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Vallino V, Berni A, Coletto A, Serafino S, Bandello F, Reibaldi M, Borrelli E. Structural OCT and OCT angiography biomarkers associated with the development and progression of geographic atrophy in AMD. Graefes Arch Clin Exp Ophthalmol 2024; 262:3421-3436. [PMID: 38689123 PMCID: PMC11584504 DOI: 10.1007/s00417-024-06497-8] [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: 01/12/2024] [Revised: 04/12/2024] [Accepted: 04/25/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Geographic atrophy (GA) is an advanced, irreversible, and progressive form of age-related macular degeneration (AMD). Structural optical coherence tomography (OCT) and OCT angiography (OCTA) have been largely used to characterize this stage of AMD and, more importantly, to define biomarkers associated with the development and progression of GA in AMD. METHODS Articles pertaining to OCT and OCTA biomarkers related to the development and progression of GA with relevant key words were used to search in PubMed, Researchgate, and Google Scholar. The articles were selected based on their relevance, reliability, publication year, published journal, and accessibility. RESULTS Previous reports have highlighted various OCT and OCTA biomarkers linked to the onset and advancement of GA. These biomarkers encompass characteristics such as the size, volume, and subtype of drusen, the presence of hyperreflective foci, basal laminar deposits, incomplete retinal pigment epithelium and outer retinal atrophy (iRORA), persistent choroidal hypertransmission defects, and the existence of subretinal drusenoid deposits (also referred to as reticular pseudodrusen). Moreover, biomarkers associated with the progression of GA include thinning of the outer retina, photoreceptor degradation, the distance between retinal pigment epithelium and Bruch's membrane, and choriocapillaris loss. CONCLUSION The advent of novel treatment strategies for GA underscores the heightened need for prompt diagnosis and precise monitoring of individuals with this condition. The utilization of structural OCT and OCTA becomes essential for identifying distinct biomarkers associated with the initiation and progression of GA.
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Affiliation(s)
- Veronica Vallino
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | - Alessandro Berni
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Coletto
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | - Sonia Serafino
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | - Francesco Bandello
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | - Enrico Borrelli
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, Turin, Italy.
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy.
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Yoon WT, Lee SJ, Jeong JH, Kim JH. Prediction of fellow eye neovascularization in type 3 macular neovascularization (Retinal angiomatous proliferation) using deep learning. PLoS One 2024; 19:e0310097. [PMID: 39475903 PMCID: PMC11524474 DOI: 10.1371/journal.pone.0310097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 08/25/2024] [Indexed: 11/02/2024] Open
Abstract
PURPOSE To establish a deep learning artificial intelligence model to predict the risk of long-term fellow eye neovascularization in unilateral type 3 macular neovascularization (MNV). METHODS This retrospective study included 217 patients (199 in the training/validation of the AI model and 18 in the testing set) with a diagnosis of unilateral type 3 MNV. The purpose of the AI model was to predict fellow eye neovascularization within 24 months after the initial diagnosis. The data used to train the AI model included a baseline fundus image and horizontal/vertical cross-hair scan optical coherence tomography images in the fellow eye. The neural network of this study for AI-learning was based on the visual geometry group with modification. The precision, recall, accuracy, and the area under the curve values of receiver operating characteristics (AUCROC) were calculated for the AI model. The accuracy of an experienced (examiner 1) and less experienced (examiner 2) human examiner was also evaluated. RESULTS The incidence of fellow eye neovascularization over 24 months was 28.6% in the training/validation set and 38.9% in the testing set (P = 0.361). In the AI model, precision was 0.562, recall was 0.714, accuracy was 0.667, and the AUCROC was 0.675. The sensitivity, specificity, and accuracy were 0.429, 0.727, and 0.611, respectively, for examiner 1, and 0.143, 0.636, and 0.444, respectively, for examiner 2. CONCLUSIONS This is the first AI study focusing on the clinical course of type 3 MNV. While our AI model exhibited accuracy comparable to that of human examiners, overall accuracy was not high. This may partly be a result of the relatively small number of patients used for AI training, suggesting the need for future multi-center studies to improve the accuracy of the model.
