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Martin GC, Brousse V, Connes P, Grevent D, Kossorotoff M, Da Costa L, Bourdeau H, Charlot K, Boutonnat-Faucher B, Allali S, De Montalembert M, Bremond-Gignac D, Vidal PP, Robert MP. Retinal atrophy and markers of systemic and cerebrovascular severity in homozygous sickle cell disease. Eur J Ophthalmol 2022; 32:3258-3266. [DOI: 10.1177/11206721221090794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction While paramacular retinal atrophy (PRA) is known to be found in 48% of eyes of adults and 42% of eyes of children with homozygous SCD (SS-SCD), the aim of this study is to assess the association between PRA and red blood cell (RBC) deformability, hematological markers and brain imaging abnormalities in SS-SCD. Methods This study is a subset of DREAM2, a prospective observational study performed between August 2015 and August 2016. Children (5–17 years) with SS-SCD and no history of large vessel vasculopathy, were included. Ophthalmological characteristics including visual acuity, fundus examination, OCT of central and temporal retina (with several retinal thickness measurements) were explored in relation with RBC deformability (ektacytometry), hematological and biochemical (hemolysis parameters), and neurological (cerebral oxygenation estimated by Near Infrared Spectroscopy, brain magnetic resonance imaging) investigations. Results 17 children (5 boys; mean age: 13 years) with complete ophthalmological investigations were included in the analysis; 8 exhibited PRA. RBC deformability was found to be significantly lower in children with PRA for measurements made at 1.69 Pa (0.16 a.u ± 0.02 vs 0.21 a.u ± 0.03, p = 0.02) and above, as well as cerebral oxygenation (59.25% ± 9.9 vs 71.53% ± 4.9, p = 0.02). A significant positive correlation was found between temporal retinal thickness and hemoglobin level (ρ = 0.65, p = 0.007), hematocrit (ρ = 0.53, p = 0.04) and RBC deformability at 3 Pa (ρ = 0.75, p = 0.005) and above. Conclusions These results suggest that PRA could be an early marker of systemic severity and cerebral oxygenation in SCD. Whether it could help predicting cerebral vasculopathy requires further investigations.
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Affiliation(s)
- Gilles C. Martin
- Ophthalmology Department and Rare Ophthalmological Diseases Reference Centre (OPHTARA), Necker-Enfants Malades University Hospital, APHP, Paris, France
- Borelli Centre, CNRS-SSA-ENS Paris Saclay-Paris University, Paris, France
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| | - Valentine Brousse
- General Pediatrics Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
- Institut National de la transfusion sanguine, UMR_S1134, Inserm, Paris, France
- LABEX GR-Ex, France
| | - Philippe Connes
- Faculté de Médecine Rockefeller, Laboratoire inter-universitaire de Biologie de la Motricité (LIBM EA7424), Equipe « Biologie Vasculaire et du Globule Rouge », Université Claude Bernard Lyon 1, Lyon, France
| | - David Grevent
- Radiology Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Manoelle Kossorotoff
- Pediatric Neurology Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Lydie Da Costa
- Institut National de la transfusion sanguine, UMR_S1134, Inserm, Paris, France
- LABEX GR-Ex, France
- AP-HP, Hôpital Robert Debré, service d’Hématologie Biologique, Paris, France
| | - Hélène Bourdeau
- Pediatric Neurology Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Keyne Charlot
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels Institut de Recherche Biomédicale des Armées, France
| | | | - Slimane Allali
- General Pediatrics Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
- LABEX GR-Ex, France
| | - Mariane De Montalembert
- General Pediatrics Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
- LABEX GR-Ex, France
| | - Dominique Bremond-Gignac
- Ophthalmology Department and Rare Ophthalmological Diseases Reference Centre (OPHTARA), Necker-Enfants Malades University Hospital, APHP, Paris, France
- INSERM UMRS 1138, Team 17, Centre de Recherche des Cordeliers, Sorbonne Paris University, France
| | - Pierre-Paul Vidal
- Borelli Centre, CNRS-SSA-ENS Paris Saclay-Paris University, Paris, France
| | - Matthieu P. Robert
- Ophthalmology Department and Rare Ophthalmological Diseases Reference Centre (OPHTARA), Necker-Enfants Malades University Hospital, APHP, Paris, France
- Borelli Centre, CNRS-SSA-ENS Paris Saclay-Paris University, Paris, France
