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Sun G, Wang X, Yi Z, Su Y, He L, Zheng H, Chen C. RELATIONSHIP BETWEEN RETINAL HEMORRHAGE ON GREEN AND RED CHANNELS OF ULTRA-WIDEFIELD FUNDUS IMAGES AND RETINAL PERFUSION IN ACUTE BRANCH RETINAL VEIN OCCLUSION. Retina 2024; 44:887-894. [PMID: 38165995 DOI: 10.1097/iae.0000000000004030] [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: 01/04/2024]
Abstract
PURPOSE To explore the relationship between retinal hemorrhage in the green and red channels on ultra-widefield fundus images and the nonperfusion area (NPA) on ultra-widefield fundus fluorescein angiography in patients with acute branch retinal vein occlusion (BRVO). METHODS This was a retrospective cross-sectional study with 96 patients, including 46 with ischemic BRVO and 50 with nonischemic BRVO. Correlation analysis between green channel hemorrhage (GCH), red channel hemorrhage (RCH), and NPA was performed. Panretina was divided into posterior and peripheral areas. RESULTS Ischemic BRVO showed significantly higher GCH% and RCH% than nonischemic BRVO in the peripheral regions (both P < 0.001), whereas no significant differences were observed in the panretinal and posterior areas (all P > 0.05). Significant correlations were found between NPA% in the panretinal and peripheral areas and the corresponding GCH% and RCH% (all P < 0.01). However, no significant correlation was observed between posterior NPA% and posterior GCH% or RCH% (both P > 0.05). In addition, peripheral GCH% and RCH% were related to panretinal NPA% (r = 0.506, P < 0.001; r = 0.558, P < 0.001). CONCLUSION Retinal hemorrhage on ultra-widefield fundus image was significantly associated with NPA, providing insights for assessing retinal perfusion status in acute BRVO patients.
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Affiliation(s)
- Gongpeng Sun
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China ; and
| | - Xiaoling Wang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China ; and
| | - Zuohuizi Yi
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China ; and
| | - Yu Su
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China ; and
| | - Lu He
- Physical Examination Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongmei Zheng
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China ; and
| | - Changzheng Chen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China ; and
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Haddad C, Baleine M, Motulsky E. An OCT-A Analysis of the Importance of Intermediate Capillary Plexus in Diabetic Retinopathy: A Brief Review. J Clin Med 2024; 13:2516. [PMID: 38731048 PMCID: PMC11084716 DOI: 10.3390/jcm13092516] [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: 02/15/2024] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Optical coherence tomography-angiography is a technique that allows us to non-invasively study in vivo the different retinal vascular networks. This allows a deeper understanding of retinal capillary anatomy and function, in addition to the pathophysiologic changes encountered in diverse diseases. The four retinal capillary layers have different anatomies and functions, implying distinct adaptation and roles in the course of the diseases. Diabetic retinopathy is the leading cause of blindness in working-age adults. Several studies have evaluated how each retinal capillary layer is specifically affected according to the stage of the disease. Unfortunately, too few studies have considered the intermediate capillary plexus as a separate layer, as it has often been incorporated in another layer. In this review, we shed light on the potential role the intermediate capillary plexus plays in the physiopathology of diabetic retinal disease as well as its potential use in grading diabetic retinopathy and its clinical added value in estimating the disease prognosis.
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Affiliation(s)
| | | | - Elie Motulsky
- Department of Ophthalmology, Hôpital Universitaire de Bruxelles, Erasme Hospital, 1070 Brussels, Belgium; (C.H.); (M.B.)
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Neriyanuri S, Bedggood P, Symons RCA, Metha A. Mapping the human parafoveal vascular network to understand flow variability in capillaries. PLoS One 2023; 18:e0292962. [PMID: 37831712 PMCID: PMC10575526 DOI: 10.1371/journal.pone.0292962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Capillary flow is known to be non-homogenous between vessels and variable over time, for reasons that are poorly understood. The local properties of individual vessels have been shown to have limited explanatory power in this regard. This exploratory study investigates the association of network-level properties such as vessel depth, branch order, and distance from the feeding arteriole with capillary flow. Detailed network connectivity analysis was undertaken in 3 healthy young subjects using flood-illuminated adaptive optics retinal imaging, with axial depth of vessels determined via optical coherence tomography angiography. Forty-one out of 70 vessels studied were of terminal capillary type, i.e. fed from an arterial junction and drained by a venous junction. Approximately half of vessel junctions were amenable to fitting with a model of relative branch diameters, with only a few adhering to Murray's Law. A key parameter of the model (the junction exponent) was found to be inversely related to the average velocity (r = -0.59, p = 0.015) and trough velocity (r = -0.67, p = 0.004) in downstream vessels. Aspects of cellular flow, such as the minimum velocity, were also moderately correlated (r = 0.46, p = 0.009) with distance to the upstream feeding arteriole. Overall, this study shows that capillary network topology contributes significantly to the flow variability in retinal capillaries in human eyes. Understanding the heterogeneity in capillary flow is an important first step before pathological flow states can be properly understood. These results show that flow within capillary vessels is not affected by vessel depths but significantly influenced by the upstream feeder distance as well as the downstream vessel junction exponents, but there remains much to be uncovered regarding healthy capillary flow.
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Affiliation(s)
- Srividya Neriyanuri
- Department of Optometry and Vision Sciences, The University of Melbourne, Victoria, Australia
| | - Phillip Bedggood
- Department of Optometry and Vision Sciences, The University of Melbourne, Victoria, Australia
| | - R. C. Andrew Symons
- Department of Optometry and Vision Sciences, The University of Melbourne, Victoria, Australia
- Department of Surgery, The University of Melbourne, Victoria, Australia
- Centre for Eye Research Australia, Victoria, Australia
- Department of Surgery, Alfred Hospital, Monash University, Victoria, Australia
| | - Andrew Metha
- Department of Optometry and Vision Sciences, The University of Melbourne, Victoria, Australia
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Riazi-Esfahani H, Ebrahimiadib N, Hamzeh N, Fadakar K, Khalili Pour E. Henle fiber layer hemorrhage associated with combined central retinal vein occlusion and cilioretinal artery occlusion: a case report. J Med Case Rep 2023; 17:355. [PMID: 37598197 PMCID: PMC10440029 DOI: 10.1186/s13256-023-04100-y] [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: 03/07/2022] [Accepted: 07/24/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND The purpose of this study is to describe a patient who experienced simultaneous central retinal vein and cilioretinal artery occlusions, as well as perifoveal hemorrhage in the Henle fiber. CASE PRESENTATION A 67-year-old Iranian woman presented with a 3-day history of reduced vision in her left eye. Venous tortuosity and retinal hemorrhage were observed in the retina, together with whitened regions around the fovea, consistent with the diagnosis of central retinal vein occlusion in conjunction with cilioretinal artery occlusion. In structural and en face optical coherence tomography, star-shaped hemorrhages were observed around the fovea, which looked hyperreflective in the Henle fiber layer. CONCLUSIONS We present a case of central retinal vein occlusion exacerbated by cilioretinal occlusion and hemorrhage in the Henle fiber layer. The hemorrhage is most likely the result of increased intraluminal pressure in the deep capillary plexus.
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Affiliation(s)
- Hamid Riazi-Esfahani
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran
| | - Nikoo Hamzeh
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran
| | - Kaveh Fadakar
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran
| | - Elias Khalili Pour
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran.
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McAllister IL, Smithies LA, Chen FK, Mackey DA, Sanfilippo PG. Benefits of a Laser Chorioretinal Anastomosis Plus Ranibizumab vs Ranibizumab Alone for Central Retinal Vein Occlusion: 4-Year Results. Am J Ophthalmol 2023; 252:101-110. [PMID: 37030494 DOI: 10.1016/j.ajo.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE To evaluate what clinical gains can be achieved over conventional treatment with ranibizumab alone for central retinal vein occlusion (CRVO) when causal pathology is additionally addressed successfully with a laser-induced chorio-retinal anastomosis (L-CRA). DESIGN Two-year extension of prospective, randomized controlled clinical trial. METHODS A total of 58 patients with macular edema secondary to CRVO were randomized 1:1 to receive either an L-CRA (n = 29) or sham procedure (n = 29) at baseline and then monthly intravitreal ranibizumab 0.5 mg. Outcomes (best corrected visual acuity [BCVA], central subfield thickness [CST], injection requirements) were monitored in the monthly pro re nata (PRN) ranibizumab phase from months 7 to 48. RESULTS Injection requirements for patients with a functioning L-CRA (24 of 29) during the monthly PRN period from 7 to 24 months were a mean (95% CI) of 2.18 (1.57, 2.78) injections compared to 7.07 (6.08, 8.06) (P < .0001) for control (ranibizumab alone). These decreased further over the next 2 years to 0.29 (0.14, 0.61) compared to 2.20 (1.68, 2.88) (P < .001) for the third year and 0.25 (0.11, 0.56) and 1.84 (1.34, 2.54) for the fourth year (P < .001). Mean BCVA was statistically different at all follow-up time points from month 7 through month 48 for the group with the functioning L-CRA compared to the control monotherapy group. This improved to 14.06 letters at month 48 (P = .009). There was no difference in CST between any of the groups over the 48 months of follow-up. CONCLUSION For CRVO patients, addressing causal pathology in addition to conventional therapy improves BCVA and reduces injection requirements.
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Affiliation(s)
- Ian L McAllister
- From the Centre for Ophthalmology and Visual Science (I.L.M., L.A.S., F.K.C., D.A.M., P.G.S.), Lions Eye Institute, University of Western Australia, Perth, Australia.
| | - Lynne A Smithies
- From the Centre for Ophthalmology and Visual Science (I.L.M., L.A.S., F.K.C., D.A.M., P.G.S.), Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Fred K Chen
- From the Centre for Ophthalmology and Visual Science (I.L.M., L.A.S., F.K.C., D.A.M., P.G.S.), Lions Eye Institute, University of Western Australia, Perth, Australia
| | - David A Mackey
- From the Centre for Ophthalmology and Visual Science (I.L.M., L.A.S., F.K.C., D.A.M., P.G.S.), Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Paul G Sanfilippo
- From the Centre for Ophthalmology and Visual Science (I.L.M., L.A.S., F.K.C., D.A.M., P.G.S.), Lions Eye Institute, University of Western Australia, Perth, Australia; Centre for Eye Research Australia (P.G.S.), University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
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Yang D, Tang Z, Ran A, Nguyen TX, Szeto S, Chan J, Wong CYK, Hui V, Tsang K, Chan CKM, Tham CC, Sivaprasad S, Lai TYY, Cheung CY. Assessment of Parafoveal Diabetic Macular Ischemia on Optical Coherence Tomography Angiography Images to Predict Diabetic Retinal Disease Progression and Visual Acuity Deterioration. JAMA Ophthalmol 2023; 141:641-649. [PMID: 37227703 PMCID: PMC10214181 DOI: 10.1001/jamaophthalmol.2023.1821] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/31/2023] [Indexed: 05/26/2023]
Abstract
Importance The presence of diabetic macular ischemia (DMI) on optical coherence tomography angiography (OCTA) images predicts diabetic retinal disease progression and visual acuity (VA) deterioration, suggesting an OCTA-based DMI evaluation can further enhance diabetic retinopathy (DR) management. Objective To investigate whether an automated binary DMI algorithm using OCTA images provides prognostic value on DR progression, diabetic macular edema (DME) development, and VA deterioration in a cohort of patients with diabetes. Design, Setting, and Participants In this cohort study, DMI assessment of superficial capillary plexus and deep capillary plexus OCTA images was performed by a previously developed deep learning algorithm. The presence of DMI was defined as images exhibiting disruption of fovea avascular zone with or without additional areas of capillary loss, while absence of DMI was defined as images presented with intact fovea avascular zone outline and normal distribution of vasculature. Patients with diabetes were recruited starting in July 2015 and were followed up for at least 4 years. Cox proportional hazards models were used to evaluate the association of the presence of DMI with DR progression, DME development, and VA deterioration. Analysis took place between June and December 2022. Main Outcomes and Measures DR progression, DME development, and VA deterioration. Results A total of 321 eyes from 178 patients were included for analysis (85 [47.75%] female; mean [SD] age, 63.39 [11.04] years). Over a median (IQR) follow-up of 50.41 (48.16-56.48) months, 105 eyes (32.71%) had DR progression, 33 eyes (10.28%) developed DME, and 68 eyes (21.18%) had VA deterioration. Presence of superficial capillary plexus-DMI (hazard ratio [HR], 2.69; 95% CI, 1.64-4.43; P < .001) and deep capillary plexus-DMI (HR, 3.21; 95% CI, 1.94-5.30; P < .001) at baseline were significantly associated with DR progression, whereas presence of deep capillary plexus-DMI was also associated with DME development (HR, 4.60; 95% CI, 1.15-8.20; P = .003) and VA deterioration (HR, 2.12; 95% CI, 1.01-5.22; P = .04) after adjusting for age, duration of diabetes, fasting glucose, glycated hemoglobin, mean arterial blood pressure, DR severity, ganglion cell-inner plexiform layer thickness, axial length, and smoking at baseline. Conclusions and Relevance In this study, the presence of DMI on OCTA images demonstrates prognostic value for DR progression, DME development, and VA deterioration.
