal hemangioblastoma using ultra widefield imaging. Indian J Ophthalmol 2020; 67:2029-2034. [PMID: 31755444 PMCID: PMC6896565 DOI: 10.4103/ijo.ijo_802_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose: Retinal hemangioblastomas (RHs) are characteristic of von Hippel-Lindau (VHL) disease. Early diagnosis of retinal lesions may aid in systemic diagnosis. Early identification of VHL is life-saving and also prevents vision loss. Fundus fluorescein angiography (FFA) is a useful tool in the diagnosis and management of RHs. The aim of this study is to report FFA features of RH using ultra-widefield (UWF) imaging. Methods: A retrospective cross-sectional study of consecutive patients of RH who underwent UWF FFA at a tertiary eye care center. Images were analyzed and assessed by authors. The main outcome measures were (a) the number and size of RH in each eye and (b) vascular characteristics of the retina. UWF-FFA characteristics in each eye were tabulated. The number of clock hours involved by these characteristics and their correlation with the number and size of RH were analyzed. Results: The study evaluated 24 eyes of 13 patients. The mean age was 28.4 years. The median number of RHs in an eye was 3.5 (range 1–16), and the size of RHs varied from 0.1 to 4 disc diameters. Novel UWF-FFA findings noted in this study were the presence of abnormal capillary network in 22 of 24 eyes (91.7%), capillary leakage in 15 of 24 eyes (62.5%), and capillary telangiectasia in 7 of 24 eyes (29.2%). In addition, feeder arterioles and venules showed bulbous projections in 8 of 24 eyes (33.3%). Conclusion: The UWF-FFA characteristics of RH, which have not been described before, were identified. These add to our understanding of the pathogenesis of the disease and may pave the way for future therapeutic targets.
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Affiliation(s)
- Pradeep Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Raghav Ravani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Dhanda
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Wang X, Xu A, Yi Z, He L, Liu J, Zheng H, Chen C. Observation of the far peripheral retina of normal eyes by ultra-wide field fluorescein angiography. Eur J Ophthalmol 2020; 31:1177-1184. [PMID: 32452265 DOI: 10.1177/1120672120926453] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE The appearance of the far peripheral retina in normal eyes was observed using an Optos ultra-wide field fluorescein angiography imaging system. METHODS A cross-sectional study of ultra-wide field pseudocolor and angiography images obtained using the Optos 200Tx. Four different non-vascular and six vascular-associated fluorescence features in far peripheral retina were analyzed. RESULTS A total of 166 eyes in 83 patients met the inclusion criteria. The mean patient age was 40.78 ± 10.94 years (range: 20-65 years) with a female-to-male ratio of 0.98. Slight cataract were present in 64 eyes (38.55%), low to moderate myopia in 50 eyes (30.12%), and unspecified visual disturbances in 52 eyes (31.33%). Far peripheral retinas were found to have mottled florescent band in 42.17% eyes, ground glass hyperfluorescence in 84.34% eyes, granular hyperfluorescence in 12.65% eyes, local mottled fluorescence in 10.84% eyes, vascular anastomosis with a peripheral avascular area in 36.23% eyes, invisible capillary details in 50.67% eyes, vessels passing through the ora serrata in 16.98% eyes, late-phase slight leakage in 32.53% eyes, angiectasis in 18.67% eyes, and microaneurysm in 34.94% eyes. CONCLUSION Ultra-wide field fluorescein angiography revealed various fluorescence features in the periphery of normal eyes, providing a basis for interpreting normal and pathological changes in peripheral retina and an important reference for clinical work.