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Lynch G, Scott AW, Linz MO, Han I, Andrade Romo JS, Linderman RE, Carroll J, Rosen RB, Chui TY. Foveal avascular zone morphology and parafoveal capillary perfusion in sickle cell retinopathy. Br J Ophthalmol 2019; 104:473-479. [PMID: 31337609 PMCID: PMC6980907 DOI: 10.1136/bjophthalmol-2019-314567] [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: 05/13/2019] [Revised: 07/03/2019] [Accepted: 07/06/2019] [Indexed: 11/30/2022]
Abstract
Background/aims To assess foveal avascular zone (FAZ) morphology and parafoveal capillary perfusion in patients with various stages of sickle cell retinopathy (SCR) using optical coherence tomography angiography (OCT-A). Methods This is a multi-institutional retrospective study of patients with various stages of SCR compared with healthy controls. Parafoveal OCT-A images obtained using a commercial spectral domain-OCT system were reviewed. Foveal-centred 3×3 mm full vascular slab OCT-As were used for image processing and data analysis. FAZ area, perimeter, and acircularity index were determined on the OCT-A image after manual delineation of the FAZ border. Quadrant-based parafoveal capillary density and per cent area deviating from normal distribution were also measured. Results Fifty-two patients with SCR (33 non-proliferative and 19 proliferative) and 20 age and race-matched healthy controls were included. One randomly selected eye per study participant was analysed. FAZ perimeter and acircularity index were significantly greater in SCR eyes when compared with the controls. While parafoveal capillary density was significantly lower, per cent area deviated from normal distribution was significantly higher in SCR eyes than that of the control. However, no statistically significant difference between the two SCR stages was observed. In quadrant-based analysis, the temporal quadrant showed greater parafoveal capillary dropout due to SCR, with the most profound effect in patients with proliferative SCR. Conclusions Abnormal FAZ morphology and altered parafoveal capillary perfusion were found in patients with SCR. Our customised OCT-A image analysis method uniquely highlights significant quantitative alterations in perfusion density mapping in a qualitative display, with minimal obscuration of OCT-A image detail.
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Affiliation(s)
- Giselle Lynch
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA.,Ophthalmology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Adrienne W Scott
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, Maryland, USA
| | - Marguerite O Linz
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, Maryland, USA
| | - Ian Han
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, Maryland, USA.,Ophthalmology & Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Jorge S Andrade Romo
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA
| | - Rachel E Linderman
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joseph Carroll
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Richard B Rosen
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA.,Ophthalmology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Toco Y Chui
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA .,Ophthalmology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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Abstract
Cell dehydration is a distinguishing characteristic of sickle cell disease and an important contributor to disease pathophysiology. Due to the unique dependence of Hb S polymerization on cellular Hb S concentration, cell dehydration promotes polymerization and sickling. In double heterozygosis for Hb S and C (SC disease) dehydration is the determining factor in disease pathophysiology. Three major ion transport pathways are involved in sickle cell dehydration: the K-Cl cotransport (KCC), the Gardos channel (KCNN4) and Psickle, the polymerization induced membrane permeability, most likely mediated by the mechano-sensitive ion channel PIEZO1. Each of these pathways exhibit unique characteristics in regulation by oxygen tension, intracellular and extracellular environment, and functional expression in reticulocytes and mature red cells. The unique dependence of K-Cl cotransport on intracellular Mg and the abnormal reduction of erythrocyte Mg content in SS and SC cells had led to clinical studies assessing the effect of oral Mg supplementation. Inhibition of Gardos channel by clotrimazole and senicapoc has led to Phase 1,2,3 trials in patients with sickle cell disease. While none of these studies has resulted in the approval of a novel therapy for SS disease, they have highlighted the key role played by these pathways in disease pathophysiology.
