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Sadiq SA, Mishra S, Mirza RG. Hyperreflective Vasculature: A Negative Prognostic Sign for Retinal Vein Occlusion on Near-Infrared Reflectance Imaging. Ophthalmic Surg Lasers Imaging Retina 2023; 54:266-270. [PMID: 37184991 DOI: 10.3928/23258160-20230404-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND AND OBJECTIVE To investigate the clinical significance of hyperreflective vasculature visualized on near-infrared reflectance (NIR) in patients with retinal vein occlusion (RVO). METHODS In this retrospective study, RVO patients with NIR imaging and at least 1-year follow-up, and without confounding disease, were included. Two blinded independent graders identified vascular hyperreflectivity (HR) by detection of whiter signals in vessels. Visual acuity (VA), macular thickness (MT), and number of administered anti-vascular endothelial growth factor (anti-VEGF) injections were assessed. RESULTS RVO patients with HR (n = 20) and without HR (n = 31) demonstrated similarity in age, sex, and class of RVO. At presentation, the HR group had higher MT (P = 0.002) but no difference in VA (P = 0.1018). At 1 year, patients with HR had worse VA (P = 0.001), decreased MT (P = 0.011), and received more anti-VEGF injections (P < 0.001). CONCLUSION RVO patients with HR on NIR had significantly worse visual outcomes. Vascular HR on NIR imaging may be a biomarker, portending worse visual prognoses in RVO. [Ophthalmic Surg Lasers Imaging Retina 2023;54:266-270.].
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Schmidt MF, Christensen JL, Dahl VA, Toosy A, Petzold A, Hanson JVM, Schippling S, Frederiksen JL, Larsen M. Automated detection of hyperreflective foci in the outer nuclear layer of the retina. Acta Ophthalmol 2023; 101:200-206. [PMID: 36073938 DOI: 10.1111/aos.15237] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/12/2022] [Accepted: 08/14/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Hyperreflective foci are poorly understood transient elements seen on optical coherence tomography (OCT) of the retina in both healthy and diseased eyes. Systematic studies may benefit from the development of automated tools that can map and track such foci. The outer nuclear layer (ONL) of the retina is an attractive layer in which to study hyperreflective foci as it has no fixed hyperreflective elements in healthy eyes. In this study, we intended to evaluate whether automated image analysis can identify, quantify and visualize hyperreflective foci in the ONL of the retina. METHODS This longitudinal exploratory study investigated 14 eyes of seven patients including six patients with optic neuropathy and one with mild non-proliferative diabetic retinopathy. In total, 2596 OCT B-scan were obtained. An image analysis blob detector algorithm was used to detect candidate foci, and a convolutional neural network (CNN) trained on a manually labelled subset of data was then used to select those candidate foci in the ONL that fitted the characteristics of the reference foci best. RESULTS In the manually labelled data set, the blob detector found 2548 candidate foci, correctly detecting 350 (89%) out of 391 manually labelled reference foci. The accuracy of CNN classifier was assessed by manually splitting the 2548 candidate foci into a training and validation set. On the validation set, the classifier obtained an accuracy of 96.3%, a sensitivity of 88.4% and a specificity of 97.5% (AUC 0.989). CONCLUSION This study demonstrated that automated image analysis and machine learning methods can be used to successfully identify, quantify and visualize hyperreflective foci in the ONL of the retina on OCT scans.
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Affiliation(s)
- Mathias Falck Schmidt
- Department of Neurology, Clinic of Optic Neuritis, The Danish Multiple Sclerosis Center (DMSC), Rigshospitalet, Glostrup, Denmark
| | - Jakob Lønborg Christensen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | - Vedrana Andersen Dahl
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | - Ahmed Toosy
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, Queen Square UCL Institute of Neurology, University College London, London, UK
| | - Axel Petzold
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Neuro-ophthalmology Expertise Centre, University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,UCL Institute of Neurology, London, UK
| | - James V M Hanson
- Department of Ophthalmology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Sven Schippling
- Multimodal Imaging in Neuroimmunological Diseases (MINDS), University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jette Lautrup Frederiksen
- Department of Neurology, Clinic of Optic Neuritis, The Danish Multiple Sclerosis Center (DMSC), Rigshospitalet and University of Copenhagen, Glostrup, Denmark
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet and University of Copenhagen, Glostrup, Denmark
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Pilotto E, Torresin T, Bacelle ML, De Mojà G, Ferrara AM, Zovato S, Midena G, Midena E. Hyper-reflective retinal foci as possible in vivo imaging biomarker of microglia activation in von Hippel-Lindau disease. PLoS One 2022; 17:e0272318. [PMID: 35960779 PMCID: PMC9374205 DOI: 10.1371/journal.pone.0272318] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 07/17/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose von Hippel-Lindau (VHL) disease is caused by a mutation of the VHL gene and characterized by the development of retinal hemangioblastomas (RH). Current pathophysiologic mechanisms of RH development and progression are still insufficient to predict RH behavior. VHL gene is involved in the cellular response to hypoxia and in many intracellular signaling pathways expressed both in angiogenesis and inflammation. Optical coherence tomography (OCT) allows to identify hyper-reflective retinal foci (HRF) known as aggregates of activated microglial cells as possible in vivo biomarker of local inflammation. The aim of the present study was to investigate the presence of HRF in patients with genetically confirmed VHL disease. Methods In this cross-sectional study, patients with VHL underwent complete ophthalmological examination and OCT with HRA + OCT Spectralis. HRF were manually identified and calculated in inner (IR), outer (OR) and full retina. Age-matched healthy subjects were enrolled as controls. Results 113 eyes of 63 VHL patients and 56 eyes of 28 healthy subjects were evaluated. HRF number was significantly higher in VHL than in controls in IR (28.06 ± 7.50 vs 25.25 ± 6.64, p = 0.042). No difference was observed in OR and in full retina (OR: 7.73 ± 2.59 vs 7.95 ± 2.51, p = 0.599; full retina: 35.79 ± 8.77 vs 33.20 ± 7.47, p = 0.093). Conclusion The increase of HRF, which mirror retinal microglial activation, characterizes VHL eyes. The role of activated microglia in the retina of VHL eyes needs to be better investigated, mainly considering local VHL disease manifestations.