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Affiliation(s)
- Xiaoling Wang
- Eye Center, 117921Renmin Hospital of Wuhan University, Wuhan, P.R. China
| | - A'min Xu
- Eye Center, 117921Renmin Hospital of Wuhan University, Wuhan, P.R. China
| | - Zuohuizi Yi
- Eye Center, 117921Renmin Hospital of Wuhan University, Wuhan, P.R. China
| | - Lu He
- Eye Center, 117921Renmin Hospital of Wuhan University, Wuhan, P.R. China
| | - Juejun Liu
- Eye Center, 117921Renmin Hospital of Wuhan University, Wuhan, P.R. China
| | - Hongmei Zheng
- Eye Center, 117921Renmin Hospital of Wuhan University, Wuhan, P.R. China
| | - Changzheng Chen
- Eye Center, 117921Renmin Hospital of Wuhan University, Wuhan, P.R. China
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Patel SN, Shi A, Wibbelsman TD, Klufas MA. Ultra-widefield retinal imaging: an update on recent advances. Ther Adv Ophthalmol 2020; 12:2515841419899495. [PMID: 32010879 PMCID: PMC6971964 DOI: 10.1177/2515841419899495] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/10/2019] [Indexed: 11/23/2022] Open
Abstract
The development of ultra-widefield retinal imaging has accelerated our understanding of common retinal diseases. As we continue to validate the diagnostic and prognostic significance of pathology in the retinal periphery, the ability to visualize and evaluate these features in an efficient and patient-friendly manner will become more important. Current interest in ultra-widefield imaging includes the development of potential biomarkers of disease progression and indicators of preclinical disease development. This article reviews the current ultra-widefield imaging systems and recent advances in their applications to clinical practice with a focus on diabetic retinopathy, retinal vein occlusion, uveitis, and pediatric retina.
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Affiliation(s)
- Samir N Patel
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Angell Shi
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Turner D Wibbelsman
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael A Klufas
- Assistant Professor of Ophthalmology, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1020, Philadelphia, PA 19107, USA
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18
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Jeng-Miller KW, Soomro T, Scott NL, Rao P, Marlow E, Chang EY, Ells A, Chau F, Nudleman E, Calvo CM, Patel N, Schwartz R, Cernichiaro-Espinosa LA, Montoya AG, Goldstein J, Harper CA, Baumal CR, Hartnett ME, Harbour JW, Besirli CG, Gupta MP, Chan RVP, Drenser KA, Capone A, Murray TG, Mukai S, Trese MT, Berrocal AM, Wong SC, Yonekawa Y. Longitudinal Examination of Fellow-Eye Vascular Anomalies in Coats' Disease With Widefield Fluorescein Angiography: A Multicenter Study. Ophthalmic Surg Lasers Imaging Retina 2019; 50:221-227. [PMID: 30998243 DOI: 10.3928/23258160-20190401-04] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/05/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Retinovascular anomalies in the fellow eyes of patients with Coats' disease have been described, but the clinical significance is unknown, as well as whether these lesions progress over time. PATIENTS AND METHODS This is an international, multicenter, retrospective, observational cohort study of fellow-eye abnormalities on widefield fluorescein angiography in patients with Coats' disease. RESULTS Three hundred fifty eyes of 175 patients with Coats' disease were analyzed. A total of 33 patients (18.8%) demonstrated abnormal fellow-eye findings: 14 (42.4%) telangiectasias, 18 (54.5%) aneurysms, six (18.2%) segmental non-perfusion, six (18.2%) leakage, and two (6.0%) vascular tortuosity. All eyes were asymptomatic, and none of the lesions progressed over time. There was no association between fellow-eye findings with severity of Coats' disease (P = .16), patient age (P = .16), or presence of systemic vascular disease (P = .16). CONCLUSIONS The vascular abnormalities in fellow eyes of patients with Coats' disease did not progress over time. Observation is a reasonable initial management strategy. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:221-227.].
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Moinuddin O, Wood EH, Drenser KA. Adult Coats' Disease, Dubin-Johnson Syndrome, and the Search for Targeted Therapies. Ophthalmic Surg Lasers Imaging Retina 2019; 50:318-321. [PMID: 31100164 DOI: 10.3928/23258160-20190503-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/05/2018] [Indexed: 11/20/2022]
Abstract
Coats' disease is nonhereditary retinal vascular disorder characterized by telangiectatic retinal vessels with prominent aneurysmal changes and exudation. A conclusive etiology has not yet been determined. In this retrospective case report and literature review, a 64-year-old male with Dubin-Johnson syndrome presented with unilateral retinal vascular changes and exudation consistent with a diagnosis of adult Coats' disease. The authors conclude that patients with Dubin-Johnson syndrome carry mutations in a multidrug resistance associated protein (MRP). MRPs are also expressed in the retina, retinal pigment epithelium, and vascular endothelium, where they export toxins and metabolites, and may serve as a therapeutic target. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:318-321.].
