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Kim JH, Jeong HC, Shin YU, Lee WJ. Hemodialysis-induced positional changes in lamina cribrosa. Sci Rep 2024; 14:15250. [PMID: 38956090 PMCID: PMC11219866 DOI: 10.1038/s41598-024-65700-2] [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: 01/24/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
This study is aimed to investigate the effect of hemodialysis (HD) on the lamina cribrosa (LC) of the optic nerve head (ONH) using swept-source optical coherence tomography (SS-OCT) and other ophthalmological parameters in patients with end-stage kidney disease (ESKD). This prospective observational study included 29 patients who underwent HD for ESKD. ONH parameters including neural canal diameter (NCD), peripapillary vertical height (PVH), and anterior LC depth (LCD), were assessed using SS-OCT. Changes in the ONH parameters before and after HD were statistically analysed. Correlations between changes in the LCD and other ocular and systemic measurements were identified using Pearson's correlation analyses. The mean anterior LCD significantly decreased from 441.6 ± 139.8 μm before HD to 413.5 ± 141.7 μm after HD (P = 0.001). Mean NCD and PVH did not show significant changes after HD (P = 0.841 and P = 0.574, respectively). A significant correlation was found between changes in the anterior LCD and the mean ocular perfusion pressure (r = 0.397, P = 0.036). We observed a significant decrease in anterior LCD after HD. Our study suggests that HD can influence the ONH, especially in the LC.
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Affiliation(s)
- Ji Hong Kim
- Department of Ophthalmology, Hanyang University College of Medicine, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea
- Department of Ophthalmology, Hanyang University Seoul Hospital, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea
| | - Hyo Chan Jeong
- Department of Ophthalmology, Hanyang University College of Medicine, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea
- Department of Ophthalmology, Hanyang University Seoul Hospital, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea
| | - Yong Un Shin
- Department of Ophthalmology, Hanyang University College of Medicine, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea
- Department of Ophthalmology, Hanyang University Guri Hospital, Guri, Korea
| | - Won June Lee
- Department of Ophthalmology, Hanyang University College of Medicine, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea.
- Department of Ophthalmology, Hanyang University Seoul Hospital, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea.
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Kang M, Oh J, Kim M, Byeon SH, Kim SS, Shin JY. Extracellular fluid excess linked to reduced choroidal vascularity index in patients with chronic kidney disease. Sci Rep 2024; 14:12769. [PMID: 38834727 DOI: 10.1038/s41598-024-63444-7] [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: 09/14/2023] [Accepted: 05/29/2024] [Indexed: 06/06/2024] Open
Abstract
Extracellular fluid (ECF) excess is common in patients with chronic kidney disease (CKD). This study (involving 284 patients with CKD) explored the association between choroidal vascularity index (CVI) and ECF excess. We categorised patients into three groups based on extracellular water/total body water: normal, mildly overhydrated, and severely overhydrated. The more severe ECF status was associated with a lower CVI after adjustment (B = - 0.902, p = 0.001). In non-diabetic patients, both vascular luminal (LA, p < 0.001) and stromal areas (SA, p = 0.003) were significantly reduced in patients with severe ECF excess compared to others, whereas diabetic patients showed no significant differences in LA (p = 0.96) and SA (p = 0.86) based on ECF excess status. These findings suggest that ECF status may influence CVI in patients with CKD, underscoring the need for further research to clarify its direct impact on choroidal changes.
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Affiliation(s)
- Minjae Kang
- Department of Ophthalmology, Institute of Vision Research, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Jongrok Oh
- Department of Ophthalmology, Institute of Vision Research, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joo Youn Shin
- Department of Ophthalmology, Institute of Vision Research, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea.