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Affiliation(s)
- Elisabetta Pilotto
- Department of Neuroscience—Ophthalmology, University of Padova, Padova, Italy
- * E-mail:
| | - Tommaso Torresin
- Department of Neuroscience—Ophthalmology, University of Padova, Padova, Italy
| | - Maria Laura Bacelle
- Department of Neuroscience—Ophthalmology, University of Padova, Padova, Italy
| | - Gilda De Mojà
- Department of Neuroscience—Ophthalmology, University of Padova, Padova, Italy
- Oftalmico Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | | | - Stefania Zovato
- Familial Tumor Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Padova, Italy
| | | | - Edoardo Midena
- Department of Neuroscience—Ophthalmology, University of Padova, Padova, Italy
- IRCCS, Fondazione Bietti, Rome, Italy
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Pengo M, Miante S, Franciotta S, Ponzano M, Torresin T, Bovis F, Rinaldi F, Perini P, Saiani M, Margoni M, Bertoldo A, Sormani MP, Pilotto E, Midena E, Gallo P, Puthenparampil M. Retinal Hyperreflecting Foci Associate With Cortical Pathology in Multiple Sclerosis. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2022; 9:9/4/e1180. [PMID: 35606113 PMCID: PMC9128002 DOI: 10.1212/nxi.0000000000001180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/08/2022] [Indexed: 11/15/2022]
Abstract
Background and ObjectivesMicroglia, the resident immune cell of the brain and retina, is widespread activated in the white and gray matter (GM) in multiple sclerosis (MS). The objective of this study is to evaluate the presence and number of hyperreflecting foci (HRF), considered clusters of activated and proliferating retinal microglia, and their association with clinical and radiologic disease parameters in relapsing-remitting MS (RRMS).MethodsAt baseline, 80 patients with RRMS underwent optical coherence tomography (OCT) and 3T-MRI (including 3-dimensional T1, fluid-attenuated inversion recovery, and double inversion recovery sequences), closed to their disease onset (6.3 ± 5.1 months). These patients were then clinically and radiologically followed up for a mean of 43 months, evaluating the no evidence of disease activity (NEDA) condition, further divided into clinical (cNEDA) and radiologic (rNEDA). Patients with a clinical history or MRI/OCT findings suggestive of optic neuritis (ON) were excluded from the study.ResultsCompared with healthy controls, the HRF number was significantly higher in the inner nuclear layer (INL) of patients with RRMS (19.55 ± 5.65 vs 13.84 ± 2.57, p < 0.001) and associated with INL volume (β: 1.21, p < 0.001). GM lesion volume significantly correlated with the INL HRF count (p = 0.008). Survival analysis revealed a significant association between INL HRF and both cNEDA (p = 0.017) and rNEDA (p = 0.002).DiscussionWe found a strong association between retinal microglial proliferation and cortical pathology in RRMS, a finding suggesting a possible underlying common immunopathologic mechanism. Furthermore, microglial activation at baseline was observed to predict subsequent inflammatory events, indicating that HRF might be a candidate prognostic biomarker worthy of further investigation.Classification of EvidenceThis study provides Class II evidence that in patients with early RRMS but without ON, the number of HRF on OCT of the retinal inner nuclear layer is associated with cNEDA and rNEDA.
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Parrozzani R, Midena G, Frizziero L, Marchione G, Midena E. RADIATION MACULOPATHY IS ANTICIPATED BY OCT HYPERREFLECTIVE RETINAL FOCI: A Large, Prospective, Confirmation Study. Retina 2022; 42:752-759. [PMID: 34803131 DOI: 10.1097/iae.0000000000003359] [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: 11/26/2022]
Abstract
PURPOSE To investigate, by means of spectral domain optical coherence tomography, retinal reflectivity changes as an early biomarker anticipating radiation-induced macular edema (ME) in patients treated by iodine-125 (I-125) brachytherapy. METHODS Thirty patients planned for I-125 brachytherapy because of uveal melanoma were prospectively included and followed every 4 months for five years. Reflectivity alterations, namely hyperreflective retinal foci, were characterized and counted by two independent masked examiners by means of spectral domain optical coherence tomography imaging. Hyperreflective retinal foci were defined as discrete intraretinal reflectivity changes ≤30 µm, with reflectivity similar to nerve fiber layer and without back shadowing. RESULTS Macular edema occurred in 17 patients (24.2 ±15.1 months) (group 1) after irradiation. Thirteen patients showed no signs of ME at the 5-year follow-up (group 2). The number of hyperreflective retinal foci was statistically higher in sequential visits until the evidence of ME in group 1 vs group 2 (P < 0.0001). In group 1, hyperreflective retinal foci at the follow-up before the evidence of ME were significantly related to the OCT central subfield thickness at ME appearance (P = 0.0002, r2=0.6129). The intergrader agreement was almost perfect (intraclass correlation coefficient = 0.80). CONCLUSION Hyperreflective retinal foci may be considered as an early in vivo imaging biomarker of retinal inflammatory response to ocular irradiation, anticipating the development of radiation maculopathy.
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Affiliation(s)
| | | | - Luisa Frizziero
- Department of Ophthalmology, University of Padova, Padova, Italy; and
| | - Giulia Marchione
- Department of Ophthalmology, University of Padova, Padova, Italy; and
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy; and
- IRCCS-Fondazione Bietti, Rome, Italy
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Brambati M, Borrelli E, Capone L, Querques L, Sacconi R, Battista M, Bandello F, Querques G. Changes in Macular Perfusion After ILUVIEN® Intravitreal Implant for Diabetic Macular Edema: An OCTA Study. Ophthalmol Ther 2022; 11:653-660. [PMID: 35088300 PMCID: PMC8927530 DOI: 10.1007/s40123-022-00455-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/07/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction The aim of this study was to investigate changes in macular perfusion in patients affected by diabetic macular edema (DME) and treated with ILUVIEN® (fluocinolone acetonide intravitreal implant) 0.19 mg using optical coherence tomography angiography (OCTA). Methods This was a retrospective cohort study that included patients aged > 18 years with type 2 non-proliferative diabetic retinopathy (DR) and DME at baseline. All patients were treated with the ILUVIEN® implant. A minimum of two 6 × 6-mm OCTA scans were required to ensure that all cases had a baseline OCTA and an OCTA performed at 4 months of follow-up. Qualitative and quantitative comparisons were performed. Results Ten eyes from ten subjects were included in the analysis. Mean (± standard deviation) age of the study cohort was 57.1 ± 8.3 years. Mean parafoveal perfusion density (PD) at baseline was 64.1 ± 1.8% at baseline, increasing to 66.1 ± 2.9% (p = 0.013) at the 4-month follow-up visit. Mean parafoveal PD at baseline was 64.4 ± 2.1%, increasing to 65.2 ± 2.6% (p = 0.024) after 4 months. In the qualitative assessment, 60 regions (10 areas for each subject) were graded to assess changes in retinal perfusion between the baseline and follow-up visits. This assessment revealed that 24 regions (40.0%) were characterized by a qualitative increase in perfusion after treatment, while 22 (36.7%) and 14 (23.3%) regions were featured by a stability and reduction in retinal perfusion, respectively. Conclusion OCTA analysis detects improvements in macular perfusion after treatment with ILUVIEN®. This improvement in macular perfusion may be associated with corticosteroid-related beneficial effects on leukostasis.