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Nivison-Smith L, Milston R, Chiang J, Ly A, Assaad N, Kalloniatis M. Peripheral retinal findings in populations with macular disease are similar to healthy eyes. Ophthalmic Physiol Opt 2019; 38:584-595. [PMID: 30575075 DOI: 10.1111/opo.12589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/01/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE Recent evidence suggests several macular diseases are associated with peripheral retinal changes. This study investigated the number, type and management consequences of peripheral retinal findings detected in patients attending a referral only, eye-care clinic, the Centre for Eye Health(CFEH) with macular disease. METHODS Records of 537 patients attending CFEH for a macular assessment were included in the study. Subjects were classified as having age-related macular degeneration (AMD), epiretinal membrane (ERM), central serous chorioretinopathy (CSCR), inherited macular dystrophy or no macular disease. Data extracted included reason for referral, macular findings, peripheral findings (based on examination by ultra-widefield scanning laser ophthalmoscopy), diagnosis and management. RESULTS After age-matching, the number of peripheral findings in subjects with AMD, ERM or CSCR was not significant different to normal subjects. The most common finding for all cohorts were non-specific, degenerative changes such as drusen or pigmentation (61-72%) except inherited macular dystrophy subjects who had mostly vascular findings (30%; p < 0.05). Subjects with AMD and ERM with peripheral findings were significantly more likely to be reviewed or referred to an ophthalmologist than discharged back to their community eye care provider compared to subjects without findings. However only 8% of subjects had altered management based specifically on peripheral findings suggesting the macular findings in most subjects dictated their management. For those with a change, it was significant (upgrade to referral to an ophthalmologist). Peripheral findings also flagged 5% of subjects with vascular findings for referral to their general practitioner (GP). CONCLUSIONS Overall, the percentage and distribution of peripheral retinal findings in some macular diseases was similar to normal subjects. However, subjects with peripheral findings appeared to have significant differences in management. Considering some common findings, such as peripheral drusen may be relevant to AMD pathogenesis and therefore affect management of this disease, assessment of the peripheral retina should not be overlooked when the clinical focus is on the posterior pole.
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Affiliation(s)
- Lisa Nivison-Smith
- Centre for Eye Health, University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Rebecca Milston
- Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Jaclyn Chiang
- Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Angelica Ly
- Centre for Eye Health, University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Nagi Assaad
- Centre for Eye Health, University of New South Wales, Sydney, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Randwick, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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ANALYSIS OF THE NORMAL PERIPHERAL RETINAL VASCULAR PATTERN AND ITS CORRELATION WITH MICROVASCULAR ABNORMALITIES USING ULTRA-WIDEFIELD FLUORESCEIN ANGIOGRAPHY. Retina 2019; 39:530-536. [DOI: 10.1097/iae.0000000000001984] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Rodríguez Á, Carpio-Rosso W, Rodríguez FJ. Further observations on a bilateral IRVAN syndrome case. Int Ophthalmol 2018; 39:1179-1186. [PMID: 29948501 DOI: 10.1007/s10792-018-0917-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 04/07/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Reporting clinical features of the late course of the disease after long-term follow-up in a bilaterally affected patient with idiopathic retinitis, vasculitis, retinal aneurysms and neuroretinitis (IRVAN) and new peripheral retinal findings on wide-field angiography and multimodal imaging. METHODS This was a retrospective observational study, based on current diagnostic studies including wide-field fluorescein angiography, optical coherence tomography (OCT) and treatment of aneurysms with argon laser photocoagulation. RESULTS A 21-year-old female with bilateral IRVAN syndrome-stage 2 in the right eye and stage 3 in the left eye-previously treated bilaterally with laser photocoagulation for retinal macroaneurysms and ischemic areas between 1985 and 1992. Follow-up interrupted on two occasions, with subsequent fundus re-examinations confirming the prevention of retinal neovascularization in both eyes, as recently evidenced on wide-field angiography. CONCLUSIONS A case of bilateral IRVAN disease with multiple retinal aneurysms, neuroretinitis and peripheral capillary nonperfusion successfully treated with laser photocoagulation, maintaining normal visual acuity in one eye and preventing retinal neovascular complications.
