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Namvar E, Ahmadieh H, Maleki A, Nowroozzadeh MH. Sensitivity and specificity of optical coherence tomography angiography for diagnosis and classification of diabetic retinopathy; a systematic review and meta-analysis. Eur J Ophthalmol 2023; 33:2068-2078. [PMID: 37013361 DOI: 10.1177/11206721231167458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Optical coherence tomography angiography (OCTA) is a noninvasive imaging method that can be used for the staging of diabetic retinopathy. In addition, alterations in OCTA parameters can precede the clinical fundus changes. In this review, we aimed to assess the accuracy of OCTA in diagnosis and staging of diabetic retinopathy. METHODS Two independent reviewers participated in the literature search using electronic databases (PubMed, Embase, Cochrane Library Central Register of Controlled Trials, ISI, and Scopus) from inception till December 2020. The heterogeneity of data was assessed by Q statistics, Chi-square test and I2 index. RESULTS Forty-four articles published from 2015 to the end of 2020 were included in this meta-analysis. Of these, 27 were case-control studies, 9 were case series, and 8 were cohort studies. In total, 4284 eyes of 3553 patients were assessed in this study. OCTA could differentiate diabetic retinopathy from diabetes without diabetic retinopathy with a sensitivity of 88% (95% CI: 85% to 92%) and specificity of 88% (95% CI: 85% to 91%). In addition, it could differentiate proliferative diabetic retinopathy from non-proliferative diabetic retinopathy with a sensitivity of 91% (95% CI: 86% to 95%) and specificity of 91% (95% CI:86% to 96%). The sensitivity of OCTA for diagnosing diabetic retinopathy was increased by the size of scan (3 × 3 mm: 85%; 6 × 6 mm: 91%, 12 × 12 mm: 96%). CONCLUSION OCTA, as a non-invasive method, has acceptable sensitivity and specificity for diagnosis and classification of diabetic retinopathy. A larger scan size is associated with more sensitivity for discriminating diabetic retinopathy.
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Affiliation(s)
- Ehsan Namvar
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Maleki
- Department of Ophthalmology, Alzahra Eye Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Hossein Nowroozzadeh
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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2
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Li P, Pan Q, Jiang S, Kuebler WM, Pries AR, Ning G. Visualizing the spatiotemporal pattern of yolk sac membrane vascular network by enhanced local fractal analysis. Microcirculation 2022; 29:e12746. [PMID: 34897901 DOI: 10.1111/micc.12746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 11/09/2021] [Accepted: 12/07/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To establish methods for providing a comprehensive and detailed description of the spatial distribution of the vascular networks, and to reveal the spatiotemporal pattern of the yolk sac membrane vascular network during the angiogenic procedure. METHODS Addressing the limitations in the conventional local fractal analysis, an improved approach, named scanning average local fractal dimension, was proposed. This method was conducted on 6 high-resolution vascular images of the yolk sac membrane for 3 eggs at two stages (E3 and E4) to characterize the spatial distribution of the complexity of the vascular network. RESULTS With the proposed method, the spatial distribution of the complexity of the yolk sac membrane vascular network was visualized. From E3 to E4, the local fractal dimension increased in 3 eggs, 1.80 ± 0.02 vs. 1.85 ± 0.02, 1.72 ± 0.03 vs. 1.83 ± 0.02, and 1.77 ± 0.03 vs. 1.82 ± 0.02, respectively. The mean local fractal dimension in the most distal area from the embryo proper was the lowest at E3 while the highest at E4. At E3, the most peaks of the local fractal dimension were located in the vein territories and shifted to artery territories at E4. CONCLUSIONS The spatial distribution of the complexity of the yolk sac membrane vascular network exhibited diverse patterns at different stages. In addition from E3 to E4, the increment of complexity at the intersection areas between arteries and sinus terminalis was with the most advance. This is consistent with the physiologic evidence. The present work provides a potential approach for investigating the spatiotemporal pattern of the angiogenic process.
