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Rohowetz LJ, Kunkler AL, Sengillo JD, Lazzarini TA, Lam BL, Berrocal AM. Choroideremia presenting as vision loss secondary to choroidal neovascularization. Ophthalmic Genet 2024; 45:175-179. [PMID: 37575054 DOI: 10.1080/13816810.2023.2245117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/23/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Choroidal neovascularization (CNV) is a rare complication of choroideremia that occurs secondary to relative atrophy of the retinal pigment epithelium and eventual rupture of Bruch's membrane. The ideal management of CNV in choroideremia is unclear. MATERIALS AND METHODS Case report. OBSERVATIONS A 14-year-old male with no known ocular history presented to the eye emergency department complaining of a central scotoma in the right eye for 4 days. He had no past medical history and family history was unremarkable for known ocular disease. Visual acuity was 20/70 in the right eye and 20/30 in the left eye. Posterior segment exam revealed chorioretinal atrophy extending from the outer macula to the midperiphery in both eyes. There was CNV with associated subretinal hemorrhage in the right eye. Optical coherence tomography demonstrated the presence of CNV with subretinal fluid in the right eye and parafoveal outer retinal atrophy in both eyes. Genetic testing revealed a hemizygous exon 2 deletion on the CHM gene, pathogenic for choroideremia. The patient received a total of 3 injections 4 weeks apart followed by 1 injection 6 weeks later with resolution of the subretinal hemorrhage and reduction in CNV size with improvement in visual acuity to 20/20 at last follow-up exam. CONCLUSIONS AND IMPORTANCE Choroidal neovascularization is a rare cause of central vision loss in patients with choroideremia. In this report, we demonstrate a good functional and anatomic response to intravitreal bevacizumab in a 14-year-old patient with undiagnosed choroideremia who presented with CNV-induced central vision loss.
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Affiliation(s)
- Landon J Rohowetz
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Anne L Kunkler
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Jesse D Sengillo
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Thomas A Lazzarini
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Byron L Lam
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
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2
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Heath Jeffery RC, Chen FK. Macular neovascularization in inherited retinal diseases: A review. Surv Ophthalmol 2024; 69:1-23. [PMID: 37544613 DOI: 10.1016/j.survophthal.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
Inherited retinal diseases (IRDs) are the most common cause of blindness in working-age adults. Macular neovascularization (MNV) may be a presenting feature or occurs as a late-stage complication in several IRDs. We performed an extensive literature review on MNV associated with IRDs. MNV is a well-known complication of Sorsby fundus dystrophy and pseudoxanthoma elasticum. Those with late-onset Stargardt disease may masquerade as exudative age-related macular degeneration (AMD) when MNV is the presenting feature. Peripherinopathies may develop MNV that responds well to a short course of anti-vascular endothelial growth factor (anti-VEGF) therapy, while bestrophinopathies tend to develop MNV in the early stages of the disease without vision loss. Enhanced S-cone syndrome manifests type 3 MNV that typically regresses into a subfoveal fibrotic nodule. MNV is only a rare complication in choroideraemia and rod-cone dystrophies. Most IRD-related MNVs exhibit a favorable visual prognosis requiring less intensive regimens of anti-vascular endothelial growth factor therapy compared to age-related macular degeneration. We discuss the role of key imaging modalities in the diagnosis of MNV across a wide spectrum of IRDs and highlight the gaps in our knowledge with respect to the natural history and prognosis to pave the way for future directions of research.
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Affiliation(s)
- Rachael C Heath Jeffery
- Centre for Ophthalmology and Visual Science (Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia; Royal Victorian Eye and Ear Hospital (Centre for Eye Research Australia), East Melbourne, VIC, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia; Royal Victorian Eye and Ear Hospital (Centre for Eye Research Australia), East Melbourne, VIC, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, East Melbourne, VIC, Australia; Department of Ophthalmology, Royal Perth Hospital, Perth, WA, Australia.
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3
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Wongchaisuwat N, Wang J, Yang P, Everett L, Gregor A, Sahel JA, Nischal KK, Pennesi ME, Gillingham MB, Jia Y. Optical coherence tomography angiography of choroidal neovascularization in long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD). Am J Ophthalmol Case Rep 2023; 32:101958. [PMID: 38161518 PMCID: PMC10757195 DOI: 10.1016/j.ajoc.2023.101958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose To report the clinical utility of optical coherence tomography angiography (OCTA) for demonstrating choroidal neovascularization (CNV) associated with Long-Chain 3-Hydroxyacyl-CoA Dehydrogenase Deficiency (LCHADD) retinopathy. Methods Thirty-three participants with LCHADD (age 7-36 years; median 17) were imaged with OCTA and the Center for Ophthalmic Optics & Lasers Angiography Reading Toolkit (COOL-ART) software was implemented to process OCTA scans. Results Seven participants (21 %; age 17-36 years; median 25) with LCHADD retinopathy demonstrated evidence of CNV by retinal examination or presence of CNV within outer retinal tissue on OCTA scans covering 3 × 3 and/or 6 × 6-mm. These sub-clinical CNVs are adjacent to hyperpigmented areas in the posterior pole. CNV presented at stage 2 or later of LCHADD retinopathy prior to the disappearance of RPE pigment in the macula. Conclusion OCTA can be applied as a non-invasive method to evaluate the retinal and choroidal microvasculature. OCTA can reveal CNV in LCHADD even when the clinical exam is inconclusive. These data suggest that the incidence of CNV is greater than expected and can occur even in the early stages of LCHADD retinopathy.
