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Gu Q, Pan T, Cheng R, Huang J, Zhang K, Zhang J, Yang Y, Cheng P, Liu Q, Shen H. Macular vascular and photoreceptor changes for diabetic macular edema at early stage. Sci Rep 2024; 14:20544. [PMID: 39232012 PMCID: PMC11374796 DOI: 10.1038/s41598-024-71286-6] [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: 06/03/2024] [Accepted: 08/27/2024] [Indexed: 09/06/2024] Open
Abstract
This study was intended to investigate the macular vascular and photoreceptor changes for diabetic macular edema (DME) at the early stage. A total of 255 eyes of 134 diabetes mellitus patients were enrolled and underwent an ophthalmological and systemic evaluation in this cross-sectional study. Early DME was characterized by central subfoveal thickness (CST) value between 250 and 325 μm, intact ellipsoid zone, and an external limiting membrane. While non-DME was characterized by CST < 250 μm with normal retinal morphology and structure. Foveal avascular zone (FAZ) area ≤ 0.3 mm2 (P < 0.001, OR = 0.41, 95% CI 0.26-0.67 in the multivariate analysis) and HbA1c level ≤ 8% (P = 0.005, OR = 0.37, 95% CI 0.19-0.74 in multivariate analysis) were significantly associated with a higher risk of early DME. Meanwhile, no significant differences exist in cone parameters between non-DME and early DME eyes. Compared with non-DME eyes, vessel diameter, vessel wall thickness, wall-to-lumen ratio, the cross-sectional area of the vascular wall in the upper side were significantly decreased in the early DME eyes (P = 0.001, P < 0.001, P = 0.005, P = 0.003 respectively). This study suggested a vasospasm or vasoconstriction with limited further photoreceptor impairment at the early stage of DME formation. CST ≥ 250 μm and FAZ ≤ 0.3 mm2 may be the indicator for early DME detection.
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Affiliation(s)
- Qinyuan Gu
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Ting Pan
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Ruiwen Cheng
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Junlong Huang
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Kang Zhang
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Junyan Zhang
- Department of Clinical Epidemiology and Evidence-Based Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Yang Yang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China.
| | - Peng Cheng
- Department of Gerontology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China.
| | - Qinghuai Liu
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China.
| | - Han Shen
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China.
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Balas M, Issa M, Popovic MM, Moayad L, Zajner C, Aponte PO, Hamli H, Yan P, Wright T, Melo IM, Muni RH. ADAPTIVE OPTICS IMAGING IN DIABETIC RETINOPATHY: A Prospective Cohort Study. Retina 2024; 44:1115-1123. [PMID: 38478760 DOI: 10.1097/iae.0000000000004088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
PURPOSE To investigate the correlation between diabetic retinopathy (DR) severity and microscopic retinal and vascular alterations using adaptive optics imaging. METHODS In this single-center, prospective cohort study, adult participants with healthy eyes or DR underwent adaptive optics imaging. Participants were classified into control/mild nonproliferative DR, moderate/severe nonproliferative DR, and proliferative DR. Adaptive optics imaging using the RTX1 camera was obtained from 48 participants (87 eyes) for photoreceptor data and from 36 participants (62 eyes) for vascular data. RESULTS Photoreceptor parameters significantly differed between DR groups at 2° and 4° of retinal eccentricity. Wall-to-lumen ratio varied significantly at 2° eccentricity, while other vascular parameters remained nonsignificant. Cone density and dispersion were the strongest predictors for DR severity ( P < 0.001) in multivariable generalized estimating equation modeling, while other vascular parameters remained nonsignificant between DR severity groups. All photoreceptor parameters showed significant correlations with visual acuity overall and across most DR severity groups. CONCLUSION To date, this is one of the largest studies evaluating the use of adaptive optics imaging in DR. Adaptive optics imaging was demonstrated to differentiate between various levels of disease severity in DR. These results support the potential role in diagnostic and therapeutic microstructural evaluation in research and clinical practice.
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Affiliation(s)
- Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mariam Issa
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Lana Moayad
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Chris Zajner
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Paola Oquendo Aponte
- Department of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
- Department of Ophthalmology, Unity Health Toronto, Toronto, Ontario, Canada; and
| | - Hesham Hamli
- Department of Ophthalmology, Unity Health Toronto, Toronto, Ontario, Canada; and
| | - Peng Yan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Kensington Eye Institute, Toronto, Ontario, Canada
| | - Tom Wright
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Kensington Eye Institute, Toronto, Ontario, Canada
| | - Isabela M Melo
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Unity Health Toronto, Toronto, Ontario, Canada; and
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Unity Health Toronto, Toronto, Ontario, Canada; and
- Kensington Eye Institute, Toronto, Ontario, Canada
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Paques M, Krivosic V, Castro-Farias D, Dulière C, Hervé D, Chaumette C, Rossant F, Taleb A, Lebenberg J, Jouvent E, Tadayoni R, Chabriat H. Early remodeling and loss of light-induced dilation of retinal small arteries in CADASIL. J Cereb Blood Flow Metab 2024; 44:1089-1101. [PMID: 38217411 PMCID: PMC11179609 DOI: 10.1177/0271678x241226484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/29/2023] [Accepted: 12/21/2023] [Indexed: 01/15/2024]
Abstract
A major hurdle to therapeutic development in cerebral small vessel diseases is the lack of in-vivo method that can be used repeatedly for evaluating directly cerebral microvessels. We hypothesised that Adaptive Optics (AO), which allows resolution images up to 1-2 μm/pixel at retinal level, could provide a biomarker for monitoring vascular changes in CADASIL, a genetic form of such condition. In 98 patients and 35 healthy individuals, the wall to lumen ratio (WLR), outer and inner diameter, wall thickness and wall cross-sectional area were measured in a parapapillary and/or paramacular retinal artery. The ratio of vessel diameters before and after light flicker stimulations was also calculated to measure vasoreactivity (VR). Multivariate mixed-model analysis showed that WLR was increased and associated with a larger wall thickness and smaller internal diameter of retinal arteries in patients. The difference was maximal at the youngest age and gradually reduced with aging. Average VR in patients was less than half of that of controls since the youngest age. Any robust association was found with clinical or imaging manifestations of the disease. Thus, AO enables the detection of early functional or structural vascular alterations in CADASIL but with no obvious link to the clinical or imaging severity.