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Affiliation(s)
- Peilun Li
- Department of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Qing Pan
- College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Sheng Jiang
- Department of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Wolfgang M Kuebler
- Institute of Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Axel R Pries
- Institute of Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gangmin Ning
- Department of Biomedical Engineering, Zhejiang University, Hangzhou, China
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Tamplin MR, Deng W, Garvin MK, Binkley EM, Hyer DE, Buatti JM, Ledolter J, Boldt HC, Kardon RH, Grumbach IM. Temporal Relationship Between Visual Field, Retinal and Microvascular Pathology Following 125I-Plaque Brachytherapy for Uveal Melanoma. Invest Ophthalmol Vis Sci 2021; 62:3. [PMID: 33393969 PMCID: PMC7794259 DOI: 10.1167/iovs.62.1.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To define the temporal relationship of vascular versus neuronal abnormalities in radiation retinopathy. Methods Twenty-five patients with uveal melanoma treated with brachytherapy and sixteen controls were tested. Functional outcome measures included visual acuity and threshold perimetry (HVF 10-2), while structural outcomes included retinal thickness by OCT and vascular measures by OCT angiography and digital fundus photography. The degree of structural abnormality was determined by intereye asymmetry compared with normal subject asymmetry. Diagnostic sensitivity and specificity of each measure were determined using receiver operating characteristic curves. The relationships between the outcome measures were quantified by Spearman correlation. The effect of time from brachytherapy on visual function, retinal layer thickness, and capillary density was also determined. Results Within the first 2 years of brachytherapy, outcome measures revealed visual field loss and microvascular abnormalities in 38% and 31% of subjects, respectively. After 2 years, they became more prevalent, increasing to 67% and 67%, respectively, as did retinal thinning (50%). Visual field loss, loss of capillary density, and inner retinal thickness were highly correlated with one another. Diagnostic sensitivity and specificity were highest for abnormalities in digital fundus photography, visual field loss within the central 10°, and decrease in vessel density. Conclusions Using quantitative approaches, radiation microvasculopathy and visual field defects were detected earlier than loss of inner retinal structure after brachytherapy. Strong correlations eventually developed between vascular pathology, change in retinal thickness, neuronal dysfunction, and radiation dose. Radiation-induced ischemia seems to be a primary early manifestation of radiation retinopathy preceding visual loss.
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Affiliation(s)
- Michelle R Tamplin
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, United States
| | - Wenxiang Deng
- Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States.,Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States
| | - Mona K Garvin
- Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States.,Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States
| | - Elaine M Binkley
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Daniel E Hyer
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, United States
| | - John M Buatti
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, United States
| | - Johannes Ledolter
- Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States.,Henry B. Tippie College of Business, University of Iowa, Iowa City, Iowa, United States
| | - H Culver Boldt
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Randy H Kardon
- Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States.,Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Isabella M Grumbach
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, United States.,Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States.,Abboud Cardiovascular Research Center, Division of Cardiovascular Medicine, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
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4
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Hekimsoy V, Kılınç Hekimsoy H, Şekeroğlu MA, Kaya EB, Tokgözoğlu L. The relationship between retinal microcirculation and right heart catheterization and echocardiography findings in patients with idiopathic pulmonary arterial hypertension. Microcirculation 2021; 28:e12704. [PMID: 33971060 DOI: 10.1111/micc.12704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/20/2021] [Accepted: 05/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the possible alterations of retinal microcirculation associated with right-sided intracardiac pressures in patients with IPAH. METHODS Twenty patients with IPAH and 20 age- and sex-matched healthy controls were included in the study. Hemodynamic data were obtained from the most recent right heart catheterization. Echocardiographic examination was performed within 24 h of ophthalmological examination. For the right eyes of all participants, high-resolution scans of chorioretinal microvascular networks at different depths of the retina were captured via OCT angiography. RESULTS The perfusion of the superficial and deep capillary plexus (SCP and DCP), and choriocapillaris (CCP) flow area were significantly lower than those in healthy control subjects (p < .05 for all). In IPAH group, PVR and mPAP were correlated significantly with the perfusion measurements at SCP and DCP (r = .461, r = .626 and r = .625, r =0.730, respectively, p < .05). sPAP and TRV were positively correlated with the perfusion measurements at SCP and DCP (r = .600, r = .662 and r = .670, r = .655 p < .05). CONCLUSIONS The positive correlation of retinal perfusion at SCP and DCP with right-sided echocardiographic and hemodynamic measurements unveiled that retinal microcirculation is affected by the pressure alterations in the pulmonary circulation of IPAH patients.