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Affiliation(s)
- Won Tae Yoon
- Department of Ophthalmology, Kim’s Eye Hospital, Seoul, South Korea
- Kim’s Eye Hospital Data Center, Seoul, South Korea
| | - Seong Jae Lee
- HumanDeep Inc., Seongnam-si, Gyeonggi-do, South Korea
| | - Jae Hee Jeong
- HumanDeep Inc., Seongnam-si, Gyeonggi-do, South Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim’s Eye Hospital, Seoul, South Korea
- Kim’s Eye Hospital Data Center, Seoul, South Korea
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Kim JH, Kim JW, Kim CG. Importance of optical coherence tomography raster scans in early detection of active fellow-eye neovascularization in unilateral neovascular age-related macular degeneration. BMC Ophthalmol 2024; 24:359. [PMID: 39169293 PMCID: PMC11337628 DOI: 10.1186/s12886-024-03613-4] [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: 03/23/2024] [Accepted: 08/05/2024] [Indexed: 08/23/2024] Open
Abstract
PURPOSE To investigate the incidence of and risk factors for failure of detection of active fellow-eye neovascularization on optical coherence tomography(OCT) crosshair scans in patients with unilateral neovascular age-related macular degeneration(AMD). METHODS In this retrospective study, patients who experienced the development of active neovascularization in the fellow eye during the follow-up period were included(n = 75). Cases in which the neovascularization in the fellow eye could be identified solely through crosshair scans were defined as the crosshair scan detection group(n = 63). Cases in which the aforementioned findings could not be identified through crosshair scans but could be identified through raster scans were defined as the raster scan detection group(n = 12). The factors were compared between the two groups. Risk factors related to undetected neovascularization on crosshair scans were additionally identified. RESULTS Active fellow-eye neovascularization, was not detected on OCT crosshair scans in 12 cases(16.0%) but was identified on raster scans in all cases. There was a significant difference in the proportion of neovascularization types between the crosshair scan detection group and the raster scan detection group(P = 0.023). Among the 35 fellow-eye neovascularization cases in patients with type 3 macular neovascularization(MNV), 10(28.6%) were not detected on crosshair scans. Multivariate analysis revealed a significantly higher risk for undetectable fellow-eye neovascularization on crosshair scans in patients with type 3 MNV than in those with typical neovascular AMD(P = 0.037,β = 9.600). CONCLUSIONS Our findings suggest the need for routine OCT raster scans during fellow-eye examinations in patients with unilateral neovascular AMD, particularly when the first-affected eye is diagnosed with type 3 MNV.
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Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea.
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
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Haj Najeeb B, Schmidt-Erfurth U. The potential key role of choroidal non-perfusion and rod degeneration in the pathogenesis of macular neovascularization type 3. Eye (Lond) 2024; 38:1836-1839. [PMID: 38499856 PMCID: PMC11226597 DOI: 10.1038/s41433-024-03034-z] [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: 06/28/2023] [Revised: 01/12/2024] [Accepted: 03/08/2024] [Indexed: 03/20/2024] Open
Abstract
Macular neovascularization type 3 (MNV3) is a multifactorial disease with distinct epidemiological, clinical, pathomorphological and topographical characteristics. This review of the literature discusses the latest experimental and clinical outcomes that could explain the pathogenesis of retinal neovascularization. Although patients with MNV3 are usually older than those with MNV1 or 2, their lesions do not coexist with, precede, or follow other types in the same eye. The regional distribution of MNV3 lesions is characterized as confined to the parafoveal macula without any involvement of the rod-free foveal area. Focal outer retinal atrophy and choroidal non-perfusion are the main structural features that occur prior to the development of retinal neovascularization. Also, histological and experimental studies of MNV3 and other non-neovascular age-related macular degeneration diseases complicated with MNV3-like lesions strongly suggest rod degeneration contributes to the pathogenesis. Therefore, the retinal neovascularization in MNV3 has a different pathogenesis from the choroidal neovascularization in MNV1 and 2 and emerging evidence indicates that choroidal non-prefusion and rod degeneration play a key role in the pathogenesis of MNV3. Accordingly, we suggest a sequence of pathological events that start with choroidal non-perfusion due to advanced age followed by hypoxia of the outer retina at the parafoveal area. This induces a remarkable degeneration of rods that triggers the growth of retinal neovascularization due to the imbalance of the angiogenic factors in the outer retina.