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Affiliation(s)
- Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ziqi Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Anran Ran
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Truong X. Nguyen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Simon Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Jason Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Cherie Y. K. Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Vivian Hui
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Ken Tsang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Carmen K. M. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Clement C. Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Timothy Y. Y. Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- 2010 Eye & Cataract Centre, Hong Kong Special Administrative Region, China
| | - Carol Y. Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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Crincoli E, Colantuono D, Miere A, Zhao Z, Ferrara S, Souied EH. Perivenular Capillary Rarefaction in Diabetic Retinopathy: Interdevice Characterization and Association to Clinical Staging. OPHTHALMOLOGY SCIENCE 2023; 3:100269. [PMID: 36875334 PMCID: PMC9978849 DOI: 10.1016/j.xops.2023.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/29/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
Purpose Geometric perfusion deficit (GPD) is a newly described OCT angiography (OCTA) parameter identifying the total area of presumed retinal ischemia. The aim of our study is to characterize differences in GPD and other common quantitative OCTA parameters between macular full field, perivenular zones, and periarteriolar zones for each clinical stage of nonproliferative diabetic retinopathy (DR) and to assess the influence of ultrahigh-speed acquisition and averaging on the described differences. Design Prospective observational study. Participants Forty-nine patients, including 11 (22.4%) with no sign of DR, 12 (24.5%) with mild DR, 13 (26.5%) with moderate DR, and 13 (26.5%) with severe DR. Patients with diabetic macular edema, proliferative DR, media opacity, head tremor, and overlapping retinal diseases or systemic diseases influencing OCTA were excluded. Methods OCT angiography was performed 3 times for each patient: 1 using Solix Fullrange single volume (V1) mode, 1 using Solix Fullrange 4 volumes mode with automatically averaged scan (V4), and 1 using AngioVue. Main Outcome Measures Full macular, periarteriolar, and perivenular perfusion density (PD), vessel length density (VLD), vessel density index, and GPD for both the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Results In patients showing no sign of DR, PD and VLD were significantly lower in the perivenular area in both the DCP and SCP using V1 and V4, whereas GPD was significantly higher in the perivenular zone in the DCP and SCP with all 3 devices. In patients with mild DR, all 3 measurements (PD, VLD, and GPD) were significantly different in the perivenular zone with all 3 devices. In patients with moderate DR, PD and VLD were lower in the DCP and SCP when measured with V1 and V4. Moreover, GPD was higher in the perivenular zone in the DCP with all 3 devices, whereas only V4 detected a difference in the SCP. In severe DR, only V4 detected a lower PD and VLD and a higher GPD in the DCP of the perivenular zone. V4 also detected a higher GPD in the SCP. Conclusions Geometric perfusion deficit highlights prevalent perivenular location of macular capillary ischemia in all stages of DR. In severe DR patients, only averaging technology allows detection of the same finding. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Key Words
- Capillary ischemia
- DCP, deep capillary plexus
- DR, diabetic retinopathy
- Diabetic retinopathy
- GPD, geometric perfusion deficit
- Geometric perfusion density
- OCT angiography
- OCTA, OCT angiography
- PD, perfusion density
- ROIs, regions of interest
- SCP, superficial capillary plexus
- V1, single volume
- V4, 4 volumes mode with automatically averaged scan
- VDI, vessel density index
- VLD, vessel length density
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Affiliation(s)
- Emanuele Crincoli
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Créteil, France
- Catholic University of “Sacro Cuore”, Rome, Italy
| | - Donato Colantuono
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Créteil, France
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Créteil, France
- Correspondence: Alexandra Miere, MD, PhD, Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, Créteil, 94100, France.
| | - Zhanlin Zhao
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Créteil, France
| | | | - Eric H. Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Créteil, France
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Ong JX, Bou Ghanem GO, Nesper PL, Moonjely J, Fawzi AA. Optical Coherence Tomography Angiography of Volumetric Arteriovenous Relationships in the Healthy Macula and Their Derangement in Disease. Invest Ophthalmol Vis Sci 2023; 64:6. [PMID: 37133834 PMCID: PMC10166119 DOI: 10.1167/iovs.64.5.6] [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: 05/31/2022] [Accepted: 04/09/2023] [Indexed: 05/04/2023] Open
Abstract
Purpose To characterize relative arteriovenous connectivity of the healthy macula imaged by optical coherence tomography angiography (OCTA) using a new volumetric tool. Methods OCTA volumes were obtained for 20 healthy controls (20 eyes). Two graders identified superficial arterioles and venules. We implemented a custom watershed algorithm to identify capillaries most closely connected to arterioles and venules by using the large vessels as seeds to flood the vascular network. We calculated ratios of arteriolar- to venular-connected capillaries (A/V ratios) and adjusted flow indices (AFIs) for superficial capillary plexuses (SCPs), middle capillary plexuses (MCPs), and deep capillary plexuses (DCPs). We also analyzed two eyes with proliferative diabetic retinopathy (PDR) and one eye with macular telangiectasia (MacTel) to evaluate the utility of this method in visualizing pathological vascular connectivity. Results In healthy eyes, the MCP showed a greater proportion of arteriolar-connected vessels than the SCP and DCP (all P < 0.001). In the SCP, the arteriolar-connected AFI exceeded the venular-connected AFI, but this pattern reversed in the MCP and DCP, with higher venular-connected AFI (all P < 0.001). In PDR eyes, preretinal neovascularization originated from venules, whereas intraretinal microvascular abnormalities were heterogeneous, with some originating from venules and others representing dilated MCP capillary loops. In MacTel, diving SCP venules formed the epicenter of the outer retinal anomalous vascular network. Conclusions Healthy eyes showed a higher MCP A/V ratio but relatively slower arteriolar vs. venular flow velocity in the MCP and DCP, which may explain deep retinal vulnerability to ischemia. In eyes with complex vascular pathology, our connectivity findings were consistent with histopathologic studies.
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Affiliation(s)
- Janice X Ong
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Ghazi O Bou Ghanem
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Peter L Nesper
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Jessica Moonjely
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Amani A Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
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Breazzano MP, Ledesma-Gil G, Essilfie JO, Bacci T, Pandey A, Yannuzzi LA. RETINAL RACEMOSE HEMANGIOMA (RETINAL ARTERIOVENOUS COMMUNICATION) DIAGNOSED AND MANAGED WITH MULTIMODAL IMAGING. Retin Cases Brief Rep 2023; 17:279-284. [PMID: 34033599 DOI: 10.1097/icb.0000000000001167] [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
BACKGROUND/PURPOSE Retinal racemose hemangioma is a rare congenital abnormality of the retinal vasculature with a variety of secondary manifestations that can cause vision loss, including macular edema. This report aims to demonstrate the use of swept-source optical coherence tomography angiography in further characterizing this abnormality. METHODS Case report with multimodal imaging including swept-source optical coherence tomography angiography. RESULTS A 56-year-old woman with blurred vision was diagnosed macular edema secondary to retinal racemose hemangioma. Localization of the arterial-venous connection was identified with swept-source optical coherence tomography angiography at the deep capillary plexus. Conservative management of the associated foveal exudation ultimately led to a favorable outcome. CONCLUSION Observation or topical therapy may be useful and warranted in select cases of retinal racemose hemangioma. The anomalous vascular connection in retinal racemose hemangioma seems to originate at the level of the deep capillary plexus in this case; however, larger studies are necessary for corroboration. Evolving angiographic modalities such as swept-source optical coherence tomography angiography may continue to provide insights for this rare disease.
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Affiliation(s)
- Mark P Breazzano
- Vitreous Retina Macula Consultants of New York, New York, New York
- Columbia University College of Physicians and Surgeons, New York, New York
- Department of Ophthalmology, New York University, New York, New York
- Manhattan Eye, Ear, and Throat Hospital, Lenox Hill Hospital, New York, New York
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, New York
| | - Gerardo Ledesma-Gil
- Vitreous Retina Macula Consultants of New York, New York, New York
- Institute of Ophthalmology, Fundación Conde de Valenciana, Mexico City, Mexico
| | - Juliet O Essilfie
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, New York University, New York, New York
- Manhattan Eye, Ear, and Throat Hospital, Lenox Hill Hospital, New York, New York
| | - Tommaso Bacci
- Manhattan Eye, Ear, and Throat Hospital, Lenox Hill Hospital, New York, New York
| | - Avi Pandey
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, New York
- Columbia University College of Physicians and Surgeons, New York, New York
- Department of Ophthalmology, New York University, New York, New York
- Manhattan Eye, Ear, and Throat Hospital, Lenox Hill Hospital, New York, New York
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Kim JT, Jun JH, Lee SC, Lee MW. Retinal microvasculature and choriocapillaris impairments according to the stage of dry age-related macular degeneration. Clin Exp Ophthalmol 2023; 51:36-43. [PMID: 36067116 DOI: 10.1111/ceo.14165] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to analyse the retinal microvasculature and choriocapillaris according to the dry age-related macular degeneration (AMD) stage and to identify factors associated with their microvasculatures. METHODS Patients were divided into four groups: normal controls, early, intermediate and advanced AMD groups. The vessel density (VD) of superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris was compared using optical coherence tomography angiography among the groups. Linear regression analysis was performed to identify factors associated with the VD. RESULTS The VDs of the SCP were 22.1 ± 5.7, 19.1 ± 5.4, 18.0 ± 6.4 and 12.2 ± 6.4% (p < 0.001); the VDs of the DCP were 22.4 ± 4.5, 20.7 ± 4.3, 18.1 ± 5.3 and 14.6 ± 5.8% (p < 0.001); the VDs of the choriocapillaris were 29.4 ± 3.7, 26.4 ± 4.8, 24.5 ± 4.9 and 24.2 ± 3.7% (p < 0.001) in the control, early, intermediate, and advanced groups, respectively. AMD stage and age were significantly associated with the VDs of all layers, and the VDs of the SCP and DCP were associated with visual acuity (both p < 0.001). Additionally, hypertension was associated with the VDs of the DCP (p = 0.027) and choriocapillaris (p = 0.024). CONCLUSIONS The retinal microvasculature and choriocapillaris tended to become more impaired as the AMD stage progressed. Age was significantly associated with the microvasculature impairments of all layers, and hypertension was significantly associated with impairments of the DCP microvasculature and choriocapillaris.
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Affiliation(s)
- Jung-Tae Kim
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Ji-Ho Jun
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Sung-Chul Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Min-Woo Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
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11
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Retinal ischemic cascade: New insights into the pathophysiology and imaging findings. Surv Ophthalmol 2022; 68:380-387. [PMID: 36464134 DOI: 10.1016/j.survophthal.2022.11.009] [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: 04/15/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
Retinal ischemia gives rise to a complex spectrum in which the cumulative profile of ischemia of the middle and inner retina can be highly variable. We reviewed the current knowledge on paracentral acute middle maculopathy (PAMM) pathophysiology and accompanying risk factors, the middle and inner retinal vasculature and blood flow, and the vulnerability of the middle retina in vaso-occlusive disorders. The inner nuclear layer (INL) is easily affected by slight degrees of retinal hypoperfusion and ischemia. INL infarction starts at perivenular sites, manifesting as skip PAMM lesions and a fern-like appearance in cross-sectional and en face views, respectively. With horizontal progression, INL infarction may develop into diffuse globular PAMM. If vertical progression occurs, the entire middle and inner portions of the retina can be affected. Transmural infarction of the middle and inner retina would be at the end of this spectrum. This gradient of ischemic progression resembles an ischemic cascade. We review the evidence supporting the term "retinal ischemic cascade," which encompasses a broad continuum of manifestations with roots in middle retinal infarction. With this terminology, variations in spatial and temporal progression and resolution of ischemia can also be delivered; it further enables addressing the possible associations between the middle and inner retinal ischemic patterns.