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Affiliation(s)
- Álvaro Rodríguez
- Fundación Oftalmológica Nacional, Carrera 13 #13-50, Bogotá D.C., Colombia. .,Universidad del Rosario, Bogotá D.C., Colombia.
| | - Willy Carpio-Rosso
- Fundación Oftalmológica Nacional, Carrera 13 #13-50, Bogotá D.C., Colombia.,Universidad del Rosario, Bogotá D.C., Colombia
| | - Francisco J Rodríguez
- Fundación Oftalmológica Nacional, Carrera 13 #13-50, Bogotá D.C., Colombia.,Universidad del Rosario, Bogotá D.C., Colombia
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Quantification of radiation retinopathy after beam proton irradiation in centrally located choroidal melanoma. Graefes Arch Clin Exp Ophthalmol 2018; 256:1599-1604. [PMID: 29948179 DOI: 10.1007/s00417-018-4036-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/12/2018] [Accepted: 06/02/2018] [Indexed: 10/14/2022] Open
Abstract
PURPOSE To localize and quantify ischemic changes induced by proton beam irradiation of central choroidal melanoma and to identify baseline predictors correlated with the extent of ischemic changes. METHODS Retrospective chart review of patients with central choroidal melanoma treated by proton beam irradiation and conducted widefield fluorescein angiography (≥ 20 months after radiation therapy). Quantification and location of ischemic areas and correlation to baseline predictors. Multiple linear regression model was performed for analyses. RESULTS Twenty-five eyes from 25 patients were included in final analysis. Mean largest basal tumor area was 56.6 ± 40.0 mm2 and mean maximal tumor prominence 2.5 ± 1.4 mm. Mean total radiated area was 339.1 ± 68.3 mm2. All patients showed ischemic changes. Mean ischemic area was 387.6 ± 123.3 mm2 and mean ischemic index (ischemic area/total visible area) was 0.53 ± 0.23. Twenty-two patients (88%) presented ischemic changes outside of the irradiation field, which comprised of 23% of total ischemic area. Mean angular distance between lateral border of irradiation field and ischemic area outside of the radiated area was 44.8 ± 36.5°. Multivariable analysis revealed a positive correlation of total ischemic area with total radiated area (p = 0.02) and initial sonographic tumor prominence (p = 0.02). CONCLUSIONS Ischemic changes induced by proton beam irradiation of central choroidal melanoma were localized and quantified. Ischemic changes exceed the tumor area distinctly and are found also outside of the irradiation field in the majority of patients. Size of irradiation area and tumor prominence are positively correlated with extent of ischemic area.
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Rabiolo A, Marchese A, Sacconi R, Cicinelli MV, Grosso A, Querques L, Querques G, Bandello F. Refining Coats' disease by ultra-widefield imaging and optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 2017; 255:1881-1890. [PMID: 28875282 DOI: 10.1007/s00417-017-3794-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/21/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The purpose of our study was to describe ultra-widefield (UWF) imaging and optical coherence tomography angiography (OCT-A) findings in affected and fellow eyes of patients with Coats' disease. METHODS Consecutive patients affected by Coats' disease were prospectively recruited at the Department of Ophthalmology, San Raffaele Hospital, Milan, Italy in this cross-sectional, observational study. Patients underwent UWF color fundus photographs, UWF green autofluorescence, UWF fluorescein angiography (FA), optical coherence tomography (OCT), with 3 × 3 mm and 6 × 6 mm OCT-A scans of the macula. Images were qualitatively evaluated by two independent operators for the presence of pathology. RESULTS Eleven patients affected by Coats' disease (eight males, mean age 17.1 ± 6.7 years). Nine and two patients had a clinical diagnosis of unilateral and bilateral disease, respectively. Five eyes had macular fibrosis. All clinically affected eyes exhibited retinal pathology at UWF imaging with the temporal sector most involved followed by the inferior, nasal, superior and macula. In all eyes with macular fibrosis, OCT-A revealed replacement of the foveal avascular zone with coarse vessels suggestive of vascularized fibrosis and flow void area in the choriocapillaris due to a masking effect; type 3 neovascularization was seen in 75% of cases. Seven out of nine clinically unaffected fellow eyes showed retinal pathology at UWF FA with the temporal quadrant most involved. CONCLUSION We demonstrated that Coats' disease is a highly asymmetric bilateral disease and that UWF imaging is able to identify more retinal pathology than standard fundus imaging, thus guiding proper retinal photocoagulation. OCT-A allowed easy identification of type 3 neovascularization in a proportion of patients with macular fibrosis.