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Engelmann J, Burke J, Hamid C, Reid-Schachter M, Pugh D, Dhaun N, Moukaddem D, Gray L, Strang N, McGraw P, Storkey A, Steptoe PJ, King S, MacGillivray T, Bernabeu MO, MacCormick IJC. Choroidalyzer: An Open-Source, End-to-End Pipeline for Choroidal Analysis in Optical Coherence Tomography. Invest Ophthalmol Vis Sci 2024; 65:6. [PMID: 38833259 PMCID: PMC11156207 DOI: 10.1167/iovs.65.6.6] [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: 12/05/2023] [Accepted: 04/22/2024] [Indexed: 06/06/2024] Open
Abstract
Purpose To develop Choroidalyzer, an open-source, end-to-end pipeline for segmenting the choroid region, vessels, and fovea, and deriving choroidal thickness, area, and vascular index. Methods We used 5600 OCT B-scans (233 subjects, six systemic disease cohorts, three device types, two manufacturers). To generate region and vessel ground-truths, we used state-of-the-art automatic methods following manual correction of inaccurate segmentations, with foveal positions manually annotated. We trained a U-Net deep learning model to detect the region, vessels, and fovea to calculate choroid thickness, area, and vascular index in a fovea-centered region of interest. We analyzed segmentation agreement (AUC, Dice) and choroid metrics agreement (Pearson, Spearman, mean absolute error [MAE]) in internal and external test sets. We compared Choroidalyzer to two manual graders on a small subset of external test images and examined cases of high error. Results Choroidalyzer took 0.299 seconds per image on a standard laptop and achieved excellent region (Dice: internal 0.9789, external 0.9749), very good vessel segmentation performance (Dice: internal 0.8817, external 0.8703), and excellent fovea location prediction (MAE: internal 3.9 pixels, external 3.4 pixels). For thickness, area, and vascular index, Pearson correlations were 0.9754, 0.9815, and 0.8285 (internal)/0.9831, 0.9779, 0.7948 (external), respectively (all P < 0.0001). Choroidalyzer's agreement with graders was comparable to the intergrader agreement across all metrics. Conclusions Choroidalyzer is an open-source, end-to-end pipeline that accurately segments the choroid and reliably extracts thickness, area, and vascular index. Especially choroidal vessel segmentation is a difficult and subjective task, and fully automatic methods like Choroidalyzer could provide objectivity and standardization.
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Affiliation(s)
- Justin Engelmann
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Jamie Burke
- School of Mathematics, University of Edinburgh, Edinburgh, United Kingdom
| | - Charlene Hamid
- Clinical Research Facility and Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Megan Reid-Schachter
- Clinical Research Facility and Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Dan Pugh
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Neeraj Dhaun
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Diana Moukaddem
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Lyle Gray
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Niall Strang
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Paul McGraw
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Amos Storkey
- Institute for Adaptive and Neural Computation, School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Paul J. Steptoe
- Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, United Kingdom
| | - Stuart King
- School of Mathematics, University of Edinburgh, Edinburgh, United Kingdom
| | - Tom MacGillivray
- Clinical Research Facility and Imaging, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Miguel O. Bernabeu
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, United Kingdom
- The Bayes Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Ian J. C. MacCormick
- Institute for Adaptive and Neural Computation, School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Roskal-Wałek J, Gołębiewska J, Mackiewicz J, Wałek P, Bociek A, Biskup M, Odrobina D, Jaroszyński A. The Haemodialysis Session Effect on the Choroidal Thickness and Retinal and Choroidal Microcirculation-A Literature Review. J Clin Med 2023; 12:7729. [PMID: 38137798 PMCID: PMC10743986 DOI: 10.3390/jcm12247729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Haemodialysis (HD) is currently the most commonly used method of renal replacement therapy. The process of dialysis involves numerous changes that affect many systems, including the eye. The changes occurring in the course of HD may affect the ocular parameters, such as intraocular pressure, central corneal thickness, retinal thickness, retinal nerve fibre layer thickness, and choroidal thickness (CT). The choroid, being one of the most vascularized tissues, is characterized by the highest ratio of blood flow to tissue volume in the entire body, may be particularly susceptible to changes occurring during HD, and at the same time reflect the microcirculatory status and its response to HD. Patients with end-stage renal disease subjected to dialysis are highly susceptible to systemic microvascular dysfunction. Moreover, it is considered that the process of HD itself contributes to vascular dysfunction. Nowadays, thanks to the development of imaging techniques, the widely available optical coherence tomography (OCT) tests allow for the assessment of CT, while OCT-angiography allows for a quick, non-invasive, and repeatable assessment of the condition of retinal and choroidal microcirculation, which significantly expands our knowledge regarding the reaction of ocular microcirculation due to HD. The assessment of both retinal and choroidal circulation is even more attractive because retinal circulation is autoregulated, while choroidal circulation is mainly controlled by extrinsic autonomic innervation. Thus, assessment of the choroidal response to an HD session may provide the possibility to indirectly evaluate the functions of the autonomic system in patients subjected to HD. At a time when the importance of microcirculation in systemic and renal diseases is becoming increasingly evident, the assessment of ocular microcirculation appears to be a potential biomarker for assessing the condition of systemic microcirculation. In this work, we present a review of the literature on the effect of the HD session on CT and the retinal and choroidal microcirculation.