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Affiliation(s)
- Nida Wongchaisuwat
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jie Wang
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
| | - Paul Yang
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
| | - Lesley Everett
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, USA
| | - Ashley Gregor
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, USA
| | - Jose Alain Sahel
- Vision Institute, University of Pittsburgh Medical Center and School of Medicine, Pennsylvania, USA
| | - Ken K. Nischal
- Vision Institute, University of Pittsburgh Medical Center and School of Medicine, Pennsylvania, USA
- UPMC Children's Hospital, Pennsylvania, USA
| | - Mark E. Pennesi
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, USA
| | - Melanie B. Gillingham
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, USA
| | - Yali Jia
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
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4
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Makuloluwa A, Madhusudhan S. Clinical outcomes of treated macular neovascularisation secondary to inherited retinal diseases: a literature review. BMJ Open Ophthalmol 2023; 8:e001309. [PMID: 37493670 PMCID: PMC10364169 DOI: 10.1136/bmjophth-2023-001309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023] Open
Abstract
Many inherited retinal diseases (IRD) can be associated with, or be secondarily complicated by, macular neovascularisation (MNV), which has been variably treated with intravitreal antivascular endothelial growth factor, steroids, laser and surgery. In this article, we aim to present a consolidated literature review of management of IRD-related MNV.
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Affiliation(s)
- Aruni Makuloluwa
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Savita Madhusudhan
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
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5
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Iovino C, Iodice CM, Pisani D, Damiano L, Di Iorio V, Testa F, Simonelli F. Clinical Applications of Optical Coherence Tomography Angiography in Inherited Retinal Diseases: An Up-to-Date Review of the Literature. J Clin Med 2023; 12:jcm12093170. [PMID: 37176614 PMCID: PMC10179546 DOI: 10.3390/jcm12093170] [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: 03/21/2023] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Optical coherence tomography angiography (OCT-A) is a valuable imaging technique, allowing non-invasive, depth-resolved, motion-contrast, high-resolution images of both retinal and choroidal vascular networks. The imaging capabilities of OCT-A have enhanced our understanding of the retinal and choroidal alterations that occur in inherited retinal diseases (IRDs), a group of clinically and genetically heterogeneous disorders that may be complicated by several vascular conditions requiring a prompt diagnosis. In this review, we aimed to comprehensively summarize all clinical applications of OCT-A in the diagnosis and management of IRDs, highlighting significant vascular findings on retinitis pigmentosa, Stargardt disease, choroideremia, Best disease and other less common forms of retinal dystrophies. All advantages and limitations of this novel imaging modality will be also discussed.
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Affiliation(s)
- Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Clemente Maria Iodice
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Danila Pisani
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Luciana Damiano
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Valentina Di Iorio
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Francesco Testa
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
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Sacconi R, Fragiotta S, Sarraf D, Sadda SR, Freund KB, Parravano M, Corradetti G, Cabral D, Capuano V, Miere A, Costanzo E, Bandello F, Souied E, Querques G. Towards a better understanding of non-exudative choroidal and macular neovascularization. Prog Retin Eye Res 2023; 92:101113. [PMID: 35970724 DOI: 10.1016/j.preteyeres.2022.101113] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/14/2022] [Accepted: 08/03/2022] [Indexed: 02/01/2023]
Abstract
Non-exudative macular and choroidal neovascularization (MNV and CNV) usually refers to the entity of treatment-naïve type 1 neovascularization in the absence of associated signs of exudation. Histopathological studies, dating back in the early 70s, identified the presence of non-exudative MNV, but the first clinical report of this finding was in the late 90s using indocyanine green angiography in eyes with age-related macular degeneration (AMD). With more advanced retinal imaging, there has been an ever increasing appreciation of non-exudative MNV associated with AMD and CNV with other macular disorders. However, consensus regarding the exact definition and the clinical management of this entity is lacking. Furthermore, there may be variation in the imaging features and clinical course suggesting that a spectrum of disease may exist. Herein, we review the large body of published work that has provided a better understanding of non-exudative MNV and CNV in the last decade. The prevalence, multimodal imaging features, clinical course, and response to treatment are discussed to elucidate further key insights about this entity. Based on these observations, this review also proposes a new theory about the origin and course of different sub-types of non-exudative MNV/CNV which can have different etiologies and pathways according to the clinical context of disease.
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Affiliation(s)
- Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Fragiotta
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA; Greater Los Angeles VA Healthcare Center, Los Angeles, CA, United States
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, CA, United States; Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, United States
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, United States; Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, United States
| | | | - Giulia Corradetti
- Doheny Eye Institute, Los Angeles, CA, United States; Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Diogo Cabral
- Vitreous Retina Macula Consultants of New York, New York, NY, United States; Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, United States
| | - Vittorio Capuano
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | - Alexandra Miere
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | | | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eric Souied
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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7
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Nguyen TTP, Ni S, Liang G, Khan S, Wei X, Skalet A, Ostmo S, Chiang MF, Jia Y, Huang D, Jian Y, Campbell JP. Widefield Optical Coherence Tomography in Pediatric Retina: A Case Series of Intraoperative Applications Using a Prototype Handheld Device. Front Med (Lausanne) 2022; 9:860371. [PMID: 35860728 PMCID: PMC9289179 DOI: 10.3389/fmed.2022.860371] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 06/15/2022] [Indexed: 11/18/2022] Open
Abstract
Optical coherence tomography (OCT) has changed the standard of care for diagnosis and management of macular diseases in adults. Current commercially available OCT systems, including handheld OCT for pediatric use, have a relatively narrow field of view (FOV), which has limited the potential application of OCT to retinal diseases with primarily peripheral pathology, including many of the most common pediatric retinal conditions. More broadly, diagnosis of all types of retinal detachment (exudative, tractional, and rhegmatogenous) may be improved with OCT-based assessment of retinal breaks, identification of proliferative vitreoretinopathy (PVR) membranes, and the pattern of subretinal fluid. Intraocular tumors both benign and malignant often occur outside of the central macula and may be associated with exudation, subretinal and intraretinal fluid, and vitreoretinal traction. The development of wider field OCT systems thus has the potential to improve the diagnosis and management of myriad diseases in both adult and pediatric retina. In this paper, we present a case series of pediatric patients with complex vitreoretinal pathology undergoing examinations under anesthesia (EUA) using a portable widefield (WF) swept-source (SS)-OCT device.