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Affiliation(s)
- Michel Paques
- Paris Eye Imaging Group, Clinical Investigation Center 1423, Quinze-Vingts Hospital, Sorbonne Université, INSERM, Paris, France
| | - Valérie Krivosic
- Paris Eye Imaging Group, Clinical Investigation Center 1423, Quinze-Vingts Hospital, Sorbonne Université, INSERM, Paris, France
- Ophthalmology Department, Hôpital Lariboisière, APHP and Université Paris-Cité, France
- Centre de Référence des Maladies Vasculaires Rares du Cerveau et de l'Œil (CERVCO), Hôpital Lariboisière, Paris, AP-HP, France
| | - Daniela Castro-Farias
- Paris Eye Imaging Group, Clinical Investigation Center 1423, Quinze-Vingts Hospital, Sorbonne Université, INSERM, Paris, France
| | - Cédric Dulière
- Paris Eye Imaging Group, Clinical Investigation Center 1423, Quinze-Vingts Hospital, Sorbonne Université, INSERM, Paris, France
| | - Dominique Hervé
- Centre de Référence des Maladies Vasculaires Rares du Cerveau et de l'Œil (CERVCO), Hôpital Lariboisière, Paris, AP-HP, France
- Translational Neurovascular Centre and Departement of Neurology, FHU NeuroVasc, Paris, France
| | - Céline Chaumette
- Paris Eye Imaging Group, Clinical Investigation Center 1423, Quinze-Vingts Hospital, Sorbonne Université, INSERM, Paris, France
| | | | - Abbas Taleb
- Centre de Référence des Maladies Vasculaires Rares du Cerveau et de l'Œil (CERVCO), Hôpital Lariboisière, Paris, AP-HP, France
| | - Jessica Lebenberg
- Translational Neurovascular Centre and Departement of Neurology, FHU NeuroVasc, Paris, France
- Université Paris-Cité, Inserm, NeuroDiderot, U1141, Paris, France
| | - Eric Jouvent
- Centre de Référence des Maladies Vasculaires Rares du Cerveau et de l'Œil (CERVCO), Hôpital Lariboisière, Paris, AP-HP, France
- Translational Neurovascular Centre and Departement of Neurology, FHU NeuroVasc, Paris, France
- Université Paris-Cité, Inserm, NeuroDiderot, U1141, Paris, France
| | - Ramin Tadayoni
- Paris Eye Imaging Group, Clinical Investigation Center 1423, Quinze-Vingts Hospital, Sorbonne Université, INSERM, Paris, France
- Ophthalmology Department, Hôpital Lariboisière, APHP and Université Paris-Cité, France
- Centre de Référence des Maladies Vasculaires Rares du Cerveau et de l'Œil (CERVCO), Hôpital Lariboisière, Paris, AP-HP, France
| | - Hugues Chabriat
- Centre de Référence des Maladies Vasculaires Rares du Cerveau et de l'Œil (CERVCO), Hôpital Lariboisière, Paris, AP-HP, France
- Translational Neurovascular Centre and Departement of Neurology, FHU NeuroVasc, Paris, France
- Université Paris-Cité, Inserm, NeuroDiderot, U1141, Paris, France
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Johnson DA, Doble N, Choi SS. Quantitative Analysis of the Vasculature and Cone Photoreceptors in Subjects With Diabetes Without Diabetic Retinopathy. Curr Eye Res 2024; 49:650-662. [PMID: 38407181 DOI: 10.1080/02713683.2024.2320787] [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: 10/27/2023] [Accepted: 02/13/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE To characterize any differences in the vasculature and cone photoreceptor packing geometry (CPG) between subjects with diabetes without/no diabetic retinopathy (NDR) and healthy controls. METHODS Eight NDR and five controls were enrolled. Optical coherence tomography angiography (OCTA) taken at the macula was used to measure vessel density, vessel length density, and vessel density index (VDI) in three vascular plexuses, namely, the superficial vascular plexus, intermediate capillary plexus, and deep capillary plexus (DCP). The choriocapillaris (CC) flow deficit (FD) was also measured. OCTA images were binarized and processed to extrapolate the parafovea and parafoveal quadrants and the OCTA indices mentioned above. The CC was processed with six different radii to quantify FD. Adaptive optics - scanning laser ophthalmoscopy images were acquired and processed to extract CPG indices, i.e., cone density (CD), cone-to-cone spacing (CS), linear dispersion index, heterogeneity packing index and percent of cells with six neighbors at 3.6° in the temporal retina. RESULTS In all eyes, statistically significant differences were found (i) in parafoveal FD across the six radii (p < 0.001) and (ii) in the correlation between the parafoveal temporal quadrant (PTQ) DCP VDI and CS (r = 0.606, p = 0.048). No other significant correlations were found. For OCTA or CPG indices, no significant differences were found between the cohorts in the parafovea or parafoveal quadrants. CONCLUSIONS CS is the most sensitive CPG index for detecting alterations in the cone mosaic. The DCP and the cone photoreceptors are significantly correlated, indicating that alterations in the DCP can affect the cones. Future work elucidating the vascular alterations and neurodegeneration present in diabetic eyes should focus on the DCP and multiple CPG indices, not solely CD. Moreover, such alterations are highly localized, hence using larger regions e.g. parafovea versus smaller areas, such as the PTQ, will potentially mask significant correlations.
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Affiliation(s)
- Danae A Johnson
- College of Optometry, The Ohio State University, Columbus, OH, USA
| | - Nathan Doble
- College of Optometry, The Ohio State University, Columbus, OH, USA
- Department of Ophthalmology and Vision Science, Havener Eye Institute, The Ohio State University, Columbus, OH, USA
| | - Stacey S Choi
- College of Optometry, The Ohio State University, Columbus, OH, USA
- Department of Ophthalmology and Vision Science, Havener Eye Institute, The Ohio State University, Columbus, OH, USA
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Kortuem FC, Kempf M, Merle DA, Kuehlewein L, Pohl L, Reith M, Jung R, Ott S, Stingl K, Stingl K. A morphometric analysis of the retinal arterioles with adaptive optics imaging in RPE65-associated retinal dystrophy after treatment with voretigene neparvovec. Acta Ophthalmol 2024; 102:e358-e366. [PMID: 37715554 DOI: 10.1111/aos.15765] [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: 04/18/2023] [Revised: 07/03/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE To investigate the changes in retinal arterial architecture after treatment with voretigene neparvovec in patients with retinal dystrophy caused by bi-allelic mutations in the RPE65 gene. METHODS Sixteen eyes treated with voretigene neparvovec at the University Eye Clinic in Tuebingen, Germany, underwent adaptive optics ophthalmoscopy (AO) imaging at baseline and 2 weeks, 1, 3, 6 and 12 months after treatment. Follow-up was performed in six eyes of four patients. For each eye, five different positions at arterial vessels were selected and the wall-to-lumen ratio (WLR), the lumen diameter (LD) and the wall cross-sectional area (WCSA) were measured by the manufacturer's software over the observational period. RESULTS Vast retinal atrophy dominated all gained AO images. WLR fluctuated in the observation period without statistically significant change. LD and WCSA changed significantly after 2 weeks from the baseline examination and returned to values similar to baseline thereafter. There were no signs of inflammation such as macrophages or perivascular accumulated fluid visible. CONCLUSION AO imaging of the retinal vessels in RPE65-associated retinal dystrophies (IRD) is challenging. There was no change in the retinal arterial vasculature over the observation period of 12 months that would indicate inflammatory changes. Decrease of the LD and WCSA shortly after treatment might be caused by the perioperative prednisolone intake. AO of retinal vessels can be used as a diagnostic module to complement monitoring the disease and effects of genetic treatments if the acquisition is possible in selected cases.