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12
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The OCT angular sign of Henle fiber layer (HFL) hyperreflectivity (ASHH) and the pathoanatomy of the HFL in macular disease. Prog Retin Eye Res 2022:101135. [DOI: 10.1016/j.preteyeres.2022.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
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13
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Ramtohul P, Iovino C, Au A, Bacci T, Pichi F, Corradetti G, Corvi F, Manoharan N, Marin AI, Tadayoni R, Sadda S, Freund KB, Sarraf D. Clinical and Morphologic Characteristics of Perivenular Fernlike Leakage on Ultrawide-field Fluorescein Angiography. Ophthalmol Retina 2022; 6:1070-1079. [PMID: 35545196 DOI: 10.1016/j.oret.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To analyze the spectrum of the perivenular fernlike leakage on ultrawide-field fluorescein angiography (UWFA) and discuss its potential implications in the current understanding of the retinal venous outflow. DESIGN Retrospective, observational case series. PARTICIPANTS Eyes presenting with fernlike patterns of dye leakage on UWFA were included in this study. METHODS Analysis of the clinical characteristics and multimodal imaging findings using UWFA and wide-angle swept-source OCT-angiography (SS-OCTA). MAIN OUTCOME MEASURES The disease spectrum, anatomic origin, and clinical implications of this fernlike leakage. RESULTS Multimodal retinal images from 40 eyes of 29 patients with fernlike leakage on UWFA were studied. The underlying etiologies included a wide range of inflammatory disorders, including pars planitis (18 eyes) and central retinal vein occlusion (2 eyes). On UWFA, the fernlike leakage originated from the retinal capillaries and venules directly adjacent to the veins and spared the periarterial zone. This perivenular fernlike leakage involved the far periphery in all cases and progressed more diffusely and centripetally in cases with more severe intraocular inflammation. On wide-angle SS-OCTA, the impairment of deep capillary plexus (DCP) flow signals precisely colocalized with the perivenular fernlike leakages identified on UWFA. CONCLUSIONS The fernlike leakage on UWFA refers to the distinctive perivenular dye leakage that originates from the retinal capillaries and venules. Multimodal imaging correlation suggests that the predominant impairment is at the level of the DCP. The axial symmetry of the fernlike leakage with the veins and sparing of the periarterial zone may support the dominant venous role of the DCP.
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Affiliation(s)
- Prithvi Ramtohul
- Centre Hospitalier Universitaire de l'Hôpital Nord, chemin des Bourrely, Marseille, France; Vitreous Retina Macula Consultants of New York, New York, New York
| | - Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Adrian Au
- Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Tommaso Bacci
- Vitreous Retina Macula Consultants of New York, New York, New York; Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Giulia Corradetti
- Department of Ophthalmology, Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, California
| | - Federico Corvi
- Department of Ophthalmology, Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, California
| | - Niranjan Manoharan
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Alejandro Itzam Marin
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Ramin Tadayoni
- Université de Paris, Ophthalmology Department, AP-HP, Hôpital Lariboisière, Paris, France; Hôpital Fondation Adolphe de Rothschild, 75019, Paris, France
| | - SriniVas Sadda
- Department of Ophthalmology, Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, California
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, NYU Grossman School of New York, New York, New York
| | - David Sarraf
- Stein Eye Institute, University of California Los Angeles, Los Angeles, California.
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14
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Verma A, Magesan K, Amose T, Alagorie AR, Gnanaraj R, Sadda SR, Sen P. Age-related assessment of foveal avascular zone and surrounding capillary networks with swept source optical coherence tomography angiography in healthy eyes. Eye (Lond) 2022; 36:1857-1864. [PMID: 35948688 PMCID: PMC9500041 DOI: 10.1038/s41433-022-02146-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 03/09/2022] [Accepted: 06/13/2022] [Indexed: 11/09/2022] Open
Abstract
AIM To assess the macular capillary networks and foveal avascular zone (FAZ) with swept-source optical coherence tomography angiography in healthy eyes. METHODS This cross-sectional, prospective, observational study enrolled 222 eyes of 116 healthy participants with no ocular or systemic disease. SS-OCTA images were captured using the PLEX Elite 9000 (Carl Zeiss Meditec Inc., Dublin, CA, USA) with a 6 × 6 mm pattern centered on the foveal center. Vessel length density (VLD), perfusion density (PD), and FAZ parameters were analyzed using the manufacturer's automated software. RESULTS A significant negative correlation was observed between age and average VLD in the superficial plexus, and average PD in both the superficial plexus and the whole retina. A significant positive correlation between age and foveal avascular zone perimeter and area was also noted. Age-wise comparisons showed a trend for an increase in VLD and PD until 40 years of age, with a subsequent decrease in the older age in the macular region. The central subfield showed a decrease in the vessel density measurements in the 21-40 age group. FAZ area and perimeter were the mirror inverse of the central subfield vessel density measurements with a numerically greater area and perimeter in the 21-40 age group compared to the 0-20 and 41-60 age groups. FAZ circularity was significantly reduced after 40 years of age. CONCLUSION Age-related changes in the vessel density and FAZ parameters in the healthy macula are complex and vary with the macular location. These results carry significance when interpreting the data from diseased eyes.
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Affiliation(s)
- Aditya Verma
- Shri Bhagwan Mahavir VitreoRetinal Services, Medical Research Foundation, Tamil Nadu, India.
| | - Kowsigan Magesan
- Elite School of Optometry, Unit of Medical Research Foundation, Tamil Nadu, India
| | - T Amose
- Elite School of Optometry, Unit of Medical Research Foundation, Tamil Nadu, India
| | | | - Ramya Gnanaraj
- Shri Bhagwan Mahavir VitreoRetinal Services, Medical Research Foundation, Tamil Nadu, India
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Parveen Sen
- Shri Bhagwan Mahavir VitreoRetinal Services, Medical Research Foundation, Tamil Nadu, India
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15
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Su B, Zhu X, Yang K, Xiao Y, Li C, Shi K, Qu J, Lu F, Li M, Cui L. Age- and sex-related differences in the retinal capillary plexus in healthy Chinese adults. EYE AND VISION 2022; 9:38. [PMID: 36180939 PMCID: PMC9526290 DOI: 10.1186/s40662-022-00307-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND To assess age- and sex-related changes in the superficial retinal capillary plexus (SCP) and deep retinal capillary plexus (DCP) in healthy Chinese adults. METHODS In this cross-sectional study, all data were derived from the community-based Jidong Eye Cohort Study. Participants underwent optical coherence tomography angiography (OCTA) and other ocular and systemic examinations. The vessel densities of the whole measured area, parafovea, and four quadrants in the SCP and DCP were measured. RESULTS We recruited 1036 eyes of 1036 healthy participants; the mean age was 40.4 ± 9.8 years, and 449 (43.3%) participants were males. The SCP and DCP vessel densities in all regions, except for temporal and nasal regions in the SCP, non-linearly decreased with age. The DCP vessel densities began to decrease at approximately 35 years of age, while the SCP vessel densities began to decrease at approximately 40 years of age. The DCP vessel densities decreased more rapidly than the SCP vessel densities at 35-50 years of age. The DCP vessel densities remained stable or slightly decreased after the age of 50 years in females, while those decreased linearly in most regions in males. CONCLUSIONS The retinal vessel density decreased earlier and more rapidly in the DCP than in the SCP, and the effect of aging on the DCP vessel density was sex-dependent. Our findings suggest that age and sex should be considered when interpreting clinical quantitative OCTA data.
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Affiliation(s)
- Binbin Su
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Xiaoxuan Zhu
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Kai Yang
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Yunfan Xiao
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Chunmei Li
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Keai Shi
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Jia Qu
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Fan Lu
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Ming Li
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Lele Cui
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
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16
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Cabral D, Fradinho AC, Pereira T, Ramakrishnan MS, Bacci T, An D, Tenreiro S, Seabra MC, Balaratnasingam C, Freund KB. Macular Vascular Imaging and Connectivity Analysis Using High-Resolution Optical Coherence Tomography. Transl Vis Sci Technol 2022; 11:2. [PMID: 35648637 PMCID: PMC9172017 DOI: 10.1167/tvst.11.6.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/06/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To characterize macular blood flow connectivity in vivo using high-resolution optical coherence tomography (HighRes OCT). Methods Cross-sectional, observational study. Dense (6-µm interscan distance) perifoveal HighRes OCT raster scans were performed on healthy participants. To mitigate the limitations of projection-resolved OCT-angiography, flow and structural data were used to observe the vascular structures of the superficial vascular complex (SVC) and the deep vascular complex. Vascular segmentation and rendering were performed using Imaris 9.5 software. Inflow and outflow patterns were classified according to vascular diameter and branching order from superficial arteries and veins, respectively. Results Eight eyes from eight participants were included in this analysis, from which 422 inflow and 459 outflow connections were characterized. Arteries had direct arteriolar connections to the SVC (78%) and to the intermediate capillary plexus (ICP, 22%). Deep capillary plexus (DCP) inflow derived from small-diameter vessels succeeding ICP arterioles. The most prevalent outflow pathways coursed through superficial draining venules (74%). DCP draining venules ordinarily merged with ICP draining venules and drained independently of superficial venules in 21% of cases. The morphology of DCP draining venules in structural HighRes OCT is distinct from other vessels crossing the inner nuclear layer and can be used to identify superficial veins. Conclusions Vascular connectivity analysis supports a hybrid circuitry of blood flow within the human parafoveal macula. Translational Relevance Characterization of parafoveal macular blood flow connectivity in vivo using a precise segmentation of HighRes OCT is consistent with ground-truth microscopy studies and shows a hybrid circuitry.
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Affiliation(s)
- Diogo Cabral
- Vitreous Retina Macula Consultants of New York, NY, USA
- CEDOC, NOVA Medical School I Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Ana C. Fradinho
- CEDOC, NOVA Medical School I Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Telmo Pereira
- CEDOC, NOVA Medical School I Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | | | - Tommaso Bacci
- Vitreous Retina Macula Consultants of New York, NY, USA
| | - Dong An
- Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia, Australia
- Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Sandra Tenreiro
- CEDOC, NOVA Medical School I Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Miguel C. Seabra
- CEDOC, NOVA Medical School I Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
- UCL Institute of Ophthalmology, London, UK
| | - Chandrakumar Balaratnasingam
- Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia, Australia
- Lions Eye Institute, Nedlands, Western Australia, Australia
| | - K. Bailey Freund
- Vitreous Retina Macula Consultants of New York, NY, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
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17
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Au A, Jung J, Johnson MW, Baumal C, Daily MJ, Gomolin JE, Gupta RR, Rahimy E, Wu L, Sadda SR, Sarraf D. Henle Fiber Layer Hemorrhage in Macular Telangiectasia Type 2: Is Right Eye Dominance Coincidence or Consequence? Am J Ophthalmol 2022; 241:80-86. [PMID: 35469791 DOI: 10.1016/j.ajo.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/29/2022] [Accepted: 04/06/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To summarize all reported cases of Henle fiber layer (HFL) hemorrhage in the absence of subretinal neovascularization (SRNV) in patients with macular telangiectasia type 2 (MacTel2) and to propose a mechanism for the right-sided predominance of this unique presentation. DESIGN Perspective. METHODS Collection, review, and analysis of all cases in the literature and in the authors' databases of HFL hemorrhage in MacTel2, including analysis of baseline and follow-up multimodal retinal imaging findings of selected cases. Elucidation of the complex interplay of systemic venous pressure with the deep retinal capillary plexus and hypothesis regarding the right-sided predilection of HFL hemorrhage complicating MacTel2. RESULTS Ten patients presented with a unilateral, characteristic radial macular hemorrhage within the HFL that affected only the right eye in all cases. Absence of SRNV was confirmed by fluorescein angiography and/or optical coherence tomography angiography. The hemorrhage resolved spontaneously in at least 7 of the 10 eyes. The HFL hemorrhage may plausibly be explained by dysfunction of the deep capillary plexus in MacTel2 combined with an acute rise in central venous pressure, for which the right side may be at increased risk. CONCLUSIONS HFL hemorrhage can complicate MacTel2 in the absence of SRNV, and the radial pattern of blood affecting only the right eye is remarkable. The right eye predominance may be multifactorial in etiology. Related factors may include the right-sided predilection of MacTel2 and/or increased right-sided dural sinus drainage related to normal anatomical variation.
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18
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Zhu X, Yang K, Xiao Y, Ye C, Zheng J, Su B, Zheng Y, Zhang X, Shi K, Li C, Lu F, Qu J, Li M, Cui L. Association of cigarette smoking with retinal capillary plexus: an optical coherence tomography angiography study. Acta Ophthalmol 2022; 100:e1479-e1488. [PMID: 35396902 DOI: 10.1111/aos.15157] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/18/2022] [Accepted: 03/30/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the association between cigarette smoking and retinal capillary plexus (RCP) using optical coherence tomography angiography (OCTA) and to examine whether potential vascular risk factors could impact their association. METHODS This is a cross-sectional, community-based study. The Jidong Eye Cohort Study included participants aged ≥18 years in the Jidong community (Tangshan city, northern China) from August 2019 to January 2020. All participants underwent comprehensive ophthalmic examination and completed detailed smoking questionnaires. Retinal vessel density in the superficial and deep RCP was automatically measured using OCTA. RESULTS Of the 2598 participants included in the study, 2026 (78.0%) never smoked and 572 (22.0%) had a history of smoking (494 [19.0%] current smokers and 78 [3.0%] former smokers). The median (interquartile range) age was 41 (34-52) years for the non-smoking group and 45 (35-54.5) years for the smoking group. Multivariable analysis showed that smoking history is associated with a low deep RCP vessel density in the parafovea (β, -0.53; 95% confidence interval [CI], -0.82 to -0.24) and four quadrants. Increased smoking pack-years were associated with reduced deep RCP vessel density in the parafovea (p for trend <0.001) and four quadrants. The significant interaction between diabetes and smoking only was found for superficial RCP vessel density in the parafovea (p for interaction = 0.014) and four quadrants except for the temporal quadrants. CONCLUSIONS Cigarette smoking is an independent risk factor for reduced deep RCP vessel density. Our findings imply the potential detrimental effect of smoking on the occurrence of ocular diseases.