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Affiliation(s)
- Maria Brambati
- Department of Ophthalmology, University Vita-Salute-IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Enrico Borrelli
- Department of Ophthalmology, University Vita-Salute-IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Luigi Capone
- Department of Ophthalmology, University Vita-Salute-IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Lea Querques
- Department of Ophthalmology, University Vita-Salute-IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute-IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Battista
- Department of Ophthalmology, University Vita-Salute-IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute-IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute-IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
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Retinal Glial Cells in Von Hippel-Lindau Disease: A Novel Approach in the Pathophysiology of Retinal Hemangioblastoma. Cancers (Basel) 2021; 14:cancers14010170. [PMID: 35008334 PMCID: PMC8750586 DOI: 10.3390/cancers14010170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/21/2021] [Accepted: 12/27/2021] [Indexed: 11/26/2022] Open
Abstract
Simple Summary The in vivo optical coherence tomography analysis of the biomarkers of retinal microglia and macroglia in Von Hippel–Lindau disease represents an innovative field of research. The different behavior of these glial cells in Von Hippel–Lindau patients provides new data regarding the pathophysiology of retinal hemangioblastoma, the most common ocular manifestation of this hereditary disorder. Moreover, these biomarkers show a different behavior in Von Hippel–Lindau patients in relation to the presence or absence of retinal hemangioblastoma. Therefore, we can hypothesize that retinal hemangioblastoma is mainly due to the activation of macroglia by previously activated microglial cells. Abstract Background: Von Hippel–Lindau (VHL) disease is a neoplastic syndrome caused by a mutation of the VHL tumor suppressor gene. Retinal hemangioblastoma (RH) is a vascularized tumor and represents the most common ocular manifestation of this disease. At the retinal level, VHL protein is able to regulate tumor growth, angiogenic factors, and neuroinflammation, probably stimulating retinal glial cells. The aim of the present study was to analyze in vivo the optical coherence tomography (OCT) biomarkers of retinal macroglia and microglia in a cohort of VHL patients. Methods: The mean thicknesses of macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), and peripapillary retinal nerve fiber layer (pRNFL) were measured with OCT as biomarkers of retinal macroglia. OCT images were also analyzed to detect and quantify hyperreflective retinal foci (HRF), a biomarker of retinal activated microglia. Results: 61 eyes of 61 VHL patients (22 eyes (36.07%) with peripheral RH and 39 eyes (63.93%) without RH) and 28 eyes of 28 controls were evaluated. pRNFL was thinner in VHL patients (p < 0.05) and in VHL without RH (p < 0.01) compared to controls, and thicker in VHL patients with RH than in those without RH (p < 0.05). The thickness of mRNFL (p < 0.0001) and GCL (p < 0.05) was reduced in VHL patients and in VHL without RH compared to controls, whereas mRNFL (p < 0.0001) and GCL (p < 0.05) were increased in VHL patients with RH compared to those without RH. HRF were significantly higher in number in VHL patients and in VHL without RH, than in controls, and significantly lower (p < 0.05) in the eyes of VHL patients with RH, than in those without RH. Conclusions: The OCT analysis, which detects and allows to quantify the biomarkers of retinal microglia (HRF) and macroglia (pRNFL, mRNFL and GCL), showed a different behavior of these two retinal glial cells populations in VHL patients, related to the presence or absence of peripheral RH. These data allow to hypothesize a novel pathophysiologic pathway of retinal hemangioblastoma in VHL disease.
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Hyperreflective foci in the choroid of normal eyes. Graefes Arch Clin Exp Ophthalmol 2021; 260:759-769. [PMID: 34674030 DOI: 10.1007/s00417-021-05469-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/11/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To investigate hyperreflective choroidal foci (HCF) using en face swept-source optical coherence tomography (SS-OCT) and determine the factors that contribute to the distribution of HCF in normal eyes. METHODS In this retrospective study, we included healthy eyes with a normal fundus. HCF were defined as hyperreflective spots on en face SS-OCT images. The number, mean area, total area, and circularity of the HCF were compared with various choroid measurements obtained using SS-OCT, SS-OCT angiography, and fundus photography. RESULTS We investigated 51 eyes from 51 patients. The mean patient age was 56.0 ± 14.7 years, and 32 (62.7%) were female. The number and total area of HCF did not differ between the female and male patients and the right and left eyes. The number of HCF was correlated with the stromal area of the choroid (r = 0.291, P = 0.040) and subfoveal choroidal vascularity index (r = - 0.364, P = 0.009). The total area of HCF was correlated with the stromal area of the choroid (r = 0.283, P = 0.045). However, the number and total area of HCF were not correlated with age, degree of macular tessellation, subfoveal choroidal thickness, and choriocapillaris vascular density and flow void area. CONCLUSION HCF were observed in normal eyes, and their distribution was associated with the underlying stromal component of the choroid. The results of this study can be used as a reference for determining abnormal hyperreflective foci in the choroid of the eyes with various diseases.
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A Comparison of Hyper-Reflective Retinal Spot Counts in Optical Coherence Tomography Images from Glaucomatous and Healthy Eyes. J Clin Med 2021; 10:jcm10204668. [PMID: 34682789 PMCID: PMC8538917 DOI: 10.3390/jcm10204668] [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: 08/06/2021] [Revised: 10/03/2021] [Accepted: 10/07/2021] [Indexed: 01/24/2023] Open
Abstract
Purpose: To compare the number of hyper-reflective retinal spots (HRS) in optical coherence tomography (OCT) images of healthy controls and patients affected with primary open angle glaucoma (POAG). Methods: Thirty patients affected with POAG and 34 healthy controls were recruited and underwent raster OCT examination of the macular region. Among the acquired B-scans, the one with the lowest foveal thickness was selected, and a central area of 3000 μm was defined (region of interest, ROI), in order to identify HRS. HRS were defined as small point-like hyper-reflective elements, detectable at the visual inspection of the OCT image. HRS were independently counted by two investigators in the ROI of each OCT scan. Results: Inter-rater agreement for HRS counting was good to excellent (ICC = 0.96, 95% CI: 0.83–0.99). More HRS were found in the OCT images from glaucoma patients, in comparison with healthy controls (average value: 90.5 ± 13.02 and 74.72 ± 11.35, for glaucoma and healthy subjects, respectively; p < 0.01). Significant correlations between the average number of HRS and visual field mean deviation (MD, p = 0.01) and pattern standard deviation (PSD, p < 0.01) were found. Conclusions: OCT images from glaucoma patients showed a higher number of HRS when compared with healthy controls. As HRS have been hypothesized to be a sign of neuroinflammation, these results may support the role of neuroinflammation in glaucoma etiopathogenesis.