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Affiliation(s)
- Vedat Hekimsoy
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hilal Kılınç Hekimsoy
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Mehmet Ali Şekeroğlu
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Ergün Barış Kaya
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Lale Tokgözoğlu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Ye P, Zhu T, Zheng F, Zhou M, Fang X, Yao K. Microvascular comparison in younger and older patients with retinal vein occlusion analyzed by OCT angiography. BMC Ophthalmol 2021; 21:161. [PMID: 33820544 PMCID: PMC8022394 DOI: 10.1186/s12886-021-01931-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background To compare changes in retinal microvasculature of young and elderly patients with retinal vein occlusion (RVO) after anti-VEGF treatment. Methods RVO patients who underwent anti-VEGF treatment were retrospectively reviewed and categorized into two groups based on age. The OCT angiography images were obtained during each visit. Best corrected visual acuity (BCVA), vessel density (VD) and foveal avascular zone (FAZ) were measured and compared between the two groups. Vision improvements and retinal microvasculature changes were also correlated. Results Twenty patients with 20 eyes were enrolled in the younger group and 46 patients with 46 eyes were enrolled in the older group. Younger patients demonstrated better BCVA, higher VD and smaller FAZ than older patients at 12 months after the first anti-VEGF treatment. The improvement of VD was observed only in the younger group. A positive correlation between vision improvement and VD increase was noted. Conclusions Young patients with RVO can achieve rapid rehabilitation of deep retinal vasculature which lead to a better visual outcome.
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Affiliation(s)
- Panpan Ye
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88, Jiefang Road, 310009, Hangzhou, China
| | - Tiepei Zhu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88, Jiefang Road, 310009, Hangzhou, China
| | - Fang Zheng
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88, Jiefang Road, 310009, Hangzhou, China
| | - Min Zhou
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88, Jiefang Road, 310009, Hangzhou, China.,The Institute of Translational Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoyun Fang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88, Jiefang Road, 310009, Hangzhou, China.
| | - Ke Yao
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88, Jiefang Road, 310009, Hangzhou, China.
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Cabrera DeBuc D, Feuer WJ, Persad PJ, Somfai GM, Kostic M, Oropesa S, Mendoza Santiesteban C. Investigating Vascular Complexity and Neurogenic Alterations in Sectoral Regions of the Retina in Patients With Cognitive Impairment. Front Physiol 2020; 11:570412. [PMID: 33240097 PMCID: PMC7680898 DOI: 10.3389/fphys.2020.570412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/08/2020] [Indexed: 12/21/2022] Open
Abstract
Evidence is accumulating that cognitive function, and visual impairment may be related. In this pilot study, we investigated whether multifractal dimension and lacunarity analyses performed in sectoral regions of the retina may reveal changes in patients with cognitive impairment (CI) that may be masked in the study considering the whole retinal branching pattern. Prospective age-matched subjects (n = 69) with and with no CI and without the presence of any ophthalmic history were recruited (age > 55+ years). The Montreal Cognitive Assessment (MoCA) was used to measure CI, and full-field electroretinogram (ERG) was performed. Also, visual performance exams were conducted using the Rabin cone contrast test (CCT). Quantification of the retinal structure was performed in retinal fundus images [45o field of view (FOV), optic disk centered] with excellent quality for all individuals [19 healthy controls (HC) and 20 patients with CI] after evaluating the inclusion and exclusion criteria in all study participants recruited (n = 69). The skeletonized vasculature network that comprised the whole branching pattern observable in the full 45° FOV was obtained for each image and divided into nine equal regions (superotemporal, superior, superonasal, macular, optic disk, nasal, inferotemporal, inferior, and inferonasal). The multifractal behavior was analyzed by calculating the generalized dimension Dq (Do, D1, and D2), the lacunarity parameter (Λ), and singularity spectrum f(α) in the nine sectoral skeletonized images as well as in the skeletons that comprised the whole branching pattern observable in the full 45° FOV. The analyses were performed using the ImageJ program together with the FracLac plug-in. Independent sample t-tests or Mann Whitney U test and Pearson correlation coefficient were used to find associations between all parameters in both groups. The effect size (Cohen’s d) of the difference between both groups was also assessed. A p-value < 0.05 was considered statistically significant. Significant correlations between multifractal and Λ parameters with the MoCA and implicit time ERG-parameter were observed in the regional analysis. In contrast, no trend was found when considering the whole retinal branching pattern. Analysis of combined structural-functional parameters in sectoral regions of the retina, instead of individual retinal biomarkers, may provide a useful clinical marker of CI.