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Affiliation(s)
- Xiaoxuan Zhu
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Kai Yang
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Yunfan Xiao
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Cong Ye
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Jingwei Zheng
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Binbin Su
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Yang Zheng
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Xinyao Zhang
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Keai Shi
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Chunmei Li
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Fan Lu
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Jia Qu
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Ming Li
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Lele Cui
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
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Garg I, Uwakwe C, Le R, Lu ES, Cui Y, Wai KM, Katz R, Zhu Y, Moon JY, Li CY, Laíns I, Eliott D, Elze T, Kim LA, Wu DM, Miller JW, Husain D, Vavvas DG, Miller JB. Nonperfusion Area and Other Vascular Metrics by Wider Field Swept-Source OCT Angiography as Biomarkers of Diabetic Retinopathy Severity. OPHTHALMOLOGY SCIENCE 2022; 2:100144. [PMID: 35647573 PMCID: PMC9137369 DOI: 10.1016/j.xops.2022.100144] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Purpose To study the wider field swept-source optical coherence tomography angiography (WF SS-OCTA) metrics, especially non-perfusion area (NPA), in the diagnosing and staging of DR. Design Cross-sectional observational study (November 2018-September 2020). Participants 473 eyes of 286 patients (69 eyes of 49 control patients and 404 eyes of 237 diabetic patients). Methods We imaged using 6mm×6mm and 12mm×12mm angiograms on WF SS-OCTA. Images were analyzed using the ARI Network and FIJI ImageJ. Mixed effects multiple regression models and receiver operator characteristic analysis was used for statistical analyses. Main Outcome Measures Quantitative metrics such as vessel density (VD); vessel skeletonized density (VSD); foveal avascular zone (FAZ) area, circularity, and perimeter; and NPA in DR and their relative performance for its diagnosis and grading. Results Among patients with diabetes (median age 59 years), 51 eyes had no DR, 185 eyes (88 mild, 97 moderate-severe) had non-proliferative DR (NPDR); and 168 eyes had proliferative DR (PDR). Trend analysis revealed a progressive decline in superficial capillary plexus (SCP) VD and VSD, and increased NPA with increasing DR severity. Additionally, there was a significant reduction in deep capillary plexus (DCP) VD and VSD in early DR (mild NPDR), but the progressive reduction in advanced DR stages was not significant. NPA was the best parameter to diagnose DR (AUC:0.96), whereas all parameters combined on both angiograms efficiently diagnosed (AUC:0.97) and differentiated between DR stages (AUC range:0.83-0.97). The presence of diabetic macular edema was associated with reduced SCP and DCP VD and VSD within mild NPDR eyes, whereas an increased VD and VSD in SCP among moderate-severe NPDR group. Conclusions Our work highlights the importance of NPA, which can be more readily and easily measured with WF SS-OCTA compared to fluorescein angiography. It is additionally quick and non-invasive, and hence can be an important adjunct for DR diagnosis and management. In our study, a combination of all OCTA metrics on both 6mm×6mm and 12mm×12mm angiograms had the best diagnostic accuracy for DR and its severity. Further longitudinal studies are needed to assess NPA as a biomarker for progression or regression of DR severity.
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Affiliation(s)
- Itika Garg
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Chibuike Uwakwe
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Rongrong Le
- Harvard Retinal Imaging Lab, Boston, Massachusetts,Wenzhou Medical University Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Edward S. Lu
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Ying Cui
- Harvard Retinal Imaging Lab, Boston, Massachusetts,Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Karen M. Wai
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Raviv Katz
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Ying Zhu
- Harvard Retinal Imaging Lab, Boston, Massachusetts,Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jade Y. Moon
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Chloe Y. Li
- Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Inês Laíns
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Dean Eliott
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Tobias Elze
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, Massachusetts
| | - Leo A. Kim
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, Massachusetts
| | - David M. Wu
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Joan W. Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Deeba Husain
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Demetrios G. Vavvas
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - John B. Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Harvard Retinal Imaging Lab, Boston, Massachusetts,Correspondence: John B. Miller, MD, Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Harvard Retinal Imaging Lab, 243 Charles Street, Boston, MA 02114.
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20
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Zouache MA. Variability in Retinal Neuron Populations and Associated Variations in Mass Transport Systems of the Retina in Health and Aging. Front Aging Neurosci 2022; 14:778404. [PMID: 35283756 PMCID: PMC8914054 DOI: 10.3389/fnagi.2022.778404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/13/2022] [Indexed: 11/17/2022] Open
Abstract
Aging is associated with a broad range of visual impairments that can have dramatic consequences on the quality of life of those impacted. These changes are driven by a complex series of alterations affecting interactions between multiple cellular and extracellular elements. The resilience of many of these interactions may be key to minimal loss of visual function in aging; yet many of them remain poorly understood. In this review, we focus on the relation between retinal neurons and their respective mass transport systems. These metabolite delivery systems include the retinal vasculature, which lies within the inner portion of the retina, and the choroidal vasculature located externally to the retinal tissue. A framework for investigation is proposed and applied to identify the structures and processes determining retinal mass transport at the cellular and tissue levels. Spatial variability in the structure of the retina and changes observed in aging are then harnessed to explore the relation between variations in neuron populations and those seen among retinal metabolite delivery systems. Existing data demonstrate that the relation between inner retinal neurons and their mass transport systems is different in nature from that observed between the outer retina and choroid. The most prominent structural changes observed across the eye and in aging are seen in Bruch’s membrane, which forms a selective barrier to mass transfers at the interface between the choroidal vasculature and the outer retina.
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21
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Chiaravalli G, Guidoboni G, Sacco R, Radell J, Harris A. A multi-scale/multi-physics model for the theoretical study of the vascular configuration of retinal capillary plexuses based on OCTA data. MATHEMATICAL MEDICINE AND BIOLOGY : A JOURNAL OF THE IMA 2022; 39:77-104. [PMID: 34849954 PMCID: PMC8906920 DOI: 10.1093/imammb/dqab018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/30/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
The retinal tissue is highly metabolically active and is responsible for translating the visual stimuli into electrical signals to be delivered to the brain. A complex vascular structure ensures an adequate supply of blood and oxygen, which is essential for the function and survival of the retinal tissue. To date, a complete understanding of the configuration of the retinal vascular structures is still lacking. Optical coherence tomography angiography has made available a huge amount of imaging data regarding the main retinal capillary plexuses, namely the superficial capillary plexuses (SCP), intermediate capillary plexuses (ICP) and deep capillary plexuses (DCP). However, the interpretation of these data is still controversial. In particular, the question of whether the three capillary plexuses are connected in series or in parallel remains a matter of debate. In this work, we address this question by utilizing a multi-scale/multi-physics mathematical model to quantify the impact of the two hypothesized vascular configurations on retinal hemodynamics and oxygenation. The response to central retinal vein occlusion (CRVO) and intraocular pressure (IOP) elevation is also simulated depending on whether the capillary plexuses are connected in series or in parallel. The simulation results show the following: (i) in the in series configuration, the plexuses exhibit a differential response, with DCP and ICP experiencing larger pressure drops than SCP; and (ii) in the in parallel configuration, the blood flow redistributes uniformly in the three plexuses. The different vascular configurations show different responses also in terms of oxygen profiles: (i) in the in series configuration, the outer nuclear layer, outer plexiform layer and inner nuclear layer (INL) are those most affected by CRVO and IOP elevation; and (ii) in the in parallel configuration the INL and ganglion cell layer are those most affected. The in series results are consistent with studies on paracentral acute middle maculopathy, secondary to CRVO and with studies on IOP elevation, in which DCP and ICP and the retinal tissues surrounding them are those most affected by ischemia. These findings seem to suggest that the in series configuration better describes the physiology of the vascular retinal capillary network in health and disease.
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Affiliation(s)
| | - Giovanna Guidoboni
- Department of Electrical Engineering and Computer Science, Department of Mathematics, University of Missouri, Columbia, MO 65211, USA
| | - Riccardo Sacco
- Department of Mathematics, Politecnico di Milano, Milan20133, Italy
| | - Jake Radell
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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22
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Evliyaoglu F, Kurt M, Yilmaz M, Akpolat C. Evaluation of microvascular density and retinal vessel diameter in gestational and type 2 diabetes using swept-source OCT-A technology. J Fr Ophtalmol 2022; 45:430-437. [DOI: 10.1016/j.jfo.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 10/19/2022]
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23
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Perspectives on diabetic retinopathy from advanced retinal vascular imaging. Eye (Lond) 2022; 36:319-327. [PMID: 34987198 PMCID: PMC8807653 DOI: 10.1038/s41433-021-01825-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/05/2021] [Accepted: 10/14/2021] [Indexed: 02/03/2023] Open
Abstract
Diabetic retinopathy (DR) is a microvascular complication of diabetes and the most common cause of acquired vision loss in adults worldwide. DR is associated with long-term chronic hyperglycaemia and its detrimental effects on the neurovascular structure and function of the retina. Direct imaging of the retinal vasculature and staging of DR has been traditionally based on fundoscopy and fluorescein angiography, which provide only 2D views of the retina, and in the case of fluorescein angiography, requires an invasive dye injection. In contrast, advanced retinal imaging modalities like optical coherence tomography angiography (OCTA) and adaptive optics (AO) are non-invasive and provide depth-resolved, 3D visualization of retinal vessel structure as well as blood flow. Recent studies utilizing these imaging techniques have shown promise in evaluating quantitative vascular parameters that correlate tightly to clinical DR staging, elucidating functional changes in early diabetes, and monitoring DR treatment response. In this article, we discuss and synthesize the results of advanced retinal imaging studies in DR and their implications for our clinical and pathophysiologic understanding of the disease. Based on the recent literature, we also propose a model to describe the differential changes in vascular structure and flow that have been described on advanced retinal imaging as DR progresses. Future studies of these imaging modalities in larger and more diverse populations, as well as corroboration with histological and functional studies, will be important to further our understanding of DR.
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24
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Vessel Density and Retinal Thickness from Optical Coherence Tomography Angiography as New Indexes in Adolescent Myopia. J Ophthalmol 2021; 2021:6069833. [PMID: 34956668 PMCID: PMC8694993 DOI: 10.1155/2021/6069833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/28/2021] [Accepted: 11/29/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose To evaluate and quantify blood perfusion and retinal thickness (RT) from the perspective of quadrants by optical coherence tomography angiography (OCTA) in adolescents with myopia and explore the relationship between axial elongation and related indexes of OCTA. Methods A total of 88 subjects (149 eyes) with different degrees of myopia were included in this cross-sectional study. Vessel density (VD) and RT of quadrants in macular and peripheral regions were measured through OCTA. Results The superficial VD (SVD) of the parainferior region was significantly correlated with axial length (AL) between the emmetropia (EM) group and high myopia (HI) group (P=0.012). There were significant differences in deep VD (DVD) in all quadrants, except for the foveal, perifoveal, and peri-inferior regions (P > 0.05). However, there were significant alterations in the whole, parainferior, and perinasal regions (P=0.030, 0.023, and 0.035) in the low-to-moderate myopia (L–M) group compared with those in the HI group. There were significant differences in the RT in all quadrants, except for the foveal, paratemporal, and paranasal regions (P > 0.05) between the EM and L–M groups and the foveal region (P > 0.05) between the EM and HI groups. Nevertheless, only RT in the peri-inferior region of the L–M and HI groups showed significant differences. AL was negatively correlated with SVD in the perifoveal and parainferior regions (r = −0.179, P=0.029; r = −0.227, P=0.005) and inversely correlated with DVD and RT in almost all quadrants, except for the foveal region (r = −0.020, P=0.811; r = 0.135, P=1.000). Conclusion DVD and RT were closely associated with the severity of myopia and might be new indexes in assessing and detecting myopia development via OCTA.
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25
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Borrelli E, Sacconi R, Querques G, Bandello F. Optical coherence tomography angiography in the management of diabetic retinopathy. Indian J Ophthalmol 2021; 69:3009-3014. [PMID: 34708736 PMCID: PMC8725121 DOI: 10.4103/ijo.ijo_1367_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The introduction of optical coherence tomography angiography (OCTA) has granted a significant improvement in the assessment of patients with diabetes. In this review, we will provide a description of the prominent OCTA findings in diabetes. In detail, this imaging technology proved that both the retinal and choroidal circulation is affected in diabetic subjects. The recent employment of widefield technology and a three-dimensional (3D) visualization in OCTA imaging are also discussed.