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Affiliation(s)
- Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Dembélé A, Toure B, Sarro Y, Guindo A, Fané B, Offredo L, Kené S, Conaré I, Tessougué O, Traoré Y, Badiaga Y, Sidibé M, Diabaté D, Coulibaly M, Kanta M, Ranque B, Diallo D. Prévalence et facteurs de risque de la rétinopathie drépanocytaire dans un centre de suivi drépanocytaire d’Afrique subsaharienne. Rev Med Interne 2017; 38:572-577. [DOI: 10.1016/j.revmed.2017.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/12/2017] [Accepted: 01/23/2017] [Indexed: 11/30/2022]
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Mo S, Krawitz B, Efstathiadis E, Geyman L, Weitz R, Chui TYP, Carroll J, Dubra A, Rosen RB. Imaging Foveal Microvasculature: Optical Coherence Tomography Angiography Versus Adaptive Optics Scanning Light Ophthalmoscope Fluorescein Angiography. Invest Ophthalmol Vis Sci 2017; 57:OCT130-40. [PMID: 27409463 PMCID: PMC4968918 DOI: 10.1167/iovs.15-18932] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To compare the use of optical coherence tomography angiography (OCTA) and adaptive optics scanning light ophthalmoscope fluorescein angiography (AOSLO FA) for characterizing the foveal microvasculature in healthy and vasculopathic eyes. METHODS Four healthy controls and 11 vasculopathic patients (4 diabetic retinopathy, 4 retinal vein occlusion, and 3 sickle cell retinopathy) were imaged with OCTA and AOSLO FA. Foveal perfusion maps were semiautomatically skeletonized for quantitative analysis, which included foveal avascular zone (FAZ) metrics (area, perimeter, acircularity index) and vessel density in three concentric annular regions of interest. On each set of OCTA and AOSLO FA images, matching vessel segments were used for lumen diameter measurement. Qualitative image comparisons were performed by visual identification of microaneurysms, vessel loops, leakage, and vessel segments. RESULTS Adaptive optics scanning light ophthalmoscope FA and OCTA showed no statistically significant differences in FAZ perimeter, acircularity index, and vessel densities. Foveal avascular zone area, however, showed a small but statistically significant difference of 1.8% (P = 0.004). Lumen diameter was significantly larger on OCTA (mean difference 5.7 μm, P < 0.001). Microaneurysms, fine structure of vessel loops, leakage, and some vessel segments were visible on AOSLO FA but not OCTA, while blood vessels obscured by leakage were visible only on OCTA. CONCLUSIONS Optical coherence tomography angiography is comparable to AOSLO FA at imaging the foveal microvasculature except for differences in FAZ area, lumen diameter, and some qualitative features. These results, together with its ease of use, short acquisition time, and avoidance of potentially phototoxic blue light, support OCTA as a tool for monitoring ocular pathology and detecting early disease.