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Affiliation(s)
- Bilal Haj Najeeb
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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Kang D, Lee YJ, Nam KT, Choi M, Yun C. Hyperreflective foci distribution in eyes with dry age-related macular degeneration with subretinal drusenoid deposits. Graefes Arch Clin Exp Ophthalmol 2023; 261:2821-2828. [PMID: 37231279 DOI: 10.1007/s00417-023-06127-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/13/2023] [Accepted: 05/19/2023] [Indexed: 05/27/2023] Open
Abstract
PURPOSE To investigate the distribution of hyperreflective foci (HRF) in eyes with dry age-related macular degeneration (AMD). METHODS We retrospectively reviewed optical coherence tomography (OCT) images of 58 dry AMD eyes presenting HRF. The distribution of HRF according to the early treatment diabetic retinopathy study area was analyzed according to the presence of subretinal drusenoid deposits (SDDs). RESULTS We classified 32 eyes and 26 eyes into the dry AMD with SDD group (SDD group) and dry AMD without SDD group (non-SDD group), respectively. The non-SDD group had higher prevalence and density of HRF at the fovea (65.4% and 1.71 ± 1.48) than the SDD group (37.5% and 0.48 ± 0.63, P = 0.035 and P < 0.001, respectively). However, the prevalence and density of HRF in the outer circle area of the SDD group (81.3% and 0.11 ± 0.09) were greater than those of the non-SDD group (53.8% and 0.05 ± 0.06, p = 0.025 and p = 0.004, respectively). The SDD group showed higher prevalence and mean densities of HRF in the superior and temporal area than in the non-SDD group (all, p < 0.05). CONCLUSION HRF distributions in dry AMD varied according to the presence of SDDs. This might support that the degenerative features may be different between dry AMD eyes with and without SDDs.
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Affiliation(s)
| | - Young Joo Lee
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Ki Tae Nam
- Department of Ophthalmology, Jeju National University College of Medicine, Jeju, Korea
| | - Mihyun Choi
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Cheolmin Yun
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.
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Difference in characteristics and lesion reactivation between type 3 macular neovascularization with and without subretinal fluid at baseline. Graefes Arch Clin Exp Ophthalmol 2023; 261:401-408. [PMID: 36112220 DOI: 10.1007/s00417-022-05833-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/08/2022] [Accepted: 09/09/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To compare the characteristics and incidence rates of lesion reactivation after anti-vascular endothelial growth factor (VEGF) treatment in type 3 macular neovascularization (MNV) with and without subretinal fluid (SRF) at baseline. METHODS This retrospective study included 95 patients diagnosed with type 3 MNV. After the initial loading injections, re-treatment was performed when lesion reactivation occurred defined as the re-accumulation of subretinal or intraretinal fluid or the new development of a retinal/subretinal hemorrhage. The differences in the baseline characteristics and the incidence rates of lesion reactivation were compared between patients with SRF (SRF group, n = 42) and those without SRF (non-SRF group, n = 53). RESULTS At diagnosis, the mean visual acuity was worse (0.68 ± 0.41 vs 0.50 ± 0.36; P = 0.032), mean central retinal thickness was greater (515.4 ± 145.9 μm vs 383.8 ± 105.5 μm; P < 0.001), and the incidence of focal retinal hemorrhages was higher (90.5% vs 66.0%; P = 0.005) in the SRF group than in the non-SRF group. In the SRF group, the first lesion reactivation was noted in 89.7% at a mean of 5.8 ± 4.4 months after the third injection. In the non-SRF group, the first lesion reactivation was noted in 70.6% at a mean of 6.1 ± 3.8 months. There was a significant difference in lesion reactivation between the two groups (P = 0.019). CONCLUSIONS The difference in the baseline characteristics and incidence of lesion reactivation between type 3 MNV with and without SRF suggests that the presence of SRF may be indicative of more advanced disease with a high risk of visual deterioration. This result also suggests the need for more active treatment to preserve vision in patients with SRF.