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Affiliation(s)
- Friederike C Kortuem
- Center for Ophthalmology, University Eye Hospital, University of Tübingen, Tübingen, Germany
| | - Melanie Kempf
- Center for Ophthalmology, University Eye Hospital, University of Tübingen, Tübingen, Germany
- Center for Rare Eye Diseases, University of Tübingen, Tübingen, Germany
| | - David A Merle
- Center for Ophthalmology, University Eye Hospital, University of Tübingen, Tübingen, Germany
- Center for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Laura Kuehlewein
- Center for Ophthalmology, University Eye Hospital, University of Tübingen, Tübingen, Germany
- Center for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
| | - Lisa Pohl
- Center for Ophthalmology, University Eye Hospital, University of Tübingen, Tübingen, Germany
| | - Milda Reith
- Center for Ophthalmology, University Eye Hospital, University of Tübingen, Tübingen, Germany
| | - Ronja Jung
- Center for Ophthalmology, University Eye Hospital, University of Tübingen, Tübingen, Germany
| | - Saskia Ott
- Center for Ophthalmology, University Eye Hospital, University of Tübingen, Tübingen, Germany
| | - Krunoslav Stingl
- Center for Ophthalmology, University Eye Hospital, University of Tübingen, Tübingen, Germany
- Center for Rare Eye Diseases, University of Tübingen, Tübingen, Germany
| | - Katarina Stingl
- Center for Ophthalmology, University Eye Hospital, University of Tübingen, Tübingen, Germany
- Center for Rare Eye Diseases, University of Tübingen, Tübingen, Germany
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Huang RS, Mihalache A, Popovic MM, Munn C, Balas M, Issa M, Melo IM, Friedman A, Wright T, Yan P, Muni RH. ASSOCIATION OF INTRAVENOUS FLUORESCEIN ANGIOGRAPHY AND ADAPTIVE OPTICS IMAGING IN DIABETIC RETINOPATHY: A Prospective Case Series. Retina 2024; 44:689-699. [PMID: 38011843 DOI: 10.1097/iae.0000000000004012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
PURPOSE To our knowledge, we present the first case series investigating the relationship between adaptive optics (AO) imaging and intravenous fluorescein angiography (IVFA) parameters in patients with diabetic retinopathy. METHODS Consecutive patients with diabetic retinopathy older than age 18 years presenting to a single center in Toronto, Canada, from 2020 to 2021 were recruited. Adaptive optics was performed with the RTX1 camera (Imagine Eyes, Orsay, France) at retinal eccentricities of 2° and 4°. Intravenous fluorescein angiography was assessed with the artificial intelligence-based RETICAD system to extract blood flow, perfusion, and blood-retinal-barrier (BRB) permeability at the same retinal locations. Correlations between AO and IVFA parameters were calculated using Pearson's correlation coefficient. RESULTS Across nine cases, a significant positive correlation existed between photoreceptor spacing on AO and BRB permeability (r = 0.303, P = 0.027), as well as perfusion (r = 0.272, P = 0.049) on IVFA. When stratified by location, a significant positive correlation between photoreceptor dispersion and both BRB permeability and perfusion (r = 0.770, P = 0.043; r = 0.846, P = 0.034, respectively) was observed. Cone density was also negatively correlated with BRB permeability (r = -0.819, P = 0.046). CONCLUSION Photoreceptor spacing on AO was significantly correlated with BRB permeability and perfusion on IVFA in patients with diabetic retinopathy. Future studies with larger sample sizes are needed to understand the relationship between AO and IVFA parameters in diverse patient populations.
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Affiliation(s)
- Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Mihalache
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Colyn Munn
- Emagix Inc, Halifax, Nova Scotia, Canada
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mariam Issa
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Isabela Martins Melo
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Alon Friedman
- Emagix Inc, Halifax, Nova Scotia, Canada
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tom Wright
- Kensington Vision and Research Centre, Kensington Eye Institute, Toronto, Ontario, Canada; and
| | - Peng Yan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Kensington Vision and Research Centre, Kensington Eye Institute, Toronto, Ontario, Canada; and
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
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Kortuem FC, Merle DA, Reith M, Kuehlewein L, Jung R, Holocher S, Stingl K, Stingl K, Kempf M. Defining reference values of arterioles in healthy individuals for studies with adaptive optics imaging. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1348900. [PMID: 38984139 PMCID: PMC11182109 DOI: 10.3389/fopht.2024.1348900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/15/2024] [Indexed: 07/11/2024]
Abstract
Purpose To investigate age-dependent wall to lumen ratio (WLR) reference values for healthy individuals in adaptive optics imaging (AO). WLR serves as an objective, dimensionless parameter for the evaluation of structural changes in vessels caused by conditions like arterial hypertension, diabetes or vascular stenosis. Methods 50 right eyes of healthy individuals were examined by adaptive optics imaging. The central big arterioles and smaller arterial branches at least one disc diameter away from the optic disc, approximately above or below the macula were measured by the manufacturer's software. The wall-lumen-ratio (WLR), the wall cross-sectional area (WCSA) and lumen diameter (LD) were assessed. Subsequent data analysis was performed with a focus on variables including age, gender and blood pressure. Results Normative values for WLR, WCSA and LD in 5 different age groups could be established. However, no significant differences between the age groups were found. Intra-subject comparisons revealed significantly higher WLRs on peripheral branches when compared to central arterioles. WLR showed in this normotensive cohort no relevant correlation with the systolic, diastolic and mean blood pressure. Gender and intraocular pressure had no influence on the vascular parameters. Conclusion AO is capable of examining vascular alterations in arterioles at an almost microscopic level. Age did not seem to alter WLR, normotensive blood pressure parameters showed also no significant impact. AO-based vessel analysis may provide clinically useful biomarkers for cardiovascular health and should be tested in future studies.