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Affiliation(s)
- Enrico Borrelli
- Department of Ophthalmology, San Raffaele University Hospital, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, San Raffaele University Hospital, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, San Raffaele University Hospital, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, San Raffaele University Hospital, Milan, Italy
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26
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Duan J, Li M, Wu Z, Zhang Z. Total venous nature of retinal deep capillary plexus inferred by continuity of prominent middle limiting membrane sign in optical coherence tomography. PLoS One 2021; 16:e0257698. [PMID: 34547044 PMCID: PMC8454985 DOI: 10.1371/journal.pone.0257698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/07/2021] [Indexed: 11/21/2022] Open
Abstract
This study aimed to theoretically identify the vascular nature of the deep capillary plexus (DCP) by examining patients presenting with both paracentral acute middle maculopathy (PAMM) and prominent middle limiting membrane (p-MLM) sign and p-MLM sign alone in spectral-domain optical coherence tomography (SD-OCT). A retrospective review of the medical records of patients with retinal vein or artery occlusion from two tertiary medical centers was performed. Consecutive patients with a clinical diagnosis of all categories of retinal artery occlusion (RAO) and retinal vein occlusion (RVO) (branch or central and ischemic or non-ischemic) who had undergone SD-OCT imaging from January 2015 to May 2020 were recruited and their p-MLM signs and PAMM lesions were assessed. We included 118 patients who presented with p-MLM sign with or without PAMM lesions. Amon them, 40 were female and 78 were male, with a mean age of 61.1 years. Of the 109 patients with both p-MLM sign and PAMM lesions, 23 had branch RAO, two had branch RVO, 67 had central RAO, 13 had central RVO, and four had a combination of central RAO and central RVO. All nine patients with the p-MLM sign alone had central RVO accompanied by cystoid macular edema. In all the enrolled patients, the hyperreflective lines of the p-MLM sign were continuous, regardless of the type of PAMM lesions. In conclusion, when PAMM and p-MLM sign are examined together, further proof regarding the possible complete venous nature of the vasculature of the retinal DCP might be speculated.
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Affiliation(s)
- Jialiang Duan
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Minhao Li
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Zhifeng Wu
- Department of Ophthalmology, Affiliated Wuxi Clinical College of Nantong University, Wuxi, Jiangsu Province, People’s Republic of China
- Department of Ophthalmology, The Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, People’s Republic of China
| | - Zhengwei Zhang
- Department of Ophthalmology, Affiliated Wuxi Clinical College of Nantong University, Wuxi, Jiangsu Province, People’s Republic of China
- Department of Ophthalmology, The Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, People’s Republic of China
- * E-mail:
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27
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Maltsev DS, Kulikov AN, Burnasheva MA, Freund KB. Vascular Microanatomy of Small Resolved Paracentral Acute Middle Maculopathy Lesions. Ophthalmol Retina 2021; 5:928-934. [PMID: 33309964 DOI: 10.1016/j.oret.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 11/04/2020] [Accepted: 12/07/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE To study microvascular characteristics of small resolved paracentral acute middle maculopathy (PAMM) lesions in fellow eyes of patients with unilateral retinal vein occlusion (RVO). DESIGN Prospective cross-sectional study. PARTICIPANTS Patients with prior unilateral branch or central RVO and OCT evidence of resolved PAMM in the fellow, otherwise normal, eye were recruited prospectively and imaged with OCT angiography (OCTA). METHODS The resolved PAMM lesions were identified as focal areas of inner nuclear layer thinning over an anteriorly displaced outer plexiform layer (OPL). En face OCTA projections showing the location and size of the resolved PAMM lesions were created using 2 OPL segmentation lines with -9-μm and 0-μm offsets, and the cumulative distribution was evaluated. Anterior to the resolved PAMM lesions, vessels in the superficial vascular plexus were traced to identify small arterioles supplying the affected areas. MAIN OUTCOME MEASURES Cumulative spatial distribution on small resolved PAMM lesions. RESULTS From 24 fellow eyes of 24 patients with unilateral RVO (15 men and 9 women; mean age, 62.1 ± 13.6 years), 152 resolved PAMM lesions were identified. Of these lesions, 130 (85.5%) were found within the perifoveal region, and only 12 (7.9%) were found within the temporal quadrant. Of 28 lesions analyzed, the arteriole supplying the affected area was a single side branch of a larger vessel, with only 3 supplied by a terminal branch. CONCLUSIONS Small resolved PAMM lesions in fellow eyes of patients with unilateral RVO are most prevalent in perifoveal regions supplied by side branches of low-order retinal arteries.
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Affiliation(s)
- Dmitrii S Maltsev
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russian Federation.
| | - Alexei N Kulikov
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russian Federation
| | - Maria A Burnasheva
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russian Federation
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York
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28
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Kim J, Park KH. TEMPORAL CHANGES OF PARAFOVEAL MICROVASCULATURE AFTER EPIRETINAL MEMBRANE SURGERY: An Optical Coherence Tomography Angiography Study. Retina 2021; 41:1839-1850. [PMID: 33512895 DOI: 10.1097/iae.0000000000003132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate whether the parafoveal capillary architecture predicts clinical course and visual outcomes after epiretinal membrane (ERM) surgery. METHODS A total of 71 eyes of 71 patients treated with vitrectomy for idiopathic ERM were enrolled. The parafoveal capillary displacement and fractal geometries were compared according to the stage of ERM. Correlations between the parafoveal capillary displacement in the superficial capillary plexus, the fractal dimension and lacunarity in the deep capillary plexus (DCP), foveal thickness, and visual outcomes were evaluated. RESULTS Compared with eyes with mild ERM, eyes with severe ERM exhibited higher parafoveal capillary displacement in the superficial capillary plexus, lower fractal dimension and higher lacunarity in the DCP, and greater foveal thickness (P < 0.05). The parafoveal capillary displacement in the superficial capillary plexus and fractal dimension and lacunarity in the DCP improved significantly, particularly at 1 month postoperatively (P < 0.05) and reached a plateau thereafter. The preoperative fractal dimension in the DCP showed a significant correlation with the best-corrected visual acuity at all follow-up time points (P < 0.05). CONCLUSION The parafoveal fractal dimension in the DCP was significantly correlated with the visual acuity before and after ERM surgery. The parafoveal fractal dimension may serve as a predictive marker for visual outcomes after ERM surgery.
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Affiliation(s)
- Jongshin Kim
- Departments of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea ; and
- Departments of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyu Hyung Park
- Departments of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea ; and
- Departments of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
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29
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Sebastiani S, Pellegrini M, Giannaccare G, Sarraf D. PARACENTRAL ACUTE MIDDLE MACULOPATHY ASSOCIATED WITH PHOSPHODIESTERASE-5 INHIBITOR THERAPY. Retin Cases Brief Rep 2021; 15:519-522. [PMID: 30365416 DOI: 10.1097/icb.0000000000000839] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To present an atypical case of paracentral acute middle maculopathy occurred upon awakening in the morning within hours after phosphodiesterase-5 (PDE-5) inhibitor consumption at bedtime. METHODS Multimodal retinal imaging findings, including fluorescein angiography, spectral domain optical coherence tomography, optical coherence tomography angiography, and microperimetry of a particular case of paracentral acute middle maculopathy lesion that follow the distribution of the cilioretinal artery. RESULTS A 52-year-old healthy man presented with an acute paracentral scotoma in his left eye upon awakening in the morning, after the use of a PDE-5 inhibitor pill the previous night. Spectral domain optical coherence tomography illustrated a hyperreflective band-like lesion at the level of the inner nuclear layer, consistent with a diagnosis of paracentral acute middle maculopathy, along the course of the cilioretinal artery that appeared normally perfused with fluorescein angiography. Optical coherence tomography angiography showed a perfusion deficit and capillary pruning of the retinal deep capillary plexus, with preserved intermediate capillary plexus, that colocalized with the paracentral scotoma confirmed with microperimetry. CONCLUSION To our knowledge, this is the first report of paracentral acute middle maculopathy after the use of PDE-5 inhibitor. Nocturnal arterial hypotension exacerbated by the vasodilatory effect of the PDE-5 inhibitor may have caused transient cilioretinal artery hypo/nonperfusion and insufficiency. Paracentral acute middle maculopathy may represent the earliest form of ischemia in the central macular region, occurring after a milder vascular insult.
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Affiliation(s)
- Stefano Sebastiani
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy ; and
| | - Marco Pellegrini
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy ; and
| | - Giuseppe Giannaccare
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy ; and
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California
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30
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Retinal Vascular Changes during the Menstrual Cycle Detected with Optical Coherence Tomography Angiography. J Ophthalmol 2021; 2021:5514575. [PMID: 34336258 PMCID: PMC8292083 DOI: 10.1155/2021/5514575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/02/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the effects of the menstrual cycle on the retinal vascular status of healthy women by optical coherence tomography angiography (OCTA). Materials and Methods Healthy women with regular natural menstrual cycles of 28 to 30 days were recruited for this prospective study. The women's retinal vascular status was measured by OCTA at 3 time points: the early follicular, ovulatory, and midluteal phases of the menstrual cycle. The main outcome measures were foveal avascular zone (FAZ) parameters, perfusion density (PD) percentage in the superficial retinal capillary plexus (SCP), and PD percentage in the deep retinal capillary plexus (DCP). The mean arterial pressure (MAP), spherical equivalent (SE), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and axial (AL) were also measured in a same menstrual cycle. Results In total, 62 right eyes of 62 women were included in the study. The mean age was 27.0 ± 1.73 (range, 24 to 31) years, and the mean menstrual cycle was 28.90 ± 0.84 (range, 28 to 30) days. The mean values of the DCP-PD parameters were significantly decreased in the nasal and inferior ETDRS subfields during the ovulatory phase. The mean DCP-PD in the nasal ETDRS subfield in the early follicular, ovulatory, and luteal phases was 54.11 ± 2.85, 56.39 ± 3.03, and 55.70 ± 3.27, respectively. The mean DCP-PD in the inferior ETDRS subfield in the early follicular, ovulatory, and midluteal phases was 52.90 ± 3.30, 54.86 ± 2.51, and 55.21 ± 2.64, respectively. No significant differences were found in MAP, SE, AL, IOP, FAZ area, or other quadrants of PD parameters, and no significant correlation was found between parameters by OCTA and age, MAP,SE, axial length, or IOP. Conclusions The DCP-PD decreased in the nasal and inferior ETDRS subfields during the ovulatory phase in our study. This may indicate the need to consider the menstrual phase when interpreting DCP-PD parameters by OCTA in healthy women.
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CHARACTERIZATION BY FRACTAL DIMENSION ANALYSIS OF THE RETINAL CAPILLARY NETWORK IN PARKINSON DISEASE. Retina 2021; 40:1483-1491. [PMID: 31479087 DOI: 10.1097/iae.0000000000002641] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To characterize retinal capillary complexity by optical coherence tomography angiography in Parkinson disease. METHOD Twenty-five Parkinson disease patients and 25 age- and gender-matched healthy controls were recruited. Optical coherence tomography angiography and optical coherence tomography imaged the superficial and deep retinal capillary plexuses and retinal structure. Retinal capillary skeleton density, retinal capillary perfusion density, and fractal dimension analysis of retinal capillary complexity were performed in the total annular zone and quadrant sectors. The thickness of retinal nerve fiber layer, ganglion cell layer and inner plexiform layer, and total retinal thickness were extracted from retinal structural images. Relationships among the retinal capillaries, retinal structure, and clinical parameters were analyzed. RESULTS The superficial retinal capillary plexus in Parkinson disease patients had lower retinal capillary skeleton and perfusion densities and capillary complexity in the total annular zone and all quadrant sectors compared with healthy control subjects. The deep retinal capillary plexus retinal capillary complexity was decreased in the total annular zone and the superior and inferior quadrants. The retinal capillary complexity in the inferior quadrant was negatively correlated with the best-corrected visual acuity and disease duration (r = -0.61, r = -0.43, respectively, both P < 0.05). CONCLUSION As determined by fractal analysis, retinal capillary complexity can be an objective biomarker in Parkinson disease.
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Falavarjani KG, Mirshahi R, Riazi-Esfahani H, Anvari P, Habibi A, Ashraf Khorasani M, Shad E. Spatial distribution of diabetic capillary non-perfusion. Microcirculation 2021; 28:e12719. [PMID: 34105840 DOI: 10.1111/micc.12719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/02/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the distribution of capillary non-perfusion (CNP) in superficial and deep capillary plexuses (SCP and DCP) in eyes with diabetic retinopathy (DR). METHODS In this retrospective case series, macular optical coherence tomography angiography (OCTA) images were obtained from eyes with DR without diabetic macular edema (DME). The area of CNP in SCP and DCP was delineated using an automated approach after excluding the foveal avascular zone (FAZ) and major retinal vessels. The distribution and spatial correlation of the CNP in each layer were analyzed. RESULTS Forty-three eyes of 27 patients with DR with a mean age of 59.10 ± 9.05 years were included. The mean CNP area in SCP was statistically significantly higher than DCP (0.722 ± 0.437 mm2 vs. 0.184 ± 0.145 mm2 , respectively, p < .001). There was a statistically significant association between mean BCVA (0.28 ± 0.21 logMAR) and CNP area in DCP (p = .01). After automated subtraction of CNP areas in DCP from SCP, 25.43 ± 15.05% of CNP areas in the DCP had co-localized CNP areas in SCP. The CNP percentage was statistically significantly different between the concentric rings on foveal center, both in SCP and in DCP (both p < .001) showing a decreasing trend from the outer ring toward the center. CONCLUSION In DR, SCP is more ischemic than DCP. This is in contrast to the previously described oxygenation-dependent ischemic cascade following acute retinal vascular occlusions. This study provides further insight into the retinal ischemia in DR.