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Affiliation(s)
- Delia Cabrera DeBuc
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - William J Feuer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - Patrice J Persad
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - Gabor Mark Somfai
- Department of Ophthalmology, City Hospital Waid and Triemli, Zurich, Switzerland.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Maja Kostic
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - Susel Oropesa
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
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Ashraf M, Sampani K, Abu-Qamar O, Cavallerano J, Silva PS, Aiello LP, Sun JK. Optical Coherence Tomography Angiography Projection Artifact Removal: Impact on Capillary Density and Interaction with Diabetic Retinopathy Severity. Transl Vis Sci Technol 2020; 9:10. [PMID: 32832217 PMCID: PMC7414622 DOI: 10.1167/tvst.9.7.10] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/29/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose The purpose of this study was to assess how projection artifact removal (PAR) alters optical coherence tomography angiography (OCTA) assessment of superficial capillary plexus (SCP) and deep capillary plexus (DCP) in eyes of patients with diabetes. Methods We acquired 3 × 3 mm scans with RTVue-XR Avanti (Optovue, Inc., Fremont, CA), which were analyzed with PAR software (PAROCTA) and without (non-PAROCTA). SCP, DCP, and full thickness retina vascular density (VD) and vessel linear density (VLD) were manually calculated using ImageJ (version 1.51). Adjusted flow index (AFI) was manually assessed for full thickness images. Results Among 323 eyes of 194 patients (no diabetic retinopathy [DR]: 28 eyes; mild nonproliferative DR (NPDR): 96 eyes; moderate: 82 eyes; severe: 32 eyes; and proliferative DR [PDR]: 81 eyes), SCP VD and VLD were lower with PAROCTA than with non-PAROCTA only in eyes with moderate (VD: P = 0.017; VLD: P = 0.046), severe (P = 0.016; P = 0.009), and PDR (P < 0.001; P = 0.002). DCP VD and VLD were higher with PAROCTA as compared to non-PAROCTA only in eyes with no DR (VD and VLD: P < 0.001), mild (VD and VLD: P < 0.001), moderate (VD: P = 0.005; and VLD: P < 0.001), and severe (VD: P = 0.009; VLD: P < 0.001). Full thickness PAROCTA and non-PAROCTA VD and VLD differed only in eyes with no DR where PAROCTA estimates were higher (VD: P = 0.009; VLD: P = 0.02). PAROCTA AFI was lower than non-PAROCTA AFI for all DR severity levels (P < 0.001) except no DR. Conclusions Although differential effects of PAROCTA software are expected on SCP versus DCP measurements, these findings also suggest an interaction between PAROCTA and DR severity on assessment of VD. Conclusions from previous studies that have not corrected VD with PAR software should be carefully reviewed with regard to the role of specific vascular layers in DR. Translational Relevance Previous OCTA studies that have not corrected VD with PAR software should be carefully reviewed with regard to the role of individual vascular layers in differing severity levels of DR.
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Affiliation(s)
- Mohamed Ashraf
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Konstantina Sampani
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Omar Abu-Qamar
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Jerry Cavallerano
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Paolo S Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer K Sun
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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8
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Yang HS, Kang TG, Park H, Heo JS, Park J, Lee KS, Choi S. Quantitative evaluation of choriocapillaris using optical coherence tomography and optical coherence tomography angiography in patients with central serous chorioretinopathy after half-dose photodynamic therapy. PLoS One 2020; 15:e0227718. [PMID: 31929582 PMCID: PMC6957295 DOI: 10.1371/journal.pone.0227718] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/24/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To quantify the structural and perfusion changes in choriocapillaris in chronic central serous chorioretinopathy after half-dose photodynamic therapy by using spectral-domain optical coherence tomography and optical coherence tomography angiography. METHODS This retrospective interventional case series examined the eyes of patients with central serous chorioretinopathy. Patients underwent full ophthalmic examinations, including spectral-domain optical coherence tomography and angiography, prior to and 1, 3, and 6 months after the treatment. Clinical and tomographic features of the choriocapillaris and choroidal thickness and vascular changes were evaluated by assessing flow signal voids. RESULTS All 56 eyes of 56 patients showed complete resolution of subretinal fluid at 3 months after photodynamic therapy. The best-corrected visual acuity significantly improved at 6 months (p<0.001). The central subfield thickness, subfoveal choroidal thickness, subfoveal choroidal large vessel layer thickness, and mean total area of flow signal voids decreased significantly at 6 months (all p values < 0.001), but the subfoveal choriocapillaris layer thickness did not change significantly at 6 months (p≥0.16). Multivariate analysis revealed positive linear correlations of the central subfield thickness and subfoveal choroidal large vessel layer thickness with the mean total area of flow signal voids at 6 months (p<0.001). There was a negative linear correlation between the subfoveal choriocapillaris layer and the mean total area of flow signal voids at 6 months (p = 0.013). CONCLUSION Half-dose photodynamic therapy improved the anatomic and functional outcomes of central serous chorioretinopathy, induced subfoveal choroidal thickness thinning, and increased choriocapillaris perfusion. In addition, the recovery of the subfoveal choriocapillaris layer thickness and improved choriocapillaris perfusion were closely associated.