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Uemura A, Fruttiger M, D'Amore PA, De Falco S, Joussen AM, Sennlaub F, Brunck LR, Johnson KT, Lambrou GN, Rittenhouse KD, Langmann T. VEGFR1 signaling in retinal angiogenesis and microinflammation. Prog Retin Eye Res 2021; 84:100954. [PMID: 33640465 PMCID: PMC8385046 DOI: 10.1016/j.preteyeres.2021.100954] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 02/12/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022]
Abstract
Five vascular endothelial growth factor receptor (VEGFR) ligands (VEGF-A, -B, -C, -D, and placental growth factor [PlGF]) constitute the VEGF family. VEGF-A binds VEGF receptors 1 and 2 (VEGFR1/2), whereas VEGF-B and PlGF only bind VEGFR1. Although much research has been conducted on VEGFR2 to elucidate its key role in retinal diseases, recent efforts have shown the importance and involvement of VEGFR1 and its family of ligands in angiogenesis, vascular permeability, and microinflammatory cascades within the retina. Expression of VEGFR1 depends on the microenvironment, is differentially regulated under hypoxic and inflammatory conditions, and it has been detected in retinal and choroidal endothelial cells, pericytes, retinal and choroidal mononuclear phagocytes (including microglia), Müller cells, photoreceptor cells, and the retinal pigment epithelium. Whilst the VEGF-A decoy function of VEGFR1 is well established, consequences of its direct signaling are less clear. VEGFR1 activation can affect vascular permeability and induce macrophage and microglia production of proinflammatory and proangiogenic mediators. However the ability of the VEGFR1 ligands (VEGF-A, PlGF, and VEGF-B) to compete against each other for receptor binding and to heterodimerize complicates our understanding of the relative contribution of VEGFR1 signaling alone toward the pathologic processes seen in diabetic retinopathy, retinal vascular occlusions, retinopathy of prematurity, and age-related macular degeneration. Clinically, anti-VEGF drugs have proven transformational in these pathologies and their impact on modulation of VEGFR1 signaling is still an opportunity-rich field for further research.
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Affiliation(s)
- Akiyoshi Uemura
- Department of Retinal Vascular Biology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
| | - Marcus Fruttiger
- UCL Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK.
| | - Patricia A D'Amore
- Schepens Eye Research Institute of Massachusetts Eye and Ear, 20 Staniford Street, Boston, MA, 02114, USA.
| | - Sandro De Falco
- Angiogenesis Laboratory, Institute of Genetics and Biophysics "Adriano Buzzati-Traverso", Via Pietro Castellino 111, 80131 Naples, Italy; ANBITION S.r.l., Via Manzoni 1, 80123, Naples, Italy.
| | - Antonia M Joussen
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200 Berlin, and Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Florian Sennlaub
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012, Paris, France.
| | - Lynne R Brunck
- Bayer Consumer Care AG, Pharmaceuticals, Peter-Merian-Strasse 84, CH-4052 Basel, Switzerland.
| | - Kristian T Johnson
- Bayer Consumer Care AG, Pharmaceuticals, Peter-Merian-Strasse 84, CH-4052 Basel, Switzerland.
| | - George N Lambrou
- Bayer Consumer Care AG, Pharmaceuticals, Peter-Merian-Strasse 84, CH-4052 Basel, Switzerland.
| | - Kay D Rittenhouse
- Bayer Consumer Care AG, Pharmaceuticals, Peter-Merian-Strasse 84, CH-4052 Basel, Switzerland.
| | - Thomas Langmann
- Laboratory for Experimental Immunology of the Eye, Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Joseph-Stelzmann-Str. 9, 50931, Cologne, Germany.
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Midena E, Torresin T, Velotta E, Pilotto E, Parrozzani R, Frizziero L. OCT Hyperreflective Retinal Foci in Diabetic Retinopathy: A Semi-Automatic Detection Comparative Study. Front Immunol 2021; 12:613051. [PMID: 33968016 PMCID: PMC8100046 DOI: 10.3389/fimmu.2021.613051] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/30/2021] [Indexed: 12/04/2022] Open
Abstract
Optical coherence tomography (OCT) allows us to identify, into retinal layers, new morphological entities, which can be considered clinical biomarkers of retinal diseases. According to the literature, solitary, small (<30 µm), medium level hyperreflective (similar to retinal fiber layer) retinal foci (HRF) may represent aggregates of activated microglial cells and an in vivo biomarker of retinal inflammation. The identification and quantification of this imaging biomarker allows for estimating the level and possibly the amount of intraretinal inflammation in major degenerative retinal disorders, whose inflammatory component has already been demonstrated (diabetic retinopathy, age-related macular degeneration, radiation retinopathy). Currently, diabetic retinopathy (DR) probably represents the best clinical model to apply this analysis in the definition of this clinical biomarker. However, the main limitation to the clinical use of HRF is related to the technical difficulty of counting them: a time-consuming methodology, which also needs trained examiners. To contribute to solve this limitation, we developed and validated a new method for the semi-automatic detection of HRF in OCT scans. OCT scans of patients affected by DR, were analyzed. HRF were manually counted in High Resolution spectral domain OCT images. Then, the same OCT scans underwent semi-automatic HRF counting, using an ImageJ software with four different settings profiles. Statistical analysis showed an excellent intraclass correlation coefficient (ICC) between the manual count and each of the four semi-automated methods. The use of the second setting profile allows to obtain at the Bland–Altman graph a bias of −0.2 foci and a limit of agreement of ±16.3 foci. This validation approach opens the way not only to the reliable and daily clinical applicable quantification of HRF, but also to a better knowledge of the inflammatory component—including its progression and regression changes—of diabetic retinopathy.
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Affiliation(s)
- Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy.,IRCCS-Fondazione Bietti, Rome, Italy
| | - Tommaso Torresin
- Department of Ophthalmology, University of Padova, Padova, Italy
| | - Erika Velotta
- Department of Ophthalmology, University of Padova, Padova, Italy
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12
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Willey JS, Britten RA, Blaber E, Tahimic CG, Chancellor J, Mortreux M, Sanford LD, Kubik AJ, Delp MD, Mao XW. The individual and combined effects of spaceflight radiation and microgravity on biologic systems and functional outcomes. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, TOXICOLOGY AND CARCINOGENESIS 2021; 39:129-179. [PMID: 33902391 PMCID: PMC8274610 DOI: 10.1080/26896583.2021.1885283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Both microgravity and radiation exposure in the spaceflight environment have been identified as hazards to astronaut health and performance. Substantial study has been focused on understanding the biology and risks associated with prolonged exposure to microgravity, and the hazards presented by radiation from galactic cosmic rays (GCR) and solar particle events (SPEs) outside of low earth orbit (LEO). To date, the majority of the ground-based analogues (e.g., rodent or cell culture studies) that investigate the biology of and risks associated with spaceflight hazards will focus on an individual hazard in isolation. However, astronauts will face these challenges simultaneously Combined hazard studies are necessary for understanding the risks astronauts face as they travel outside of LEO, and are also critical for countermeasure development. The focus of this review is to describe biologic and functional outcomes from ground-based analogue models for microgravity and radiation, specifically highlighting the combined effects of radiation and reduced weight-bearing from rodent ground-based tail suspension via hind limb unloading (HLU) and partial weight-bearing (PWB) models, although in vitro and spaceflight results are discussed as appropriate. The review focuses on the skeletal, ocular, central nervous system (CNS), cardiovascular, and stem cells responses.