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Affiliation(s)
- Friederike C Kortuem
- University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - David A Merle
- University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
- Institute for Ophthalmic Research, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Milda Reith
- University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Laura Kuehlewein
- University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Ronja Jung
- University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Saskia Holocher
- University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Krunoslav Stingl
- University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
- Center for Rare Eye Diseases, University of Tübingen, Tübingen, Germany
| | - Katarina Stingl
- University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
- Center for Rare Eye Diseases, University of Tübingen, Tübingen, Germany
| | - Melanie Kempf
- University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
- Center for Rare Eye Diseases, University of Tübingen, Tübingen, Germany
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Jandaghian Bidgoli M, Jamalnia S, Pashmforosh M, Shaterian N, Darabiyan P, Rafi A. The effect of Orem self-care model on the improvement of symptoms and quality of life in patients with diabetes: A scoping review. INVESTIGACION Y EDUCACION EN ENFERMERIA 2024; 42:e08. [PMID: 39083820 PMCID: PMC11290896 DOI: 10.17533/udea.iee.v42n1e08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 02/02/2024] [Indexed: 08/02/2024]
Abstract
Objective to evaluate the association of Orem self-care model improvement of symptoms and quality of life in patients with diabetes. Methods A scoping review was carried on bibliographic databases: PubMed-Medline, Scopus, SID and Magiran. The inclusion criteria encompassed studies examining the impact of the Orem self-care model on diabetic patients. Studies considered for inclusion needed to have full-text availability and be written in either English or Persian, with key words including "Models", "Nursing", "Quality of Life", and "Diabetes Mellitus". CONSORT checklist and STROBE statement were selected for quality assessment. Results A total of 9 studies were included, all using quantitative methodology and focusing on adults or older adults. The majority of articles focused on quality of life and diabetic symptoms. 8 studies showed positive outcomes after implementation of the model. The findings indicate that this model led to an enhanced level of self-efficacy, improved quality of life, and better self-care practices among diabetic patients. Conclusion Orem self-care model can reduce the diabetic symptoms and improve the quality of life, self-efficacy and self-care in these patients.
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Affiliation(s)
| | - Sheida Jamalnia
- Department of Nursing and Midwifery, Kazeroun Branch, Islamic Azad University, Kazeroun, Iran. 3 Ph.D student of e-Learning, virtual School, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Negin Shaterian
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran.
| | - Pouriya Darabiyan
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Ahvaz, Iran.
| | - Alireza Rafi
- M.Sc of Nursing, Behbahan Faculty of Medical Sciences, Behbahan, Iran.
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Adejumo T, Ma G, Son T, Kim TH, Le D, Dadzie AK, Ahmed S, Yao X. Adaptive vessel tracing and segmentation in OCT enables the robust detection of wall-to-lumen ratio abnormalities in 5xFAD mice. BIOMEDICAL OPTICS EXPRESS 2023; 14:6350-6360. [PMID: 38420326 PMCID: PMC10898580 DOI: 10.1364/boe.504317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/25/2023] [Accepted: 11/12/2023] [Indexed: 03/02/2024]
Abstract
The wall-to-lumen ratio (WLR) of retinal blood vessels promises a sensitive marker for the physiological assessment of eye conditions. However, in vivo measurement of vessel wall thickness and lumen diameter is still technically challenging, hindering the wide application of WLR in research and clinical settings. In this study, we demonstrate the feasibility of using optical coherence tomography (OCT) as one practical method for in vivo quantification of WLR in the retina. Based on three-dimensional vessel tracing, lateral en face and axial B-scan profiles of individual vessels were constructed. By employing adaptive depth segmentation that adjusts to the individual positions of each blood vessel for en face OCT projection, the vessel wall thickness and lumen diameter could be reliably quantified. A comparative study of control and 5xFAD mice confirmed WLR as a sensitive marker of the eye condition.
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Affiliation(s)
- Tobiloba Adejumo
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Guangying Ma
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Taeyoon Son
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Tae-Hoon Kim
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA
| | - David Le
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Albert K Dadzie
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Shaiban Ahmed
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Xincheng Yao
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
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10
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Sapoznik KA, Gast TJ, Carmichael-Martins A, Walker BR, Warner RL, Burns SA. Retinal Arteriolar Wall Remodeling in Diabetes Captured With AOSLO. Transl Vis Sci Technol 2023; 12:16. [PMID: 37962539 PMCID: PMC10653262 DOI: 10.1167/tvst.12.11.16] [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: 04/27/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
Purpose Adaptive optics scanning laser ophthalmoscopy (AOSLO) enables the visualization and measurement of the retinal microvasculature structure in humans. We investigated the hypothesis that diabetes mellitus (DM) induces remodeling to the wall structure in small retinal arterioles. These alterations may allow better understanding of vascular remodeling in DM. Methods We imaged retinal arterioles in one eye of 48 participants (26 with DM and 22 healthy controls) with an AOSLO. Structural metrics of 274 arteriole segments (203 with DM and 71 healthy controls) ≤ 50 µm in outer diameter (OD) were quantified and we compared differences in wall thickness (WT), wall-to-lumen ratio (WLR), inner diameter (ID), OD, and arteriolar index ratio (AIR) between controls and participants with DM. We also compared the individual AIR (iAIR) in groups of individuals. Results The WLR, WT, and AIRs were significantly different in the arteriole segments of DM participants (P < 0.001). The iAIR was significantly deviated in the DM group (P < 0.001) and further division of the participants with DM into groups revealed that there was an effect of the presence of diabetic retinopathy (DR) on the iAIR (P < 0.001). Conclusions DM induces remodeling of wall structure in small retinal arterioles and in groups of individuals. The use of AIR allows us to assess remodeling independently of vessel size in the retina and to compute an index for each individual subject. Translational Relevance High-resolution retinal imaging allows noninvasive assessment of small retinal vessel remodeling in DM that can improve our understanding of DM and DR in living humans.
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Affiliation(s)
- Kaitlyn A. Sapoznik
- School of Optometry, Indiana University, Bloomington, IN, USA
- College of Optometry, University of Houston, Houston, TX, USA
| | - Thomas J. Gast
- School of Optometry, Indiana University, Bloomington, IN, USA
| | | | | | - Raymond L. Warner
- School of Optometry, Indiana University, Bloomington, IN, USA
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
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11
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Tang J, Liu H, Mo S, Zhu Z, Huang H, Liu X. Cone Density Distribution and Related Factors in Patients Receiving Hydroxychloroquine Treatment. Invest Ophthalmol Vis Sci 2023; 64:29. [PMID: 37713205 PMCID: PMC10506682 DOI: 10.1167/iovs.64.12.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Purpose Hydroxychloroquine is an effective treatment for rheumatic diseases; however, retinal damage is a possible side effect. We aimed to identify the retinal area and related risk factors associated with cone density reduction caused by hydroxychloroquine. Methods We recorded the retinal images of patients with rheumatic diseases taking hydroxychloroquine (n = 44) and compared them with images of healthy controls (n = 107). Cone density was obtained in vertical and horizontal axes. Regions of decreased cone density and associations between age, rheumatic disease type, dosage for ideal body weight, and cone density were evaluated. Results Cone densities were significantly lower in hydroxychloroquine-treated patients than in sex- and age-matched controls in the vertical axis (P < 0.001), with no significant difference in the horizontal axis (P = 0.120); in healthy elderly than in healthy young people in the horizontal axis (P < 0.001), with no significant difference in the vertical axis (P = 0.100); in hydroxychloroquine-treated elderly than in hydroxychloroquine-treated young patients in both axes (both P < 0.05); among patients with different rheumatic disease types, with no significant difference in the vertical axis (P = 0.294). The daily dose was negatively correlated with cone density in the vertical axis and inferior quadrant. Conclusions Hydroxychloroquine reduces retinal cone cell density in the vertical axis. Cone density loss in the horizontal axis increases with age; further, hydroxychloroquine dosage is negatively correlated with cone density in the vertical axis and inferior quadrant. Early screening of hydroxychloroquine-related retinal injury should consider changes in cone density in the vertical axis.