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Affiliation(s)
- Shelley Mo
- Icahn School of Medicine at Mount Sinai, New York, New York, United States 2Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Brian Krawitz
- Icahn School of Medicine at Mount Sinai, New York, New York, United States 2Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Eleni Efstathiadis
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States 3William E. Macaulay Honors College, New York, New York, United States
| | - Lawrence Geyman
- Icahn School of Medicine at Mount Sinai, New York, New York, United States 2Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Rishard Weitz
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Toco Y P Chui
- Icahn School of Medicine at Mount Sinai, New York, New York, United States 2Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Joseph Carroll
- Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States 5Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States 6Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, Unit
| | - Alfredo Dubra
- Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States 5Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States 6Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, Unit
| | - Richard B Rosen
- Icahn School of Medicine at Mount Sinai, New York, New York, United States 2Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
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Kord Valeshabad A, Wanek J, Zelkha R, Lim JI, Camardo N, Gaynes B, Shahidi M. Conjunctival microvascular haemodynamics in sickle cell retinopathy. Acta Ophthalmol 2015; 93:e275-80. [PMID: 25429907 DOI: 10.1111/aos.12593] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 10/06/2014] [Indexed: 01/27/2023]
Abstract
PURPOSE To determine alterations in bulbar conjunctival microvascular haemodynamics in sickle cell retinopathy (SCR) subjects with focal macular thinning (FMT). METHODS Conjunctival microcirculation imaging and spectral domain optical coherence tomography (SD-OCT) were performed in 22 subjects (eyes) diagnosed with SCR. Based on evaluation of SD-OCT retinal thickness maps, eyes were assigned to one of the two groups: with or without FMT. Conjunctival venular diameter and axial blood velocity were measured in multiple venules in each eye by customized image analysis algorithms. Measurements were then categorized into two vessel size groups (vessel size 1 and 2) and compared between FMT groups. A Pearson correlation coefficient was computed to assess the relationship between retinal thickness and axial blood velocity. RESULTS Mean age, haematocrit, sickle cell haemoglobin type and median retinopathy score were not significantly different between the two groups (p ≥ 0.1). Retinal thickness in parafoveal and perifoveal temporal subfields was significantly lower in eyes with FMT as compared to eyes without FMT (p ≤ 0.04). There was a significant effect of FMT on axial blood velocity (p = 0.04), while the effect of vessel size was not significant (p = 0.4). In vessel size 1, axial blood velocity was lower in eyes with FMT than in eyes without FMT (p = 0.03), while in vessel size 2, there was no statistically significant difference between FMT groups (p = 0.1). In vessel size 1, there was a significant positive correlation between axial blood velocity and retinal thickness in the perifoveal (r = 0.48, p = 0.02) and parafoveal (r = 0.43, p = 0.04) temporal subfields. CONCLUSION Conjunctival axial blood velocity in small venules is reduced in SCR subjects with focal macular thinning.
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Affiliation(s)
- Ali Kord Valeshabad
- Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois USA
| | - Justin Wanek
- Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois USA
| | - Ruth Zelkha
- Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois USA
| | - Jennifer I. Lim
- Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois USA
| | - Nicole Camardo
- Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois USA
| | - Bruce Gaynes
- Department of Ophthalmology; Loyola University Medical Center; Chicago Illinois USA
| | - Mahnaz Shahidi
- Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois USA
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Elagouz M, Jyothi S, Gupta B, Sivaprasad S. Sickle Cell Disease and the Eye: Old and New Concepts. Surv Ophthalmol 2010; 55:359-77. [DOI: 10.1016/j.survophthal.2009.11.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 11/15/2009] [Accepted: 11/17/2009] [Indexed: 10/19/2022]
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Fany A, Boni S, Adjorlolo C, Konan MLT, Gbe K, Coulibaly F, Berete R. La rétinopathie chez le porteur du trait drépanocytaire AS : mythe ou réalité ? J Fr Ophtalmol 2004; 27:1025-30. [PMID: 15557865 DOI: 10.1016/s0181-5512(04)96259-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The retinopathy of sickle cell diseases is an ischemic retinopathy that occurs frequently in the major forms of HbSS and HbSC sickle cell diseases. The retinopathy of sickle trait HbAS has not been described extensively. PATIENTS AND METHODS The aim of this study was to describe the retinal characteristics and thus gain better knowledge of sickle trait HbAS retinopathy. Seventy HbAS patients had a complete ocular examination including fluorescein angiography. RESULTS Seventy percent of the patients had retinal lesions, with 49.3% non-vasoproliferative lesions, 22.7% prevasoproliferative lesions and 2.7% neovascular lesions. DISCUSSION AND CONCLUSION Retinopathy is associated with the HbAS sickle cell trait, but it is less serious than in the major forms of sickle cell syndrome.
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Affiliation(s)
- A Fany
- Service d'Ophtalmologie, CHU de Treichville, Abidjan, Côte d'Ivoire
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