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Affiliation(s)
| | | | - Elizabeth Blaber
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute
| | | | | | - Marie Mortreux
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center
| | - Larry D. Sanford
- Department of Radiation Oncology, Eastern Virginia Medical School
| | - Angela J. Kubik
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute
| | - Michael D. Delp
- Department of Nutrition, Food and Exercise Sciences, Florida State University
| | - Xiao Wen Mao
- Division of Biomedical Engineering Sciences (BMES), Department of Basic Sciences, Loma Linda University
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13
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Neuroretinal Imaging Inflammatory Biomarkers Anticipating Radiation-Induced Macular Edema. Retina 2020; 39:e45-e46. [PMID: 31568188 DOI: 10.1097/iae.0000000000002647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Frizziero L, Midena G, Longhin E, Berton M, Torresin T, Parrozzani R, Pilotto E. Early Retinal Changes by OCT Angiography and Multifocal Electroretinography in Diabetes. J Clin Med 2020; 9:jcm9113514. [PMID: 33143008 PMCID: PMC7692230 DOI: 10.3390/jcm9113514] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 12/21/2022] Open
Abstract
Background: To evaluate the earliest retinal morphological and functional changes in diabetic eyes without or with early signs of diabetic retinopathy (DR). Methods: Twenty-two eyes with no DR (noDR group), 22 eyes with mild DR (DR group), and 18 healthy nondiabetic eyes (controls) were enrolled. All eyes were studied by means of spectral domain optical coherence tomography (OCT), OCT angiography (OCTA), and multifocal electroretinogram (mfERG). Results: A significantly higher number of OCT hyperreflective intraretinal foci (HRF) was found in both noDR and DR groups versus controls, but not between DR groups. The OCTA parameters of the superficial vascular plexus (SVP) were significantly reduced in the noDR group both versus controls and DR group (p < 0.05). The OCTA parameters of the intermediate capillary plexus (ICP) were significantly reduced in the DR group versus controls. An increased number of altered hexagons on mfERG was found in the noDR versus the DR group (p = 0.0192). Conclusions: Retinal vascular and functional parameters are differently involved in diabetic eyes; major vascular changes in the SVP and functional alterations of the mfERG are present in diabetic eyes with no clinical microvascular signs of DR, while ICP is mainly involved when early ophthalmoscopic signs of DR are present. The integrated use of mfERG and OCTA provides new significant insights into the pathogenesis of diabetic related retinal disease.
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Affiliation(s)
- Luisa Frizziero
- IRCCS—Fondazione Bietti, 00198 Rome, Italy
- Correspondence: ; Tel.: +39-049-821-2110
| | - Giulia Midena
- Institute of Ophthalmology, Policlinico Gemelli, IRCCS, 00168 Rome, Italy;
| | - Evelyn Longhin
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (E.L.); (T.T.); (R.P.); (E.P.)
| | | | - Tommaso Torresin
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (E.L.); (T.T.); (R.P.); (E.P.)
| | - Raffaele Parrozzani
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (E.L.); (T.T.); (R.P.); (E.P.)
| | - Elisabetta Pilotto
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (E.L.); (T.T.); (R.P.); (E.P.)
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15
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Chorioretinal Side Effects of Therapeutic Ocular Irradiation: A Multimodal Imaging Approach. J Clin Med 2020; 9:jcm9113496. [PMID: 33138120 PMCID: PMC7693915 DOI: 10.3390/jcm9113496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 12/18/2022] Open
Abstract
Radiation chorioretinopathy, radiation maculopathy, and radiation optic neuropathy are the major complications of ophthalmic radiotherapy. Optical coherence tomography (OCT) and OCT angiography (OCTA) are revolutionary imaging methods, allowing the visualization of the retinal cellular architecture and the retinal vascular system, respectively. In recent years this multimodal imaging approach has been applied to several retinal disease, but its role in the clinical characterization of retinal complications secondary to ophthalmic radiotherapy has not yet been defined. The purpose of this review is to critically evaluate the role of OCT and OCTA in the clinical assessment of radiation-induced chorioretinopathy, maculopathy, and optic neuropathy.
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16
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Cennamo G, Montorio D, Bernardo R, Farella A, Liuzzi R, Breve MA, Reibaldi M, Cennamo G. Retinal Vascular Changes in Radiation Maculopathy after Intravitreal Ranibizumab by Optical Coherence Tomography Angiography. J Clin Med 2020; 9:jcm9061618. [PMID: 32471149 PMCID: PMC7356529 DOI: 10.3390/jcm9061618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 11/16/2022] Open
Abstract
In this prospective study, we investigated the structural and vascular retinal changes at baseline and after Ranibizumab injections at the last follow up to one year in patients affected by Radiation Maculopathy (RM) after plaque brachytheraphy in choroidal melanoma, using Spectral Domain Optical Coherence Tomography (SD-OCT) and OCT Angiography (OCTA). A total of 40 eyes with RM of 40 patients (18 females, 22 males, mean age 51.9 ± 11 years) that underwent ruthenium-106 plaque brachytherapy were included. All patients received one monthly intravitreal injection of Ranibizumab (Pro Re Nata regimen). We analyzed the Foveal Avascular Zone (FAZ) area, the retinal vessel density (VD) of the superficial capillary plexus (SCP) and of the deep capillary plexus (DCP), using OCTA, and we detected the Central Foveal Thickness (CFT) by SD-OCT at baseline and after treatment. At the last follow up, we found a significant improvement of the CFT (p < 0.001) while OCTA parameters revealed no change in VD of the SCP (p = 0.402), DCP (p = 0.282), and FAZ area (p = 0.255), resulting in a stabilization of the visual acuity (p = 0.210) respect to baseline. The absence of functional improvement, despite the anatomical recovery of the macula, could be due to the absence of improvement in FAZ area and in retinal VD after treatment. OCTA parameters could represent predictive biomarkers to anti-vascular endothelial growth factor (anti-VEGF) intravitreal response and to help to better understand the physiopathological mechanisms of the RM.
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Affiliation(s)
- Gilda Cennamo
- Eye Clinic, Public Health Department, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Daniela Montorio
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (D.M.); (R.B.); (M.A.B.); (G.C.)
| | - Roberta Bernardo
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (D.M.); (R.B.); (M.A.B.); (G.C.)
| | - Antonio Farella
- Functional and Morphologic Department of Radiotherapy and Legal Medicine, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Raffaele Liuzzi
- Institute of Biostructure and Bioimaging, National Research Council (CNR), 80145 Naples, Italy;
| | - Maria Angelica Breve
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (D.M.); (R.B.); (M.A.B.); (G.C.)
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Torino, 10124 Torino, Italy
- Correspondence:
| | - Giovanni Cennamo
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (D.M.); (R.B.); (M.A.B.); (G.C.)