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Affiliation(s)
- Jun Tang
- Department of Rheumatology and Immunology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
- Institute of Life Science and Laboratory of Tissue and Cell Biology, Lab Teaching & Management Center, Chongqing Medical University, Chongqing, China
| | - Hua Liu
- Department of Ophthalmology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
| | - Shiyan Mo
- Department of Rheumatology and Immunology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
| | - Zhihong Zhu
- Department of Ophthalmology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
| | - Houbin Huang
- Department of Ophthalmology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
| | - Xiaofei Liu
- Department of Rheumatology and Immunology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
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12
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Evaluation of Morphological Changes in Retinal Vessels in Type 1 Diabetes Mellitus Patients with the Use of Adaptive Optics. Biomedicines 2022; 10:biomedicines10081926. [PMID: 36009472 PMCID: PMC9406131 DOI: 10.3390/biomedicines10081926] [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: 07/09/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction. Diabetes mellitus contributes to the development of microvascular complications in the eye. Moreover, it affects multiple end organs, including brain damage, leading to premature death. The use of adaptive optics technique allows to perform non-invasive in vivo assessment of retinal vessels and to identify changes in arterioles about 100 μm in diameter. The retinal vasculature may be a model of the cerebral vessels both morphologically and functionally. Aim. To evaluate morphological parameters of retinal arterioles in patients with type 1 diabetes mellitus (DM1). Material and methods. The study included 22 DM1 patients (13 females) aged 43.00 ± 9.45 years with a mean diabetes duration of 22.55 ± 10.05 years, and 23 healthy volunteers (10 females) aged 41.09 ± 10.99 years. Blood pressure, BMI, waist circumference, and metabolic control markers of diabetes were measured in both groups. Vascular examinations were performed using an rtx1 adaptive optics retinal camera (Imagine Eyes, Orsay, France); the vessel wall thickness (WT), lumen diameter (LD), wall-to-lumen ratio (WLR), and vascular wall cross-sectional area (WCSA) were assessed. Statistical analysis was performed with the application of IMB SPSS version 23 software. Results. The DM1 group did not differ significantly in age, BMI, waist circumference, blood pressure, or axial length of the eye compared to the control group. Intraocular pressure (IOP) in both groups was normal, but in the DM1 group it was significantly higher. The DM1 group had significantly higher WT, WLR, and WCSA. These parameters correlated significantly with the duration of diabetes, but not with IOP. Conclusions. The presented study demonstrates the presence of significant morphological changes in retinal vessels in DM1 patients without previously diagnosed diabetic retinopathy. Similar changes may occur in the brain and may be early indicators of cardiovascular risk, but further investigation is required to confirm that.
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13
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Arterial Hypertension and the Hidden Disease of the Eye: Diagnostic Tools and Therapeutic Strategies. Nutrients 2022; 14:nu14112200. [PMID: 35683999 PMCID: PMC9182467 DOI: 10.3390/nu14112200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 02/01/2023] Open
Abstract
Hypertension is a major cardiovascular risk factor that is responsible for a heavy burden of morbidity and mortality worldwide. A critical aspect of cardiovascular risk estimation in hypertensive patients depends on the assessment of hypertension-mediated organ damage (HMOD), namely the generalized structural and functional changes in major organs induced by persistently elevated blood pressure values. The vasculature of the eye shares several common structural, functional, and embryological features with that of the heart, brain, and kidney. Since retinal microcirculation offers the unique advantage of being directly accessible to non-invasive and relatively simple investigation tools, there has been considerable interest in the development and modernization of techniques that allow the assessment of the retinal vessels’ structural and functional features in health and disease. With the advent of artificial intelligence and the application of sophisticated physics technologies to human sciences, consistent steps forward have been made in the study of the ocular fundus as a privileged site for diagnostic and prognostic assessment of diverse disease conditions. In this narrative review, we will recapitulate the main ocular imaging techniques that are currently relevant from a clinical and/or research standpoint, with reference to their pathophysiological basis and their possible diagnostic and prognostic relevance. A possible non pharmacological approach to prevent the onset and progression of retinopathy in the presence of hypertension and related cardiovascular risk factors and diseases will also be discussed.
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14
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Hemodynamic and morphological changes of the central retinal artery in myopic eyes. Sci Rep 2022; 12:7104. [PMID: 35501327 PMCID: PMC9061854 DOI: 10.1038/s41598-022-11087-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Due to excessive elongation of the eyeball, myopia-related vascular abnormalities are frequently observed in the central retinal artery (CRA) and its intraretinal branches. In addition to inconsistency in previously reported findings, hemodynamic (reduced flow velocity, increased vascular resistance) and morphological changes (narrower vessel diameter) were usually studied separately. This cross-sectional study evaluated the hemodynamic and morphological characteristics concurrently in a large sample of healthy myopes, by using the color Doppler ultrasound and adaptive optics retinal camera. Results showed that the retrobulbar segment of CRA had a tendency of slightly reduced flow velocity in eyeballs with longer axial length, but the correlation was not significant after adjusting for the multiple correlations. Vascular resistance was not affected by the axial elongation. With respect to the intraretinal branches, no significant changes in longer eyes of total diameter or lumen diameter were observed, while both the wall thickness and the wall cross-sectional area were significantly increased, but only a marginally increase in the wall to lumen ratio was found with increasing axial length. This implies some potential small artery remodeling in the intraretinal CRA branches. Overall, blood supply of the inner retina in healthy young myopes is likely to be maintained. Additionally, morphological parameters of vascular microstructure could be potential biomarkers to monitor myopia progression and understand myopia-related vascular abnormalities in future studies.