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Affiliation(s)
- Joanna Roskal-Wałek
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland;
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (P.W.); (A.B.); (D.O.); (A.J.)
| | - Joanna Gołębiewska
- Department of Ophthalmology, Military Institute of Aviation Medicine, 01-755 Warsaw, Poland;
- Medical Faculty, Lazarski University, 02-662 Warsaw, Poland
| | - Jerzy Mackiewicz
- Department of Vitreoretinal Surgery, Medical University of Lublin, 20-079 Lublin, Poland;
| | - Paweł Wałek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (P.W.); (A.B.); (D.O.); (A.J.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Agnieszka Bociek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (P.W.); (A.B.); (D.O.); (A.J.)
| | - Michał Biskup
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland;
| | - Dominik Odrobina
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (P.W.); (A.B.); (D.O.); (A.J.)
- Ophthalmology Clinic Boni Fratres Lodziensis, 93-357 Łódź, Poland
| | - Andrzej Jaroszyński
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (P.W.); (A.B.); (D.O.); (A.J.)
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Zegrari S, Mouallem A, Audard V, Jouan N, Grimbert P, Jung C, Sakhi H, Souied EH, Miere A. Optical coherence tomography angiography analysis of changes in the retina and the choroid after hemodialysis for end stage kidney disease. Int Ophthalmol 2023; 43:4473-4479. [PMID: 37589862 DOI: 10.1007/s10792-023-02847-3] [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: 06/25/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE To study effects of hemodialysis (HD) on retinal and choroidal vasculature in patients with end-stage kidney disease (ESKD) using optical coherence tomography angiography (OCTA). METHODS In this prospective study, we investigated eyes of patients undergoing hemodialysis for ESKD from Mondor University Hospital. Only one eye/patient was considered. Subfoveal choroidal thickness (SCT) was measured on enhanced-depth imaging optical coherence tomography (EDI-OCT) before and after the hemodialysis session. OCTA was used to extract retinal vascular density (superficial and deep capillary plexus, SCP, DCP) and choriocapillaris non-perfusion. Clinical, demographic and biological parameters (Blood B-Nitric Peptid rate prior to HD session) were reviewed. RESULTS Twenty patients (mean age 53.2 ± 13.6 years, 10 males and 10 females) were included in this prospective study. SCT significantly decreased after the HD session (234.3 ± 56.14 µm before HD to 211.9 ± 60.79 µm after hemodialysis (Wilcoxon signed-rank test, p = 0.003)). Non-perfusion in the choriocapillaris significantly increased after HD (41.65 ± 3.58 before HD, 42.95 ± 3.19 after HD, p = 0.036) while no significant modification of the vascular density was observed in the retinal vasculature (SCP, DCP) around the macular zone or the optic nerve. An increased plasma B-Nitric Peptide (BNP) level prior to the onset of the HD session was significantly correlated with the decrease of the SCT (r = 0.45, p = 0.043). CONCLUSION Hemodialysis in patients with ESKD is associated with a significant decrease in SCT and an increase in non-perfusion in the choriocapillaris on OCTA. A High BNP level prior to the onset of the hemodialysis appears to be correlated with the decrease in SCT.
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Affiliation(s)
- Samira Zegrari
- Department of Ophthalmology, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, 40, Avenue de Verdun, 94010, Créteil, France
| | - Alexandra Mouallem
- Department of Ophthalmology, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, 40, Avenue de Verdun, 94010, Créteil, France
| | - Vincent Audard
- Department of Nephrology, Henri Mondor Hospital, Créteil, France
| | - Narindra Jouan
- Department of Nephrology, Henri Mondor Hospital, Créteil, France
| | | | - Camille Jung
- Clinical Research Center, GRC Macula and Biological Ressources Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Hichem Sakhi
- Department of Cardiology, Marie-Lannelongue Hospital, Plessis-Robinson, France
| | - Eric H Souied
- Department of Ophthalmology, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, 40, Avenue de Verdun, 94010, Créteil, France
| | - Alexandra Miere
- Department of Ophthalmology, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, 40, Avenue de Verdun, 94010, Créteil, France.