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17
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Pilotto E, Miante S, Torresin T, Puthenparampil M, Frizziero L, Federle L, Gallo P, Midena E. Hyperreflective Foci in the Retina of Active Relapse-Onset Multiple Sclerosis. Ophthalmology 2020; 127:1774-1776. [PMID: 32359844 DOI: 10.1016/j.ophtha.2020.03.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 01/04/2023] Open
Affiliation(s)
| | - Silvia Miante
- Multiple Sclerosis Centre of the Veneto Region, Neurology Clinic, Department of Neurosciences, University of Padova, Padova, Italy
| | | | - Marco Puthenparampil
- Multiple Sclerosis Centre of the Veneto Region, Neurology Clinic, Department of Neurosciences, University of Padova, Padova, Italy.
| | | | - Lisa Federle
- Multiple Sclerosis Centre of the Veneto Region, Neurology Clinic, Department of Neurosciences, University of Padova, Padova, Italy
| | - Paolo Gallo
- Multiple Sclerosis Centre of the Veneto Region, Neurology Clinic, Department of Neurosciences, University of Padova, Padova, Italy
| | - Edoardo Midena
- Ophthalmology Clinic, University of Padova, Padova, Italy
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18
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Yu C, Xie S, Niu S, Ji Z, Fan W, Yuan S, Liu Q, Chen Q. Hyper‐reflective foci segmentation in SD‐OCT retinal images with diabetic retinopathy using deep convolutional neural networks. Med Phys 2019; 46:4502-4519. [PMID: 31315159 DOI: 10.1002/mp.13728] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Chenchen Yu
- School of Computer Science and Engineering Nanjing University of Science and Technology Nanjing 210094 China
| | - Sha Xie
- School of Computer Science and Engineering Nanjing University of Science and Technology Nanjing 210094 China
| | - Sijie Niu
- School of Information Science and Engineering University of Jinan Jinan 250022 China
| | - Zexuan Ji
- School of Computer Science and Engineering Nanjing University of Science and Technology Nanjing 210094 China
| | - Wen Fan
- Department of Ophthalmology the First Affiliated Hospital with Nanjing Medical University Nanjing 210029 China
| | - Songtao Yuan
- Department of Ophthalmology the First Affiliated Hospital with Nanjing Medical University Nanjing 210029 China
- The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University Suzhou 215228 China
| | - Qinghuai Liu
- Department of Ophthalmology the First Affiliated Hospital with Nanjing Medical University Nanjing 210029 China
| | - Qiang Chen
- School of Computer Science and Engineering Nanjing University of Science and Technology Nanjing 210094 China
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IDENTIFICATION AND CLASSIFICATION OF MACULAR MORPHOLOGIC BIOMARKERS RELATED TO VISUAL ACUITY IN RADIATION MACULOPATHY: A Multimodal Imaging Study. Retina 2019; 40:1419-1428. [PMID: 31283736 DOI: 10.1097/iae.0000000000002615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify and classify, by a multimodal imaging approach, the most relevant macular morphologic biomarkers related to visual acuity in patients affected by radiation maculopathy secondary to brachytherapy. METHODS Fifty-one consecutive patients previously treated with Iodine-125 brachytherapy because of uveal melanoma were enrolled. Each patient underwent full ophthalmologic examination including best-corrected visual acuity and multimodal macular imaging analysis. Macular morphological parameters were processed by a stepwise selection analysis. RESULTS Three macular parameters were identified as the most relevant macular morphologic biomarkers of poor visual acuity: the vertical thickness of the thickest macular cyst (P = 0.0001), the presence of foveal inner segment/outer segment (IS/OS) layer disruption (P = 0.0054), and the presence of foveal retinal pigment epithelium atrophy (0.0884). The intergrader agreement for these morphologic biomarkers was 0.98, 0.92, and 0.92, respectively (interclass correlation coefficient). CONCLUSION The vertical thickness of the thickest macular cyst, the presence of foveal retinal pigment epithelium atrophy, and IS/OS layer disruption can be used to clinically characterize radiation maculopathy. These parameters allow for separation of the edematous component of radiation maculopathy, which is potentially treatable in early disease stages, from late onset atrophic components, which are theoretically irreversible.
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20
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Yao X, Zhai M, Zhou L, Yang L. Protective effects of SND1 in retinal photoreceptor cell damage induced by ionizing radiation. Biochem Biophys Res Commun 2019; 514:919-925. [PMID: 31084926 DOI: 10.1016/j.bbrc.2019.04.189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/23/2019] [Accepted: 04/28/2019] [Indexed: 12/20/2022]
Abstract
Staphylococcal nuclease and tudor domain containing 1 (SND1) has multiple functions in a variety of cellular processes. Here, we assessed the effects of SND1 in cellular DNA damage after ionizing radiation (IR). Knocking down SND1 in the mouse-derived photoreceptor 661 W cell line markedly inhibited cell proliferation and increased apoptosis after IR treatment. After DNA damage, SND1 induced Ataxia telangiectasia mutated kinase (ATM) signaling to launch DNA repair. Defects of SND1 were associated with missing response to DNA damage signal to cell cycle checkpoints or DNA repair. The current findings reveal SND1 as a new regulatory factor in DNA damage response.
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Affiliation(s)
- Xuyang Yao
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Mengying Zhai
- Department of Immunology, Tianjin Medical University, Tianjin, China
| | - Lingyi Zhou
- Department of Immunology, Tianjin Medical University, Tianjin, China
| | - Liu Yang
- Department of Ophthalmology, Peking University First Hospital, Beijing, China.
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21
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Parlak M, Erden B, Saatci AO. Retinal crystalline deposits in a patient who received chemotherapy and radiotherapy for nasopharyngeal carcinoma and subsequent anti-VEGF treatment for the bilateral radiation maculopathy. GMS OPHTHALMOLOGY CASES 2019; 9:Doc01. [PMID: 30828511 PMCID: PMC6381419 DOI: 10.3205/oc000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report the occurrence of intraretinal crystalline deposits in a patient who received several anti-VEGF injections and one session of focal laser treatment for the treatment of radiation retinopathy during the treatment process. She had received three cycles of epirubicin and cisplatin together with radiation therapy seven years prior to detection of the maculopathy. The multimodal imaging features and the possible cause of the retinal crystalline deposits are discussed.
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Affiliation(s)
- Melih Parlak
- Ulm University Medical School, Department of Ophthalmology, Ulm, Germany
| | - Burcin Erden
- Dokuz Eylul University Medical School, Ophthalmology Department, Izmir, Turkey
| | - Ali Osman Saatci
- Dokuz Eylul University Medical School, Ophthalmology Department, Izmir, Turkey
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22
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Mao XW, Boerma M, Rodriguez D, Campbell-Beachler M, Jones T, Stanbouly S, Sridharan V, Nishiyama NC, Wroe A, Nelson GA. Combined Effects of Low-Dose Proton Radiation and Simulated Microgravity on the Mouse Retina and the Hematopoietic System. Radiat Res 2018; 192:241-250. [PMID: 30430917 DOI: 10.1667/rr15219.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The purpose of the current study was to characterize the effects of simulated microgravity and radiation-induced changes in retina and retinal vasculature, and to assess the accompanying early changes in immune cells and hematological parameters. To better understand the effects of spaceflight, we used a combination of treatments designed to simulate both the radiation and low-gravity aspects of space conditions. To simulate the broad energy spectrum of a large solar particle event (SPE) and galactic cosmic ray (GCR) radiation, male C57BL/6J mice were exposed to whole-body irradiation using fully modulated beams of 150-MeV protons containing particles of energy from 0 to 150 MeV and a uniform dose-vs.-depth profile. The mice were also hindlimb-unloaded (HLU) by tail suspension. Mice were unloaded for 7 days, exposed to 50 cGy, unloaded for an additional 7 days and then sacrificed for tissue isolation at days 4 and 30 after the combined treatments. Increases in the number of apoptotic cells were observed in the endothelial cells of mice that received radiation alone or with HLU compared to controls at both days 4 and 30 (P < 0.05). Endothelial nitric oxide synthase (eNOS) levels were significantly elevated in the retina after irradiation only or combined with HLU compared to controls at the 30-day time point (P < 0.05). The most robust changes were observed in the combination group, suggesting a synergistic response to radiation and unloading. For hematopoietic parameters, our analysis indicated the main effects for time and radiation at day 4 after treatments (day 11 postirradiation) (P < 0.05), but a smaller influence of HLU for both white blood cell and lymphocyte counts. The group treated with both radiation and HLU showed greater than 50% reduction in lymphocyte counts compared to controls. Radiation-dependent differences were also noted in specific lymphocyte subpopulations (T, B, natural killer cells). This study shows indications of an early effect of low-dose radiation and spaceflight conditions on retina and immune populations.