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15
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Schreur V, Larsen MB, Sobrin L, Bhavsar AR, Hollander AI, Klevering BJ, Hoyng CB, Jong EK, Grauslund J, Peto T. Imaging diabetic retinal disease: clinical imaging requirements. Acta Ophthalmol 2022; 100:752-762. [PMID: 35142031 DOI: 10.1111/aos.15110] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 12/12/2021] [Accepted: 01/20/2022] [Indexed: 12/27/2022]
Abstract
Diabetic retinopathy (DR) is a sight-threatening complication of diabetes mellitus (DM) and it contributes substantially to the burden of disease globally. During the last decades, the development of multiple imaging modalities to evaluate DR, combined with emerging treatment possibilities, has led to the implementation of large-scale screening programmes resulting in improved prevention of vision loss. However, not all patients are able to participate in such programmes and not all are at equal risk of DR development and progression. In this review, we discuss the relevance of the currently available imaging modalities for the evaluation of DR: colour fundus photography (CFP), ultrawide-field photography (UWFP), fundus fluorescein angiography (FFA), optical coherence tomography (OCT), OCT angiography (OCTA) and functional testing. Furthermore, we suggest where a particular imaging technique of DR may aid the evaluation of the disease in different clinical settings. Combining information from various imaging modalities may enable the design of more personalized care including the initiation of treatment and understanding the progression of disease more adequately.
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Affiliation(s)
- Vivian Schreur
- Department of Ophthalmology, Donders Institution for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | - Morten B. Larsen
- Research Unit of Ophthalmology University of Southern Denmark Odense Denmark
- Department of Ophthalmology Odense University Hospital Odense Denmark
| | - Lucia Sobrin
- Department of Ophthalmology, Harvard Medical School Massachusetts Eye and Ear Infirmary Boston USA
| | | | - Anneke I. Hollander
- Department of Ophthalmology, Donders Institution for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | - B. Jeroen Klevering
- Department of Ophthalmology, Donders Institution for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | - Carel B. Hoyng
- Department of Ophthalmology, Donders Institution for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | - Eiko K. Jong
- Department of Ophthalmology, Donders Institution for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | - Jakob Grauslund
- Research Unit of Ophthalmology University of Southern Denmark Odense Denmark
- Department of Ophthalmology Odense University Hospital Odense Denmark
| | - Tunde Peto
- Research Unit of Ophthalmology University of Southern Denmark Odense Denmark
- Centre for Public Health Queen's University Belfast Belfast UK
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16
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Baltă F, Cristescu IE, Mirescu AE, Baltă G, Zemba M, Tofolean IT. Investigation of Retinal Microcirculation in Diabetic Patients Using Adaptive Optics Ophthalmoscopy and Optical Coherence Angiography. J Diabetes Res 2022; 2022:1516668. [PMID: 35097129 PMCID: PMC8791707 DOI: 10.1155/2022/1516668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/21/2021] [Accepted: 01/03/2022] [Indexed: 01/08/2023] Open
Abstract
The current research approaches the retinal microvasculature of healthy volunteers (17 subjects), patients with diabetes mellitus without retinopathy (19 subjects), and of diabetic patients with nonproliferative (17 subjects) and proliferative (21 subjects) diabetic retinopathy, by using adaptive optics ophthalmoscopy and optical coherence ophthalmoscopy angiography. For each imaging technique, several vascular parameters have been calculated in order to achieve a comparative analysis of these imaging biomarkers between the four studied groups. The results suggest that diabetic patients with or without diabetic retinopathy prove signs of retinal arteriole structural alterations, mainly showed by altered values of wall to lumen ratio, calculated for the superior or inferior temporal branch of the central retinal artery, near the optic nerve head, and significant changes of the vascular density in the retinal superficial capillary plexus. Both adaptive optics ophthalmoscopy and optical coherence ophthalmoscopy angiography are providing useful information about the retinal microvasculature from early onset of diabetic disease, having a promising diagnostic and prognostic role in the future.
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Affiliation(s)
- Florian Baltă
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Clinical Emergency Eye Hospital, 030167 Bucharest, Romania
- “Retina” Clinic, 014142 Bucharest, Romania
| | - Irina-Elena Cristescu
- “Retina” Clinic, 014142 Bucharest, Romania
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Andrada-Elena Mirescu
- Clinical Emergency Eye Hospital, 030167 Bucharest, Romania
- Department of Ophthalmology, “Ovidius” University of Medicine, 900470 Constanta, Romania
| | - George Baltă
- Clinical Emergency Eye Hospital, 030167 Bucharest, Romania
| | - Mihail Zemba
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Ioana Teodora Tofolean
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- “Retina” Clinic, 014142 Bucharest, Romania
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17
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Adaptive Optics Ophthalmoscopy in Diabetic Retinopathy. ARS MEDICA TOMITANA 2021. [DOI: 10.2478/arsm-2021-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Abstract
Diabetic retinopathy is the leading cause of visual loss and blindness in working-age adults and represents the most common microvascular complication of diabetes mellitus.
The current research assesses the retinal arterioles status in healthy volunteers and diabetic patients, in order to detect early retinal changes by using adaptive optics ophthalmoscopy (AOO), a cutting edge, noninvasive imaging technique. Our patients were evaluated between 2021-2022 in the Retina Clinic Bucharest, Romania. All of them underwent a complete ophthalmologic examination. By using rtx1™ adaptive optics retinal camera (Imagine Eyes, Orsay, France) together with the manufacturer’s software (AO detect artery, Imagine Eyes, France), several vascular parameters of the retinal arteriole were calculated, including wall to lumen ratio (WLR), vessel diameter (VD), lumen diameter (LD), mean wall thickness (WT) and cross-sectional area of the vascular wall (WCSA).
All five studied vascular parameters were found to have higher values in diabetic patients, when compared to healthy volunteers. The differences were statistically significant for WT, WLR and WCSA (p values under 0.05).
Adaptive optics ophthalmoscopy represents a cutting-edge technique, opening a new era in the medical retina field. It provides useful data regarding the retinal vascular status, in a non-invasive manner, being a promising tool in the diagnosis, staging and follow-up of diabetic retinal disease.
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18
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Bakker E, Dikland FA, van Bakel R, Andrade De Jesus D, Sánchez Brea L, Klein S, van Walsum T, Rossant F, Farías DC, Grieve K, Paques M. Adaptive optics ophthalmoscopy: a systematic review of vascular biomarkers. Surv Ophthalmol 2021; 67:369-387. [PMID: 34090882 DOI: 10.1016/j.survophthal.2021.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 12/28/2022]
Abstract
Retinal vascular diseases are a leading cause for blindness and partial sight certifications. By applying adaptive optics (AO) to conventional imaging modalities, the microstructures of the retinal vasculature can be observed with high spatial resolution, hence offering a unique opportunity for the exploration of the human microcirculation. The objective of this systematic review is to describe the current state of retinal vascular biomarkers imaged by AO flood illumination ophthalmoscopy (FIO) and AO scanning laser ophthalmoscopy (SLO). A literature research was conducted in the PubMed and Scopus databases on July 9, 2020. From 217 screened studies, 42 were eligible for this review. All studies underwent a quality check regarding their content. A meta-analysis was performed for the biomarkers reported for the same pathology in at least three studies using the same modality. The most frequently studied vascular biomarkers were the inner diameter (ID), outer diameter (OD), parietal thickness (PT), wall cross-sectional area (WCSA), and wall-to-lumen ratio (WLR). The applicability of AO vascular biomarkers has been mostly explored in systemic hypertension using AO FIO and in diabetes using AO SLO. The result of the meta-analysis for hypertensive patients showed that WLR, PT, and ID were significantly different when compared to healthy controls, while WCSA was not (P < 0.001, P = 0.002, P < 0.001, and P = 0.070, respectively). The presented review shows that, although a substantial number of retinal vascular biomarkers have been explored in AO en face imaging, further clinical research and standardization of procedures is needed to validate such biomarkers for the longitudinal monitoring of arterial hypertension and other diseases.
