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Fernández-Hernández R, Rustullet-Olivé M, Vega-Lopez Z, Vilaplana-Blanch D. Choroidal triangular syndrome following ocular trauma: A case report. J Fr Ophtalmol 2023; 46:e358-e360. [PMID: 37500323 DOI: 10.1016/j.jfo.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 07/29/2023]
Affiliation(s)
- R Fernández-Hernández
- Department of Ophtalmology, Hospital de la Esperança (Parc de Salut Mar), Avenida Santuario, Ptge. de Sant Josep la Muntanya, 12, 08024 Barcelona, Spain.
| | - M Rustullet-Olivé
- Department of Ophtalmology, Hospital de la Esperança (Parc de Salut Mar), Avenida Santuario, Ptge. de Sant Josep la Muntanya, 12, 08024 Barcelona, Spain
| | - Z Vega-Lopez
- Department of Ophtalmology, Hospital de la Esperança (Parc de Salut Mar), Avenida Santuario, Ptge. de Sant Josep la Muntanya, 12, 08024 Barcelona, Spain
| | - D Vilaplana-Blanch
- Department of Ophtalmology, Hospital de la Esperança (Parc de Salut Mar), Avenida Santuario, Ptge. de Sant Josep la Muntanya, 12, 08024 Barcelona, Spain
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2
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Huang D, Liu YA, Hacein-Bey L, Moussa K. Combined central retinal artery and medial posterior ciliary artery occlusion: Localizing the lesion. Am J Ophthalmol Case Rep 2023; 30:101823. [PMID: 36874357 PMCID: PMC9976205 DOI: 10.1016/j.ajoc.2023.101823] [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: 12/03/2022] [Revised: 01/21/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023] Open
Abstract
Purpose To report a rare case of a combined central retinal artery (CRA) and medial posterior ciliary artery (MPCA) occlusion due to an atherosclerotic lesion in the common trunk supplying both arteries. Observations A 75-year-old man presented with acute vision loss associated with elevated intraocular pressure in the right eye. Multi-modal imaging revealed a combined retinal and choroidal infarction in the distribution of the CRA and MPCA, localizing the lesion to the common trunk of the ophthalmic artery supplying both the CRA and MPCA. Neurovascular imaging provided supportive evidence for the diagnosis. Conclusions and importance A simultaneous retinal and choroidal vascular occlusion is an uncommon presentation. Familiarity with the anatomy of the ophthalmic arteries and its branches facilitates localizing the lesion.
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Affiliation(s)
- Denis Huang
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Yin Allison Liu
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA.,Departments of Neurology and Neurological Surgery, University of California, Davis, Sacramento, CA, USA
| | - Lotfi Hacein-Bey
- Department of Radiology, University of California, Davis, Sacramento, CA, USA
| | - Kareem Moussa
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
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3
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Casella AMB, Mansour AM, EC S, do Prado RB, Meirelles R, Wong K, Yassine S, Monteiro MLR. Choroidal ischemia as one cardinal sign in giant cell arteritis. Int J Retina Vitreous 2022; 8:69. [PMID: 36153565 PMCID: PMC9509624 DOI: 10.1186/s40942-022-00422-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To describe chorioretinal signs in a case series of Giant Cell Arteritis (GCA). Methods This is a multicenter retrospective observational case series with GCA that presented with a headache and an abrupt, unilateral loss in vision. Workup included temporal artery biopsies, intravenous fluorescein angiography, optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), blood levels of erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Results There are a total of 8 GCA instances presented. Average age was 74.5. (Range 68–83 years). The patients reported that one eye's visual loss had suddenly started, along with a fresh headache and other systemic symptoms. Eight patients exhibited choroidal ischemia, five paracentral acute middle maculopathy (PAMM) lesions, five cotton wool spots, four anterior ischemic optic neuropathy, and one central retinal arterial occlusion at the time of presentation. The average ESR at presentation was 68 mm/hr (range 4–110), and 4/6 individuals had a significant increase. The mean CRP level was 6.2 mg/dL (range 2.0–15.4), and the level was always over the normal range. All patients' temporal artery biopsies were positive. Conclusion Alongside PAMM lesions, cotton wool spots, anterior ischemic optic neuropathy, and central retinal artery occlusion, choroidal ischemia is a key angiographic indicator in the diagnosis of GCA. It may be crucial to recognize these typical ischemic chorioretinal signs while diagnosing GCA.