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Affiliation(s)
- X W Mao
- Department of Basic Sciences, Division of Radiation Research, Loma Linda University School of Medicine and Medical Center, Loma Linda, California
| | - M Boerma
- Division of Radiation Health, Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - D Rodriguez
- Department of Basic Sciences, Division of Radiation Research, Loma Linda University School of Medicine and Medical Center, Loma Linda, California
| | - M Campbell-Beachler
- Department of Basic Sciences, Division of Radiation Research, Loma Linda University School of Medicine and Medical Center, Loma Linda, California
| | - T Jones
- Department of Basic Sciences, Division of Radiation Research, Loma Linda University School of Medicine and Medical Center, Loma Linda, California
| | - S Stanbouly
- Department of Basic Sciences, Division of Radiation Research, Loma Linda University School of Medicine and Medical Center, Loma Linda, California
| | - V Sridharan
- Division of Radiation Health, Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - N C Nishiyama
- Department of Basic Sciences, Division of Radiation Research, Loma Linda University School of Medicine and Medical Center, Loma Linda, California
| | - A Wroe
- Department of Radiation Medicine, Loma Linda University School of Medicine and Medical Center, Loma Linda, California
| | - G A Nelson
- Department of Basic Sciences, Division of Radiation Research, Loma Linda University School of Medicine and Medical Center, Loma Linda, California
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23
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Pilotto E, Leonardi F, Stefanon G, Longhin E, Torresin T, Deganello D, Cavarzeran F, Miglionico G, Parrozzani R, Midena E. Early retinal and choroidal OCT and OCT angiography signs of inflammation after uncomplicated cataract surgery. Br J Ophthalmol 2018; 103:1001-1007. [PMID: 30127073 DOI: 10.1136/bjophthalmol-2018-312461] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/18/2018] [Accepted: 07/26/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate, by means of optical coherence tomography (OCT) and OCT angiography (OCTA), early retinal, choroidal and macular perfusion changes induced by a local inflammatory reaction secondary to uncomplicated cataract surgery. METHODS Selected eyes undergoing cataract surgery were enrolled in a prospective study. OCT and OCTA were performed before cataract surgery (T0) and at day: 1 (T1), 7 (T7), 30 (T30) and 90 (T90). Inner (IR) and outer retinal (OR) volumes, choroidal volume, hyper-reflective retinal spots (HRS) in IR and OR changes were measured at OCT. Macular perfusion was analysed in superficial (SCP), intermediate (ICP) and deep retinal capillary plexuses (DCP). RESULTS Nine eyes of nine selected patients were consecutively enrolled. Mean IR volume changed after surgery (p=0.0001), increasing progressively from 4.391±0.231 mm³ at T0 to 4.573±0.241 mm³ at T30, p=0.0002. Both mean OR and choroidal volume increased, mainly at T30, but not significantly (p=0.4360 and p=0.2300, respectively). Mean HRS changed during follow-up, increasing at first in IR and later in OR (at T1 and T7, respectively, both p<0.0001). Macular ICP and DCP perfusion increased at T1, whereas macular SCP perfusion did not change. At T90, all OCT and OCTA parameters had almost reached baseline levels. CONCLUSIONS The increase of HRS at first in IR and later in OR seems to confirm their inflammatory nature. Early OCTA changes (underline) underscore a selective susceptibility of DCP and ICP to a localised inflammatory reaction induced by cataract surgery.
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Affiliation(s)
| | | | | | - Evelyn Longhin
- Department of Ophthalmology, University of Padova, Padova, Italy
| | - Tommaso Torresin
- Department of Ophthalmology, University of Padova, Padova, Italy
| | - Davide Deganello
- Department of Ophthalmology, University of Padova, Padova, Italy
| | | | | | | | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy .,Fondazione Bietti, IRCCS, Rome, Italy
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24
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Mao XW, Boerma M, Rodriguez D, Campbell-Beachler M, Jones T, Stanbouly S, Sridharan V, Wroe A, Nelson GA. Acute Effect of Low-Dose Space Radiation on Mouse Retina and Retinal Endothelial Cells. Radiat Res 2018; 190:45-52. [PMID: 29741442 DOI: 10.1667/rr14977.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
There is concern that degradation of vision as a result of space flight may compromise both mission goals and long-term quality of life after space travel. The visual disturbances may be due to a combination of intracerebral pressure changes and exposure to ionizing radiation. The retina and the retinal vasculature play important roles in vision, yet have not been studied extensively in relationship to space travel and space radiation. The goal of the current study was to characterize oxidative damage and apoptosis in retinal endothelial cells after whole-body gamma-ray, proton and oxygen (16O) ion radiation exposure at 0.1 to 1 Gy. Six-month-old male C57Bl/6J mice were whole-body irradiated with 600 MeV/n 16O ions (0, 0.1, 0.25, 1 Gy), solar particle event (SPE)-like protons (0, 0.1, 0.25, 0.5 Gy) or 60Co gamma rays (0, 0.1, 0.25, 0.5 Gy). Eyes were isolated for examining endothelial nitric oxide synthase (eNOS) expression and characterization of apoptosis in retina and retinal endothelial cells at two weeks postirradiation. The expression of eNOS was significantly increased in the retina after proton and 16O ion exposure. 16O ions induced over twofold increase in eNOS expression compared to proton exposure at two weeks postirradiation ( P < 0.05). TUNEL assays showed dose-dependent increases in apoptosis in the retina after irradiation. Low doses of 16O ions elicited apoptosis in the mouse retinal endothelial cells with the most robust changes observed after 0.1 Gy irradiation ( P < 0.05) compared to controls. Data also showed that 16O ions induced a higher frequency of apoptosis in retinal endothelial cells compared to protons ( P < 0.05). In summary, our study revealed that exposure to low-dose ionizing radiation induced oxidative damage and apoptosis in the retina. Significant changes in retinal endothelial cells occur at doses as low as 0.1 Gy. There were significant differences in the responses of endothelial cells among the radiation types examined here.