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Affiliation(s)
- Alessandro Rabiolo
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Alessandro Marchese
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy.,Eye Clinic, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Andrea Grosso
- Department of Ophthalmology, Santo Spirito Hospital, Casale Monferrato, Alessandria, Italy.,Centre for Macular Research, San Mauro Torinese, Turin, Italy
| | - Lea Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy.,G. B. Bietti Foundation-IRCCS, Rome, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
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Zarei M, Hamzeloui P, Rooipoor R, Fard MA. A CASE OF NEUROFIBROMATOSIS TYPE 2 WITH UNUSUAL CLINICAL FEATURES. Retin Cases Brief Rep 2017; 14:96-99. [PMID: 28834919 DOI: 10.1097/icb.0000000000000630] [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
PURPOSE To report a case of a neurofibromatosis Type 2 with unusual clinical features. METHODS Observational clinical case report. RESULTS A 22-year-old woman was referred with bilateral blurred vision and macular "scars." Ocular examination revealed bilateral posterior subcapsular and cortical cataract, optic disk swelling, hyperpigmented macular lesions, epiretinal membrane, and macular temporal dragging. Spectral-domain optical coherence tomographic imaging showed bilateral epiretinal membranes, peripapillary nerve fiber layer thickening, and vitreoretinal tractional bands. In the right eye, focal choroidal excavation was noted at the site of the macular lesion. In fluorescein angiography, mild vascular leakage, capillary nonperfusion, and ground glass hyperfluorescence was seen in temporal periphery of the right eye. Brain imaging showed intracranial calcification and vestibular schwannoma, which was removed by a neurosurgeon. A clinical diagnosis of neurofibromatosis Type 2 was made. CONCLUSION A case of neurofibromatosis Type 2 with some possibly novel or rare findings, namely, focal choroidal excavation, ash leaf spots, and intracranial calcifications was presented.
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Affiliation(s)
- Mohamma Zarei
- Eye Research Center, Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Ultra-Wide-Field Fluorescein Angiography in Microscopic Polyangiitis. Case Rep Ophthalmol Med 2016; 2016:9834684. [PMID: 27872779 PMCID: PMC5107226 DOI: 10.1155/2016/9834684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/20/2016] [Accepted: 10/11/2016] [Indexed: 11/17/2022] Open
Abstract
A 25-year-old Hispanic female presented with 5 months of dry eyes and 2 months of bilateral photophobia and decreased vision. On examination, she had bilateral anterior uveitis and mild disc edema of the left eye. A complete infectious and inflammatory work-up was positive for elevated antinuclear antibodies and p-ANCA, leading to a diagnosis of microscopic polyangiitis. One year after initial treatment and steroid taper, an ultra-wide-field fluorescein angiography revealed peripheral vasculitis, outside of the standard traditional field of view, leading to an increase in immunomodulatory therapy and illustrating the utility of wide-field angiography for managing patients with uveitis.
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Ultra-wide-field scanning laser ophthalmoscopy assists in the clinical detection and evaluation of asymptomatic early-stage familial exudative vitreoretinopathy. Graefes Arch Clin Exp Ophthalmol 2016; 255:39-47. [DOI: 10.1007/s00417-016-3415-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/30/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022] Open
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