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Affiliation(s)
- Thanh-Tin P. Nguyen
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, United States
| | - Shuibin Ni
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, United States
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, United States
| | - Guangru Liang
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, United States
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, United States
| | - Shanjida Khan
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, United States
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, United States
| | - Xiang Wei
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, United States
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, United States
| | - Alison Skalet
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, United States
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, United States
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, United States
- Department of Dermatology, Oregon Health and Science University, Portland, OR, United States
| | - Susan Ostmo
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, United States
| | - Michael F. Chiang
- National Eye Institute, National Institutes of Health, Bethesda, MD, United States
| | - Yali Jia
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, United States
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, United States
| | - David Huang
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, United States
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, United States
| | - Yifan Jian
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, United States
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, United States
| | - J. Peter Campbell
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, United States
- *Correspondence: J. Peter Campbell,
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8
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Jarc-Vidmar M, Sega R, Jaki-Mekjavic P. Intravitreal bevacizumab treatment for exudative choroidal neovascularisation in best vitelliform macular dystrophy. Eur J Ophthalmol 2021; 33:11206721211057684. [PMID: 34779297 DOI: 10.1177/11206721211057684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe results of intravitreal bevacizumab treatment of the secondary choroidal neovascularisation in Best vitelliform macular dystrophy in an adult and paediatric patient, and present the management of three asymptomatic patients with confirmed BEST1 gene mutation. CASE SERIES DESCRIPTION Five patients from the same family with the Best vitelliform macular dystrophy are presented. In two patients (aged 63 and 4 years) secondary choroidal neovascularisation caused a rapid decline in visual acuity. In the adult patient with advanced Best vitelliform macular dystrophy, visual acuity did not improve despite eight intravitreal bevacizumab injections to the right eye. The formation of a central scar and rapid reoccurrence of choroidal neovascularisation three months after completing the initial treatment affected the outcome. As for the paediatric patient with bilateral choroidal neovascularisation in the vitelliform stage of Best vitelliform macular dystrophy, a complete recovery of visual acuity was observed after two (left eye) and three (right eye) bevacizumab injections, with adjunctive amblyopia treatment. The other three patients with an abnormal electrooculogram reported no visual problems during more than 10 years of follow-up. Minimal changes were seen on optical coherence tomography in the youngest patient. CONCLUSIONS Intravitreal bevacizumab seems to be an effective treatment for exudative choroidal neovascularisation in the vitelliform stage of Best vitelliform macular dystrophy; however, it may not be beneficial in the advanced stages of Best vitelliform macular dystrophy. It is important to regularly screen all family members with an abnormal electrooculogram and confirmed mutation for vitelliform changes and choroidal neovascularisation from an early age. The decision for anti-vascular endothelial growth factor treatment should be made on a case-to-case basis as complications may arise.
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Affiliation(s)
| | - Rok Sega
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
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9
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Ranjan R, Salian R, Verghese S, Manayath GJ, D'Souza P, Kanakath AV, Shah PK, Saravanan VR, Venkatapathy N. Pediatric choroidal neovascularization: Etiology and treatment outcomes with anti-vascular endothelial growth factors. Eur J Ophthalmol 2021; 32:2355-2367. [PMID: 34615395 DOI: 10.1177/11206721211048799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the etiology and treatment outcomes of choroidal neovascularization (CNV) in a pediatric population with intravitreal anti-vascular endothelial growth factors (VEGF). METHODS Retrospective single center interventional case series. A total of 26 eyes of 23 consecutive pediatric patients with CNV of various etiologies were treated with intravitreal injection of anti-VEGF agents. RESULTS There were 15 males (65.2%) and eight females (34.8%), diagnosed with CNV during the study period. The mean age at presentation with CNV was 11.7 ± 3.3 years, (range 4-16 years) and the mean follow was 28.1 ± 18 months, (range 8-72 months). Inflammatory CNV was the most common etiology. The mean best corrected visual acuity (BCVA) and mean central macular thickness (CMT) at presentation, were logMAR 0.8 ± 0.3 and 367.6 ± 134.8 µm respectively. At the final visit, CNV in all eyes remained regressed with significant improvement in mean BCVA to logMAR 0.4 ± 0.4 (p < 0.0001) and mean CMT to 242.5 ± 82.4 µm (p < 0.0001). A mean of two intravitreal injections per eye was required for CNV regression. CONCLUSION Intravitreal anti-VEGF therapy for pediatric CNV is an effective treatment in majority of affected eyes.
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Affiliation(s)
- Ratnesh Ranjan
- Department of Retina and Vitreous services, Aravind Eye Hospital, Coimbatore, India
| | - Romit Salian
- Department of Retina and Vitreous services, Aravind Eye Hospital, Coimbatore, India
| | - Shishir Verghese
- Department of Retina and Vitreous services, Aravind Eye Hospital, Coimbatore, India
| | - George J Manayath
- Department of Retina and Vitreous services, Aravind Eye Hospital, Coimbatore, India
| | - Palmeera D'Souza
- Department of Retina and Vitreous services, Aravind Eye Hospital, Coimbatore, India
| | | | - Parag K Shah
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Coimbatore, India
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10
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Lejoyeux R, Benillouche J, Ong J, Errera MH, Rossi EA, Singh SR, Dansingani KK, da Silva S, Sinha D, Sahel JA, Freund KB, Sadda SR, Lutty GA, Chhablani J. Choriocapillaris: Fundamentals and advancements. Prog Retin Eye Res 2021; 87:100997. [PMID: 34293477 DOI: 10.1016/j.preteyeres.2021.100997] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 12/19/2022]
Abstract
The choriocapillaris is the innermost structure of the choroid that directly nourishes the retinal pigment epithelium and photoreceptors. This article provides an overview of its hemovasculogenesis development to achieve its final architecture as a lobular vasculature, and also summarizes the current histological and molecular knowledge about choriocapillaris and its dysfunction. After describing the existing state-of-the-art tools to image the choriocapillaris, we report the findings in the choriocapillaris encountered in the most frequent retinochoroidal diseases including vascular diseases, inflammatory diseases, myopia, pachychoroid disease spectrum disorders, and glaucoma. The final section focuses on the development of imaging technology to optimize visualization of the choriocapillaris as well as current treatments of retinochoroidal disorders that specifically target the choriocapillaris. We conclude the article with pertinent unanswered questions and future directions in research for the choriocapillaris.