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Su Z, Mao Y, Qi Z, Xie M, Liang X, Hu B, Wang X, Jiang F. Impact of Hemodialysis on Subfoveal Choroidal Thickness Measured by Optical Coherence Tomography: A Systematic Review and a Pooled Analysis of Self-Controlled Case Series. Ophthalmol Ther 2023; 12:2265-2280. [PMID: 37440090 PMCID: PMC10441954 DOI: 10.1007/s40123-023-00761-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/20/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Hemodialysis (HD) has various effects on the body, including optimizing body fluid composition and volume, which may have an impact on subfoveal choroidal thickness (SCT) in individuals with end-stage kidney disease (ESKD). However, previous studies have produced conflicting results regarding the effect of HD on SCT in patients with ESKD. Therefore, we conducted a meta-analysis to investigate the influence of HD on SCT. METHODS A comprehensive search of relevant studies and bibliographies was conducted using Embase, PubMed, and Web of Science databases up to September 2022. Weighted mean difference (WMD) and 95% confidence interval (CI) were used to summarize the SCT change. Heterogeneity and publication bias were assessed, and a random-effects model was employed for the meta-analysis. Subgroup analyses were also performed to evaluate the influence of factors such as diabetes mellitus (DM), the severity of diabetic retinopathy (DR), diurnal variation adjustment, optical coherence tomography (OCT) types, and OCT scan modes. RESULTS A total of 15 studies involving 1010 eyes were eligible for this meta-analysis, including 552 diabetic eyes, 230 non-diabetic eyes, and the remaining 228 eyes were uncategorized. The meta-analysis revealed a significant reduction in SCT after HD (WMD = -13.66 μm; 95% CI -24.29 to -3.03 μm; z = -5.115, P < 0.0001). Subgroup analysis indicated a significant difference between the DM and non-DM groups (WMD = -24.10 μm vs. -15.37 μm, 95% CI -27.39 to -20.80 μm vs. -19.07 to -11.66 μm; P = 0.001). Additionally, the group with proliferative diabetic retinopathy (PDR) exhibited a more pronounced reduction in SCT (WMD = -28.66 μm; 95% CI -37.10 to -20.23; z = -6.660, P < 0.0001). Adjusting for diurnal variation, different types or scan modes of OCT did not significantly affect the results. CONCLUSION HD leads to a significant decrease in SCT among patients with ESKD, especially in patients with DM with PDR.
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Affiliation(s)
- Zixuan Su
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yamin Mao
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhiyi Qi
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Meng Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xueqing Liang
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Banghuan Hu
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinghua Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Fagang Jiang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Jain M, Mohan S, van Dijk EHC. Central serous chorioretinopathy: Pathophysiology, systemic associations, and a novel etiological classification. Taiwan J Ophthalmol 2022; 12:381-393. [PMID: 36660127 PMCID: PMC9843580 DOI: 10.4103/2211-5056.362601] [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: 09/15/2022] [Accepted: 10/04/2022] [Indexed: 12/08/2022] Open
Abstract
Central serous chorioretinopathy (CSC) has remained an enigmatic disease since its initial description by Von Graefe. Over the years, multiple risk factors have been recognized: these include psychological stress, behavioral traits, and corticosteroids. The basic pathophysiology of CSC involves choroidal thickening, vascular congestion, altered choroidal blood flow (ChBF), and choroidal hyperpermeability, leading to retinal pigment epithelium decompensation and subsequent neurosensory detachment. Multiple organ systems, mainly the nervous, cardiovascular, endocrinal, and renal systems participate in the control of the vascular tone and the ChBF via hypothalamus-pituitary-adrenal axis and renin-angiotensin-aldosterone system, while others such as the hepatic system regulate the enzymatic degradation of corticosteroids. Many vasoactive and psychotropic drugs also modulate the ocular perfusion. In addition, there are anatomical and genetic predispositions that determine its progression to the chronic or recurrent form, through cellular response and angiogenesis. We herein review the basic pathophysiology and immunogenetics in CSC along with the role of multiple organ systems. With this background, we propose an etiological classification that should provide a framework for customized therapeutic interventions.
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Affiliation(s)
- Manish Jain
- Department of Ophthalmology, Al Dhannah Hospital, Abu Dhabi, United Arab Emirates,Address for correspondence: Dr. Manish Jain, Department of Ophthalmology, Al Dhannah Hospital, Abu Dhabi, United Arab Emirates. E-mail:
| | - Sashwanthi Mohan
- Department of Vitreous and Retina, Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
| | - Elon H. C. van Dijk
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
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Kim DS, Kim BS, Cho H, Shin JH, Shin YU. Associations between Choriocapillaris Flow on Optical Coherence Tomography Angiography and Cardiovascular Risk Profiles of Patients with Acute Myocardial Infarction. J Pers Med 2022; 12:jpm12050839. [PMID: 35629261 PMCID: PMC9147039 DOI: 10.3390/jpm12050839] [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: 04/14/2022] [Revised: 05/15/2022] [Accepted: 05/18/2022] [Indexed: 12/10/2022] Open
Abstract
We evaluated the association between macular perfusion assessed via optical coherence tomography angiography (OCTA) and the cardiovascular risk profiles of patients with acute myocardial infarction (AMI). Patients with AMI who underwent comprehensive ophthalmological examinations and retinal OCTA were evaluated retrospectively. Retinal OCTA was performed for each patient within 3 days of admission. Quantitative analyses of the vessel density (VD) of the superficial capillary plexus (SCP) layers, deep capillary plexus layers (DCP), and choriocapillaris were performed after image processing. The 10-year risk of atherosclerotic cardiovascular disease (ASCVD), Global Registry of Acute Coronary Events (GRACE) score, reduction of atherothrombosis for continued health (REACH) score, and thrombolysis in myocardial infarction (TIMI) risk score were assessed. Sixty patients were included. VD in SCP and DCP was not associated with a 10-year ASCVD risk; however, choriocapillaris flow void features were significantly correlated with the 10-year ASCVD risk: decreased count, increased average size, and increased signal void area were correlated with increased 10-year ASCVD risk, GRACE score, REACH score, and TIMI risk score. In the multivariate analysis, a 10-year ASCVD risk (adjusted odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01–1.08) and brain natriuretic peptide (adjusted OR, 1.00; 95% CI, 1.00–1.01) were significantly associated with the highest tertile of the average size of the choriocapillaris. Choriocapillaris flow void features measured using OCTA were associated with cardiovascular risk profiles in patients with AMI. OCTA may be used as an indicator of cardiovascular risk profiles and could improve cardiovascular risk assessments.