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Berlin A, Cabral D, Chen L, Messinger JD, Balaratnasingam C, Mendis R, Ferrara D, Freund KB, Curcio CA. Histology of type 3 macular neovascularization and microvascular anomalies in treated age-related macular degeneration: a case study. OPHTHALMOLOGY SCIENCE 2023; 3:100280. [PMID: 36970117 PMCID: PMC10033755 DOI: 10.1016/j.xops.2023.100280] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
Purpose To investigate intraretinal neovascularization and microvascular anomalies by correlating in vivo multimodal imaging with corresponding ex vivo histology in a single patient. Design A case study comprising clinical imaging from a community-based practice, and histologic analysis at a university-based research laboratory (clinicopathologic correlation). Participants A White woman in her 90s treated with numerous intravitreal anti-VEGF injections for bilateral type 3 macular neovascularization (MNV) secondary to age-related macular degeneration (AMD). Methods Clinical imaging comprised serial infrared reflectance, eye-tracked spectral-domain OCT, OCT angiography, and fluorescein angiography. Eye tracking, applied to the 2 preserved donor eyes, enabled the correlation of clinical imaging signatures with high-resolution histology and transmission electron microscopy. Main Outcome Measures Histologic/ultrastructural descriptions and diameters of vessels seen in clinical imaging. Results Six vascular lesions were histologically confirmed (type 3 MNV, n = 3; deep retinal age-related microvascular anomalies [DRAMAs], n = 3). Pyramidal (n = 2) or tangled (n = 1) morphologies of type 3 MNV originated at the deep capillary plexus (DCP) and extended posteriorly to approach without penetrating persistent basal laminar deposit. They did not enter the subretinal pigment epithelium (RPE)-basal laminar space or cross the Bruch membrane. Choroidal contributions were not found. The neovascular complexes included pericytes and nonfenestrated endothelial cells, within a collagenous sheath covered by dysmorphic RPE cells. Deep retinal age-related microvascular anomaly lesions extended posteriorly from the DCP into the Henle fiber and the outer nuclear layers without evidence of atrophy, exudation, or anti-VEGF responsiveness. Two DRAMAs lacked collagenous sheaths. External and internal diameters of type 3 MNV and DRAMA vessels were larger than comparison vessels in the index eyes and in aged normal and intermediate AMD eyes. Conclusions Type 3 MNV vessels reflect specializations of source capillaries and persist during anti-VEGF therapy. The collagenous sheath of type 3 MNV lesions may provide structural stabilization. If so, vascular characteristics may be useful in disease monitoring in addition to fluid and flow signal detection. Further investigation with longitudinal imaging before exudation onset will help determine if DRAMAs are part of the type 3 MNV progression sequence. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Haj Najeeb B, Schmidt-Erfurth U. Do patients with unilateral macular neovascularization type 3 need AREDS supplements to slow the progression to advanced age-related macular degeneration? Eye (Lond) 2022:10.1038/s41433-022-02249-2. [PMID: 36175488 DOI: 10.1038/s41433-022-02249-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/13/2022] [Accepted: 09/07/2022] [Indexed: 11/09/2022] Open
Abstract
Given the wide spectrum of unique characteristics of macular neovascularization type 3 (MNV3) compared with types 1 and 2, we suggest regrading the colour photography assessment of the AREDS study to verify the impact of AREDS supplements on eyes with MNV3.
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Affiliation(s)
- Bilal Haj Najeeb
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
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Haj Najeeb B, Deak GG, Mylonas G, Sacu S, Gerendas BS, Schmidt-Erfurth U. THE RAP STUDY, REPORT 5: REDISCOVERING MACULAR NEOVASCULARIZATION TYPE 3: Multimodal Imaging of Fellow Eyes over 24 months. Retina 2022; 42:485-493. [PMID: 35188490 PMCID: PMC8852687 DOI: 10.1097/iae.0000000000003330] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore the condition of fellow eyes of patients with macular neovascularization Type 3 (MNV3) and to verify whether the retinal-choroidal anastomosis (RCA) develops equally in all MNV types. METHODS The contralateral eyes of 94 patients with MNV3, 96 patients with MNV1, and 96 patients with MNV2 were included. Multimodal imaging was performed. The MNV3 stage including the development of fibrosis and RCA over 24 months was determined. RESULTS In the contralateral eyes of patients of the solitary (one lesion) MNV3 group, 32 eyes (42.1%) showed early/intermediate age-related macular degeneration, 25 eyes (33%) showed MNV3, and 11 eyes (14.5%) experienced fibrosis, of which 4 eyes (5.2%) had a RCA, 7 eyes (9.2%) had atrophy after resolved MNV3, and 1 eye (1.3%) developed MNV1. In the multifocal (more than one lesion) MNV3 group, 2 eyes (11.1%) showed early/intermediate age-related macular degeneration, 9 eyes (50%) showed 15 MNV3 lesions, and 4 eyes (22.2%) showed fibrosis, of which 2 eyes (11.1%) manifested with a RCA and 3 eyes (16.7%) showed atrophy after resolved MNV3. The number of eyes with a RCA accounted for 40% of all eyes with fibrosis. The count of simultaneous bilateral multifocal MNV3 was 5 (55.6%). In the MNV1 and MNV2 groups, no eye developed a RCA. The incidence of RCAs in the scarred eyes in MNV3 was significantly higher (P < 0.0001). CONCLUSION Retinal-choroidal anastomosis is an exclusive clinical feature of MNV3. The development of the multifocal MNV3 is usually bilateral and simultaneous. The occurrence of fibrosis in MNV3 has decreased dramatically after the introduction of the antiangiogenic therapy.