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Affiliation(s)
| | | | - Joshua Ong
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Marie-Hélène Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15213, USA
| | - Sumit R Singh
- Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, San Diego, CA, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Susana da Silva
- Department of Ophthalmology and Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Debasish Sinha
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Cell Biology and Center for Biologic Imaging, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - José-Alain Sahel
- Rothschild Foundation, 75019, Paris, France; Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France; CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, Paris, France
| | - K Bailey Freund
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University of Medicine, New York, NY, USA; Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, 90033, USA; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gerard A Lutty
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, 21287, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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11
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Menteş J, Barış ME. Multimodal Imaging Characteristics of Quiescent Type 1 Neovascularization in Best Vitelliform Macular Dystrophy. Turk J Ophthalmol 2021; 51:188-191. [PMID: 34187158 PMCID: PMC8251673 DOI: 10.4274/tjo.galenos.2021.61789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/13/2021] [Indexed: 12/01/2022] Open
Abstract
This case report of a 38-year-old man with bilateral Best vitelliform macular dystrophy (BVMD) presents bilateral quiescent type 1 neovascularizations (NV) detected by optical coherence angiography (OCTA) and their multimodal imaging characteristics. It was emphasized that this kind of quiescent and asymptomatic NV may be present in nearly every stage of BVMD and it was concluded that OCTA is a noninvasive, easy, and rapid method that is superior to other imaging methods in detecting them.
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Affiliation(s)
- Jale Menteş
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Mine Esen Barış
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
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12
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OCT angiography for the diagnosis and management of choroidal neovascularization secondary to choroideremia. Am J Ophthalmol Case Rep 2021; 22:101042. [PMID: 33681533 PMCID: PMC7930354 DOI: 10.1016/j.ajoc.2021.101042] [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: 10/01/2020] [Revised: 01/11/2021] [Accepted: 02/21/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose To describe the multimodal imaging findings and treatment outcomes in choroidal neovascularization secondary to Choroideremia. Observations A 13-year-old male presented with reduced visual acuity in the left eye. He gave a history of nyctalopia. His best-corrected visual acuity (BCVA) was 20/20 in the right eye and 20/40 in the left eye. Based on multimodal imaging, the diagnosis of choroideremia in both eyes with a subfoveal choroidal neovascularization in the left eye was made. He underwent five intravitreal anti-vascular endothelial growth factor (VEGF) injections of Ranibizumab over a period of 3 years, with the final injection given due to recurrence of neovascularization. Post-treatment, his BCVA improved to 20/20 in the left eye with regression of the neovascular network. Conclusions and importance This case highlights the role of OCTA in diagnosis of choroidal neovascularization in choroideremia as well as its successful management with anti-VEGF injections with long term follow up.
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Moreira-Neto CA, Lima LH, Zett C, Pereira R, Moreira C. En-face OCT and OCT angiography analysis of macular choroidal macrovessel. Am J Ophthalmol Case Rep 2021; 21:101012. [PMID: 33490717 PMCID: PMC7811033 DOI: 10.1016/j.ajoc.2021.101012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/02/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose To analyze en-face optical coherence tomography (OCT) and decorrelation signals on OCT angiography (OCTA) in two cases of macular choroidal macrovessel (MCM). Observations Case report. Both the 64-year-old and 71-year-old females presented for a routine evaluation, and multimodal imaging analysis, including color fundus photography, indocyanine green angiography (ICG), spectral-domain optical coherence tomography (SD-OCT) and OCTA, was performed to diagnose a MCM. En-face OCT, en-face OCTA and decorrelation signals were analyzed through the MCM. In both reported cases, color fundus photograph revealed a serpiginoid lesion in the temporal macula. Red-free imaging enhanced the appearance of this lesion resembling a dilated choroidal vessel. Cross-sectional OCT showed an enlarged choroidal vessel causing elevation of the retinal pigment epithelium (RPE) within the fovea. En-face OCTA with segmentation below the choriocapillaris enhanced the MCM delineation. En-face OCT with segmentation below the choriocapillaris showed MCM with a greater distinctness than the en-face OCTA imaging. Decorrelation signals were not observed within MCM on cross-sectional OCTA. Conclusion and importance En-face OCT and decorrelation signals on OCTA may have diagnostic value in distinguishing macular choroidal macrovessel from other choroidal vascular diseases.
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Affiliation(s)
| | - Luiz H Lima
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Claudio Zett
- Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
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14
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Parodi MB, Arrigo A, Bandello F. Optical Coherence Tomography Angiography Quantitative Assessment of Macular Neovascularization in Best Vitelliform Macular Dystrophy. Invest Ophthalmol Vis Sci 2021; 61:61. [PMID: 32602906 PMCID: PMC7415901 DOI: 10.1167/iovs.61.6.61] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To describe quantitative characteristics of macular neovascularization (MNV) in vitelliform macular dystrophy (VMD) patients by means of optical coherence tomography angiography (OCTA). Methods The study design was a prospective case series. All patients underwent complete ophthalmologic assessment, optical coherence tomography, and OCTA. The quantitative OCTA parameters examined included vessel tortuosity and vessel dispersion of the MNV. The primary outcome was OCTA characterization of MNV in VMD. Secondary outcomes included the evolution of MNV over the follow-up. Results A total of 78 eyes were recruited for the study. MNV was identified in 50 eyes (64%) at baseline and in 51 eyes (65%) at the end of the follow-up (mean follow-up, 24.7 ± 9.7 months). MNV was detected in four out of the 30 eyes classified as stages 2 and 3 (13%), showing exudative manifestations and undergoing ranibizumab treatment, leading to clinical stabilization. OCTA detected MNV in 46 out of 48 eyes (96%) classified as stages 4 and 5, showing no evidence of exudative manifestation. All of the non-exudative MNVs were merely observed over the follow-up and received no treatment. At the end of the follow-up, 47 out of 48 eyes displayed MNV (98%). Non-exudative MNVs remained stable over the follow-up. Statistically significant differences were found when comparing vessel tortuosity and vessel dispersion in the two MNV subforms. Conclusions VMD is characterized by two MNV subforms. Exudative MNV is rare and may develop in the early stages of the disease, in association with bleeding and fluid formation. Non-exudative MNV develops very commonly in the advanced stage of VMD, without any exudative manifestation.