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Choroidal involvement in systemic vasculitis: a systematic review. J Ophthalmic Inflamm Infect 2022; 12:14. [PMID: 35377017 PMCID: PMC8980189 DOI: 10.1186/s12348-022-00292-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/24/2022] [Indexed: 01/19/2023] Open
Abstract
Systemic vasculitides are a large group of heterogeneous diseases characterized by inflammatory destruction of blood vessels targeting diverse organs and tissues including the eye. As the most vascularized layer of the eye, the choroid is expected to be affected in multiple systemic rheumatologic diseases with vascular involvement. While there are plenty of studies investigating retinal vascular involvement, choroidal vascular involvement in systemic vasculitides has not been investigated in isolation. However, choroidal manifestations including thickness changes, choroidal vasculitis and ischemia may be the earliest diagnostic features of systemic vasculitic diseases. Thus, multimodal imaging of the choroid may help early detection of choroidal involvement which may also have prognostic implications in these life-threatening diseases. This article aimed to review involvement of the choroid in systemic vasculitic diseases.
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5
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Fogel-Levin M, Sadda SR, Rosenfeld PJ, Waheed N, Querques G, Freund KB, Sarraf D. Advanced retinal imaging and applications for clinical practice: A consensus review. Surv Ophthalmol 2022; 67:1373-1390. [DOI: 10.1016/j.survophthal.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 01/20/2023]
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6
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TRIANGULAR SIGN OF AMALRIC IN INTRAVASCULAR LYMPHOMA. Retin Cases Brief Rep 2022; 16:20-24. [PMID: 32826773 DOI: 10.1097/icb.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE AND METHODS To report a case of bilateral ocular ischemia caused by intravascular lymphoma with the presence of bilateral triangular sign of Amalric. RESULTS A 67-year-old woman was admitted to our hospital for progressive paraplegia and a 6-month history of acute painless vision loss in the right eye. Initial examination showed vision of counting fingers in the right eye and 20/20 in the left eye with normal anterior examination. Fundus examination revealed a likely previous central retinal artery occlusion in the right eye with pale nerve and attenuated vessels. Both fundi had triangular regions of pigmentary change known as the triangular sign of Amalric, indicative of choroidal ischemia. However, the left eye was asymptomatic. Neuroimaging revealed multifocal enhancing lesions throughout the central nervous system of unclear etiology. An extensive neurologic and systemic workup was unrevealing, including a brain biopsy, and empiric treatment for an unspecified inflammatory condition with intravenous corticosteroids was initiated. During her hospitalization, she developed acute painless vision loss in the left eye, and examination showed no light perception vision in both eyes with signs of acute retinal and choroidal ischemia in the left eye. A subsequent brain biopsy revealed intravascular lymphoma. CONCLUSION Triangular pigmentary changes indicate choroidal ischemia and can be seen in many conditions. This patient presented with the triangular sign of Amalric in both eyes, including her asymptomatic left eye. Intravascular lymphoma should be considered in cases of concomitant inflammatory brain lesions and chorioretinal ischemia.
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Abstract
INTRODUCTION Ischemic choroidal diseases are an underdiagnosed entity. The clinical pattern varies according to the size and the localisation of the affected vascular structure. CLINICAL PRESENTATION In eyes with occlusion of the long posterior ciliary arteries, characteristic triangular patches of choroidal ischemia (Amalric sign) are seen, which in the course of time merge into well-defined areas of atrophy of the retinal pigment epithelium. Above the non-perfused choroidal areas, hyperpigmented, grouped lines appear (Siegrist streaks). Circumscribed ischemia of smaller choroidal arterioles and capillary vessels appears as multifocal, yellowish lesions in the posterior fundus (Elschnig spots). Vortex vein occlusion becomes manifest as exudative haemorrhagic choroidal swelling in the periphery. CAUSES OF CHOROIDAL ISCHEMIA Apart from arterial hypertension as a major risk factor, some immunological disorders such as giant cell arteritis and systemic lupus erythematosus and haematological pathologies also affect choroidal perfusion. Furthermore, choroidal ischemia occurs due to local inflammation, as found in eyes with acute multifocal posterior placoid pigment epitheliopathy (APMPPE). Rarely, choroidal infarction is of iatrogenic origin or drug-induced. Recent advances in imaging, such as the introduction of enhanced depth imaging optical coherence tomography (EDI-OCT) and OCT angiography (OCT-A), have improved the visualisation of the choroidal vasculature and complement the classical angiographic procedures. In patients with age-related macular degeneration (AMD) and diabetes, some changes in choroidal blood flow and vascular structure have also been noted. While in AMD the choroidal pathologies correlate with the disease progression and the functional prognosis, the pathophysiological relationship between diabetic choroidopathy and retinopathy is currently unclear. MANAGEMENT AND CONCLUSION With regard to the limited therapeutic options for choroidal ischemia, optimisation of the cardiovascular risk profile and the management of accompanying ocular and systemic diseases are essential.