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Affiliation(s)
- Bilal Haj Najeeb
- Department of Ophthalmology, Vienna Reading Center, Medical University of Vienna, Vienna, Austria; and
- Department of Ophthalmology, Macula Clinic, Medical University of Vienna, Vienna, Austria
| | - Gabor G. Deak
- Department of Ophthalmology, Vienna Reading Center, Medical University of Vienna, Vienna, Austria; and
- Department of Ophthalmology, Macula Clinic, Medical University of Vienna, Vienna, Austria
| | - Georgios Mylonas
- Department of Ophthalmology, Vienna Reading Center, Medical University of Vienna, Vienna, Austria; and
| | - Stefan Sacu
- Department of Ophthalmology, Macula Clinic, Medical University of Vienna, Vienna, Austria
| | - Bianca S. Gerendas
- Department of Ophthalmology, Vienna Reading Center, Medical University of Vienna, Vienna, Austria; and
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology, Vienna Reading Center, Medical University of Vienna, Vienna, Austria; and
- Department of Ophthalmology, Macula Clinic, Medical University of Vienna, Vienna, Austria
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Kim JH, Kim JW, Kim CG. Difference Between the Incidence of Retinal Fluid Subtypes and Their Association with Visual Outcomes According to the Types of Macular Neovascularization in a Korean Population. J Ocul Pharmacol Ther 2022; 38:261-268. [PMID: 35119292 DOI: 10.1089/jop.2021.0103] [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] [Indexed: 02/06/2023] Open
Abstract
Purpose: To investigate differences in the incidence of retinal fluid subtypes among different subtypes of macular neovascularization (MNV) and evaluate the influence of the presence of retinal fluid subtypes on visual outcome in each subtype of MNV. Methods: This retrospective study included 248 patients (248 eyes) diagnosed with treatment-naive neovascular age-related macular degeneration and polypoidal choroidal vasculopathy (PCV). The incidence of retinal fluid subtypes at diagnosis and during the 24-month follow-up was compared among the different subtypes of MNV. In addition, visual acuity was compared between patients with and without the retinal fluid subtypes. Results: At diagnosis, there was a significant difference in the incidence of subretinal fluid (SRF), intraretinal fluid (IRF), and subretinal pigment epithelial fluid among type 1 MNV, type 2 MNV, type 3 MNV, and PCV (P < 0.001). The incidence of SRF (P < 0.001) during follow-up also differed among the 4 groups. In patients with type 1 MNV and IRF, the visual acuity at diagnosis (P = 0.004) and at 24 months (P < 0.001) were significantly worse. However, the presence of SRF was not associated with poor visual acuity. In type 3 MNV, there was no significant difference in visual acuity between patients with and without SRF/IRF. Conclusion: The results of this study indicate that the clinical significance of retinal fluid subtypes may differ in different subtypes of MNV, suggesting the need for analysis in isolation of each MNV subtype in fluid-based prognostication.