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Stattin M, Ahmed D, Glittenberg C, Krebs I, Ansari-Shahrezaei S. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FOR THE DETECTION OF SECONDARY CHOROIDAL NEOVASCULARIZATION IN VITELLIFORM MACULAR DYSTROPHY. Retin Cases Brief Rep 2020; 14:49-52. [PMID: 28817420 DOI: 10.1097/icb.0000000000000626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Optical coherence tomography angiography (OCTA) is used to assess vascular abnormality in advanced stage vitelliform macular dystrophy (VMD2). METHODS Multimodal imaging including spectral domain (SD) OCT, autofluorescence (AF), fluorescein (FA) and indocyanine green angiography (ICGA) as well as optical coherence tomography angiography were performed. PATIENTS Two eyes in one young patient with diagnosed vitelliform macular dystrophy were investigated for progressive visual dysfunction. RESULTS Optical coherence tomography angiography identified neovascular formation within the outer retina and the choriocapillaris respectively while all other imaging methods were inconclusive. CONCLUSION Optical coherence tomography angiography was superior to conventional angiography in the detection of choroidal neovascularization (CNV) in advanced retinal disorders like vitelliform macular dystrophy.
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Affiliation(s)
- Martin Stattin
- Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria
- Department of Ophthalmology, Rudolf Foundation Hospital, Juchgasse, Vienna, Austria
| | - Daniel Ahmed
- Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria
- Department of Ophthalmology, Rudolf Foundation Hospital, Juchgasse, Vienna, Austria
| | - Carl Glittenberg
- Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria
- Topcon Europe Medical BV, Essebaan, Capelle aan den IJssel, Netherlands; and
| | - Ilse Krebs
- Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria
- Department of Ophthalmology, Rudolf Foundation Hospital, Juchgasse, Vienna, Austria
| | - Siamak Ansari-Shahrezaei
- Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria
- Department of Ophthalmology, Rudolf Foundation Hospital, Juchgasse, Vienna, Austria
- Department of Ophthalmology, Medical University of Graz, Graz, Auenbruggerplatz, Austria
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16
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Batıoğlu F, Yanık Ö, Demirel S, Çağlar Ç, Özmert E. A Case of Best Disease Accompanied by Pachychoroid Neovasculopathy. Turk J Ophthalmol 2019; 49:226-229. [PMID: 31486612 PMCID: PMC6761379 DOI: 10.4274/tjo.galenos.2019.38073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The aim of this case presentation is to describe ocular findings of a 22-year-old patient with Best vitelliform macular dystrophy accompanied by pachychoroid neovasculopathy. Color fundus photography, fundus autofluorescence (FAF), optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) images were reviewed. Fundoscopic examination showed bilateral yellowish vitelliform-like submacular deposits. FAF revealed these deposits as hyperautofluorescent spots. OCT showed flat irregular pigment epithelial detachments corresponding to these submacular deposits. OCT showed choroidal thickening and dilatation of the large outer oval choroidal vessels. Fundus fluorescein angiography could not be performed because the patient was pregnant. En face OCTA images of the choriocapillaris illustrated the choroidal neovascular network. In this case report, we describe for the first time the coexistence of Best vitelliform macular dystrophy and pachychoroid neovasculopathy with OCTA images enabling visualization of the neovascular network in a patient with contraindication for fluorescein angiography.
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Affiliation(s)
- Figen Batıoğlu
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Özge Yanık
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Sibel Demirel
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Çağatay Çağlar
- Hitit University Faculty of Medicine, Department of Ophthalmology, Çorum, Turkey
| | - Emin Özmert
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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17
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Ong SS, Patel TP, Singh MS. Optical Coherence Tomography Angiography Imaging in Inherited Retinal Diseases. J Clin Med 2019; 8:jcm8122078. [PMID: 31795241 PMCID: PMC6947168 DOI: 10.3390/jcm8122078] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/20/2019] [Indexed: 12/25/2022] Open
Abstract
Optical coherence tomography angiography (OCTA) is a novel, noninvasive imaging modality that allows depth-resolved imaging of the microvasculature in the retina and the choroid. It is a powerful research tool to study the pathobiology of retinal diseases, including inherited retinal dystrophies. In this review, we provide an overview of the evolution of OCTA technology, compare the specifications of various OCTA devices, and summarize key findings from published OCTA studies in inherited retinal dystrophies including retinitis pigmentosa, Stargardt disease, Best vitelliform macular dystrophy, and choroideremia. OCTA imaging has provided new data on characteristics of these conditions and has contributed to a deeper understanding of inherited retinal disease.
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18
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Brambati M, Borrelli E, Sacconi R, Bandello F, Querques G. Choroideremia: Update On Clinical Features And Emerging Treatments. Clin Ophthalmol 2019; 13:2225-2231. [PMID: 31819346 PMCID: PMC6874149 DOI: 10.2147/opth.s195564] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022] Open
Abstract
Choroideremia (CHM) is an X-linked chorioretinal dystrophy characterized by progressive degeneration of the choroid, retinal pigment epithelium and retina. This disease is caused by mutations in the X-linked CHM gene encoding a Ras-related GTPase Rab escort protein (REP)-1, which is extremely important for the retinal function. Clinically, male-affected patients have a progressive reduction in visual acuity. This disease is formally considered incurable, although new promising treatments have been recently introduced. In this article, a review of the salient pathogenetic features of choroideremia, essential for the proper interpretation of therapeutic approaches, is followed by a discussion of the fundamental clinical features of this hereditary disease. Finally, relevant new therapeutic approaches in this disease will be discussed, including gene therapy, stem cells, small molecules, and retinal prosthesis.