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Affiliation(s)
- Elise Bakker
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands; Clinical Technology, Delft University of Technology, Delft, The Netherlands
| | - Felix Anne Dikland
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands; Clinical Technology, Delft University of Technology, Delft, The Netherlands
| | - Roan van Bakel
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands; Clinical Technology, Delft University of Technology, Delft, The Netherlands
| | - Danilo Andrade De Jesus
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
| | - Luisa Sánchez Brea
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Theo van Walsum
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Florence Rossant
- ISEP, Institut Supérieur d'Electronique de Paris, Issy-les-Moulineaux, France
| | - Daniela Castro Farías
- Paris Eye Imaging Group, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, INSERM-DHOS Clinical Investigation Center, Paris, France
| | - Kate Grieve
- Paris Eye Imaging Group, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, INSERM-DHOS Clinical Investigation Center, Paris, France
| | - Michel Paques
- Paris Eye Imaging Group, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, INSERM-DHOS Clinical Investigation Center, Paris, France
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Association of changes of retinal vessels diameter with ocular blood flow in eyes with diabetic retinopathy. Sci Rep 2021; 11:4653. [PMID: 33633255 PMCID: PMC7907275 DOI: 10.1038/s41598-021-84067-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/09/2021] [Indexed: 12/25/2022] Open
Abstract
We investigated morphological changes of retinal arteries to determine their association with the blood flow and systemic variables in type 2 diabetes patients. The patients included 47 non-diabetic retinopathy eyes, 36 mild or moderate nonproliferative diabetic retinopathy (M-NPDR) eyes, 22 severe NPDR (S-NPDR) eyes, 32 PDR eyes, and 24 normal eyes as controls. The mean wall to lumen ratio (WLR) measured by adaptive optics camera was significantly higher in the PDR groups than in all of the other groups (all P < 0.001). However, the external diameter of the retinal vessels was not significantly different among the groups. The mean blur rate (MBR)-vessel determined by laser speckle flowgraphy was significantly lower in the PDR group than in the other groups (P < 0.001). The WLR was correlated with MBR-vessel (r = − 0.337, P < 0.001), duration of disease (r = 0.191, P = 0.042), stage of DM (r = 0.643, P < 0.001), systolic blood pressure (r = 0.166, P < 0.037), and presence of systemic hypertension (r = 0.443, P < 0.001). Multiple regression analysis demonstrated that MBR-vessel (β = − 0.389, P < 0.001), presence of systemic hypertension (β = 0.334, P = 0.001), and LDL (β = 0.199, P = 0.045) were independent factors significantly associated with the WLR. The increased retinal vessel wall thickness led to a narrowing of lumen diameter and a decrease in the blood flow in the PDR group.
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Dehvan F, Qasim Nasif F, Dalvand S, Ausili D, Hasanpour Dehkordi A, Ghanei Gheshlagh R. Self-care in Iranian patients with diabetes: A systematic review and meta-analysis. Prim Care Diabetes 2021; 15:80-87. [PMID: 32921619 DOI: 10.1016/j.pcd.2020.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Self-care is a major factor in managing diabetes. This study aimed to determine the self-care status of Iranian patients with diabetes and to estimate the percentage of self-care in these individuals through a systematic review and meta-analysis. METHODS In this systematic review and meta-analysis 53 domestic articles published in Farsi and English were evaluated. We conducted database searches in domestic and foreign databases of Scientific Information Database (SID), MagIran, Google Scholar, Web of Science, Pub Med, and Scopus with no time limit. Data analysis was performed in Stata version 12 using meta-analysis method and the random effects model. RESULTS A total of 50 articles (53 groups) with a sample size of 9565 were systematically reviewed. The percentage of self-care in patients with diabetes was reported to be 48.86 (95% confidence interval [CI]: 43.79-53.94). According to the results, the percentage of self-care score was higher in patients with type I diabetes (55.53) when compared with patients with type II diabetes (49.26). CONCLUSIONS Since patients with diabetes obtained only half of the self-care score and given the importance of self-care in controlling and treating diabetes, it is necessary to perform actions to improve self-care such as benefiting from health facilities, and social and family support.
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Affiliation(s)
- Fazel Dehvan
- Department of Nursing, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Farah Qasim Nasif
- Department of English, College of Education, Bayan University, Erbil, Kurdistan, Iraq
| | - Sahar Dalvand
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Ali Hasanpour Dehkordi
- Social Determinants of Health Research Center, School of Allied Medical Sciences, Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | - Reza Ghanei Gheshlagh
- Spiritual Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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21
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Bueno JM, Cruz-Castillo R, Avilés-Trigueros M, Bautista-Elivar N. Arrangement of the photoreceptor mosaic in a diabetic rat model imaged with multiphoton microscopy. BIOMEDICAL OPTICS EXPRESS 2020; 11:4901-4914. [PMID: 33014589 PMCID: PMC7510868 DOI: 10.1364/boe.399835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 06/11/2023]
Abstract
Diabetic retinopathy (DR) is defined as a microvascular pathology. However, some data have suggested that the retinal photoreceptors (PRs) might be important in the pathogenesis of this ocular disease. In this study the organization of the PRs in control and diabetic-induced rats was compared using multiphoton microscopy. The PR mosaic was imaged at different locations in non-stained retinas. The density of PRs was directly quantified from cell counting. The spatially resolved density presents a double-slope pattern (from the central retina towards the periphery) in both healthy and pathological samples, although the values for the latter were significantly lower all across the retina. Moreover, Voronoi analysis was performed to explore changes in PR topography. In control specimens a hexagonally packed structure was dominant. However, despite the non-controlled effects of the disease in retinal structures, this PR regularity was fairly maintained in diabetic retinas.