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Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
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11
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Zhang Y, Sadda SR, Sarraf D, Swain TA, Clark ME, Sloan KR, Warriner WE, Owsley C, Curcio CA. Spatial Dissociation of Subretinal Drusenoid Deposits and Impaired Scotopic and Mesopic Sensitivity in AMD. Invest Ophthalmol Vis Sci 2022; 63:32. [PMID: 35212721 PMCID: PMC8883144 DOI: 10.1167/iovs.63.2.32] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Subretinal drusenoid deposits (SDD) first appear in the rod-rich perifovea and can extend to the cone-rich fovea. To refine the spatial relationship of visual dysfunction with SDD burden, we determined the topography of mesopic and scotopic light sensitivity in participants with non-neovascular AMD with and without SDD. Methods Thirty-three subjects were classified into three groups: normal (n = 9), AMD-Drusen (with drusen and without SDD; n = 12), and AMD-SDD (predominantly SDD; n = 12). Mesopic and scotopic microperimetry were performed using 68 targets within the Early Treatment Diabetic Retinopathy Study grid, including points at 1.7° from the foveal center (rod:cone ratio, 0.35). Age-adjusted linear regression was used to compare mesopic and scotopic light sensitivities across groups. Results Across the entire Early Treatment Diabetic Retinopathy Study grid and within individual subfields, the three groups differed significantly for mesopic and scotopic light sensitivities (all P < 0.05). The AMD-SDD group exhibited significantly decreased mesopic and scotopic sensitivity versus both the normal and the AMD-Drusen groups (all P < 0.05), while AMD-Drusen and normal eyes did not significantly differ (all P > 0.05). The lowest relative sensitivities were recorded for scotopic light levels, especially in the central subfield, in the AMD-SDD group. Conclusions SDD-associated decrements in rod-mediated vision can be detected close to the foveola, and these deficits are proportionately worse than functional loss in the rod-rich perifovea. This finding suggests that factors other than the previously hypothesized direct cytotoxicity to photoreceptors and local transport barrier limitations may negatively impact vision. Larger prospective studies are required to confirm these observations.
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Affiliation(s)
- Yuhua Zhang
- Doheny Eye Institute, Los Angeles, California, United States.,Department of Ophthalmology, University of California - Los Angeles, Los Angeles, California, United States
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, California, United States.,Department of Ophthalmology, University of California - Los Angeles, Los Angeles, California, United States
| | - David Sarraf
- Department of Ophthalmology, University of California - Los Angeles, Los Angeles, California, United States.,Jules Stein Eye Institute, Los Angeles, California, United States
| | - Thomas A Swain
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Mark E Clark
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Kenneth R Sloan
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - William E Warriner
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States.,Research Computing, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Haj Najeeb B, Deak GG, Sacu S, Schmidt-Erfurth U, Gerendas BS. The RAP study, report 4: morphological and topographical characteristics of multifocal macular neovascularization type 3. Graefes Arch Clin Exp Ophthalmol 2022; 260:141-147. [PMID: 34436646 PMCID: PMC8763817 DOI: 10.1007/s00417-021-05332-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/23/2021] [Accepted: 07/16/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To report on the morphological characteristics and regional distribution of multifocal macular neovascularization type 3 (mMNV3). METHODS Twenty-two consecutive eyes of 21 patients with mMNV3 were included using multimodal imaging. The count and stage of lesions of all MNV types and the existence of exudate and hemorrhage were determined. Also, we addressed the regional distribution of MNV3 lesions between the superior-inferior and the nasal-temporal halves of the macula, and the range of the distance of the lesions from the central fovea. Furthermore, we explored the number of feeding vessels including the cilioretinal artery. RESULTS We found 51 lesions in 22 eyes of 21 patients. They were bifocal in 16 (73%) eyes, trifocal in 5 (23%), and quadrifocal in one (4%). No lesion of MNV1 or 2 was found. Fifteen (68%), 2 (9%), and 16 (73%) eyes were associated with retinal hard exudate, subretinal pigment epithelium exudate, and intraretinal hemorrhage, respectively. Thirty (59%) lesions were located in the temporal half of the macula, whereas 21 (41%) were located nasally (p = 0.07). One (2%) lesion was closer than 500 µm, 49 (96%) between 500 and 1500 µm, and one (2%) between 1500 and 3000 µm. The lesions were supplied by one arteriole in one (4%) eye, two arterioles in 16 (73%) eyes, and 3 arterioles in 5 (23%) eyes. The CRA contributed as a feeding vessel in 5 (23%) eyes. CONCLUSION The multifocal variant of MNV3 has specific morphological and topographical characteristics. Multimodal imaging allows the understanding of the pathomorphological condition in more detail.