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Affiliation(s)
- Maria Brambati
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Enrico Borrelli
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Riccardo Sacconi
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Francesco Bandello
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Giuseppe Querques
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
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19
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Philip S, Xu X, Laud KG, Sengillo JD, Tsang SH, Yannuzzi LA. Choroidal neovascularization in an adolescent with RDH12-associated retinal degeneration. Ophthalmic Genet 2019; 40:362-364. [PMID: 31424981 DOI: 10.1080/13816810.2019.1655770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Leber congenital amaurosis (LCA) due to RDH12 mutations typically manifests with severe vision loss and panretinal dystrophy. We sought to describe a case of LCA with choroidal neovascularization (CNV) in a 17-year-old patient. Materials and Methods: Case report of a 17-year old with LCA who presented with acute central vision loss of the right eye in the context of a chronic retinal dystrophy. Multimodal retinal imaging including spectral-domain optical coherence tomography and indocyanine green angiography revealed CNV. Results: A 17-year-old boy with previously diagnosed LCA/early-onset retinal dystrophy (EOSRD), with subsequently identified biallelic mutations in RDH12 was found to have type 2 CNV. Patient was treated with intravitreal ranibizumab and exhibited improvement on follow-up exam. Conclusions: Choroidal neovascularization may be a unique occurrence in RDH12-associated retinal dystrophy. Successful treatment of the neovascularization could be accomplished with intravitreal antivasogenic therapy.
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Affiliation(s)
- Shawn Philip
- Vitreous Retina Macula Consultants of New York , New York , New York , USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital , New York , New York , USA.,Lake Erie College of Osteopathic Medicine , Erie , Pennsylvania , USA
| | - Xiaoyu Xu
- Vitreous Retina Macula Consultants of New York , New York , New York , USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital , New York , New York , USA.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guanghzhou , China
| | - Ketan G Laud
- Ophthalmic Consultants of Long Island , Lynbrook , New York , USA
| | - Jesse D Sengillo
- Department of Medicine, Reading Hospital of Tower Health , West Reading , Pennsylvania , USA
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University , New York , New York , USA.,Jonas Children's Vision Care, and Bernard & Shirlee Brown Glaucoma Laboratory , New York , New York , USA
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York , New York , New York , USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital , New York , New York , USA
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20
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Chen RC, Traboulsi EI, Rachitskaya A. Chronic Choroidal Neovascular Membrane in Choroideremia Treated With Intravitreal Bevacizumab. Ophthalmic Surg Lasers Imaging Retina 2019; 50:e188-e192. [DOI: 10.3928/23258160-20190605-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 01/03/2019] [Indexed: 11/20/2022]
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21
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Murro V, Mucciolo DP, Giorgio D, Sodi A, Passerini I, Virgili G, Rizzo S. Optical Coherence Tomography Angiography (OCT-A) in young choroideremia (CHM) patients. Ophthalmic Genet 2019; 40:201-206. [DOI: 10.1080/13816810.2019.1611880] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Vittoria Murro
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Dario Pasquale Mucciolo
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Dario Giorgio
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Andrea Sodi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Ilaria Passerini
- Department of Genetic Diagnosis, Careggi Teaching Hospital, Florence, Italy
| | - Gianni Virgili
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Stanislao Rizzo
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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22
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Li H, Ding X, Lu L, Yang J, Ma J. Morphometry of the normal retinal periarteral capillary-free zone and changes during severe nonproliferative diabetic retinopathy. Clin Hemorheol Microcirc 2019; 72:169-178. [PMID: 30829616 DOI: 10.3233/ch-180458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To explore the normal morphological features of the retinal periarteral capillary free zone (paCFZ) and the changes associated with severe non-proliferative diabetic retinopathy (NPDR) by optical coherence tomography angiography (OCTA). METHODS A total of 148 normal subjects and 115 patients with severe NPDR were enrolled. Spectral-domain OCTA was used to acquire the image with a Cirrus prototype. Diameter and area of each paCFZ quadrant and adjacent large artery diameter was estimated. RESULTS In healthy subjects, the maximum width of paCFZ in the temporal quadrant (169.38 ± 19.26 μm) was smaller than the other three quadrants (all P <0.001). The ratio of maximum paCFZ width to artery caliber was much larger in the nasal quadrants than the rest quadrants (Ps <0.05). In patients with severe NPDR, both maximum width and area of paCFZ were significant larger, and the retinal artery inner diameters significant smaller in each quadrant compared to normal subjects (Ps <0.05). The ratio of paCFZ maximum width to artery caliber maximum width was significant greater, and the ratio of paCFZ area to artery caliber was significantly higher in all quadrants compared to normal eyes (Ps <0.05). CONCLUSIONS OCTA provides noninvasive and quantitative measurement of paCFZ dimensions. The maximum width and area of paCFZ quadrants and the ratios of these parameters to adjacent inner artery width and area are elevated in severe NPDR, suggesting that changes in paCFZ dimension can be used as clinical indices for diseases associated with changes in retinal microcirculation and oxygen pressure.PRÉCIS:Optical coherence tomography angiography revealed differences in retinal periarteral capillary free zone (paCFZ) morphometry between health retina and severe non-proliferative diabetic retinopathy. Morphometric indices of paCFZ may be useful for monitoring disease occurrence and progression.
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Affiliation(s)
- H Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - X Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - L Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - J Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - J Ma
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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23
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Jung JU, Kim YM, Kang YK, Park DH, Shin JP. Choroidal Neovascularization in a Patient with Best Disease. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.8.808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jae Uk Jung
- Department of Ophthalmology, Kyungpook National University School of Medicin, Daegu, Korea
| | - Yu Min Kim
- Department of Ophthalmology, Kyungpook National University School of Medicin, Daegu, Korea
| | - Yong Koo Kang
- Department of Ophthalmology, Kyungpook National University School of Medicin, Daegu, Korea
| | - Dong Ho Park
- Department of Ophthalmology, Kyungpook National University School of Medicin, Daegu, Korea
| | - Jae Pil Shin
- Department of Ophthalmology, Kyungpook National University School of Medicin, Daegu, Korea
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Mitsios A, Dubis AM, Moosajee M. Choroideremia: from genetic and clinical phenotyping to gene therapy and future treatments. Ther Adv Ophthalmol 2018; 10:2515841418817490. [PMID: 30627697 PMCID: PMC6311551 DOI: 10.1177/2515841418817490] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/05/2018] [Indexed: 11/15/2022] Open
Abstract
Choroideremia is an X-linked inherited chorioretinal dystrophy leading to blindness by late adulthood. Choroideremia is caused by mutations in the CHM gene which encodes Rab escort protein 1 (REP1), an ubiquitously expressed protein involved in intracellular trafficking and prenylation activity. The exact site of pathogenesis remains unclear but results in degeneration of the photoreceptors, retinal pigment epithelium and choroid. Animal and stem cell models have been used to study the molecular defects in choroideremia and test effectiveness of treatment interventions. Natural history studies of choroideremia have provided additional insight into the clinical phenotype of the condition and prepared the way for clinical trials aiming to investigate the safety and efficacy of suitable therapies. In this review, we provide a summary of the current knowledge on the genetics, pathophysiology, clinical features and therapeutic strategies that might become available for choroideremia in the future, including gene therapy, stem cell treatment and small-molecule drugs with nonsense suppression action.