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Affiliation(s)
- Dae Sung Kim
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si 11923, Korea; (D.S.K.); (H.C.)
| | - Byung Sik Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si 11923, Korea;
| | - Heeyoon Cho
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si 11923, Korea; (D.S.K.); (H.C.)
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si 11923, Korea;
- Correspondence: (J.-H.S.); (Y.U.S.); Tel.: +82-31-560-2216 (J.-H.S.); +82-31-560-2168 (Y.U.S.)
| | - Yong Un Shin
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si 11923, Korea; (D.S.K.); (H.C.)
- Correspondence: (J.-H.S.); (Y.U.S.); Tel.: +82-31-560-2216 (J.-H.S.); +82-31-560-2168 (Y.U.S.)
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Choroidal vascularity index of patients with coronary artery disease. Sci Rep 2022; 12:3036. [PMID: 35194148 PMCID: PMC8864027 DOI: 10.1038/s41598-022-07120-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
Abstract
We investigated the changes in subfoveal choroidal thickness and choroidal vascularity index (CVI) and their relationship with the severity of coronary artery stenosis in patients with cardiovascular risk factors and symptoms suggestive of coronary artery disease (CAD). Ninety patients who underwent coronary angiography (CAG) for evaluation of their coronary artery status and cardiac symptoms were included. Forty-two patients showed no evidence of CAD; 31 patients had one to two vessel disease; and 17 had a triple vessel disease. There were no significant differences in the subfoveal choroidal thickness among the three groups; however, the CVI in the triple vessel disease group was lower than those in the other groups. The CVI values were good predictors of the presence of triple-vessel disease (p = 0.020). Multivariate logistic regression analysis results revealed that male sex (odds ratio 5.4, p = 0.049), hypertension (odds ratio 4.9, p = 0.017), and CVI (%, odds ratio 0.8, p = 0.016) were significant factors associated with the presence of triple vessel disease. Although CVI may not be a sensitive marker for detecting early changes in the coronary artery, it may be helpful in indicating severe CAD.
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Abstract
PURPOSE OF REVIEW Systemic retinal biomarkers are biomarkers identified in the retina and related to evaluation and management of systemic disease. This review summarizes the background, categories and key findings from this body of research as well as potential applications to clinical care. RECENT FINDINGS Potential systemic retinal biomarkers for cardiovascular disease, kidney disease and neurodegenerative disease were identified using regression analysis as well as more sophisticated image processing techniques. Deep learning techniques were used in a number of studies predicting diseases including anaemia and chronic kidney disease. A virtual coronary artery calcium score performed well against other competing traditional models of event prediction. SUMMARY Systemic retinal biomarker research has progressed rapidly using regression studies with clearly identified biomarkers such as retinal microvascular patterns, as well as using deep learning models. Future systemic retinal biomarker research may be able to boost performance using larger data sets, the addition of meta-data and higher resolution image inputs.
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Abstract
This observational case–control study assessed the differences in choroidal structure between patients with celiac disease and healthy subjects utilizing the choroidal vascularity index (CVI). Seventy-four celiac patients and 67 healthy subjects underwent a complete ophthalmological evaluation, axial length (AL) measurements and spectral-domain optical coherence tomography with enhanced depth imaging mode (EDI SD-OCT) evaluation. These images were binarized and choroidal vasculature was analyzed. Choroidal total subfoveal area (TSA), luminal subfoveal area (LSA), stromal subfoveal area (SSA), CVI and subfoveal choroidal thickness (CT) were measured. Furthermore, subfoveal CT, TSA, LSA, SSA, and CVI were also correlated with AL. A statistically significant difference was found between the two groups for TSA, LSA, SSA and subfoveal CT, but not for CVI. In celiac patients, a significant correlation was found between AL and TSA, LSA and SSA, but not with CVI. Similar findings were also noticed in the healthy subjects. Thus, celiac patients have a thicker choroid than healthy subjects, regardless of the AL, due to a proportional increase in both the vascular and stromal components, which does not alter the CVI.