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Affiliation(s)
- Bilal Haj Najeeb
- Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gabor G Deak
- Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefan Sacu
- Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Bianca S Gerendas
- Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Comment to: Fluid based visual prognostication in Type 3 macular neovascularization (MNV)- FLIP-3 Study. Retina 2021; 42:e18-e20. [PMID: 34861662 DOI: 10.1097/iae.0000000000003365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Borrelli E, Mastropasqua L, Souied E, Sadda S, Vella G, Toto L, Miere A, Corradetti G, Sacconi R, Ferro G, Sarraf D, Querques L, Mastropasqua R, Bandello F, Querques G. Longitudinal assessment of type 3 macular neovascularization using three-dimensional volume-rendering OCTA. CANADIAN JOURNAL OF OPHTHALMOLOGY 2021; 57:228-235. [PMID: 34058145 DOI: 10.1016/j.jcjo.2021.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the evolution of treatment-naive type 3 macular neovascularization (MNV) undergoing anti-vascular endothelial growth factor (VEGF) treatment through volume rendered three-dimensional (3D) optical coherence tomography angiography (OCTA). DESIGN Retrospective observational study. PARTICIPANTS Patients with type 3 MNV and age-related macular degeneration (AMD). METHODS Included subjects had three loading injections of an anti-VEGF agent. The OCTA volume data at baseline and follow-up were processed with a previously published algorithm in order to obtain a volume-rendered representation of type 3 MNV. Progressive changes in type 3 lesions were analyzed via 3D OCTA volume rendering. RESULTS A total of 14 treatment-naive eyes with type 3 MNV from 11 AMD patients (7 females) were included. At both baseline and follow-up visits, a type 3 MNV complex was identifiable. Each complex was composed of a mean number of 2.5 ± 0.7 vascular branches at baseline and 1.4 ± 0.6 at the follow-up visit (p < 0.0001). The mean changes in central macular thickness and visual acuity were significantly correlated with modifications in the number of type 3 MNV branches (ρ = -0.533, p = 0.049, and ρ = -0.581, and p = 0.040, respectively). CONCLUSIONS This study demonstrated that type 3 lesions do not disappear completely after loading treatment, as indicated previously by histopathologic studies. Importantly, quantitative volume changes in type 3 lesions are directly associated with treatment response.
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Affiliation(s)
- Enrico Borrelli
- Vita-Salute San Raffaele University, Milan, Italy; San Raffaele Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, Italy
| | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Eric Souied
- Department of Ophthalmology, University of Paris XII, Center Intercommunal de Creteil, Creteil, France
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, Calif; Department of Ophthalmology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, Calif
| | - Giovanna Vella
- Vita-Salute San Raffaele University, Milan, Italy; San Raffaele Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, Italy; Ophthalmology Unit, Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Alexandra Miere
- Department of Ophthalmology, University of Paris XII, Center Intercommunal de Creteil, Creteil, France
| | - Giulia Corradetti
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, Calif; Department of Ophthalmology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, Calif
| | - Riccardo Sacconi
- Vita-Salute San Raffaele University, Milan, Italy; San Raffaele Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, Italy
| | - Giada Ferro
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - David Sarraf
- Department of Ophthalmology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, Calif; Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - Lea Querques
- Vita-Salute San Raffaele University, Milan, Italy; San Raffaele Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, Italy
| | - Rodolfo Mastropasqua
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Bandello
- Vita-Salute San Raffaele University, Milan, Italy; San Raffaele Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, Italy
| | - Giuseppe Querques
- Vita-Salute San Raffaele University, Milan, Italy; San Raffaele Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, Italy; Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, Calif.