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Affiliation(s)
- Khalil Ghasemi Falavarjani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.,Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Mirshahi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pasha Anvari
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Habibi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Ashraf Khorasani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Esrafil Shad
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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33
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Leisser C, Huemer JC, Findl O. Henle Fibre Layer Haemorrhage after a Valsalva Manoeuvre. Case Rep Ophthalmol 2021; 12:105-109. [PMID: 33976665 PMCID: PMC8077655 DOI: 10.1159/000511373] [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: 07/10/2020] [Accepted: 09/03/2020] [Indexed: 12/04/2022] Open
Abstract
A male patient, 59 years of age, presented with sudden deterioration of visual acuity (VA) caused by a Henle fibre layer haemorrhage (HFLH) in our outpatient department. He reported being under treatment with acetylsalicylic acid and experienced a Valsalva manoeuvre before he observed reduced vision. Due to the impairment caused by the haemorrhage, disturbing the patient's daily activities, intravitreal injection of recombinant tissue plasminogen activator combined with SF6 and bevacizumab was offered. After this procedure, the HFLH disappeared, VA improved from 20/40 to 20/20 (Snellen) 3 months after treatment and a typical hyperreflective vertical line was seen in optical coherence tomography.
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Affiliation(s)
- Christoph Leisser
- VIROS - Vienna Institute for Research in Ocular Surgery, A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - Josef Christian Huemer
- VIROS - Vienna Institute for Research in Ocular Surgery, A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria.,NIHR Biomedical Research Center at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Oliver Findl
- VIROS - Vienna Institute for Research in Ocular Surgery, A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
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Zhioua Braham I, Kaouel H, Boukari M, Errais K, Boussen IM, Ammous I, Zhioua R. [OCT-angiography and en-face OCT in paracentral acute middle maculopathy with perivenular ischemia associated with a central retinal artery occlusion]. J Fr Ophtalmol 2021; 44:e239-e243. [PMID: 33637321 DOI: 10.1016/j.jfo.2020.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 04/21/2020] [Accepted: 06/19/2020] [Indexed: 11/17/2022]
Affiliation(s)
- I Zhioua Braham
- Service d'ophtalmologie, faculté de médecine de Tunis, hôpital universitaire Charles-Nicolle, université Tunis-El Manar, boulevard du 9-Avril 1938, 1007 Tunis, Tunisie.
| | - H Kaouel
- Service d'ophtalmologie, faculté de médecine de Tunis, hôpital universitaire Charles-Nicolle, université Tunis-El Manar, boulevard du 9-Avril 1938, 1007 Tunis, Tunisie.
| | - M Boukari
- Service d'ophtalmologie, faculté de médecine de Tunis, hôpital universitaire Charles-Nicolle, université Tunis-El Manar, boulevard du 9-Avril 1938, 1007 Tunis, Tunisie.
| | - K Errais
- Service d'ophtalmologie, faculté de médecine de Tunis, hôpital universitaire Charles-Nicolle, université Tunis-El Manar, boulevard du 9-Avril 1938, 1007 Tunis, Tunisie.
| | - I M Boussen
- Service d'ophtalmologie, faculté de médecine de Tunis, hôpital universitaire Charles-Nicolle, université Tunis-El Manar, boulevard du 9-Avril 1938, 1007 Tunis, Tunisie.
| | - I Ammous
- Service d'ophtalmologie, faculté de médecine de Tunis, hôpital universitaire Charles-Nicolle, université Tunis-El Manar, boulevard du 9-Avril 1938, 1007 Tunis, Tunisie.
| | - R Zhioua
- Service d'ophtalmologie, faculté de médecine de Tunis, hôpital universitaire Charles-Nicolle, université Tunis-El Manar, boulevard du 9-Avril 1938, 1007 Tunis, Tunisie.
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35
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Cabral D, Pereira T, Ledesma-Gil G, Rodrigues C, Coscas F, Sarraf D, Freund KB. Volume Rendering of Dense B-Scan Optical Coherence Tomography Angiography to Evaluate the Connectivity of Macular Blood Flow. Invest Ophthalmol Vis Sci 2021; 61:44. [PMID: 32561927 PMCID: PMC7415320 DOI: 10.1167/iovs.61.6.44] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose To characterize macular blood flow connectivity using volume rendering of dense B-scan (DB) optical coherence tomography angiography (OCTA) data. Methods This was a prospective, cross-sectional, observational study. DB OCTA perifoveal scans were performed on healthy subjects using the Spectralis HRA+OCT2. A volumetric projection artifact removal algorithm and customized filters were applied to raw OCTA voxel data. Volume rendering was performed using a workflow on Imaris 9.5 software. Vascular graphs were obtained from angiographic data using the algorithm threshold-loops. Superficial arteries and veins were identified from color fundus photographs and connections between adjacent arteries and veins displayed using the shortest path algorithm. Connective pathway locations were analyzed with cross-sectional OCT and OCTA to determine their course through the superficial vascular complex (SVC) and the deep vascular complex (DVC). Results Fourteen eyes from seven subjects (mean age: 28 ± 5 years; 3 women) were included in this analysis. One hundred and twenty-six vascular connections were analyzed. In all cases, the shortest path connections between superficial arteries and veins coursed through the DVC. We did not identify shortest path connections confined to the SVC. Conclusions Volumetric analysis of vascular connectivity supports a predominantly in-series arrangement of blood flow between the SVC and DVC within the human perifoveal macula.
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Cao Y, Yan J, Zhan Z, Liang Y, Han Z. Macula Structure and Microvascular Changes in Recent Small Subcortical Infarct Patients. Front Neurol 2021; 11:615252. [PMID: 33488504 PMCID: PMC7817655 DOI: 10.3389/fneur.2020.615252] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/23/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose: This study aimed to assess the macula structure and capillaries in the macula and optic nerve head in recent small subcortical infarct (RSSI) patients. Methods: This observational cross-sectional study included 40 RSSI patients and 46 healthy controls. Optical coherence tomography angiography was used to image the capillaries in the macula and optic nerve head. An inbuilt algorithm was used to measure the densities in the microvasculature of the macula [superficial retinal capillary plexus (SRCP) and deep retinal capillary plexus (DRCP)] and optic nerve head [radial peripapillary capillary (RPC)] and thickness around the optic nerve head, peripapillary retinal nerve fiber layer (pRNFL). Results: Densities in RPC (P < 0.001), SRCP (P = 0.001), and DRCP (P = 0.003) were reduced in RSSI patients when compared with healthy controls. The pRNFL thickness was thinner (P < 0.001) in RSSI patients than healthy controls. In the RSSI group, the SRCP density significantly correlated with the DRCP density (rho = 0.381, P = 0.042). The pRNFL thickness displayed a significant relationship with the RPC density (rho = 0.482, P = 0.003) in the RSSI group. Conclusions: RSSI patients showed interrupted capillary plexuses leading to its significant impairment and neurodegeneration. Our report provides insight into the macula capillary microcirculation changes in RSSI.
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Affiliation(s)
- Yungang Cao
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jueyue Yan
- School of Medicine, First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Zhenxiang Zhan
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuanbo Liang
- Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhao Han
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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37
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Borrelli E, Battista M, Sacconi R, Querques G, Bandello F. Optical Coherence Tomography Angiography in Diabetes. Asia Pac J Ophthalmol (Phila) 2021; 10:20-25. [PMID: 33512826 DOI: 10.1097/apo.0000000000000351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
ABSTRACT The introduction of optical coherence tomography angiography (OCTA) has significantly improved our knowledge on the ocular vascular alterations occurring in diabetes. In this article, we will provide a review of the prominent OCTA findings in diabetes. In details, OCTA demonstrated that both the retinal vessels and the choriocapillaris are affected in diabetic subjects. The recent employment of widefield technology and a 3-dimensional (3D) visualization in OCTA imaging are also discussed.
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Affiliation(s)
- Enrico Borrelli
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
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38
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An D, Yu P, Freund KB, Yu DY, Balaratnasingam C. Three-Dimensional Characterization of the Normal Human Parafoveal Microvasculature Using Structural Criteria and High-Resolution Confocal Microscopy. Invest Ophthalmol Vis Sci 2021; 61:3. [PMID: 32749461 PMCID: PMC7443114 DOI: 10.1167/iovs.61.10.3] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose To use structural criteria to reconcile the three-dimensional organization and connectivity of the parafoveal microvasculature. Methods The parafoveal microvasculature was perfused and labeled in 16 normal human donor eyes for lectin, alpha smooth muscle actin, and filamentous actin. Established structural criteria gathered using confocal microscopy, including vessel diameter, endothelial cell morphology, and presence/density of smooth muscle cells, were used to differentiate arteries, arterioles, capillaries, venules, and veins. Three-dimensional visualization strategies were used to define the connections between retinal arteries and veins within the superficial vascular plexus (SVP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP). Results The parafoveal microvasculature has two different inflow patterns and seven different outflow patterns. The SVP and ICP were connected to retinal arteries by arterioles. Inflow into the DCP occurred only via small arterioles (a1; mean diameter, 8.3 µm) that originated from the ICP. Direct connections between the DCP and retinal arteries were not identified. Each capillary plexus formed its own venule that drained independently or in conjunction with venules from other plexuses into a retinal vein at the level of the ganglion cell layer. For the DCP, a1 was significantly smaller than its draining venule (mean diameter, 18.8 µm; P < 0.001). Conclusions The SVP and ICP of the parafoveal microvasculature have both in series and in parallel arterial and venous connections. Arterial supply to the DCP originates from the ICP, but with direct drainage to the retinal vein. These findings may help to develop an understanding of the pattern of retinal lesions characterizing a myriad of retinal vascular diseases.
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39
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Borrelli E, Parravano M, Sacconi R, Costanzo E, Querques L, Vella G, Bandello F, Querques G. Guidelines on Optical Coherence Tomography Angiography Imaging: 2020 Focused Update. Ophthalmol Ther 2020; 9:697-707. [PMID: 32740741 PMCID: PMC7708612 DOI: 10.1007/s40123-020-00286-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Indexed: 02/07/2023] Open
Abstract
Optical coherence tomography angiography (OCTA) has significantly expanded our knowledge of the ocular vasculature. In this review, we provide a discussion of the fundamental principles of OCTA and the application of this imaging modality to study the retinal and choroidal vessels. These guidelines are focused on 2020, and include updates since the 2019 publication. Importantly, we will comment on recent findings on OCTA technology with a special focus on the three-dimensional (3D) OCTA visualization.
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Affiliation(s)
- Enrico Borrelli
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | | | - Riccardo Sacconi
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | | | - Lea Querques
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Giovanna Vella
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, 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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40
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Wang D, Au A, Duker JS, Sarraf D. PAMM and the ischemic cascade associated with radiation retinopathy. Am J Ophthalmol Case Rep 2020; 20:100918. [PMID: 32984654 PMCID: PMC7495006 DOI: 10.1016/j.ajoc.2020.100918] [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: 04/13/2020] [Revised: 06/28/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose To report a case of paracentral acute middle maculopathy (PAMM) and evidence of the ischemic cascade documented with spectral domain optical coherence tomography (SD-OCT) following radiation treatment of a choroidal melanoma. Observations A healthy young patient was evaluated for an asymptomatic choroidal nevus in the left eye. Fundus examination was remarkable for a choroidal melanocytic lesion that measured 1.8 mm in thickness by initial B-scan ultrasound. Clinical examination 6 months later showed growth of the tumor at several margins with new subretinal fluid, and a B-scan measured thickness of 1.9 mm. The lesion was diagnosed as a small choroidal melanoma and treated with gamma knife radiation with a dose of 3000 cGy. Sixteen months later, examination showed signs of radiation retinopathy including cotton wool spots and PAMM via SD-OCT and OCT angiography and evidence of the ischemic cascade (i.e., alternating zones of middle and combined middle and inner retinal layer infarction). Conclusions Radiation retinopathy can include signs of microvascular damage and ischemia including lesions such as cotton wool spots and PAMM. A case is presented in this report of radiation retinopathy with OCT evidence of PAMM and the ischemic cascade.