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Affiliation(s)
- X W Mao
- a Departments of Basic Sciences, Division of Radiation Research
| | - M Boerma
- c Division of Radiation Health, Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - D Rodriguez
- a Departments of Basic Sciences, Division of Radiation Research
| | | | - T Jones
- a Departments of Basic Sciences, Division of Radiation Research
| | - S Stanbouly
- a Departments of Basic Sciences, Division of Radiation Research
| | - V Sridharan
- c Division of Radiation Health, Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - A Wroe
- b Radiation Medicine, Loma Linda University School of Medicine and Medical Center, Loma Linda, California
| | - G A Nelson
- a Departments of Basic Sciences, Division of Radiation Research
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25
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HYPERREFLECTIVE RETINAL SPOTS IN NORMAL AND DIABETIC EYES: B-Scan and En Face Spectral Domain Optical Coherence Tomography Evaluation. Retina 2018; 37:1092-1103. [PMID: 27668929 DOI: 10.1097/iae.0000000000001304] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE To evaluate hyperreflective retinal spots (HRS), in normal subjects and diabetic patients without and with macular edema (diabetic macular edema, DME), on linear B-scans and corresponding en face image of spectral-domain optical coherence tomography. METHODS Retrospective evaluation of images of 54 eyes/subjects (16 normal subjects, 19 diabetic patients without DME, and 19 with DME). On horizontal B-scan spectral-domain optical coherence tomography, passing through the center of the fovea, the following characteristics of HRS were evaluated: location (inner retina or outer retina), size (≤30 or >30 μm), reflectivity (similar to nerve fiber layer or to retinal pigment epithelium-Bruch complex), and presence or absence of back shadowing. On en face spectral-domain optical coherence tomography, the following patterns were evaluated: 1) isolated HRS (not corresponding to any visible lesion); 2) HRS corresponding to a segment of retinal capillary or microaneurysm wall; and 3) HRS corresponding to hard exudate. All gradings were performed twice by two graders in a masked fashion. RESULTS Size ≤30 μm, reflectivity similar to nerve fiber layer, and absence of back shadowing were associated with absence of vessels or any other lesion on en face image (P = 0.0001 for all). Size >30 μm, reflectivity similar to retinal pigment epithelium-Bruch complex, presence of back shadowing, and location in the outer retina were all associated with presence of hard exudate on en face imaging (P < 0.0001 for all). Multiple logistic regression analysis showed that HRS present in the inner retina (P < 0.0001), size >30 μm (P = 0.0029), and presence of back shadowing (P < 0.0001) are directly associated with presence of microaneurysms on en face image. Intragrader and intergrader repeatability were excellent for all evaluations. CONCLUSION Hyperreflective retinal spots ≤30 μm, reflectivity similar to nerve fiber layer, and absence of back shadowing may represent activated microglial cells; HRS >30 μm, reflectivity similar to retinal pigment epithelium-Bruch complex, presence of back shadowing, and location in the outer retina may represent hard exudate; HRS >30 μm, presence of back shadowing, and location in the inner retina may represent microaneurysms. These hypotheses may be tested in further studies.
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Niu S, Yu C, Chen Q, Yuan S, Lin J, Fan W, Liu Q. Multimodality analysis of Hyper-reflective Foci and Hard Exudates in Patients with Diabetic Retinopathy. Sci Rep 2017; 7:1568. [PMID: 28484225 PMCID: PMC5431476 DOI: 10.1038/s41598-017-01733-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 04/03/2017] [Indexed: 11/28/2022] Open
Abstract
To investigate the correlations between hyper-reflective foci and hard exudates in patients with non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) by spectral-domain optical coherence tomography (SD OCT) images. Hyper-reflective foci in retinal SD OCT images were automatically detected by the developed algorithm. Then, the cropped CFP images generated by the semi-automatic registration method were automatically segmented for the hard exudates and corrected by the experienced clinical ophthalmologist. Finally, a set of 5 quantitative imaging features were automatically extracted from SD OCT images, which were used for investigating the correlations of hyper-reflective foci and hard exudates and predicting the severity of diabetic retinopathy. Experimental results demonstrated the positive correlations in area and amount between hard exudates and hyper-reflective foci at different stages of diabetic retinopathy, with statistical significance (all p < 0.05). In addition, the area and amount can be taken as potential discriminant indicators of the severity of diabetic retinopathy.
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Affiliation(s)
- Sijie Niu
- School of Information Science and Engineering, University of Jinan, Jinan, 250022, China.,School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing, 210094, China
| | - Chenchen Yu
- School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing, 210094, China
| | - Qiang Chen
- School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing, 210094, China.
| | - Songtao Yuan
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210094, China.
| | - Jiang Lin
- Department of Endocrinology, Nanjing Medical University, Nanjing, 210094, China
| | - Wen Fan
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210094, China
| | - Qinghuai Liu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210094, China
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Frizziero L, Parrozzani R, Trainiti S, Pilotto E, Miglionico G, Pulze S, Midena E. Intravitreal dexamethasone implant in radiation-induced macular oedema. Br J Ophthalmol 2017; 101:1699-1703. [PMID: 28404670 DOI: 10.1136/bjophthalmol-2017-310220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/13/2017] [Accepted: 03/15/2017] [Indexed: 11/04/2022]
Abstract
AIMS To evaluate the efficacy and duration of activity of a single intravitreal dexamethasone implant in patients affected by radiation maculopathy. METHODS Thirteen consecutive eyes of 13 patients affected by radiation maculopathy secondary to eye irradiation for a primary uveal melanoma (Iodine-125 brachytherapy) and treated with a single intravitreal 0.7 mg dexamethasone implant were retrospectively evaluated. Each patient underwent full ophthalmological examination, including fluorescein angiography and spectral domain optical coherence tomography (SD-OCT), even in en-face modality. Follow-up was performed monthly over a 6-month period. RESULTS At preinjection visit, the median central subfield thickness (CST) by SD-OCT was 407 µm (IQR, 357-524 µm) and the median best-corrected visual acuity (BCVA) was 61 ETDRS score (IQR, 54-67). The median gain of ETDRS letter at 1 month was 6.5 (IQR, 4-15) (p<0.01). The median CST showed a reduction of 120 µm (IQR, 62-134) (p<0.01). Further CST reduction was reported at 2 months' follow-up, with CST stabilisation at 3 months and maintenance of BCVA. At 4, 5 and 6 months' follow-up, all patients presented progressive retinal thickening (p<0.01) and BCVA reduction (p<0.01). No side effects were documented. CONCLUSION Intravitreal dexamethasone implant reduces macular oedema secondary to radiation maculopathy and also improved visual acuity in a consistent proportion of patients. Signs of macular oedema recurrence may be detected at a median of 4 months after injection.
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Affiliation(s)
- Luisa Frizziero
- Department of Ophthalmology, University of Padova, Padova, Italy
| | | | - Sara Trainiti
- Department of Ophthalmology, University of Padova, Padova, Italy
| | | | - Giacomo Miglionico
- G.B. Bietti Foundation, IRCCS, Ocular Oncology and Toxicology Research Unit, Roma, Italy
| | - Serena Pulze
- G.B. Bietti Foundation, IRCCS, Ocular Oncology and Toxicology Research Unit, Roma, Italy
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy.,G.B. Bietti Foundation, IRCCS, Ocular Oncology and Toxicology Research Unit, Roma, Italy
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