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12
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Lee WJ, Hong R, Kang MH, Cho H, Han SW, Yi JH, Shin YU, Seong M. Effect of Hemodialysis on Peripapillary Choroidal Thickness Measured by Swept-Source Optical Coherence Tomography. J Glaucoma 2021; 30:459-464. [PMID: 33337722 DOI: 10.1097/ijg.0000000000001762] [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] [Received: 09/06/2020] [Accepted: 11/13/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim was to investigate the effects of hemodialysis (HD) on peripapillary choroidal thickness (PCT) by swept-source optical coherence tomography and on other ophthalmologic parameters in patients with end-stage kidney disease. MATERIALS AND METHODS This was a prospective observational study. The authors evaluated 29 patients who underwent HD for end-stage kidney disease. Detailed ophthalmologic examinations and swept-source optical coherence tomography were performed immediately before and after HD. PCT was measured using the modification tool in the built-in OCT image viewer program. Changes in PCT before and after HD were statistically analyzed. RESULTS The average PCT significantly decreased from 127.3±49.2 μm before HD to 117.1±50.9 μm after HD (P<0.001). A significant correlation was found between changes in PCT and macular choroidal thickness (ρ=0.547, P=0.002). Changes in mean ocular perfusion pressure did not significantly correlate with changes in PCT (ρ=-0.049, P=0.803). CONCLUSIONS PCT significantly decreased after HD. HD could influence the optic nerve head and its surrounding structures.
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Affiliation(s)
- Won June Lee
- Department of Ophthalmology
- Department of Ophthalmology, Hanyang University Seoul Hospital, Seoul
| | - Rimkyung Hong
- Department of Ophthalmology
- Department of Ophthalmology, Hanyang University Guri Hospital, Guri, Korea
| | - Min Ho Kang
- Department of Ophthalmology
- Department of Ophthalmology, Hanyang University Guri Hospital, Guri, Korea
| | - Heeyoon Cho
- Department of Ophthalmology
- Department of Ophthalmology, Hanyang University Guri Hospital, Guri, Korea
| | - Sang-Woong Han
- Internal Medicine, Division of Nephrology, Hanyang University College of Medicine
| | - Joo-Hark Yi
- Internal Medicine, Division of Nephrology, Hanyang University College of Medicine
| | - Yong Un Shin
- Department of Ophthalmology
- Department of Ophthalmology, Hanyang University Guri Hospital, Guri, Korea
| | - Mincheol Seong
- Department of Ophthalmology
- Department of Ophthalmology, Hanyang University Guri Hospital, Guri, Korea
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Pandey R, Rana SS, Gupta V, Agarwal A, Kang M, Sharma RK, Gupta R, Suri V, Kumar S, Dhibar DP. Retino-choroidal changes in patients with acute pancreatitis: A prospective analysis of a novel biomarker. Pancreatology 2020; 20:1604-1610. [PMID: 33060018 DOI: 10.1016/j.pan.2020.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is paucity of data on ocular changes in acute Pancreatitis (AP). Moreover, subclinical alterations in retina & choroid have not been studied in AP. OBJECTIVE To prospectively study retino-choroidal changes in AP. METHODS Sixty patients (mean age 39.07 years; 41 males) with AP were followed up till recovery/death. Baseline slit-lamp examination, choroidal thickness (CT), retinal thickness (RT), choroidal vascularity index (CVI), retinal capillary density index (CDI) and arteriovenous ratio (AVR) were recorded. The patients were divided into two groups - mild (Group A; 5 patients) and moderately severe/severe (Group B; 55 patients) as per revised Atlanta classification. RESULTS Fundus examination showed mild optic disc edema with retinal hemorrhages in 6 (10%) patients in group B as compared to none in group A (p = 1.00). None of the patients had Purtscher retinopathy. Mean CT (317 ± 56.29 μm) was increased as compared to normal subjects (278.90 ± 57.84 μm, p = 0.003). The mean CVI (0.62 ± 0.04) was decreased as compared to normal (0.66 ± 0.01, p < 0.0001) as was the mean AVR (0.67 ± 0.03 vs. 0.7 ± 0.02, p < 0.0001). However, the mean RT of subjects with AP (239.68 ± 33.76 μm) was not significantly different compared to the normal subjects 253.17 ± 33.67 µm (p=NS). The mean CDI of superficial and deep plexus were comparable between normal and patients with AP. CT, RT, CVI, AVR and CDI were comparable between group A and group B as well as survivors and non-survivors. CONCLUSIONS Clinically significant ocular changes are seen infrequently in AP. However, subclinical changes in CT, CVI and AVR are observed in patients with AP compared to normal individuals.