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Affiliation(s)
- Andreas Mitsios
- Institute of Ophthalmology, University College London, London, UK
| | - Adam M Dubis
- Institute of Ophthalmology, University College London, London, UK
| | - Mariya Moosajee
- Institute of Ophthalmology, University College London, London, UK
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25
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Bertoli F, Pignatto S, Rizzetto F, Lanzetta P. A 5-Year-Old Case of Choroidal Neovascularization in Enhanced S-Cone Syndrome Treated with Ranibizumab. Case Rep Ophthalmol 2018; 9:510-515. [PMID: 30687072 PMCID: PMC6341371 DOI: 10.1159/000495743] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/25/2018] [Indexed: 12/01/2022] Open
Abstract
Introduction We describe the youngest case of enhanced S-cone syndrome (ESCS) associated with choroidal neovascularization (CNV) successfully treated with intravitreal ranibizumab injections. Case Report A 5-year-old boy presented with round-shaped fibrotic subretinal lesions in both eyes with surrounding subretinal fluid and progressive visual deterioration in the right eye. Fine foci of increased autofluorescence were observed along the arcades in both eyes. Fluorescein angiography revealed the presence of CNV in his right eye, and treatment with ranibizumab was initiated, with significant improvement in vision. Subsequent electroretinogram examination and genetic studies of the patient and his two younger siblings confirmed the diagnosis of ESCS. Conclusion CNV has been reported to occur in different inherited retinal degenerations, including ESCS. Our experience confirms that treatment with ranibizumab in patients with CNV-complicated ESCS can be potentially vision-saving.
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Affiliation(s)
- Federica Bertoli
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy.,Scientific Institute I.R.C.C.S. "Eugenio Medea" - "La Nostra Famiglia", Udine, Italy
| | - Silvia Pignatto
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | - Francesca Rizzetto
- Division of Ophthalmology, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
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26
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Murro V, Mucciolo DP, Giorgio D, Sodi A, Passerini I, Virgili G, Rizzo S. OCTA Imaging of Choroidal Neovascularization Treated Using Photodynamic Therapy in a Young Patient With Best Macular Dystrophy. Ophthalmic Surg Lasers Imaging Retina 2018; 49:969-973. [DOI: 10.3928/23258160-20181203-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 11/02/2018] [Indexed: 11/20/2022]
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27
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Singh SR, Vupparaboina KK, Goud A, Dansingani KK, Chhablani J. Choroidal imaging biomarkers. Surv Ophthalmol 2018; 64:312-333. [PMID: 30496750 DOI: 10.1016/j.survophthal.2018.11.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 12/22/2022]
Abstract
The choroid is the vascular coat of the eye, and its role has been studied in multiple chorioretinal disorders. Recent advancements in choroidal imaging techniques, including enhanced depth imaging optical coherence tomography, swept source optical coherence tomography, en face optical coherence tomography, and optical coherence tomography angiography have facilitated an in-depth analysis of the choroid. The gradual shift from manual to automated segmentation and binarization methods have led to precise and reproducible measurements of choroidal parameters. These qualitative and quantitative parameters, called choroidal imaging biomarkers, have evolved over the past decade from a simple linear subfoveal choroidal thickness to more complex 3D choroidal reconstruction, thus widening the spectrum encompassing multiple parameters. These biomarkers have provided a better understanding of the pathogenesis, are helpful in diagnostic dilemmas, and, in the future may also help to devise treatment options. The lack of normative data, absence of standardized parameters, and limitations of the imaging techniques, however, have led to ambiguity and difficulty in the interpretation of these variables. We attempt to address these lacunae in the literature and provide a basic understanding of the choroid in both health and disease using these choroidal biomarkers.
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Affiliation(s)
- Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India; Retina and Uveitis Department, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Kiran Kumar Vupparaboina
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Abhilash Goud
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India.
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Borrelli E, Sarraf D, Freund KB, Sadda SR. OCT angiography and evaluation of the choroid and choroidal vascular disorders. Prog Retin Eye Res 2018; 67:30-55. [DOI: 10.1016/j.preteyeres.2018.07.002] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 12/31/2022]
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Xue K, MacLaren RE. Ocular gene therapy for choroideremia: clinical trials and future perspectives. EXPERT REVIEW OF OPHTHALMOLOGY 2018; 13:129-138. [PMID: 31105764 DOI: 10.1080/17469899.2018.1475232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Introduction Gene therapy offers the potential for targeted replacement of single gene defects in inherited retinal degenerations. Areas covered Choroideremia is an X-linked blinding retinal disease resulting from deficiency of the CHM gene product, REP1. The disease represents an ideal target for retinal gene therapy, as it is readily diagnosed in the clinic, relatively homogenous in phenotype and slow progressing, thereby providing a wide therapeutic window for intervention. Ongoing clinical trials of retinal gene therapy for choroideremia using an adeno-associated viral vector have demonstrated safety and early efficacy. We review the clinical characteristics of the disease with a view to interpreting the findings of gene therapy clinical trials and discuss future directions. Expert commentary Choroideremia gene therapy has so far demonstrated good safety profile and early functional visual acuity gains in a proportion of trial participants, which appear to be sustained.