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Affiliation(s)
- Teresa Barth
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Deutschland
| | - Horst Helbig
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Deutschland
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8
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Choroidal alterations during the clinical course of commotio retinae. Graefes Arch Clin Exp Ophthalmol 2021; 260:65-71. [PMID: 34379185 DOI: 10.1007/s00417-021-05316-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/24/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To analyse the alterations in the choroidal structure of eyes with commotio retinae due to blunt-force trauma. METHODS This retrospective study included 51 eyes of 50 patients who underwent swept-source optical coherence tomography (SS-OCT) during their initial visit and throughout their clinical course between March 2013 and February 2020. MAIN OUTCOMES AND MEASURES This study focused on four choroidal measures: comparison of central choroidal thickness (CCT) between the injured and contralateral eyes immediately after injury, changes in the CCT, ratio of choroidal luminal and stromal properties in the injured eye during the clinical course and change in the suprachoroidal structure of the injured eye. RESULTS In 44 eyes, the CCT was successfully compared between the injured and contralateral eyes. In 30 of these eyes (70%), the CCT in the injured eye was significantly thinner than that in the contralateral eye (P < 0.01). In 33 eyes, the clinical course of the injured eyes was followed. The CCT was increased and decreased by >30 μm in 11 (33%) and 6 eyes (18%), respectively, and remained the same in 16 eyes (49%). The ratio of luminal and stromal areas in the choroid had significantly increased from 1.72 ± 0.54 at the initial visit to 1.87 ± 0.55 at the last visit (P < 0.001). In four eyes, a hemispherical dark space was observed beneath the sclerochoroidal interphase at the initial visit. CONCLUSION The choroidal structure and its luminal and stromal properties are dynamically altered during the clinical course of commotio retinae.
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9
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Brinks J, van Dijk EHC, Klaassen I, Schlingemann RO, Kielbasa SM, Emri E, Quax PHA, Bergen AA, Meijer OC, Boon CJF. Exploring the choroidal vascular labyrinth and its molecular and structural roles in health and disease. Prog Retin Eye Res 2021; 87:100994. [PMID: 34280556 DOI: 10.1016/j.preteyeres.2021.100994] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/04/2021] [Accepted: 07/07/2021] [Indexed: 12/14/2022]
Abstract
The choroid is a key player in maintaining ocular homeostasis and plays a role in a variety of chorioretinal diseases, many of which are poorly understood. Recent advances in the field of single-cell RNA sequencing have yielded valuable insights into the properties of choroidal endothelial cells (CECs). Here, we review the role of the choroid in various physiological and pathophysiological mechanisms, focusing on the role of CECs. We also discuss new insights regarding the phenotypic properties of CECs, CEC subpopulations, and the value of measuring transcriptomics in primary CEC cultures derived from post-mortem eyes. In addition, we discuss key phenotypic, structural, and functional differences that distinguish CECs from other endothelial cells such as retinal vascular endothelial cells. Understanding the specific clinical and molecular properties of the choroid will shed new light on the pathogenesis of the broad clinical range of chorioretinal diseases such as age-related macular degeneration, central serous chorioretinopathy and other diseases within the pachychoroid spectrum, uveitis, and diabetic choroidopathy. Although our knowledge is still relatively limited with respect to the clinical features and molecular pathways that underlie these chorioretinal diseases, we summarise new approaches and discuss future directions for gaining new insights into these sight-threatening diseases and highlight new therapeutic strategies such as pluripotent stem cell‒based technologies and gene therapy.