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Affiliation(s)
- Derrick Wang
- Stein Eye Institute, Department of Ophthalmology, University of California, David Geffen School of Medicine, Los Angeles (UCLA), CA, USA
| | - Adrian Au
- Stein Eye Institute, Department of Ophthalmology, University of California, David Geffen School of Medicine, Los Angeles (UCLA), CA, USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - David Sarraf
- Stein Eye Institute, Department of Ophthalmology, University of California, David Geffen School of Medicine, Los Angeles (UCLA), CA, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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41
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Optical coherence tomography angiography in diabetes: focus on microaneurysms. Eye (Lond) 2020; 35:142-148. [PMID: 32887935 DOI: 10.1038/s41433-020-01173-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/18/2020] [Accepted: 08/25/2020] [Indexed: 01/12/2023] Open
Abstract
The introduction of optical coherence tomography angiography (OCTA) has remarkably expanded our knowledge of the ocular vascular alterations occurring in diabetes. In this article, a review of the prominent OCTA findings in diabetes is followed by a description of salient histological and anatomical features of microaneurysms, essential for the proper interpretation of in vivo imaging of these retinal vascular abnormalities. The recent employment of a three-dimensional (3D) visualization in OCTA imaging is also discussed. The latter imaging technique has granted a detailed characterization of microaneurysms in vivo.
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42
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Pilotto E, Nacci EB, Ferrara AM, De Mojà G, Zovato S, Midena E. Macular Perfusion Impairment in Von Hippel-Lindau Disease Suggests a Generalized Retinal Vessel Alteration. J Clin Med 2020; 9:jcm9082677. [PMID: 32824842 PMCID: PMC7464479 DOI: 10.3390/jcm9082677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023] Open
Abstract
Background: To evaluate macular perfusion in patients with Von Hippel–Lindau (VHL) disease. Methods: VHL patients with or without peripheral retinal hemangioblastomas (RHs) were consecutively enrolled. A group of healthy subjects served as controls. Macular perfusion was analyzed by means of OCT angiography (OCTA) in the superficial vascular plexus (SVP), and in the intermediate (ICP) and deep retinal capillary (DCP) plexuses. The following OCTA parameters were measured: Vessel Area Density (VAD), Vessel Length Fraction (VLF), Vessel Diameter Index (VDI) and Fractal Dimension (FD). Results: Sixty-three VHL patients (113 eyes) and 28 healthy controls (56 eyes) were enrolled. All OCTA quantitative parameters were reduced in VHL patients vs. controls, reaching statistical significance for VAD of the SVP (0.348 ± 0.07 vs. 0.369 ± 0.06, p = 0.0368) and VDI of all plexuses (p < 0.03 for all). No significant differences were detected between eyes without or with peripheral RHs. Conclusions: Macular perfusion is reduced in VHL patients demonstrating retinal vessel changes that are independent of the presence of peripheral RHs. VHL gene mutations disrupt the hypoxia-induced (HIF)/vascular endothelium growth factors (VEGF) pathway and the Notch signaling, both essential for the normal retinal vasculogenesis and angiogenesis. Therefore, an anomalous generalized retinal vascular development may be hypothesized in VHL disease.
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Affiliation(s)
- Elisabetta Pilotto
- Department of Ophthalmology, University of Padova, 35122 Padova, Italy; (E.P.); (G.D.M.); (E.M.)
| | | | | | - Gilda De Mojà
- Department of Ophthalmology, University of Padova, 35122 Padova, Italy; (E.P.); (G.D.M.); (E.M.)
| | - Stefania Zovato
- Familial Tumor Unit, Veneto Institute of Oncology IOV-IRCCS, 35122 Padova, Italy; (A.M.F.); (S.Z.)
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, 35122 Padova, Italy; (E.P.); (G.D.M.); (E.M.)
- IRCCS—Fondazione G. B. Bietti, 00198 Rome, Italy
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Scharf J, Freund KB, Sadda S, Sarraf D. Paracentral acute middle maculopathy and the organization of the retinal capillary plexuses. Prog Retin Eye Res 2020; 81:100884. [PMID: 32783959 DOI: 10.1016/j.preteyeres.2020.100884] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023]
Abstract
The retinal capillary vasculature serves the formidable role of supplying the metabolically active inner and middle retina. In the parafoveal region, the retinal capillary plexuses (RCP) are organized in a system of three capillary layers of varying retinal depths: the superficial capillary plexus (SCP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP). While the dynamic flow through these plexuses is complex and not completely understood, current research points to a hybrid model that includes both parallel and in series components in which blood flows in a predominantly serial direction between the superficial vascular complex (SVC) and deep vascular complex (DVC). Each capillary plexus autoregulates independently, so that under most conditions the retinal vasculature supplies adequate blood flow and oxygen saturation at varying depths despite diverse environmental stressors. When the flow in the deep vascular complex (i.e. ICP and DCP) fails, an ischemic lesion referred to as Paracentral Acute Middle Maculopathy (PAMM) can be identified. PAMM is an optical coherence tomography (OCT) finding defined by the presence of a hyperreflective band at the level of the inner nuclear layer (INL) that indicates INL infarction caused by globally impaired perfusion through the retinal capillary system leading to hypoperfusion of the DVC or specifically the DCP. Patients present with an acute onset paracentral scotoma and typically experience a permanent visual defect. Lesions can be caused by a diverse set of local retinal vascular diseases and systemic disorders. PAMM is a manifestation of the retinal ischemic cascade in which the mildest forms of ischemia develop at the venular end of the DCP, i.e. perivenular PAMM, while more severe forms progress horizontally to diffusely involve the INL, and the most severe forms progress vertically to infarct the inner retina. Management is targeted toward the identification and treatment of related vasculopathic and systemic risk factors.
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Affiliation(s)
- Jackson Scharf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - K Bailey Freund
- Retina Department, Vitreous Retina Macula Consultants of New York, New York, NY, United States
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, CA, United States; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - David Sarraf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Greater Los Angeles VA Healthcare Center, Los Angeles, CA, United States.
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Systemic hypertension associated retinal microvascular changes can be detected with optical coherence tomography angiography. Sci Rep 2020; 10:9580. [PMID: 32533105 PMCID: PMC7293289 DOI: 10.1038/s41598-020-66736-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/26/2020] [Indexed: 01/05/2023] Open
Abstract
A major complication of hypertension is microvascular damage and capillary rarefaction is a known complication of hypertensive end-organ damage which confers a higher risk of systemic disease such as stroke and cardiovascular events. Our aim was to study the effect of hypertension on the retinal microvasculature using non-invasive optical coherence tomography angiography (OCTA). We performed a case-control study of 94 eyes of 94 participants with systemic hypertension and 46 normal control eyes from the Singapore Chinese Eye Study using a standardized protocol to collect data on past medical history of hypertension, including the number and type of hypertensive medications and assessed mean arterial pressure. Retinal vascular parameters were measured in all eyes using OCTA. In the multivariate analysis adjusting for confounders, compared to controls, eyes of hypertensive patients showed a decrease in the macular vessel density at the level of the superficial [OR 0.02; 95% CI, 0 to 0.64; P 0.027] and deep venous plexuses [OR 0.03; 95% CI, 0 to 0.41; P 0.009] and an increase in the deep foveal avascular zone. This shows that hypertension is associated with reduced retinal vessel density and an increased foveal avascular zone, especially in the deep venous plexus, as seen on OCTA and there is a potential role in using OCTA as a clinical tool to monitor hypertensive damage and identifying at risk patients
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Au A, Hilely A, Scharf J, Gunnemann F, Wang D, Chehaibou I, Iovino C, Grondin C, Farecki ML, Falavarjani KG, Phasukkijwatana N, Battista M, Borrelli E, Sacconi R, Powell B, Hom G, Greenlee TE, Conti TF, Ledesma-Gil G, Teke MY, Choudhry N, Fung AT, Krivosic V, Baek J, Lee MY, Sugiura Y, Querques G, Peiretti E, Rosen R, Lee WK, Yannuzzi LA, Zur D, Loewenstein A, Pauleikhoff D, Singh R, Modi Y, Hubschman JP, Ip M, Sadda S, Freund KB, Sarraf D. Relationship Between Nerve Fiber Layer Hemorrhages and Outcomes in Central Retinal Vein Occlusion. Invest Ophthalmol Vis Sci 2020; 61:54. [PMID: 32460316 PMCID: PMC7405700 DOI: 10.1167/iovs.61.5.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/09/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the depth and pattern of retinal hemorrhage in acute central retinal vein occlusion (CRVO) and to correlate these with visual and anatomic outcomes. Methods Retinal hemorrhages were evaluated with color fundus photography and fluorescein angiography at baseline and follow-up. Snellen visual acuity (VA), central foveal thickness (CFT), extent of retinal ischemia, and development of neovascularization were analyzed. Results 108 eyes from 108 patients were evaluated. Mean age was 63.6 ± 16.1 years with a predilection for the right eye (73.1%). Average follow-up was 17.2 ± 19.2 months. Mean VA at baseline was 20/126 and 20/80 at final follow-up. Baseline (P = 0.005) and final VA (P = 0.02) in eyes with perivascular nerve fiber layer (NFL) hemorrhages were significantly worse than in eyes with deep hemorrhages alone. Baseline CFT was greater in the group with perivascular hemorrhages (826 ± 394 µm) compared to the group with deep hemorrhages alone (455 ± 273 µm, P < 0.001). The 10 disc areas of retinal ischemia was more common in patients with perivascular (80.0%) and peripapillary (31.3%) versus deep hemorrhages alone (16.1%, P < 0.001). Neovascularization of the iris was more common, although this differrence was not significant, in the groups with peripapillary (14.3%) and perivascular (2.0%) NFL versus deep hemorrhages alone (0.0%). Conclusions NFL retinal hemorrhages at baseline correlate with more severe forms of CRVO, with greater macular edema, poorer visual outcomes, and greater risk of ischemia and neovascularization. This may be related to the organization of the retinal capillary plexus. The depth and pattern of distribution of retinal hemorrhages in CRVO may provide an easily identifiable early biomarker of CRVO prognosis.
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Affiliation(s)
- Adrian Au
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Assaf Hilely
- Stein Eye Institute, University of California, Los Angeles, California, United States
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jackson Scharf
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Frederic Gunnemann
- Stein Eye Institute, University of California, Los Angeles, California, United States
- Department of Ophthalmology, St. Franziskus-Hospital, Münster, Germany
| | - Derrick Wang
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Ismael Chehaibou
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Claudio Iovino
- Department of Surgical Science, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Christelle Grondin
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | | | - Khalil Ghasemi Falavarjani
- Eye Research Center and Eye Department, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nopasak Phasukkijwatana
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marco Battista
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute University Vita-Salute San Raffaele, Milan, Italy
| | - Enrico Borrelli
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute University Vita-Salute San Raffaele, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute University Vita-Salute San Raffaele, Milan, Italy
| | - Brittany Powell
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Grant Hom
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Tyler E. Greenlee
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Thais F. Conti
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | | | - Mehmet Yasin Teke
- Ophthalmology Department, Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Netan Choudhry
- Vitreous Retina Macula Specialists of Toronto, Toronto, Ontario, Canada
| | - Adrian T. Fung
- Discipline of Ophthalmology, Westmead and Central Clinical Schools, University of Sydney; Department of Ophthalmology, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Valerie Krivosic
- Hôpital Lariboisière, AP-HP, Université Paris-Diderot, Sorbonne Paris Cité. France
| | - Jiwon Baek
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Mee Yon Lee
- Department of Ophthalmology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Yoshimi Sugiura
- Vitreous Retina Macula Consultants of New York, New York, United States
| | - Giuseppe Querques
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute University Vita-Salute San Raffaele, Milan, Italy
| | - Enrico Peiretti
- Department of Surgical Science, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Richard Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Won Ki Lee
- Retina Center, Nune Eye Hospital, Gangnam-gu, Seoul, Republic of Korea
| | | | - Dinah Zur
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Loewenstein
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Rishi Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Yasha Modi
- Department of Ophthalmology, New York University School of Medicine, New York, New York, United States
| | - Jean Pierre Hubschman
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Michael Ip
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, United States
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, United States
| | - K. Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, United States
| | - David Sarraf
- Stein Eye Institute, University of California, Los Angeles, California, United States
- VA Greater Los Angeles Healthcare System, Los Angeles, California, United States
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Jung JJ, Yu DJG, Zeng A, Chen MH, Shi Y, Nassisi M, Marion KM, Sadda SR, Hoang QV. Correlation of Quantitative Measurements with Diabetic Disease Severity Using Multiple En Face OCT Angiography Image Averaging. Ophthalmol Retina 2020; 4:1069-1082. [PMID: 32389888 DOI: 10.1016/j.oret.2020.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/22/2020] [Accepted: 04/30/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the effect of averaging en face OCT angiography (OCTA) images on quantitative measurements of the retinal microvasculature and their correlation to diabetic retinopathy (DR) disease severity. DESIGN Cross-sectional cohort study. PARTICIPANTS One hundred five eyes (65 patients) comprising 28 eyes from 19 healthy, aged-matched control participants, 14 eyes from 9 diabetics without DR, and 63 eyes from 37 diabetics with varying levels of DR. METHODS Spectral-domain CIRRUS 5000 (Carl Zeiss Meditec, Dublin, CA) OCTA images with no macular edema or significant motion artifact were acquired 5 times with the 3 × 3-mm scan pattern. En face images of the superficial retinal layer (SRL) and deep retinal layer were registered and averaged. Vessel length density (VLD), perfusion density (PD), and foveal avascular zone (FAZ) parameters were measured on averaged versus single OCTA images. MAIN OUTCOME MEASURES Univariate and multivariate linear regression correlated quantitative metrics to DR severity and best-corrected visual acuity (BCVA). RESULTS Eighty-four eyes (55 patients) met the inclusion criteria. Almost uniformly, lower VLD and PD parameters were associated significantly with worse DR severity and BCVA. Multivariate linear regression for DR severity resulted in an R2 value of 0.82 and 0.77 for single and averaged groups, respectively. No variables remained associated significantly with DR severity in multivariate analysis with single images, but in averaged images, increased superior SRL PD significantly predicted worse DR severity (coefficient, 52.7; P = 0.026). Multivariate linear regression for BCVA had an R2 value of 0.42 and 0.47 for single and averaged groups, respectively. Foveal avascular zone size was not associated with DR severity when single OCTA images (P = 0.98) were considered, but was highly associated when using averaged images (coefficient, 6.18; P < 0.001). Foveal avascular zone size was predictive for logarithm of the minimum angle of resolution BCVA with averaged images (0.21; P = 0.004), but not with single images (P = 0.31). CONCLUSIONS Averaging of en face OCTA images improves the visualization of capillaries, particularly increasing the clarity of the FAZ borders, and therefore improves the correlation of vessel density and FAZ-specific parameters to DR severity and BCVA.