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Affiliation(s)
- Ranjit Pandey
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Mandeep Kang
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ravi K Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Rajesh Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Vikas Suri
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Susheel Kumar
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Deba Prasad Dhibar
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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14
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Nakano H, Hasebe H, Murakami K, Cho H, Kondo D, Iino N, Fukuchi T. Choroid structure analysis following initiation of hemodialysis by using swept-source optical coherence tomography in patients with and without diabetes. PLoS One 2020; 15:e0239072. [PMID: 32915894 PMCID: PMC7485894 DOI: 10.1371/journal.pone.0239072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/28/2020] [Indexed: 12/04/2022] Open
Abstract
We aimed to evaluate choroid structural changes using swept-source optical coherence tomography (SS-OCT) following hemodialysis initiation in diabetic and nondiabetic patients with end-stage kidney disease (ESKD). In this multicenter, prospective, cross-sectional study, diabetic (DM group; 30 eyes; 16 patients) and nondiabetic patients (NDM group; 30 eyes; 15 patients) with ESKD were evaluated after hemodialysis initiation. SS-OCT findings were analyzed using a manual delineation technique and binarization method before the first and last hemodialysis sessions, conducted approximately 2 weeks apart. Subfoveal choroidal thickness changes and mean large choroidal vessel layer thickness were significantly greater in the DM group (−13.3% ± 2.5% and −14.5% ± 5.2%, respectively) than the NDM group (−9.5% ± 3.1% and −9.2% ± 3.4%, respectively; p = 0.049 and p = 0.02, respectively). Binarized SS-OCT analysis revealed that the mean subfoveal choroidal area was significantly larger in the DM group (−21.9% ± 6.5%) than the NDM group (−17.2% ± 5.9%; p = 0.032). The change ratio in mean luminal area values was significantly greater in the DM group (−27.7% ± 8.7%) than the NDM group (−17.7% ± 5.8%; p = 0.007). The DM group exhibited substantial changes in the choroidal layer, possibly reflecting choroidal vascular disorders caused by diabetes.
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Affiliation(s)
- Hideyuki Nakano
- Department of Ophthalmology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
- * E-mail:
| | - Hiruma Hasebe
- Department of Ophthalmology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Kenji Murakami
- Department of Ophthalmology, Niigata City General Hospital, Niigata, Japan
| | - Hiroyuki Cho
- Department of Ophthalmology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
- Department of Ophthalmology, Uonuma Kikan Hospital, Minamiuonuma, Japan
| | - Daisuke Kondo
- Department of Nephrology, Niigata City General Hospital, Niigata, Japan
| | - Noriaki Iino
- Department of Nephrology, Uonuma Kikan Hospital, Minamiuonuma, Japan
| | - Takeo Fukuchi
- Department of Ophthalmology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
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15
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Farrah TE, Dhillon B, Keane PA, Webb DJ, Dhaun N. The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons. Kidney Int 2020; 98:323-342. [PMID: 32471642 PMCID: PMC7397518 DOI: 10.1016/j.kint.2020.01.039] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 12/18/2022]
Abstract
Chronic kidney disease (CKD) is common, with hypertension and diabetes mellitus acting as major risk factors for its development. Cardiovascular disease is the leading cause of death worldwide and the most frequent end point of CKD. There is an urgent need for more precise methods to identify patients at risk of CKD and cardiovascular disease. Alterations in microvascular structure and function contribute to the development of hypertension, diabetes, CKD, and their associated cardiovascular disease. Homology between the eye and the kidney suggests that noninvasive imaging of the retinal vessels can detect these microvascular alterations to improve targeting of at-risk patients. Retinal vessel-derived metrics predict incident hypertension, diabetes, CKD, and cardiovascular disease and add to the current renal and cardiovascular risk stratification tools. The advent of optical coherence tomography (OCT) has transformed retinal imaging by capturing the chorioretinal microcirculation and its dependent tissue with near-histological resolution. In hypertension, diabetes, and CKD, OCT has revealed vessel remodeling and chorioretinal thinning. Clinical and preclinical OCT has linked retinal microvascular pathology to circulating and histological markers of injury in the kidney. The advent of OCT angiography allows contrast-free visualization of intraretinal capillary networks to potentially detect early incipient microvascular disease. Combining OCT's deep imaging with the analytical power of deep learning represents the next frontier in defining what the eye can reveal about the kidney and broader cardiovascular health.