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Affiliation(s)
- J Brinks
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - E H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - I Klaassen
- Ocular Angiogenesis Group, Departments of Ophthalmology and Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - R O Schlingemann
- Ocular Angiogenesis Group, Departments of Ophthalmology and Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - S M Kielbasa
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
| | - E Emri
- Department of Clinical Genetics, Section of Ophthalmogenetics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - P H A Quax
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, the Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - A A Bergen
- Department of Clinical Genetics, Section of Ophthalmogenetics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - O C Meijer
- Department of Medicine, Division of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, the Netherlands
| | - C J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
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10
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Borrelli E, Gabela MC, Sacconi R, Querques L, Vella G, Zuccaro B, Gelormini F, Bandello F, Querques G. Choroidal luminal and stromal areas and choriocapillaris perfusion are characterised by a non-linear quadratic relation in healthy eyes. Br J Ophthalmol 2020; 105:567-572. [PMID: 32493761 DOI: 10.1136/bjophthalmol-2020-316479] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE To assess the associations among different optical coherence tomography (OCT) structural and angiography quantitative metrics used to characterise the choroid in healthy subjects. METHODS In this cross-sectional study, macular structural OCT and OCT angiography (OCTA) images were acquired from healthy subjects. The main outcome measures were: (i) choriocapillaris (CC) flow deficits percentage (FD%), (ii) choroidal luminal (LA) and stromal (SA) areas and (iii) choroidal vascularity index (CVI), which was calculated as the LA divided by the total choroidal area. These measurements were generated using previously published algorithms and were separately computed in the foveal and extrafoveal regions. RESULTS Eighty-five eyes from 85 subjects (44 males, 41 females) were included in the analysis. Mean±SD age was 47.9±22.4 years (range: 19.0 to 85.0 years). Linear regression analysis displayed no significant associations between CC FD% and other parameters (LA, SA and CVI). Importantly, non-linear regression analysis showed that the relations of LA and SA to CC FD% were all best fitted by a quadratic function. Compared with the linear models, the use of the quadratic function allowed a relative increase in the R2 coefficients. No significant non-linear associations were found between CC FD% and CVI. CONCLUSION Based on our models, changes in the luminal and stromal areas in the choroid lead to an initial increase in CC perfusion. Subsequently, further increases in LA and SA amounts are accompanied by a progressive increment in CC FD%.
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Affiliation(s)
- Enrico Borrelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lea Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giovanna Vella
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy.,Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Biancamaria Zuccaro
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Gelormini
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
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Mastropasqua R, Viggiano P, Borrelli E, Evangelista F, Libertini D, Di Antonio L, Toto L. In Vivo Mapping of the Choriocapillaris in High myopia: a Widefield Swept Source Optical Coherence Tomography Angiography. Sci Rep 2019; 9:18932. [PMID: 31831754 PMCID: PMC6908654 DOI: 10.1038/s41598-019-55192-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/18/2019] [Indexed: 01/08/2023] Open
Abstract
To report variation of choriocapillaris (CC) flow in widefield in high in myopic subjects compared with an age-matched normal control group using ultra widefield optical coherence tomography angiography (UW-OCTA). This is a Prospective, cross-sectional study. Thirty high myopia subjects and fifty healthy subjects were enrolled. Healthy and high myopia subjects were imaged with the SS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). For each eye, five 12 × 12-mm OCTA volume scans were acquired. The en face CC images were then exported to imageJ and a semi-automated algorithm was used for subsequent quantitative analysis. The main outcome was a quantitative analysis of the CC. This analysis was performed in three different regions: (i) peripapillary, (ii) macular, and (iii) periphery. In addition, CC variables were further investigated in distinct fields within these three different regions. Thirty myopic eyes (32 subjects; myopic group) and fifty eyes (50 subjects; control group) without elevated myopia were included in the analysis. Mean ± SD age was 26.9 ± 2.9 years [median: 27 years; range: 20.0–40.0 years]. Mean ± SD axial length was 26.6 ± 0.6 mm [median: 26.2 mm; range: 26.1 to 28.0 mm]. Mean ± SD axial length was 26.6 ± 0.6 mm [median: 26.2 mm; range: 26.1 to 28.0 mm] in the myopic group and 23.9 ± 1.1 mm [median: 23.9 mm; range: 21.8 to 25.9 mm] in the control group. The total signal void area was significantly greater in myopic eyes compared with control group. The peripapillary region exhibited the greatest total signal void area (p < 0.0001 vs macular region, p < 0.0001 vs peripheral region). Within the macular region, the foveal area exhibited a greater total signal void area in comparison with both the parafoveal area (p < 0.0001) and the perifoveal area (p < 0.0001). In conclusion we report quantitative mapping of the choriocapillaris in myopic eyes compared with an age-matched normal control group. The CC perfusion appears to have a wide topographical variation.