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Affiliation(s)
- Jesse J Jung
- East Bay Retina Consultants, Inc, Oakland, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
| | - Daryle Jason G Yu
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Anne Zeng
- East Bay Retina Consultants, Inc, Oakland, California
| | | | - Yue Shi
- Doheny Eye Institute, Los Angeles, California
| | - Marco Nassisi
- Doheny Eye Institute, Los Angeles, California; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Srinivas R Sadda
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Quan V Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Republic of Singapore; Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York
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47
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Baumal CR, Sarraf D, Bryant T, Gui W, Muakkassa N, Pichi F, Querques G, Choudhry N, Teke MY, Govetto A, Invernizzi A, Eliott D, Gaudric A, Cunha de Souza E, Naysan J, Lembo A, Lee GC, Freund KB. Henle fibre layer haemorrhage: clinical features and pathogenesis. Br J Ophthalmol 2020; 105:374-380. [PMID: 32376610 DOI: 10.1136/bjophthalmol-2019-315443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND To describe the clinical presentation and characteristic imaging features of deep retinal haemorrhages primarily located in the Henle fibre layer (HFL) of the macula. The spectrum of aetiologies and a comprehensive theory of pathogenesis are presented. METHODS This is a retrospective, multicentre case series evaluating eyes with retinal haemorrhage in HFL. Clinical features, underlying aetiology, systemic and ocular risk factors, visual acuity, and multimodal imaging including fundus photography and cross-sectional and en face optical coherence tomography (OCT) are presented. RESULTS Retinal haemorrhages localised to HFL in 33 eyes from 23 patients were secondary to acute blunt trauma to the head (n=2), eye (n=1) and trunk (n=1), ruptured intracranial aneurysm (Terson's syndrome, n=3), general anaesthesia (n=1), epidural anaesthesia (n=1), hypertension with anaemia (n=1), decompression retinopathy (n=1), postvitrectomy with intraocular gas (n=1), retinal vein occlusion (n=7), myopic degeneration (n=2), macular telangiectasia type 2 (n=1), and polypoidal choroidal vasculopathy (n=1). Defining clinical features included deep retinal haemorrhage with feathery margin and petaloid pattern radiating from the fovea. OCT demonstrated characteristic hyper-reflectivity from the haemorrhage delineated by obliquely oriented fibres in the Henle layer. Spontaneous resolution of HFL haemorrhage occurred after 3 months in 15 patients with follow-up. CONCLUSION The characteristic petaloid-shaped, deep intraretinal haemorrhage with a feathery margin localised to HFL is associated with various disorders. The terminology 'Henle fiber layer hemorrhage (HH)' is proposed to describe the clinical and OCT findings, which may result from abnormal retinal venous pressure from systemic or local retinovascular disorders affecting the deep capillary plexus or from choroidal vascular abnormalities.
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Affiliation(s)
| | - David Sarraf
- Retina Department, Jules Stein Eye Institute, UCLA, Los Angeles, California, USA
| | - Tara Bryant
- Ophthalmology, New England Eye Center, Boston, Massachusetts, USA
| | - Wei Gui
- Retina Department, Jules Stein Eye Institute, UCLA, Los Angeles, California, USA
| | - Nora Muakkassa
- Ophthalmology, New England Eye Center, Boston, Massachusetts, USA
| | | | | | - Netan Choudhry
- Vitreoretinal Surgery, Herzig Eye Institute, Toronto, Ontario, Canada
| | - Mehmet Yasin Teke
- Department of Ophthalmology, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Andrea Govetto
- Retina Department, Jules Stein Eye Institute, Los Angeles, California, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Milan, Italy
| | - Dean Eliott
- Retina Department, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Alain Gaudric
- Department of Ophthalmology, Lariboisière Hospital, University of Paris 7 Denis Diderot, Paris, France
| | | | - Jonathan Naysan
- Ophthalmology, North Shore-Long Island Jewish, Great Neck, New York, USA
| | - Andrea Lembo
- University Eye Clinic, San Giuseppe Hospital, Milan, Italy
| | - Grace C Lee
- Department of Ophthalmology, Kaiser Permanente, Woodland Hills, California, USA
| | - K Bailey Freund
- Retina Department, Vitreous Retina Macula Consultants of New York, New York, New York, USA
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Sun Z, Tang F, Wong R, Lok J, Szeto SKH, Chan JCK, Chan CKM, Tham CC, Ng DS, Cheung CY. OCT Angiography Metrics Predict Progression of Diabetic Retinopathy and Development of Diabetic Macular Edema: A Prospective Study. Ophthalmology 2019; 126:1675-1684. [PMID: 31358386 DOI: 10.1016/j.ophtha.2019.06.016] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/03/2019] [Accepted: 06/17/2019] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To prospectively determine the relationship of OCT angiography (OCTA) metrics to diabetic retinopathy (DR) progression and development of diabetic macular edema (DME). DESIGN Prospective, observational study. PARTICIPANTS A total of 205 eyes from 129 patients with diabetes mellitus followed up for at least 2 years. METHODS All participants underwent OCTA with a swept-source OCT device (DRI-OCT Triton, Topcon, Inc, Tokyo, Japan). Individual OCTA images of superficial capillary plexus (SCP) and deep capillary plexus (DCP) were generated by IMAGEnet6 (Basic License 10). After a quality check, automated measurements of foveal avascular zone (FAZ) area, FAZ circularity, vessel density (VD), and fractal dimension (FD) of both SCP and DCP were then obtained. MAIN OUTCOME MEASURES Progression of DR and development of DME. RESULTS Over a median follow-up of 27.14 months (interquartile range, 24.16-30.41 months), 28 of the 205 eyes (13.66%) developed DR progression. Of the 194 eyes without DME at baseline, 17 (8.76%) developed DME. Larger FAZ area (hazard ratio [HR], 1.829 per SD increase; 95% confidence interval [CI], 1.332-2.512), lower VD (HR, 1.908 per SD decrease; 95% CI, 1.303-2.793), and lower FD (HR, 4.464 per SD decrease; 95% CI, 1.337-14.903) of DCP were significantly associated with DR progression after adjusting for established risk factors (DR severity, glycated hemoglobin, duration of diabetes, age, and mean arterial blood pressure at baseline). Lower VD of SCP (HR, 1.789 per SD decrease; 95% CI, 1.027-4.512) was associated with DME development. Compared with the model with established risk factors alone, the addition of OCTA metrics improved the predictive discrimination of DR progression (FAZ area of DCP, C-statistics 0.723 vs. 0.677, P < 0.001; VD of DCP, C-statistics 0.727 vs. 0.677, P = 0.001; FD of DCP, C-statistics 0.738 vs. 0.677, P < 0.001) and DME development (VD of SCP, C-statistics 0.904 vs. 0.875, P = 0.036). CONCLUSIONS The FAZ area, VD, and FD of DCP predict DR progression, whereas VD of SCP predicts DME development. Our findings provide evidence to support that OCTA metrics improve the evaluation of risk of DR progression and DME development beyond traditional risk factors.
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Affiliation(s)
- Zihan Sun
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Fangyao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Raymond Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Jerry Lok
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Simon K H Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Jason C K Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Carmen K M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Danny S Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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49
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MULTIMODAL IMAGING OF A PRESUMED EMBOLIC CILIORETINAL ARTERY OCCLUSION. Retin Cases Brief Rep 2019; 16:141-144. [PMID: 31725598 DOI: 10.1097/icb.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe clinical features including multimodal imaging in a rare case of presumed embolic cilioretinal artery occlusion with long-term follow-up examination. METHODS A 61-year-old man presented after noticing an acute-onset central scotoma in the left eye during coronary arteriography. Fundus color photography, red-free imaging, near-infrared reflectance, spectral domain optical coherence tomography (OCT), fluorescein angiography, and swept-source OCT angiography were performed. RESULTS Color and red-free fundus imaging both showed retinal whitening in the territory corresponding to a cilioretinal artery in the left eye. Consistent with an ischemic event, the near-infrared reflectance showed a hyporeflective area in the same location. Spectral domain OCT showed hyperreflectivity and generalized thickening of the inner nuclear layer, ganglion cell layer, and retinal nerve fiber layer. Seven years later, color, red-free, and near-infrared reflectance imaging appeared normal, but the spectral domain OCT showed thinning of all retinal layers in the affected area. Furthermore, swept-source OCT angiography demonstrated markedly reduced capillary flow signal in the superficial and deep capillary plexuses, corresponding to a persistent scotoma described by the patient. CONCLUSION This case report illustrates hallmark features of a rare presumed embolic cilioretinal artery occlusion and its long-term manifestations with thorough historical and multimodal imaging data. When standard fundus imaging with color, red-free, and near-infrared reflectance appears normal years after a retinal vascular insult, OCT and OCT angiography can corroborate a patient's persistent visual deficit and provide clarity to the diagnosis.
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50
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Xu X, Yannuzzi NA, Fernández-Avellaneda P, Echegaray JJ, Tran KD, Russell JF, Patel NA, Hussain RM, Sarraf D, Freund KB. Differentiating Veins From Arteries on Optical Coherence Tomography Angiography by Identifying Deep Capillary Plexus Vortices. Am J Ophthalmol 2019; 207:363-372. [PMID: 31226248 DOI: 10.1016/j.ajo.2019.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/07/2019] [Accepted: 06/08/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE To introduce a simple method for differentiating retinal veins from arteries on optical coherence tomography angiography (OCTA). DESIGN Cross-sectional pilot study. METHODS Four default en face slabs including color depth encoded, grayscale full-thickness retina, superficial plexus, and deep capillary plexus (DCP) from nine 3×3-mm and nine 6×6-mm OCTA scans were exported and aligned. Nine ophthalmologists with minimum OCTA experience from 2 eye institutions were instructed to classify labeled vessels as arteries or veins in 3 stages. Classification was performed based on graders' own assessment at stage 1. Graders were taught that a capillary-free zone was an anatomic feature of arteries at stage 2 and were trained to identify veins originating from vortices within the DCP at stage 3. Grading accuracy was analyzed and correlated with grading time and graders' years in practice. RESULTS Overall grading accuracy in stages 1, 2, and 3 was (50.4% ± 17.0%), (75.4% ± 6.0%), and (94.7% ± 2.6%), respectively. Grading accuracy for 3×3-mm scans in stages 1, 2, and 3 was (49.9% ± 16.3%), (79.2% ± 9.6%), and (96.9% ± 3.1%), respectively. Accuracy for 6×6-mm scans in stages 1, 2, and 3 was (51.4% ± 20.8%), (72.3% ± 7.9%), and (93.2% ± 3.3%), respectively. Grading performance improved significantly at each stage (all P < .001). No significant correlation was found between accuracy and time spent grading or between accuracy and years in practice (r = -0.164 to 0.617, all P ≥ .077). CONCLUSIONS We describe a simple method for accurately distinguishing retinal arteries from veins on OCTA, which incorporates the use of vortices in the DCP to identify venous origin.
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Affiliation(s)
- 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, Guangzhou, China
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Pedro Fernández-Avellaneda
- 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; Department of Ophthalmology, Basurto University Hospital, Bilbao, Spain
| | - Jose J Echegaray
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kimberly D Tran
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jonathan F Russell
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nimesh A Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rehan M Hussain
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David Sarraf
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, USA
| | - K Bailey Freund
- 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; Department of Ophthalmology, New York University of Medicine; Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York, USA.
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