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Affiliation(s)
- Tariq E Farrah
- University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Baljean Dhillon
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Princess Alexandra Eye Pavilion, Edinburgh, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, UK
| | - David J Webb
- University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Neeraj Dhaun
- University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
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16
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Iovino C, Pellegrini M, Bernabei F, Borrelli E, Sacconi R, Govetto A, Vagge A, Di Zazzo A, Forlini M, Finocchio L, Carnevali A, Triolo G, Giannaccare G. Choroidal Vascularity Index: An In-Depth Analysis of This Novel Optical Coherence Tomography Parameter. J Clin Med 2020; 9:jcm9020595. [PMID: 32098215 PMCID: PMC7074450 DOI: 10.3390/jcm9020595] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 12/15/2022] Open
Abstract
Remarkable improvements in optical coherence tomography (OCT) technology have resulted in highly sophisticated, noninvasive machines allowing detailed and advanced morphological evaluation of all retinal and choroidal layers. Postproduction semiautomated imaging analysis with dedicated public-domain software allows precise quantitative analysis of binarized OCT images. In this regard, the choroidal vascularity index (CVI) is emerging as a new imaging tool for the measurement and analysis of the choroidal vascular system by quantifying both luminal and stromal choroidal components. Numerous reports have been published so far regarding CVI and its potential applications in healthy eyes as well as in the evaluation and management of several chorioretinal diseases. Current literature suggests that CVI has a lesser variability and is influenced by fewer physiologic factors as compared to choroidal thickness. It can be considered a relatively stable parameter for evaluating the changes in the choroidal vasculature. In this review, the principles and the applications of this advanced imaging modality for studying and understanding the contributing role of choroid in retinal and optic nerve diseases are discussed. Potential advances that may allow the widespread adoption of this tool in the routine clinical practice are also presented.
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Affiliation(s)
- Claudio Iovino
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, 09124 Cagliari, Italy
- Correspondence:
| | - Marco Pellegrini
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (M.P.); (F.B.)
| | - Federico Bernabei
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (M.P.); (F.B.)
| | - Enrico Borrelli
- Department of Ophthalmology, Hospital San Raffaele, University Vita Salute San Raffaele, 20132 Milan, Italy; (E.B.); (R.S.)
| | - Riccardo Sacconi
- Department of Ophthalmology, Hospital San Raffaele, University Vita Salute San Raffaele, 20132 Milan, Italy; (E.B.); (R.S.)
| | - Andrea Govetto
- Ophthalmology Department, Fatebenefratelli and Ophthalmic Hospital, ASST-Fatebenefratelli-Sacco, 63631 Milan, Italy; (A.G.); (G.T.)
- Vitreoretinal Division, Bristol Eye Hospital, University Hospitals Bristol NHS foundation trust, Bristol BS1 2LX, UK
| | - Aldo Vagge
- University Eye Clinic, DINOGMI, Polyclinic Hospital San Martino IRCCS, 16132 Genoa, Italy;
| | - Antonio Di Zazzo
- Department of Ophthalmology, University Campus Bio-Medico of Rome, 00128 Rome, Italy;
| | | | - Lucia Finocchio
- Department of Translational Surgery and Medicine, Ophthalmology, University of Florence, 50134 Careggi Florence, Italy;
| | - Adriano Carnevali
- Department of Ophthalmology, University “Magna Graecia”, 88100 Catanzaro, Italy; (A.C.); (G.G.)
| | - Giacinto Triolo
- Ophthalmology Department, Fatebenefratelli and Ophthalmic Hospital, ASST-Fatebenefratelli-Sacco, 63631 Milan, Italy; (A.G.); (G.T.)
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University “Magna Graecia”, 88100 Catanzaro, Italy; (A.C.); (G.G.)
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17
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Exploring choroidal angioarchitecture in health and disease using choroidal vascularity index. Prog Retin Eye Res 2020; 77:100829. [PMID: 31927136 DOI: 10.1016/j.preteyeres.2020.100829] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/30/2019] [Accepted: 01/04/2020] [Indexed: 12/21/2022]
Abstract
The choroid is one of the most vascularized structures of the human body and plays an irreplaceable role in nourishing photoreceptors. As such, choroidal dysfunction is implicated in a multitude of ocular diseases. Studying the choroid can lead to a better understanding of disease pathogenesis, progression and discovery of novel management strategies. However, current research has produced inconsistent findings, partly due to the physical inaccessibility of the choroid and the lack of reliable biomarkers. With the advancements in optical coherence tomography technology, our group has developed a novel quantitative imaging biomarker known as the choroidal vascularity index (CVI), defined as the ratio of vascular area to the total choroidal area. CVI is a potential tool in establishing early diagnoses, monitoring disease progression and prognosticating patients. CVI has been reported in existing literature as a robust marker in numerous retinal and choroidal diseases. In this review, we will discuss the current role of CVI with reference to existing literature, and make postulations about its potential and future applications.
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