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Affiliation(s)
| | - Pasquale Viggiano
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy.
| | - Enrico Borrelli
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Federica Evangelista
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Daniele Libertini
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Luca Di Antonio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
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Tripathy K, Mazumdar S. Recurrent retinal and choroidal ischemia in a case of ocular ischemic syndrome. Ther Adv Ophthalmol 2019; 11:2515841419848926. [PMID: 31321381 PMCID: PMC6628513 DOI: 10.1177/2515841419848926] [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: 12/17/2018] [Accepted: 04/15/2019] [Indexed: 12/02/2022] Open
Abstract
A 62 year-old male patient presented with fluctuating vision in both eyes. On
fundus fluorescein angiogram, there was an area of choroidal and retinal
ischemia in the left eye. The carotid evaluation revealed complete stenosis of
the right internal carotid artery and 90% stenosis of the left internal carotid
artery for which he underwent left modified endarterectomy. The vision and
angiographic features improved after the procedure. Eleven months after the
procedure, he again presented with choroidal ischemia due to recurrent left
internal carotid artery blockage which improved gradually after carotid
stenting.
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Affiliation(s)
- Koushik Tripathy
- Department of Vitreoretina and Uvea, ICARE Eye Hospital & Postgraduate Institute, Noida, India
| | - Shahana Mazumdar
- Department of Vitreoretina and Uvea, ICARE Eye Hospital & Postgraduate Institute, Noida, India
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13
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Cunningham ET, Tabbara KF, Zierhut M. Systemic Lupus Erythematosus and the Eye. Ocul Immunol Inflamm 2019; 26:1143-1145. [PMID: 30452316 DOI: 10.1080/09273948.2018.1539589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Emmett T Cunningham
- a Department of Ophthalmology , California Pacific Medical Center , San Francisco , California , USA.,b The Department of Ophthalmology , Stanford University School of Medicine , Stanford , California , USA.,c UCSF School of Medicine , The Francis I. Proctor Foundation , San Francisco , California , USA
| | - Khalid F Tabbara
- d The Eye Center , The Eye Foundation for Research in Ophthalmology , Riyadh , Saudi Arabia.,e Department of Ophthalmology , College of Medicine, King Saud University , Riyadh , Saudi Arabia
| | - Manfred Zierhut
- f Centre for Ophthalmology , University Tuebingen , Tuebingen , Germany
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14
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Borrelli E, Uji A, Toto L, Viggiano P, Evangelista F, Mastropasqua R. In Vivo Mapping of the Choriocapillaris in Healthy Eyes: A Widefield Swept-Source OCT Angiography Study. Ophthalmol Retina 2019; 3:979-984. [PMID: 31371198 DOI: 10.1016/j.oret.2019.05.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 05/01/2019] [Accepted: 05/24/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE To report variation of choriocapillaris flow in peripapillary, macular, and near- and mid-periphery regions in healthy participants using widefield swept-source (SS) OCT angiography (OCTA). DESIGN Prospective, cross-sectional study. PARTICIPANTS Fifty healthy participants. METHODS Healthy young participants were imaged with the SS OCTA system (PLEX Elite 9000; Carl Zeiss Meditec, Inc, Dublin, CA). OCT angiography scans were obtained in primary and extreme gazes and a montage was created automatically. The en face choriocapillaris images then were exported to ImageJ software version 1.50 (National Institutes of Health, Bethesda, MD), and a semiautomated algorithm was used for subsequent quantitative analysis. MAIN OUTCOME MEASURES Quantitative analysis of the choriocapillaris performed in 3 different regions: (1) peripapillary, (2) macular, and (3) periphery. In addition, choriocapillaris variables were investigated further in distinct fields within these 3 different regions. RESULTS Fifty eyes (50 participants) were included in the analysis. Mean age ± standard deviation was 25.2±5.1 years (median, 24.5 years; range, 20.0-40.0 years). The peripapillary region exhibited the greatest total signal void area (P < 0.0001 vs. the macular region; P < 0.0001 vs. the peripheral region). Within the macular region, the foveal area exhibited a greater total signal void area in comparison with both the parafoveal area (P = 0.009) and the perifoveal area (P = 0.015). In the analysis investigating the near- and mid-periphery region, the temporal sector was characterized by a lower total signal void area compared with both the superior and inferior areas (P = 0.016 and P = 0.003, respectively). CONCLUSIONS We report quantitative mapping of the choriocapillaris in healthy individuals. Choriocapillaris perfusion seems to have a wide topographic variation.