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Affiliation(s)
- Juan M. Bueno
- Laboratorio de Óptica, Instituto Universitario de Investigación en Óptica y Nanofísica, Universidad de Murcia, Murcia, Spain
| | - Ricardo Cruz-Castillo
- Área Académica de Matemáticas y Física, Instituto de Ciencias Básicas e Ingeniería, Universidad Autónoma del Estado de Hidalgo, Hidalgo, Mexico
| | - Marcelino Avilés-Trigueros
- Departamento de Oftalmología, Facultad de Medicina, Universidad de Murcia e Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, “Campus Mare Nostrum” de Excelencia International, Murcia, Spain
| | - Nazario Bautista-Elivar
- Departamento de Ingeniería Eléctrica, Tecnológico Nacional de México, Instituto Tecnológico de Pachuca, Hidalgo, Mexico
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Lopes de Faria JM, Duarte DA, Simó R, García-Ramirez M, Dátilo MN, Pasqualetto FC, Lopes de Faria JB. δ Opioid Receptor Agonism Preserves the Retinal Pigmented Epithelial Cell Tight Junctions and Ameliorates the Retinopathy in Experimental Diabetes. Invest Ophthalmol Vis Sci 2020; 60:3842-3853. [PMID: 31529081 DOI: 10.1167/iovs.19-26761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Outer blood retinal barrier breakdown is a neglected feature of diabetic retinopathy (DR). We demonstrated that the agonism of the δ opioid receptor (DOR) by epicatechin preserves the tight junction proteins in ARPE-19 cells under diabetic conditions. Presently, we aimed to evaluate the possible role of the DOR on the maintenance of tight junction of RPE layer and on the early markers of experimental DR. Methods DR markers and external retinal tight junction proteins were evaluated in CL57B diabetic mice submitted to intravitreous injection of short hairpin RNA (shRNA)-DOR (108 transducing units [TU]/mL) treated or not with DOR agonist (0.05 g/animal/d of epicatechin in drinking water) for 16 weeks. The presence of DOR in human retina from postmortem eyes from diabetic and nondiabetic donors were also performed. Results DOR is present in RPE layer and in neuro retina. The treatment with DOR agonist prevented the upregulation of the early markers of retinopathy (glial fibrillary acidic protein, VEGF) and the downregulation of pigment epithelium-derived factor, occludin, claudin-1, and zonula occludens-1 tight junction expressions. The silencing of DOR in retina of diabetic mice partially abolished the protective effects of epicatechin. In human retina specimens, DOR is present throughout the retina, similarly in nondiabetic and diabetic donors. Conclusions This set of experiments strongly indicates that the DOR agonism preserves RPE tight junctions and reduces the early markers of retinopathy in model of diabetes. These novel findings designate DOR as a potential therapeutic tool to treat DR with preservation of the RPE tight junction proteins.
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Affiliation(s)
- Jacqueline M Lopes de Faria
- Renal Pathophysiology Laboratory, Investigation on Diabetes Complications, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Diego A Duarte
- Renal Pathophysiology Laboratory, Investigation on Diabetes Complications, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Rafael Simó
- Vall d'Hebron Research Institute (VHIR) and CIBERDEM, Barcelona, Spain
| | | | - Marcella N Dátilo
- Renal Pathophysiology Laboratory, Investigation on Diabetes Complications, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Francieli C Pasqualetto
- Renal Pathophysiology Laboratory, Investigation on Diabetes Complications, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - José B Lopes de Faria
- Renal Pathophysiology Laboratory, Investigation on Diabetes Complications, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
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Cristescu I, Zagrean L, Balta F, Branisteanu D. RETINAL MICROCIRCULATION INVESTIGATION IN TYPE I AND II DIABETIC PATIENTS WITHOUT RETINOPATHY USING AN ADAPTIVE OPTICS RETINAL CAMERA. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2019; 15:417-422. [PMID: 32377236 PMCID: PMC7200121 DOI: 10.4183/aeb.2019.417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT State of art imaging techniques might be a useful tool to early detect the retinal vessels lesions in diabetes. OBJECTIVE AND DESIGN This analytical observational study investigates the retinal microcirculation changes in type I and II diabetic patients without retinopathy using adaptive optics ophthalmoscopy (AOO) and optical coherence ophthalmoscopy angiography (OCTA). SUBJECTS AND METHODS Fifty-five subjects were included in this study and were divided in three groups: type I diabetic group (n=16), type II diabetic group (n=19) and control group (n=20). An adaptive optics retinal camera was used to assess the parameters of the temporal superior retinal arterioles. Moreover, vessel density of the superficial capillary plexus across the parafoveal area was measured with OCT-A. All cases were investigated once, in a cross-sectional design. RESULTS Diabetic patients from both groups had a higher wall-to-lumen-ratio compared to the controls (p=0.01 and 0.01, respectively). Interestingly, no significant differences were found between the two diabetic groups (p=0.69). Moreover, the vessel density was smaller in the type I diabetic group than in the control group (p=0.001). CONCLUSION AOO might be a useful tool to detect early retinal vascular changes in diabetes before any clinical signs and together with OCTA it might bring important information on the prognostic and pathophysiology of the disease.
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Affiliation(s)
- I.E. Cristescu
- “Carol Davila” University of Medicine and Pharmacy - Physiology, Bucharest, Iasi, Romania
| | - L. Zagrean
- “Carol Davila” University of Medicine and Pharmacy - Physiology, Bucharest, Iasi, Romania
| | - F. Balta
- “Carol Davila” University of Medicine and Pharmacy - Ophthalmology - Iasi, Romania
| | - D.C. Branisteanu
- “Grigore T Popa” University of Medicine and Pharmacy, Faculty of Medicine, Dept. of Ophthalmology, Iasi, Romania
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Cristescu IE, Baltă F, Zăgrean L. Cone photoreceptor density in type I diabetic patients measured with an adaptive optics retinal camera. Rom J Ophthalmol 2019; 63:153-160. [PMID: 31334394 PMCID: PMC6626933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Purpose: To assess the variation in cone photoreceptor density on the basis of age compatibility between healthy subjects, on one side, and type 1 diabetic patients with no diabetic retinopathy, on the other. Methods: A high resolution adaptive optics retinal camera in flood illumination regime was employed to image cones of 15 type I diabetic patients and 16 healthy controls. For each subject we scanned the cone mosaic in 4 perifoveal areas (nasally, temporally, superiorly and inferiorly) at 2, 3 and 4 degrees eccentricity. The impact of diabetes duration, gender and age were evaluated. Results: In the type I diabetic group we found a meaningful lower cone density (p<0.05), except for the temporal meridian at 2 and 4 degrees eccentricity. Moreover, a significant asymmetry of cone photoreceptor densities was proved between the horizontal and vertical meridians in both diabetic and control groups. Conclusion: The rtx1 retinal image evaluation demonstrated photoreceptors loss in DM1 diabetic patients prior to any clinical changes. Abbreviations: AO = adaptive optics, SS = swept source, OCT = optical coherence tomography, BCVA= best corrected visual acuity, DM = diabetes mellitus, DR = diabetic retinopathy.
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Affiliation(s)
- Irina-Elena Cristescu
- Division of Physiology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
,Retina Clinic, Bucharest, Romania
| | - Florian Baltă
- Retina Clinic, Bucharest, Romania
,Clinical Ophthalmology Emergency Hospital, Bucharest, Romania
,Department of Ophthalmology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Leon Zăgrean
- Division of Physiology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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