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Affiliation(s)
- Kanmin Xue
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford & Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Robert E MacLaren
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford & Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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30
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Cohen SY, Miere A, Nghiem-Buffet S, Fajnkuchen F, Souied EH, Mrejen S. Clinical applications of optical coherence tomography angiography: What we have learnt in the first 3 years. Eur J Ophthalmol 2018; 28:491-502. [PMID: 29554812 DOI: 10.1177/1120672117753704] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A review of the literature from 2014 to 2016 was conducted, focusing on the results of optical coherence tomography angiography in different chorioretinal diseases. In only 3 years, optical coherence tomography angiography has been shown to be an effective tool for diagnosing choroidal neovascularization complicating age-related macular degeneration, pathologic myopia, and inflammatory conditions. The technique has sometimes been considered superior to conventional multimodal imaging, for example, in choroidal neovascularization associated with chronic central serous chorioretinopathy or multifocal choroiditis. In retinal vascular diseases, optical coherence tomography angiography has helped to understand the condition described as paracentral acute middle maculopathy and has been considered highly effective for the analysis of retinal vascular macular changes secondary to retinal vein occlusion or macular telangiectasia. Changes in the foveal avascular zone, also reported in diabetic maculopathy, have been shown to occur before any angiographic signs. A reduction in capillary vascular density has been reported in the fovea of eyes with malignant melanoma, but not in eyes with choroidal nevus. However, optical coherence tomography angiography is a recent technique that probably needs refinements and further studies. Nevertheless, the first 3 years of optical coherence tomography angiography use suggest its clinical relevance and useful applications in daily clinical practice.
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Affiliation(s)
- Salomon Y Cohen
- 1 Ophthalmological Center for Imaging and Laser, Paris, France.,2 Department of Ophthalmology, University of Paris-Est, Creteil, France
| | - Alexandra Miere
- 2 Department of Ophthalmology, University of Paris-Est, Creteil, France
| | | | | | - Eric H Souied
- 2 Department of Ophthalmology, University of Paris-Est, Creteil, France
| | - Sarah Mrejen
- 1 Ophthalmological Center for Imaging and Laser, Paris, France
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31
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Retinal Vascular Impairment in Best Vitelliform Macular Dystrophy Assessed by Means of Optical Coherence Tomography Angiography. Am J Ophthalmol 2018; 187:61-70. [PMID: 29288639 DOI: 10.1016/j.ajo.2017.12.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/13/2017] [Accepted: 12/15/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate vascular abnormalities at superficial (SCP) and deep (DCP) capillary plexuses and choriocapillaris (CC) in patients with Best vitelliform macular dystrophy (BVMD) by means of optical coherence tomography angiography (OCT-A). DESIGN Cross-sectional case series. METHODS Sixty-six eyes of 33 patients with BVMD (16 male) and 33 controls were consecutively enrolled. Patients were subdivided into classic stages and underwent best-corrected visual acuity (BCVA), fundus autofluorescence and spectral domain-optical coherence tomography, and 4.5 × 4.5-mm swept-source OCT-A. Choroidal neovascularization (CNV) and capillary dilations were qualitatively assessed by 2 masked ophthalmologists. Each OCT-A slab was imported into ImageJ 1.50 and digitally binarized for quantitative analyses. Foveal avascular zone (FAZ) area was measured manually; vessel density was then quantified after the exclusion of the FAZ pixels. Eyes classified as stages 3 and 4 were evaluated together. RESULTS Nineteen eyes (28.8%) revealed capillary dilations at DCP, 15 of which were in stages 1 and 2. Interestingly, CNV was detected in 24 eyes (36.4%). Quantitative analysis disclosed that stages 3-4 and 5 carry significant impairment at both SCP (P < .0001 and P = .02, respectively) and DCP (P < .0001 and P = .0004, respectively) compared to controls. FAZ area was enlarged at the DCP (P = .001). Only DCP vessel density significantly correlated with the stage and BCVA. CONCLUSIONS Patients with BVMD show significant vascular impairment at both superficial and deep retinal plexuses, correlating with functional outcomes. These findings, especially at DCP, may improve our understanding about the pathogenesis, and may help in predicting BVMD treatment efficacy.
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Hagag AM, Gao SS, Jia Y, Huang D. Optical coherence tomography angiography: Technical principles and clinical applications in ophthalmology. Taiwan J Ophthalmol 2017; 7:115-129. [PMID: 28966909 PMCID: PMC5617355 DOI: 10.4103/tjo.tjo_31_17] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Optical coherence tomography angiography (OCTA) is a functional extension of OCT that provides information on retinal and choroidal circulations without the need for dye injections. With the recent development of high-speed OCT systems and efficient algorithms, OCTA has become clinically feasible. In this review article, we discuss the technical principles of OCTA, including image processing and artifacts, and its clinical applications in ophthalmology. We summarize recent studies which qualitatively or quantitatively assess disease presentation, progression, and/or response to treatment.
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Affiliation(s)
- Ahmed M Hagag
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Simon S Gao
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Yali Jia
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - David Huang
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
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Khan HA, Mehmood A, Khan QA, Iqbal F, Rasheed F, Khan N, Pizzimenti JJ. A major review of optical coherence tomography angiography. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1356229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Hashim Ali Khan
- Ophthalmology, SEHHAT Foundation Hospital, Main KKH, Danyore, Gilgit, Pakistan
| | - Asim Mehmood
- Ophthalmology, Multan Medical & Dental College, Multan, Pakistan
| | - Qaim Ali Khan
- Ophthalmology, Poonch Medical College, AJK, Pakistan
| | - Fatima Iqbal
- School of Optometry, The University of Faisalabad, Faisalabad, Pakistan
| | - Faisal Rasheed
- Ophthalmology, Sheikh Zayd Medical College, Rahim Yar Khan, Pakistan
| | - Naeemullah Khan
- Ophthalmology, SEHHAT Foundation Hospital, Main KKH, Danyore, Gilgit, Pakistan
| | - Joseph J. Pizzimenti
- Rosenberg School of Optometry, University of the Incarte Word, San Antonio, TX, USA
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