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Affiliation(s)
- Enrico Borrelli
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy.
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Pasquale Viggiano
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Federica Evangelista
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Rodolfo Mastropasqua
- Bristol Eye Hospital, University Hospitals NHS Foundation Trust, Bristol, United Kingdom
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Hypertensive choroidopathy: Multimodal imaging and the contribution of wide-field swept-source oct-angiography. Am J Ophthalmol Case Rep 2019; 13:131-135. [PMID: 30705996 PMCID: PMC6348489 DOI: 10.1016/j.ajoc.2019.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 12/19/2018] [Accepted: 01/07/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose To present the case of a patient with a hypertensive choroidopathy and her follow-up using multimodal imaging; and to assess how wide-field swept-source (SS) Optical Coherence Tomography Angiography (OCTA) contributes to detecting the areas of hypoperfusion. Observations A 25-year-old white woman with terminal renal insufficiency, myopericarditis, and cerebrospinal fluid pressure of 37 mmHg indicating intracranial hypertension, presented with a painless loss of vision in both eyes. Her blood pressure was 190/135 mmHg. A thorough diagnosis work-up failed to reveal the etiology. The fundus examination showed arterial narrowing and moderate venous dilation in both eyes. Deep yellow spots were found bilaterally, associated with slight pigment epithelium detachments and exudative retinal detachments. Multimodal imaging showed characteristic features of choroidal involvement in hypertension. Wide-field 12 × 12 mm PlexElite map montage at the choriocapillaris slab identified areas of non-perfusion of the choriocapillaris. These areas mostly correlate with late indocyanine green angiography (ICGA)-presumed choroidal ischemia. During the follow-up, the patient's blood pressure normalized and the choriocapillaris flow improved. Conclusions and importance In this case of malignant hypertensive retinopathy with exudative retinal detachment of the posterior pole, SS-OCTA showed multiple and widespread flow voids on the choriocapillaris slabs, corresponding to the areas of hypofluorecence on ICGA, demonstrating an associated hypertensive choroidopathy. It would appear that SS-OCTA used alone is capable to show choroidal vascularization impairment in cases of hypertensive retinopathy.
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Borrelli E, Sarraf D, Freund KB, Sadda SR. OCT angiography and evaluation of the choroid and choroidal vascular disorders. Prog Retin Eye Res 2018; 67:30-55. [DOI: 10.1016/j.preteyeres.2018.07.002] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 12/31/2022]
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Tran AQ, Yannuzzi NA, Motulsky EH, Zhou XY, Galor A, Dubovy SR, Rosenfeld PJ, Lam BL. Swept-Source Optical Coherence Tomography Angiography of an Amalric Choroidal Infarction in a Rare Presentation of Giant Cell Arteritis With Bilateral Corneal Edema. Ophthalmic Surg Lasers Imaging Retina 2018; 49:e157-e160. [PMID: 30395679 DOI: 10.3928/23258160-20181002-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/28/2018] [Indexed: 11/20/2022]
Abstract
A 73-year-old woman with 2 weeks of progressive painless vision loss was found to have bilateral corneal edema, jaw claudication, and temporal headache. Multimodal imaging revealed an Amalric choroidal infarct in the left eye visualized by widefield indocyanine green angiography and swept-source optical coherence tomography angiography (SS-OCTA). Prompt intravenous corticosteroid treatment resulted in 20/20 vision, and giant cell arteritis (GCA) was confirmed by a temporal artery biopsy. The case underscores the use of widefield SS-OCTA as a non-invasive test to aid in the diagnosis of GCA, as well as bilateral cornea edema as a rare presentation of GCA. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e157-e160.].