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Chen L, Messinger JD, Kar D, Duncan JL, Curcio CA. Biometrics, Impact, and Significance of Basal Linear Deposit and Subretinal Drusenoid Deposit in Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2021; 62:33. [PMID: 33512402 PMCID: PMC7846955 DOI: 10.1167/iovs.62.1.33] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose Basal linear deposit (BLinD) is a thin layer of soft drusen material. To elucidate the biology of extracellular deposits conferring age-related macular degeneration (AMD) progression risk and inform multimodal clinical imaging based on optical coherence tomography (OCT), we examined lipid content and regional prevalence of BLinD, soft drusen, pre-BLinD, and subretinal drusenoid deposit (SDD) in AMD and non-AMD aged eyes. We estimated BLinD volume and illustrated its relation to type 1 macular neovascularization (MNV). Methods Donor eyes were classified as early to intermediate AMD (n = 25) and age-matched controls (n = 54). In high-resolution histology, we assessed BLinD/soft drusen thickness at 836 and 1716 locations in AMD and control eyes, respectively. BLinD volume was estimated using solid geometry in donor eyes, one clinically characterized. Results BLinD, drusen, type 1 MNV, and fluid occupy the sub-RPE-basal laminar space. BLinD volume in a 3-mm diameter circle may be as much as 0.0315 mm3. Osmophilic lipid was more concentrated in BLinD/drusen than SDD. In the fovea, BLinD/drusen was prevalent in AMD eyes; pre-BLinD was prevalent in control eyes. SDD was low in the fovea and high in perifovea, especially in AMD eyes. Conclusions Although invisible, BLinD may presage type 1 MNV. BLinD volume approaches the criterion OCT drusen volume of 0.03 mm3 for AMD progression risk. BLinD culminates years of subfoveal lipid accumulation. SDD is detected relatively late in life, with currently unknown precursors. Deposit topography suggests one outer retinal lipid recycling system serving specialized cone and rod physiology, and its dysregulation in AMD is due to impaired transfer to the circulation.
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Affiliation(s)
- Ling Chen
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, China
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Jeffrey D. Messinger
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Deepayan Kar
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Jacque L. Duncan
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States
| | - Christine A. Curcio
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Sassmannshausen M, Pfau M, Thiele S, Fimmers R, Steinberg JS, Fleckenstein M, Holz FG, Schmitz-Valckenberg S. Longitudinal Analysis of Structural and Functional Changes in Presence of Reticular Pseudodrusen Associated With Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2021; 61:19. [PMID: 32780863 PMCID: PMC7441376 DOI: 10.1167/iovs.61.10.19] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose To examine longitudinal changes of retinal thickness and retinal sensitivity in patients with intermediate age-related macular degeneration (iAMD) and predominantly reticular pseudodrusen (RPD). Methods At baseline 30 eyes of 25 iAMD patients underwent optical coherence tomography imaging, mesopic and scotopic fundus-controlled perimetry (FCP) with follow-up examinations at month 12 (20 eyes), 24 (12 eyes), and 36 (11 eyes). Thicknesses of different retinal layers and results of FCP testing (n = 56 stimuli) were spatially and longitudinally analyzed using linear mixed-effects models. Results At baseline, the thickness of the partial outer retinal layer (pORL, 70.21 vs. 77.47 µm) and both mesopic (16.60 vs. 18.72 dB) and scotopic (12.14 vs. 18.67 dB) retinal sensitivity were decreased in areas with RPD compared with unremarkable areas (P < 0.001). Over three years, mean change of pORL was −0.66 normative standard deviation (SD; i.e., z-score, P < 0.001) for regions with existing RPD, −0.40 SD (P < 0.001) for regions with new occurring RPD, and −0.17 SD (P = 0.041) in unremarkable regions. Decrease of scotopic and mesopic sensitivity over three years was more pronounced in areas with existing (−3.51 and −7.76 dB) and new occurring RPD (−2.06 and −5.97 dB). Structure-function analysis revealed that 1 SD decrease of pORL thickness was associated with a sensitivity reduction of 3.47 dB in scotopic and 0.79 dB in mesopic testing. Conclusions This study demonstrates progressive outer retinal degeneration and impairment of photoreceptor function in eyes with iAMD and RPD over three years. Preservation of outer retinal thickness and reduction of RPD formation may constitute meaningful surrogate endpoints in interventional trials on eyes with AMD and RPD aiming to slow outer retinal degeneration.
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Affiliation(s)
- Marlene Sassmannshausen
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, Bonn, Germany
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, Bonn, Germany.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Sarah Thiele
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, Bonn, Germany
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Medical Faculty, Bonn, Germany
| | | | - Monika Fleckenstein
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, Bonn, Germany.,John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
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