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Affiliation(s)
- Hyun Seung Yang
- Department of Ophthalmology, Seoul Shinsegae Eye Center, Eui Jung Bu, Gyeonggi-do, South Korea
| | - Tae Gu Kang
- Department of Ophthalmology, Veterans Health Service Medical Center, Seoul, South Korea
| | - Hyun Park
- Department of Endocrinology, Seoul Chuk Hospital, Eui Jung Bu, Gyeonggi-do, South Korea
| | - Ji Su Heo
- Department of Ophthalmology, Seoul Shinsegae Eye Center, Eui Jung Bu, Gyeonggi-do, South Korea
| | - Jonghoon Park
- Department of Ophthalmology, Seoul Shinsegae Eye Center, Eui Jung Bu, Gyeonggi-do, South Korea
| | - Kyung Sub Lee
- Department of Ophthalmology, Seoul Shinsegae Eye Center, Eui Jung Bu, Gyeonggi-do, South Korea
| | - Sangkyung Choi
- Department of Ophthalmology, Veterans Health Service Medical Center, Seoul, South Korea
- * E-mail:
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9
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Vujosevic S, Toma C, Villani E, Gatti V, Brambilla M, Muraca A, Ponziani MC, Aimaretti G, Nuzzo A, Nucci P, De Cilla' S. Early Detection of Microvascular Changes in Patients with Diabetes Mellitus without and with Diabetic Retinopathy: Comparison between Different Swept-Source OCT-A Instruments. J Diabetes Res 2019; 2019:2547216. [PMID: 31281849 PMCID: PMC6594252 DOI: 10.1155/2019/2547216] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 02/07/2023] Open
Abstract
Optical coherence tomography angiography (OCT-A) has recently improved the ability to detect subclinical and early clinically visible microvascular changes occurring in patients with diabetes mellitus (DM). The aim of the present study is to evaluate and compare early quantitative changes of macular perfusion parameters in patients with DM without DR and with mild nonproliferative DR (NPDR) evaluated by two different swept-source (SS) OCT-A instruments using two scan protocols (3 × 3 mm and 6 × 6 mm). One hundred eleven subjects/eyes were prospectively evaluated: 18 healthy controls (control group), 73 eyes with DM but no DR (no-DR group), and 20 eyes with mild NPDR (DR group). All quantitative analyses were performed using ImageJ and included vessel and perfusion density, area and circularity index of the FAZ, and vascular complexity parameters. The agreement between methods was assessed according to the method of Bland-Altman. A significant decrease in the majority of the considered parameters was found in the DR group versus the controls with both instruments. The results of Bland-Altman analysis showed the presence of a systemic bias between the two instruments with PLEX Elite providing higher values for the majority of the tested parameters when considering 6 × 6 mm angiocubes and a less definite difference in 3 × 3 mm angiocubes. In conclusion, this study documents early microvascular changes occurring in the macular region of patients at initial stages of DR, confirmed with both SS OCT-A instruments. The fact that early microvascular alterations could not be detected with one instrument does not necessarily mean that these alterations are not actually present, but this could be an intrinsic limitation of the device itself. Further, larger longitudinal studies are needed to better understand microvascular damage at very early stages of diabetic retinal disease and to define the strengths and weaknesses of different OCT-A devices.
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Affiliation(s)
- Stela Vujosevic
- Eye Clinic, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Caterina Toma
- Eye Clinic, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Edoardo Villani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Eye Clinic, San Giuseppe Hospital, Milan, Italy
| | - Valentina Gatti
- Eye Clinic, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Marco Brambilla
- Department of Medical Physics, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Andrea Muraca
- Eye Clinic, University Hospital “Maggiore della Carità”, Novara, Italy
| | | | - Gianluca Aimaretti
- Department of Translational Medicine, Endocrinology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Alessandro Nuzzo
- Department of Translational Medicine, Endocrinology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Paolo Nucci
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Eye Clinic, San Giuseppe Hospital, Milan, Italy
| | - Stefano De Cilla'
- Eye Clinic, University Hospital “Maggiore della Carità”, Novara, Italy
- Department of Health Sciences, University of East Piedmont “A. Avogadro”, Novara, Italy
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