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Pichi F, Fragiotta S, Freund KB, Au A, Lembo A, Nucci P, Sebastiani S, Gutierrez Hernandez JC, Interlandi E, Pellegrini F, Dolz-Marco R, Gallego-Pinazo R, Orellana-Rios J, Adatia FA, Munro M, Abboud EB, Ghazi N, Cunha Souza E, Amer R, Neri P, Sarraf D. Cilioretinal artery hypoperfusion and its association with paracentral acute middle maculopathy. Br J Ophthalmol 2018; 103:1137-1145. [PMID: 30257961 DOI: 10.1136/bjophthalmol-2018-312774] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To study the multimodal imaging findings of a large series of eyes with cilioretinal artery obstruction (CILRAO) and describe the systemic associations. METHODS Multicentre, retrospective chart review from 12 different retina clinics worldwide of eyes with CILRAO, defined as acute retinal whitening in the distribution of the cilioretinal artery, were identified. The clinical, systemic information and multimodal retinal imaging findings were collected and analysed. RESULTS A total of 53 eyes of 53 patients with CILRAO were included in the study. In 100% of eyes, fundus photography illustrated deep retinal whitening corresponding to the course of the cilioretinal artery. Twenty-eight patients (52.8%) presented with isolated CILRAO (baseline best-corrected visual acuity (BCVA) 20/50, final BCVA 20/25) associated with nocturnal hypotension, 23 patients (43.4%) with CILRAO secondary to central retinal vein occlusion (CRVO) (baseline BCVA 20/40, final BCVA 20/20) and two patients with CILRAO due to biopsy-proven giant cell arteritis (GCA) (baseline BCVA 20/175, final BCVA 20/75). With spectral domain optical coherence tomography (SD-OCT), a hyper-reflective band involving the inner nuclear layer (ie, paracentral acute middle maculopathy or PAMM) was noted in 51 eyes (28/28 eyes with isolated CILRAO and 23/23 eyes with CILRAO+CRVO) corresponding to the retinal whitening. In the two eyes with CILRAO+GCA, SD-OCT illustrated hyper-reflective ischaemia of both the middle and inner retina. CONCLUSIONS Isolated CILRAO and CILRAO secondary to CRVO are the result of hypoperfusion or insufficiency, rather than occlusion, of the cilioretinal artery and are associated with PAMM or selective infarction of the the inner nuclear layer. With GCA, there is complete occlusion of the cilioretinal artery producing ischaemia involving both the middle and inner retina associated with worse visual outcomes.
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Affiliation(s)
- Francesco Pichi
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates .,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Serena Fragiotta
- Vitreous Retina Macula Consultants of New York, New York City, New York, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York City, New York, USA
| | - Adrian Au
- Stein Eye Institute, University of California, Los Angeles, California, USA.,Greater Los Angeles VA Healthcare Center, Los Angeles, California, USA
| | - Andrea Lembo
- San Giuseppe Hospital, University Eye Clinic, Milan, Italy
| | - Paolo Nucci
- San Giuseppe Hospital, University Eye Clinic, Milan, Italy
| | - Stefano Sebastiani
- University Eye Clinic of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | | | | | - Jorge Orellana-Rios
- New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA.,University of Antofagasta, Antofagasta, Chile
| | | | - Monique Munro
- Mitchell Eye Center and Rockyview, Calgary, Alberta, Canada
| | - Emad B Abboud
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
| | - Nicola Ghazi
- Lebanese American University, Medical Center, Rizk Hospital, Beirut, Lebanon
| | | | | | - Piergiorgio Neri
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
| | - David Sarraf
- Stein Eye Institute, University of California, Los Angeles, California, USA.,Greater Los Angeles VA Healthcare Center, Los Angeles, California, USA
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Garrity ST, Holz EJ, Sarraf D. Amalric Triangular Syndrome Associated With Outer Nuclear Layer Infarction. Ophthalmic Surg Lasers Imaging Retina 2017; 48:668-670. [DOI: 10.3928/23258160-20170802-10] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/22/2017] [Indexed: 11/20/2022]
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